As we draw our second Coro placement to a close and synthesize our experiences in the nonprofit industry, we are taking an in-depth look at Pittsburgh’s major health institutions. Our issue week following our nonprofit placements centered around the topic of healthcare, and much like our last issue week, we received our assignment on Monday; however, unlike last time’s presentation on a specific policy issue, our assignment this time was much more open-ended. We as a cohort determined our own outcomes from the week; there was no limitation to what these outcomes could be, and it was up to us to determine what we wanted to learn within the healthcare space.
As a cohort, we carried out a brainstorming session. We set out to determine what our learning goals, or outcomes, would be for the week based on what was important to use as individuals and as a group, and how we could measure those goals to hold ourselves accountable for working toward them. By the end of the session, we created a long list of possible healthcare-centric outcomes, and from that list, we settled on the following six, each with their own metrics:
- Understand efforts to combat racially inequitable health outcomes in Pittsburgh and how to be an advocate. We had prior knowledge of the staunchly inequitable health outcomes that exist within Pittsburgh, and we took it upon ourselves to learn more. We determined that this goal would be met if we could name at least 3 people, initiatives, or organizations working toward combating racially inequitable health outcomes in the Pittsburgh region.
- Learn about UPMC’s relationships and Highmark’s relationships to other nonprofits. UPMC and Highmark are the two largest healthcare organizations in the Pittsburgh area, and as nonprofits themselves, we wondered what their relationships looked like with other, smaller nonprofits around them. We agreed that if we could, in a map of nonprofit organizations, be able to connect how UPMC and Highmark were related to other organizations, then we would have succeeded in achieving our outcome.
- Learn how healthcare intersects with other sectors. Healthcare overlaps with the government, the nonprofit, and the business sectors, to name a few. Because cross-sector collaboration is something we are interested in, and because Coro gives us experience in many different areas, we strove to learn how healthcare relates to other sectors. Similar to the outcome beforehand, if we could map out how healthcare organizations interacted with the nonprofit, government, and private sectors, we would have succeeded.
- Understand how the Pittsburgh healthcare sector is addressing and/or combating social determinants of health. The social determinants of health are significant factors contributing to public health. Thus, we sought to focus one of our outcomes on Pittsburgh’s efforts in regards to them. To accomplish this outcome, we wanted to leave the week being able to name one way to be involved, being able to identify three people, initiatives, and/or organizations working toward combating social determinants of health in the Pittsburgh region, and being able to include the aforementioned organizations to our previously discussed map.
- Understand how the COVID-19 pandemic has impacted people, public health discourse, and strategy. We could not focus on healthcare for the week without considering the pandemic’s impact on the sector. We hoped to learn how the pandemic has reshaped the players, discussion, and movement in the field. We concluded that success in this outcome would mean we could leave the week being able to name two strategies that have been implemented in the healthcare sector about COVID-19 and being able to list at least four tangible or intangible ways the pandemic has impacted healthcare workers.
- Identify factors that impact drug pricing, if these factors changed over time, and whether they differ in other countries. The cohort found that pharmaceutical pricing was a heated and timely discussion in the healthcare field, and we intended to learn more about it. To complete this outcome, by the end of the week, we would want to identify more than one factor that influences drug pricing and how those factors evolved or looked different internationally. It may be worth noting here, however, that this outcome was often pushed aside as we continued the week; we found that interviewees had more experience in other areas, and we chose depth of knowledge over breadth of knowledge.
To achieve these six outcomes as a cohort, we spent the week immersed in the field of healthcare. We were able to interview healthcare professionals from across the field, including doctors, nurses, social workers, and administrators, as well as individuals working in insurance, consulting, and other related healthcare nonprofits. Our wide array of interviewees allowed us to get a broad understanding of the healthcare system as well as drill down into specific topics. For each interview, we started with our overall outcomes for the week and then tailored them to each individual interviewee. To prepare for these interviews, we completed extensive research on both the interviewee and the organizations they worked for to form more informed questions. Then, as a cohort, we generated specific questions to ask each interviewee to ensure we met our individual and overall outcomes for the week. During these sessions, we were also able to tap into knowledge within the cohort, as many of us have friends and family that work within the healthcare sector that allowed us to have a unique insight. In order to share our learning and expand our knowledge, we took time out of the week to reflect on each interview. This allowed us to compare our biggest takeaways, share what we each learned, and determine what was still unclear and required further research. During this time, we again were able to share our knowledge within the cohort to answer some of each other’s questions and helped us plan our outcomes for our other interviews.
In addition to interviews, we also spent time researching specific topics and concepts to better prepare for interviews and expand our learning for the week. After our reflections and analysis, we gathered the following themes about the healthcare system throughout our interviews:
- Inequitable access to healthcare
- Especially among those in lower economic strata, who are often uninsured
- Need for culturally competent medical professionals
- Impact of social determinants, like homelessness, hunger, lack of transportation, sexual orientation, gender identity
- Addressing these can both decrease costs and increase long term health outcomes
- Importance of holistic care and wrap around services
- Difficulty of navigating the insurance system for both individuals and providers
- Importance of upstream mindset and preventative care
- Importance of innovation in health care and the planning ahead
We as a cohort recognize that it is not always possible to achieve every outcome we set for ourselves, as learning how to determine good goals is all part of the experiential learning process. As such, our success given our metrics ranged depending on the outcome. To our benefit, we found that a large portion of interviewees were able to speak on racism in the healthcare industry and social determinants of health, addressing outcomes (1) and (4), which gave us plenty of information to name individuals, organizations, and initiatives that were addressing some of these issues, and some of even came from the interviewees themselves. For example, we had representatives from the Neighborhood Resilience Project, the Persad Center, and NAMI Keystone Pennsylvania, all of which are organizations that are combating racially inequitable outcomes in Pittsburgh, thus meeting our outcome metrics. Additionally, in speaking with representatives from both Highmark and UPMC as well as people in organizations deeply impacted by these two “giants” as they were sometimes referred to, we were able to draw a lot of information about their evolving relationship to each other and the industry at large, and were able to connect them via a nonprofit map, linked here, thus satisfying outcome (2).
With regards to the map, outcome (3) became more difficult to measure the deeper we dove into the industry. While we were able to place our own placements, interviewees, and key players on a map of the nonprofit industry, we learned that even that would be incomplete due to the large quantity of nonprofits in Western PA. As such, to connect healthcare organizations to government as well as the private sector would take a broader synthesis of our entire Coro fellowship, and could be revisited at the end of the year. Consequently, we will leave outcome (3) unsatisfied until we can either narrow our scope or combine our full year of experience into a more comprehensive map.
In terms of more narrow topics, we also honed in on outcomes (5) and (6) in individual interviews, as they were more tailored to the person’s expertise. For example, we often opted not to ask interviewees about outcome (6), addressing drug prices, as it was outside of their scope of knowledge. To compensate, when we did have a representative who dealt with this issue, we chose to deep dive, and while we ended up with a wealth of knowledge about what drives up healthcare costs and premiums, the pharmaceutical industry remains something that we need to find more information on outcome (6) via people who work in that field, as we interviewed very few lobbyists or pharmaceutical representatives, with more of our interviewees being on the care and patient advocacy side of the industry. Outcome (5), dealing with the impacts of COVID-19, on the other hand, was something that most people had insights on, and we are now able to list specific impacts on certain populations that may not be obvious as a result of the pandemic. Some of these impacts include: The burdens of isolation on aging and LGBTQ communities who may already be separated from their families; telehealth practices making health visits more accessible to some in rural regions, but less to those who may not have internet access; the increased onus on healthcare professionals to combat misinformation surrounding the vaccine; and the requirement of providers to adapt to social media and other virtual platforms to reach consumers. As a result of these four and many other changes that COVID-19 has demanded of those in the healthcare industry that we could discuss, we consider the outcome (5) satisfied.
Given the recurring themes of inequitable access, misinformation, and the impacts of COVID-19, it is more important than ever for young adults to get involved in and develop a deep understanding of our healthcare system. As a group, we have developed the following extensive though by no means exhaustive list of ways for leaders to take initiative in the healthcare space:
- School/General Learning Opportunities
- Take on a research position at a local university.
- Especially in Pittsburgh, there exist a plethora of opportunities for health research not only in the biological and chemical sciences but also in the social sciences.
- Take online courses to learn about healthcare
- Interview people in you local healthcare communities about challenges they are facing
- Educate yourself about environmental justice issues in your community
- Take on a research position at a local university.
- Technology/Social Media/Communications
- Use of social media and apps
- Spread awareness about important healthcare topics
- Combat disinformation
- Advocate for inclusive healthcare policy that addresses social determinants of health
- Healthcare goes beyond just the body – homelessness, hunger, environment, and many other factors are something that any healthcare provider should be aware of
- Set up alerts to your phone about air quality and share with others
- Email and/or write elected official about important health issues
- Advocate for a community needs assessment in your community
- An example from UPMC and more information about community needs assessments in Pittsburgh can be found here: https://www.upmc.com/about/community-commitment/community-health-needs-assessment
- Use of social media and apps
- Volunteer/In-Person Work
- Volunteer at a healthcare facility
- Volunteering can go beyond in-hospital work
- Assist programs that address social determinants of health (hunger, homelessness, loneliness, etc.)
- Volunteer with organizations whose impact works in tandem with healthcare facilities
- Spend time helping out at a senior home
- Intern at a healthcare nonprofit, which includes mental health, such as the Persad Center, Hill House, or one of the many other amazing organizations in Pittsburgh our interviewees shared with us.
- Encourage collaborations in your local community to address healthcare concerns
- Take care of your own mental health and the mental health of those around you
- Join or begin an organization that works in the healthcare sector.
All of these and more are excellent ways we have learned we can become more informed and involved about the multifaceted impacts of healthcare in Western PA as a result of our outcomes and interviewees. We are looking forward to further weaving our experiences in with our past and future placements at Coro, and taking a person-centered approach to health with us into our lives and careers.