Interview with Bill Graham, President, Sequoia Hospital and Marie Violet, Director, Health and Wellness Center, Sequoia Hospital
With Mary Dunbar, Samaritan House
Over the past year, Samaritan House has featured healthcare partner leaders in celebration of their generous financial, in-kind, and volunteer support of our Redwood City and San Mateo Free Clinics. We are grateful to the many healthcare institutions, volunteer physicians, dentists, nurses, and other volunteers who have kept our Free Clinics in operation for 25 years. It is through their individual and collective support that tens of thousands of uninsured, low-income patients have received quality primary and specialty healthcare in San Mateo County.
Mary Dunbar: Thank you so much for meeting with me today, Bill and Marie! Samaritan House is grateful for the long partnership we’ve enjoyed with Sequoia Hospital. This past year Sequoia Hospital had 1,611 encounters with the Samaritan House Redwood City Free Clinic patients and provided a total of $593,699.00 of in-kind lab and radiology services. In conversations with other healthcare leaders like you, I’ve discovered that the vision for each nonprofit hospital’s community engagement is often much greater than the community benefit requirements the I.R.S. dictates. People may be surprised to learn that hospitals like Sequoia donate a significant amount of time, money, and resources to the community. What’s your vision for Sequoia Hospital and its role in the community over the next few years?
Bill Graham: I always go back to the fact that Sequoia was formed by the community. We were a district hospital created through a special vote of the population back in the mid-1940s to serve the health needs of the local residents. Ultimately, that’s our job—to provide very high-quality care and an unparalleled patient experience to our neighbors in the communities we serve. As Sequoia evolves over the coming years, we’ll continue to diversify the work that we do. We’re exploring strategic partners that allow us to build and develop new programs to meet the changing needs of the community, as well as to provide care in the outpatient setting. We know that care is shifting from inpatient (in a hospital setting) to outpatient. One of our main areas of focus will be ensuring we have enough primary care and specialty physicians to effectively address this change in the care setting. An important means of defining Sequoia’s role in the community is through the Community Health Needs Assessment and our own annual Community Benefit Report. These tools help assess and address the most urgent health needs in the county.
Mary: How exactly are those urgent health needs identified?
Marie Violet: The Healthy Community Collaborative is made of representatives from local hospitals, the county health department, the Peninsula Health Care District, and other health care providers. The collaborative, of which Sequoia Hospital was a founding member, was convened in 1994 when California first adopted the community benefit requirement (SB-697). Together, we conduct the triannual Community Health Needs Assessment. Our Community Advisory Committee is deeply involved in this process, giving input and advice on the ranking of the resultant 21 community health needs. They help prioritize which specific needs Sequoia Hospital should make a focus. From there, we take the county-wide report and create our own Community Benefit Plan. The Health & Wellness Center leads development of the plan, which is then reviewed and approved by our Community Board. Both our Community Advisory Committee and Community Board are composed of community members who represent a wide array of interests and perspectives, and who serve as catalysts for relationship building and partnerships with organizations, businesses, and individuals in the community. Sequoia’s primary focuses this year are to address diabetes, childhood obesity, health care access and delivery, behavioral health, and fitness/diet/nutrition. As we do each year, we are actively identifying what resources we currently have to address these issues and partnering with nonprofit community partners to create solutions.
Bill: The nice thing about working together is that we all start from the same baseline. No one entity could ever accomplish or address all of the issues that are identified as unmet health needs. Although San Mateo County is much healthier than many other counties, we still have issues that we need to address. Each of us, within our own particular part of the county, can narrow that down and discuss the county’s most pressing needs and then identify how we can best meet these needs based on our relationships with community partners.
Marie: Our overarching goal it to ensure that we’re supporting those who are the most underserved and vulnerable. Much of our work with the community is accomplished through the Sequoia Hospital Health & Wellness Center, and it couldn’t be done without collaboration. We come up with projects and then we find partners. It’s our role, essentially, to be the convener. It’s amazing what you can get done when that happens.
Bill: There are a lot of available resources in the community, but sometimes those resources aren’t always organized or structured in a way that’s effective. First, we identify the area that we want to be involved in, and then we ask the question “what problem are we trying to solve?” The second question we ask is, “Who’s already doing that work?” It doesn’t make sense for us to try to build something or spend a lot of money to try to fix a problem when there are many others already out there doing the same work. The leadership role we provide is bringing people together to effectively utilize resources, and coordinating and directing resources around a specific issue—something we’ve done consistently over the last 20 years.
Marie: One of the most inspiring outcomes to emerge from this collaborative process was how much all of the community service organizations enjoyed working together and discovering what each other did. I think over the years we’ve gone from many silos and a lot of competition for resources to a feeling that there is enough out there for everybody—when we work together. The needs are great, so if we take what we do best and then collaborate, we’re all successful.
Bill: Improving health care access and delivery in particular is a key priority for Sequoia. Our goal has been to identify at-risk individuals who weren’t able to return to their homes after a significant heath episode, particularly older adults. We want to help them avoid becoming dependent on infrastructure away from their home, such as skilled nursing facilities, or worse, being readmitted to the hospital. Sequoia brought together a variety of organizations, all of whom provided services to support patients in returning home after hospitalization. Samaritan House is one of these valuable partner organizations. It fills a void and plays a significant role in helping Sequoia Hospital fulfill its mission. Many who receive care through Samaritan House now have a consistent touchpoint with a physician and other medical professionals to help manage their health issues. They also gain access to other social services. Through Marie’s efforts, the partnership between Samaritan House and Sequoia Hospital helps address a critical need and improves the well-being of many members of our community.
Marie: Through our work with Samaritan House and other incredible community service organizations, the Sequoia Community Care Program was born. The program facilitates the transition from the community hospital setting to home care for adults aged 50 and older who have risk factors for hospital admission or readmission—including isolation, language and cultural barriers, inadequate support systems, or disabilities. As a part of this program, patients are tracked for 30 days after discharge, and can receive in-home safety checks, access to Meals on Wheels delivery, and other transitional support. Patients without a primary care physician are connected with Samaritan House for a post-discharge check-up and guidance on eligibility for insurance. The program has led to measurably improved recovery and outcomes for these patients.
Mary: What other types of follow-up care do you provide through the Sequoia Community Care Program to prevent re-admissions to the hospital?
Marie: At the Sequoia Hospital Health & Wellness Center, we facilitate two evidence-based programs, a Matter of Balance fall prevention class for older adults and the Diabetes Education Empowerment Program. Once per month at Belmont Library, we host a class called Maturing Gracefully with support from Friends of the Belmont Library, and it’s not unusual to have 35 to 40 people there every month to learn about a health topic.
However, we find that we have the most success in helping people when we go to them, when we provide follow up care in their own environment where they’re comfortable, rather than asking them to come to the Health & Wellness Center. A Sequoia Hospital nurse visits all the local community centers for older adults on a regular basis. She performs blood pressure checks monthly, and glucose tests quarterly to any who want them. It’s a phenomenal program because of the consistency it provides. That same nurse tracks each patient over time, and the patient can take their results to their doctor if follow-up is required, such as a medication change or something that would alert their physician to a more serious problem needing further investigation.
Bill: Yes, it’s amazing. Marie and her team can go out to the community center and provide some basic screenings and identify very problematic high blood pressure or other types of issues that could be very devastating to one’s health if not controlled. We’re able to get people connected to resources like Samaritan House to keep them from having significant complications. Samaritan House does incredible work and has been a consistent, valued resource.
Mary: What are some of the other ways that you partner with community based organizations?
Marie: The Medical Director of Samaritan House, Jason Wong, MD, was instrumental in helping us develop the Sequoia Community Care Program and currently serves on both our Community Advisory Committee and our Community Board. He has been instrumental advisor as we developed programs to address the needs of older adults and those living with and affected by diabetes.
Mary: I love Dignity Health’s Hello Humankindness campaign. What are your thoughts about Sequoia Hospital’s humankindness stories?
Bill: Hello humankindness evokes a certain awareness and way of thinking. We’re about community. From its earliest days, Sequoia Hospital has been a place where your friends, family, and neighbors come for care—and this creates a special environment. When we talk about humankindness, it’s about making these personal connections. As a result, we hear a lot of “humankindness” stories throughout the day. Many people send us letters and emails to comment on the positive ways they were treated and the high-quality, compassionate care they received here at Sequoia.
Mary: That’s really powerful. Thank you, Bill and Marie, for sharing a bit of your history on Sequoia Hospital’s collaborative partnerships in the community and for your commitment to improve the quality of life for all of San Mateo County’s residents.
About Bill Graham, President, Dignity Health Sequoia Hospital: Prior to being named Sequoia Hospital President in 2015, Bill served jointly as both Vice President of Physician and Business Development for Sequoia Hospital and Chief Strategy Officer for Dignity Health’s Bay Area Service Area. His contributions at Sequoia span the entire breadth of the hospital’s services, from securing dedicated funding and infrastructure for the award-winning Heart and Vascular Institute, to leading the development of a cardiovascular co-management program aligning three distinct physician groups, to co-leading the effort to secure $15 million in funding to reopen a closed perioperative suite. As Vice President of Physician Development, Bill expanded the Dignity Health Medical Foundation to include Sequoia Hospital, catalyzed the creation of the Sequoia Physicians Network (IPA) aligning more than 200 affiliated physicians and, with physician leaders, co-led development of a clinically integrated physician network supporting an innovative managed care strategy.
About Marie Violet, Director of the Health & Wellness Center, Dignity Health Sequoia Hospital:
Marie Violet has been serving Dignity Health Sequoia Hospital in Redwood City since 1981. In 1994, she joined the Health & Wellness Services Department, and in 1995 was appointed the department’s Director. Sequoia Hospital’s Health & Wellness Center is responsible for planning and implementing community benefit programs and initiatives within the hospital’s service area for both broad and vulnerable communities with disproportionately unmet health related needs. Programs include Chronic Disease Prevention and Management, Healthy Aging in Place, Child/Youth Healthy Development, and Community Building. Marie manages the annual Dignity Health Sequoia Hospital Community Grants Program for non-profit organizations. Marie is dedicated to developing strong collaborative relationships with community partners who share resources and demonstrate ongoing commitment to shared goals. She is co-chair of the Healthy Community Collaborative of San Mateo County, which oversees the triennial Community Health Needs Assessment.