Beyond the Four Walls: Sentara Health's Commitment to Bringing Care to Communities

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Tom Haederle

Health care providers know that access to care poses a big problem for many people who need it. The issue is often transportation, but there can also be behavioral, financial, and psychological barriers that prevent patients from setting foot inside the walls of a hospital. The answer? Bringing needed medical care to communities, clinics and neighborhoods that put it within reach of everyone.

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Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Sentara Health leaves no stone unturned in its quest to tackle the social determinants of health head-on and expand access to care in the communities it serves in thoughtful and creative ways. If you can't make it to the hospital, hospital services will come to you: via neighborhood clinics, mobile vans, even a geographic information system that helps identify populations with the greatest needs and insufficient access to health care and community services.

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Tom Haederle

Joining me to share more about Sentara's formula for success is Iris Lundy, vice president of health equity and a person with very deep ties to the community she is passionate about helping. Iris, thank you for joining me today on Advancing Health.

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Iris Lundy, RN

Thanks, Tom. So happy to be here.

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Tom Haederle

Let me plunge right in. Among other things, you are a nurse, a mother, grandmother, an Army veteran and a colon cancer survivor. And I think all of those experiences have really helped you connect in different ways to families and communities and the health care system itself. So, in terms of your personal journey, maybe you can share a little bit with our listeners about your passion to promote health equity within historically marginalized and rural communities?

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Iris Lundy, RN

Sure. You know, for those who may not see us, I am a black female. And when I think about just things that happen in our community and to me personally or to my family, it resonates. And it does - it makes me want to do more. Prior to my cancer diagnosis, I lost both of my parents to preventable diseases and I have seen other family members suffer from things that in this day and age, we should not have to based on education and just things that we could be helping to provide.

00;02;30;27 - 00;02;52;06

Iris Lundy, RN

So as for me, you know, as a cancer survivor, my journey was a little...it didn't flow like someone would normally expect. I didn't just wake up and see bleeding and say, oh, this shouldn't happen. Nor was I at an age where I should be getting a colonoscopy yet. So for me, things happened a little bit differently.

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Iris Lundy, RN

And, when I was trying to explain to my then care team what was happening with me, it's as if they were not hearing me. And then I am a nurse, as you said, and I'm sharing what I am experiencing. But they're going down the track, but they're never really hearing me. That's my perception of that. And so finally I got with a physician.

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Iris Lundy, RN

He says, I'm going to get you better. I am going to figure out what's happening with me. And he did, and he ordered a colonoscopy. And that's when it was determined I had colon cancer.

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Tom Haederle

I say, you know, the word that really leaps out, what you just said is preventable. You use that in reference to your parents passing and perhaps your own diagnosis. What is the prescription for that? How do you move the system in a way that preventable medical conditions are found sooner and acted upon sooner?

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Iris Lundy, RN

Yeah. I think we have to take the care where the people are. And we have to take them and and educate people in in a space that is physically and psychologically safe to them. Have a conversation about what is happening in our community. Hear what they're saying. Let's share with them the data we're seeing. And then let's share what we could do together to change some of this and let people make an informed decision.

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Iris Lundy, RN

I mean, I have found that to be so successful.

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Tom Haederle

I think every hospital and health system leader that we ever talked to on this podcast has made the same point that nobody does this alone. Everybody to be successful needs a community partner of some kind. So if you can take a minute to explain a little bit more about who Sentara works with in the Norfolk area and how you build those community partnerships that makes such a difference.

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Iris Lundy, RN

Sure. You know, I think one of the things you have to do is identify the voices in the community that are trusted by the community. That's very important. We have found that whether it's in the neighborhood, there is always an informal leader there. We work with those individuals. We work with, certainly our health departments, other academic institutions, those kind of things.

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Iris Lundy, RN

We certainly work with our HBCUs here. We have a medical school. We work with them. We also work with organizations like NAACP, Urban League, and other community-based organizations such as the food Bank, the YMCA. We do a lot of work with them. For mental wellness there are community based organizations that we work with also.

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Iris Lundy, RN

We understand we need all of our partners coming to the table if we're going to truly impact and improve the health of our community.

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Tom Haederle

And what are some of the specific tools that Sentara is using to do that, to bring access to care to the community where people are, meet them where they are?

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Iris Lundy, RN

Well, one, we went in and we talked to people say, hey, tell us what you need. And as they're sharing what the need is and what's missing, and we're looking at data, then we begin to take mobile RVs so that we could go at a time that was important to the community. On days that are important to the community.

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Iris Lundy, RN

If you're working 9-5, it's kind of hard to get in there. So sometimes we have to go on off hours or the weekend so that we can meet the needs of the community. How do we show up and meet people where they are? And then there are places where we have more traditional things, right? So we've actually put a clinic in one of our homeless shelters, but we've also put a clinic in the bottom of an apartment with wraparound services that are there

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Iris Lundy, RN

so it's accessible to those who live in that community.

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Tom Haederle

So much more convenient, we think, for people that otherwise would have a difficult time getting to the hospital or to a clinic that was downtown or far away or something. One thing I did want to ask about, and I mentioned this at the top, but I really would love some more information about it, is the use of the Geographic Information System technology to pinpoint and prioritize populations, with the greatest needs.

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Tom Haederle

How does that work, exactly?

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Iris Lundy, RN

I think geospatial mapping was a game changer for us. One, because you're able to visualize you can share data very quickly with whoever you're trying to talk to. So what we did was we put data, all types of data right in there so we could get a better picture. But we also looked at those social determinants, what we call the social drivers in there

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Iris Lundy, RN

also, we overlaid that. And if I wanted to look at chronic conditions I could look at that. If I wanted to know where I could slice the data any way I want to get a better picture. And then based on that, you can help me prioritize. So I'll give you an example. We were looking at breast cancer screenings and we wanted to understand where do we need to educate and take our mobile mammovan.

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Iris Lundy, RN

So when they did that for us, they could tell me who had not had a mammogram done in two or more years - highlights stuff on my map. So it shows me where we should go for education and then where we could take our mobile mammovan, you know, to provide those services. We work very closely with the analytics IT team for that type of service, but we also work with our oncology service line for that.

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Iris Lundy, RN

More importantly, I think, is that we work with those community-based organizations. They host us at their sites, so that we can maximize and get the people there and get the word out that, hey, we're going to be here providing this particular service.

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Tom Haederle

What is an amazing and effective tool that is. But the patients are de-identified in this system? You said you can slice-and-dice the data.

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Iris Lundy, RN

Absolutely. Yeah, we're able to protect privacy, but we can get down to the neighborhood level for us so that we can see that if we were going to share it, you would not be able to tell who's living where.

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Tom Haederle

You know, I was thinking hospitals and health systems across the country are trying different things to move care beyond the four walls and into neighborhoods and clinics and reach people where they are. But in the end, I think, doesn't each individual have to decide for themselves how much time and effort they're willing to put into their own care?

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Tom Haederle

I mean, it's a decision every person I think has to you either commit or you don't, or maybe you go halfway. But how do you persuade people in the end that they have to be co-partners in their own health care and work with Sentara and all the other the good things you're doing to make this happen.

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Iris Lundy, RN

I think honestly it's not a lot of persuasion you have to do. I think part of it is, is that people did not have the access. And as you know, that is one of those determinants. And so if we provide access, if we make it easy for you to be able to do it, people are more likely to do it.

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Iris Lundy, RN

It is hard to leave your job and understand you're going to miss hours of work when you feel okay. But if I say we're going to pull up there and we only need you to step out for 15-20 minutes, that's a game changer.

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Tom Haederle

And if it involves a follow up visit, you know, if something is found, say, on a site clinic check, and but you're invited to come into the hospital for further testing, are people willing to do that? Take that next step, follow up?

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Iris Lundy, RN

Absolutely. And I think it's because again, we're providing wraparound services. So we have community health workers. They walk you through your process. So it's really not like you're left alone. You don't have to figure out how do you navigate the system. We're helping you with that piece.

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Tom Haederle

That's phenomenal. You've got every important base covered, it sounds like. Where do you see your efforts going in the future? I mean, you've done so much so quickly and come so far. Where would you like to expand? What else would you like to do?

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Iris Lundy, RN

I would love to see, you know, the landscape of medicine is changing, and we are seeing that particularly when you're looking at cancers and other things that disparately impact Black and Brown and other historically marginalized or minoritized communities, we're seeing that things are increasing. So as things are increasing, us looking at that and being able to pivot to include that.

00;11;24;03 - 00;11;48;25

Iris Lundy, RN

The other thing is, is that what we may see on the horizon is a health system may look a little different than what the community sees. So we have to make sure that we're fluid enough so that we're taking into account what the community has identified as important to them, because if my blood pressure isn't bothering me, I may not find that as important.

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Iris Lundy, RN

But the stress of not having a job or not having a livable wage, those things are important. So we're also coming along in that vein also to see how we help, right? Because we understand that it's more than just a medical help. We got to help with those other pieces also.

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Tom Haederle

Based on your experience so far and Sentara's experiences as a health system and the things that you're trying to do, what advice would you give to your peers in the field who might be trying to do the same thing in their city or their neighborhood? What have you learned that you'd like to pass on?

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Iris Lundy, RN

I think one of the things that was most successful for us was going into the community and having very real and very raw conversations and listening to the community and coming back. So we have their qualitative data, their lived experience. We come back, we're looking at our data, all of the different points that we can pull together. And then it helps us paint a better picture of what is happening. And then going back to the community to say, here's what we heard from you.

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Iris Lundy, RN

Here's what we're also seeing. Does this fit with your lived experience and then how do we together move forward? Because I think if we can identify the common goal between the two of us, we can lay everything else aside and work toward that. And that has been very successful for us.

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Tom Haederle

Quick follow up on that. Sometimes, I guess there has been a disconnect between what a care team might think a community is asking for, but then when you hear their voices and people say, no, what we really need is this it may not fit with what the assumptions were starting out.

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Iris Lundy, RN

Absolutely. Absolutely. I mean, that that does happen. We were working with the school system, and sometimes you think, well, you know, this is the concern of the school. No, the school was very concerned about how do we make sure that, when a child doesn't have clean uniforms, we can wash them and get something back on that child so that they feel, you know, that we are treating them - the little person - with dignity, respect and compassion.

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Iris Lundy, RN

That was our most immediate need. We needed to make sure that we could address that need, and then we could have a larger conversation about...we understand that some children may start school late because they don't have their well child visit done, all of their immunizations. How do we partner with you and parents so that we can get children in school when they need to be?

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Tom Haederle

Is there anything that I haven't asked about that you'd like to share in this podcast, in terms of what you've learned, or what you would like people to know about the whole effort to move a health care into the community.

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Iris Lundy, RN

Tom, I think one of the things that we've learned is that, there are a lot of things that come at people quite frequently, and rapidly. And so how do we help them address those things? So when you're thinking about employment, thinking about food scarcity, some of those kind of things, and how do we break this cycle of poverty, right?

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Iris Lundy, RN

How do we help people get to that next step in their journey? So we're doing that around scholarships. We have those kind of programs. We work with schools. We're doing things so we can get young people interested in STEM programs. We're doing all kinds of things so that we can prepare our communities to move forward. And we're doing this work with them, not for them.

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Iris Lundy, RN

We are truly their neighbor.

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Tom Haederle

It sounds like you're going so far beyond strictly medical health, you know, in so many ways. And that seems to be the key to turn entire communities around. Well, thank you so much for your time and explaining some of the wonderful things that Sentara is doing in the Norfolk area, which I guess could be replicated pretty much anywhere if people have the resources and the mission drive to do it.

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Tom Haederle

Again, you have been hearing Iris Lundy, who is vice president of health equity with Sentara Health, that's in Norfolk, Virginia, talking about the wonderful ways in which her organization is moving access to care beyond hospital walls and out into the communities that it serves. Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.