SWEDISH HEALTH SERVICES Issaquah Campus Community Health Improvement Plan 2019 – 2021 TABLE OF CONTENTS

CEO LETTER 1 COMMUNITY HEALTH IMPROVEMENT PLAN 10 EXECUTIVE SUMMARY 2 Summary of Community Health MISSION, VISION, AND VALUES 3 Improvement Planning Process 10 Addressing the needs of INTRODUCTION 4 the Community: Who We Are 4 • Mental Health 11 Our Commitment to Community 4 • Drug Addiction 13 • Obesity and Diabetes 14 OUR COMMUNITY 6 • Homelessness 16 Definition of Community Served 6 • Joint and Back Pain 17 Age 6 Ethnicity 6 Other Community Benefit Programs and Evaluation Plan 17 Median Income 7 Poverty 7 PLAN APPROVAL 18

COMMUNITY NEEDS AND ASSETS APPENDIX 19 ASSESSMENT PROCESS AND RESULTS 8 A MESSAGE FROM OUR CEO

To Our Communities:

As outlined in our 2018 Community Health Needs Assessment, the following social determinants of health emerged across the communities of all Swedish locations during the assessment process: mental health, drug addiction, homelessness, obesity and diabetes, and joint or back pain.

We have completed the development of a Community Health Improvement Plan (CHIP) to specifically address many of these barriers, including strategies and measures, towards making our community a healthier place. The CHIP outlines the process of strengthening our existing programs across the Swedish system along with identifying new programs and resources to support those, and build and sustain our partnerships with key organizations to collaborate on solutions.

The next phase will involve broad implementation of the action plans details included in this 2019- 2022 CHIP, and monitoring and evaluating its short-term and long-term outcomes.

As CEO, I am proud to lead Swedish in creating health for a better world.

R. Guy Hudson, M.D., MBA Chief Executive Officer Swedish Health Services

1 | CHIP Issaquah Campus — 2019-2021 EXECUTIVE SUMMARY

About the Community Health Needs 2019 - 2021 Community Health Improvement Assessment Process Plan Priorities Nonprofit hospitals, public health agencies, accountable As a result of the findings of our 2018 Swedish Issaquah communities of health, and others are required by federal Community Health Needs Assessment (CHNA) and law, state mandates, or agency policy to conduct through a prioritization process aligned with our mission, community health needs assessment every three to five resources and hospital strategic plan, Swedish Issaquah years. This process involves reviewing community will focus on the following areas for its 2019-2021 health data, identifying and prioritizing community health Community Benefit efforts: needs, and developing a community health improvement • Mental Health plan. Historically, community health needs assessments have been planned and conducted independently, but • Drug Addiction for the first time, stakeholders in King and Snohomish • Obesity and Diabetes Counties have aligned planning and assessment cycles • Homelessness to leverage resources and improve collaboration for collective impact. • Joint and Back Pain (campus specific)

Goal of the Community Health Needs Assessment In April 2018, community members selected three to five priority areas of focus through a county-wide, coordinated community health needs assessment process. This process provides us with the opportunity to collaborate, identify community needs, and move in the same direction as other organizations. By aligning our resources with and leveraging the expertise of community partners, our collective impacts in King and Snohomish Counties is even greater. Additionally, partners are well-positioned to align timelines and coordinate future improvement cycles.

2 | CHIP Issaquah Campus — 2019-2021 MISSION, VISION, AND VALUES

Our Mission EXCELLENCE: We set the highest standards for Improve the health and well-being of each ourselves and our services. Through transformation person we serve. and innovation, we strive to improve the health and quality of life in our communities. We commit Our Vision to compassionate and reliable practices for the Health for a Better World care of all.

Our Values DIGNITY: We value, encourage and celebrate COMPASSION: We reach out to those in need. the gifts in one another. We respect the inherent We nurture the spiritual, emotional, and physical dignity and worth of every individual. We recognize well-being of one another and those we serve. each interaction as a sacred encounter. Through our healing presence, we accompany INTEGRITY: We hold ourselves accountable to those who suffer. do the right thing for the right reasons. We speak JUSTICE: We foster a culture that promotes unity truthfully and courageously with respect and and reconciliation. We strive to care wisely for our generosity. We seek authenticity with humility people, our resources, and our earth. We stand and simplicity. in solidarity with the most vulnerable, working to SAFETY: Safety is at the core of every thought remove the causes of oppression and promoting and decision. We embrace transparency and justice for all. challenge our beliefs in our relentless drive for continuous learning and improvement.

3 | CHIP Issaquah Campus — 2019-2021 INTRODUCTION

Since 1910, Swedish has been the region’s standard- Our Commitment to Community bearer for the highest-quality health care at the best Swedish Health Services dedicates resources to im- value. Our mission is to improve the health and prove the health and quality of life for the communities well-being of each person we serve. Swedish is the it serves, with special emphasis on the needs of the largest nonprofit health care provider in the greater economically poor and vulnerable. In the last five years, Swedish spent more than $900 million in community Seattle area with five hospital campuses: First Hill, benefit. We are making investments that go beyond Cherry Hill, Ballard, Edmonds and Issaquah. We also just the need for free and discounted care by improving have ambulatory care centers in Redmond and Mill access to care and developing new ways to help people Creek, and a network of more than 118 primary care stay healthy. In 2017, we spent almost $200 million on and specialty clinics throughout the greater Puget community benefit programs, including $23.9 million Sound area. on free and discounted care. The communities served by Swedish hospitals are defined by the geographic Who We Are origins of the hospitals’ inpatients. The Primary Service Area (PSA) was determined by identifying the ZIP Codes Swedish Health Services is an affiliate of the Providence for 70% of the hospitals’ patient discharges (excluding St. Joseph Health. Providence St. Joseph Health is a normal newborns). The Secondary Service Area (SSA) new organization created by the association between was determined by identifying the ZIP Codes for 71% Providence Health & Services and St. Joseph Health to 85% of the hospitals’’ patient discharges. The service with the goal of improving the health of the communities areas for all Swedish campuses focus on King County it serves, especially those who are poor and vulnerable. and Snohomish County. Together, our 111,000 caregivers (all employees) serve • Swedish Ballard is located at 5300 Tallman Avenue, in 50 hospitals, 829 clinics and comprehensive range NW, Seattle, WA 98107. The PSA consists of 8 cities of services across Alaska, California, Montana, New and 36 ZIP Codes. The SSA consists of 18 cities Mexico, Oregon, Texas and Washington. In addition and 33 ZIP Codes. to Swedish, the Providence St. Joseph Health family includes: Providence Health & Services, St. Joseph • Swedish Edmonds is located at 21601 76th Ave. W., Health; Covenant Health in West Texas; Facey Medical Edmonds, WA 98026. The PSA consists of 5 cities Foundation in Los Angeles; Hoag Memorial Presbyterian and 9 zip codes. The SSA consists of 6 cities and 9 in Orange County, California; Kadlec in Southeast ZIP Codes. Washington; and Pacific Medical Centers in Seattle. • Swedish First Hill is located at 747 Broadway, Seattle, Bringing these organizations together increases access WA 98122 and Swedish Cherry Hill is located at 500 to health care and brings quality, compassionate care to 17th Avenue, Seattle, WA 98122. These hospitals those we serve, with a focus on those most in need. share the same service area. The PSA consists of 13 cities and 53 ZIP Codes. The SSA consists of 23 cities and 35 ZIP Codes. • Swedish Issaquah is located at 751 NE Blakely Drive, Issaquah, WA 98029. The PSA consists of 12 cities and 19 ZIP Codes. The SSA consists of 16 cities and 28 ZIP Codes. Continued on the next page...

4 | CHIP Issaquah Campus — 2019-2021 INTRODUCTION CONTINUED

Planning for the Uninsured and Underinsured One way Swedish Health Services informs the public of FAP is by posting notices in high volume inpatient Our aim is to provide quality care to all our patients, and outpatient service areas. Notices are also posted regardless of ability to pay. We believe that no one should at location where a patient may pay their bill. Notices delay seeking needed medical care because they lack include contact information on how a patient can obtain health insurance. That is why Swedish Health Services more information on financial assistance, as well as has a Patient Financial Assistance Program (FAP) that where to apply for assistance. These notices are posted provides free or discounted services to eligible patients. in English and Spanish and any other languages that Our charity care program provides a 100 percent are representative of 5% or greater of patients in the discount to individuals and families between hospital’s service area. All patients who demonstrate 0-300 percent of the federal poverty level (formerly lack of financial coverage by third party insurers are 0-200 percent.) offered an opportunity to complete the Patient Financial • For example, a family of four with a household income Assistance application and are offered information, of approximately $75,000 or less would qualify. assistance, and referral as appropriate to government sponsored programs for which they may be eligible. In addition, for individuals and families between 301-400 percent of the federal poverty level, Swedish provides a discount of at least 75 percent. • For example, a family of four with a household income of approximately $75,000 - $100,000 would qualify

5 | CHIP Issaquah Campus — 2019-2021 OUR COMMUNITY

Definition of Community Served Among the Swedish campuses, the Edmonds service area has the highest percentage of residents who are Population for Total Service Area, 2017 non-Latino White (65.2%) and Hispanic or Latino (9.6%). First Hill/ The Issaquah service area has the highest percentage Ballard Edmonds Issaquah Cherry Hill of Asians/Pacific Islanders (20.3%), and the Ballard service area has the highest percentage of Blacks/African Population 2,373,420 651,452 2,846,268 1,451,299 Americans (7.4%). Source: Intellimed, ESRI, 2017

Among Swedish campus service areas, Issaquah has the Race/Ethnicity* highest percentage of children (22.5%). Edmonds and Issaquah service areas include percentages of children First Hill/ Ballard Edmonds Issaquah higher than that of the county (21.1%). Edmonds has the Cherry Hill highest percentage of seniors (14.1%) among Swedish Non-Latino 61.6% 65.2% 61.4% 59.7% hospital campuses, which exceeds the percentage of White seniors in the county (13.6%). Asian/Pacific 17.2% 16.4% 18.1% 20.3% 2017 Population by Age, King and Snohomish Counties Islander Hispanic or 9.4% 9.6% 9.1% 8.4% Latino 13.6% Black/African 21.1% 0-17 years 7.4% 5.4% 7.0% 6.8% American 18-29 years Two or more 6.0% 5.9% 5.8% 5.3% 26.9% 30-44 years races 16.6% 45-64 years Other races/ 3.6% 3.3% 3.5% 3.2% ethnicities 65 and older 21.8% Source: U.S. Census Bureau, American Community Survey, 2016; DP05 *Percentages total more than 100% as some persons selected more than one race or ethnicity category.

First Hill/ Income Poverty Ballard Edmonds Issaquah 21.116.6+21.82613.6+ Cherry Hill In the Swedish campus service areas, the median Children, household income ranges from $69,153 in the Edmonds 20.5% 21.8% 21.0% 22.5% ages 0-17 service area to $93,153 in the Issaquah service area. This Adults, disparity in income might influence health outcomes. 65.9% 64.1% 65.5% 64.6% ages 18-64 Continued on the next page... Seniors, 13.6% 14.1% 13.5% 12.9% 65+ Source: US Census Bureau American Community Survey, B01003, 2016

6 | CHIP Issaquah Campus — 2019-2021 OUR COMMUNITY CONTINUED

Median Household Income and Unemployment Rate Personal/Households Living at or Below Poverty Level (<100% Federal Poverty Level) First Hill/ Ballard Edmonds Issaquah Cherry Hill First Hill/ Ballard Edmonds Issaquah Cherry Hill Median household $76,160 $69,208 $82,071 $93,153 Individuals at 10.7% 9.7% 10.1% 8.9% income poverty level Unemploy- Households 6% 6% 6% 5% ment rate at poverty 4.2% 3.0% 4.1% 4.1% level In 2016, the federal poverty threshold for one person Children was $11,880 and for a family of four it was $24,300. living in 2.7% 1.9% 2.6% 2.5% Among Swedish campuses, the Issaquah service area poverty has the lowest rate of individuals living in poverty (8.9%) Seniors living and the Ballard service area has the highest rates of 1.0% 0.7% 1.0% 0.9% individuals (10.7%) and children living in poverty (2.7%). in poverty The Edmonds service area has the lowest rate of households (1.9%), and seniors living in poverty (0.7%).

7 | CHIP Issaquah Campus — 2019-2021 COMMUNITY NEEDS AND ASSETS ASSESSMENT PROCESS AND RESULTS

Summary of Community Needs Assessment Identification and Selection of Significant Process and Results Health Needs Secondary Data: Secondary data was collected Significant health needs were identified from the from a variety of local, county, and state sources. Community Health Needs Assessment process. Swedish then identified priorities for the Community Data analyses were conducted at the most local level Health Improvement Plan associated with the 2018 possible for the hospitals’ service areas, given the Swedish Issaquah CHNA. The priority health needs availability of the data. were: Mental Health, Drug Addiction, Obesity, Joint or Back Pain, and Diabetes. Primary Data: Stakeholder surveys and listening sessions were used to gather data and information Community Health Needs Prioritized from persons who represent the broad interests of the community served by the hospitals. Swedish Swedish Issaquah will focus on the following areas for its 2019-2021 Community Health Improvement Plan (CHIP)s: conducted surveys to gather data and opinions from community residents, and hospital leaders • Mental Health and staff who interact with patients and families in • Drug Addiction the ED and specialty clinics. • Obesity • Homelessness A full report and results of the 2018 Swedish Issaquah Community Health Needs Assessment can • Joint and Back Pain (campus specific) be accessed at: https://www.swedish.org/~/media/ Continued on the next page... Files/Providence%20Swedish/PDFs/Mission/2018/ CHNAIssaquah21419.pdf

8 | CHIP Issaquah Campus — 2019-2021 COMMUNITY NEEDS AND ASSETS ASSESSMENT PROCESS AND RESULTS CONTINUED

Needs Beyond the Hospital’s Service Program The following community health needs identified in the 2018 Swedish CHNA campus eportsr may not be addressed as part of the current CHIP. An explanation is provided below:

BALLARD EDMONDS FIRST HILL/CHERRY HILL ISSAQUAH Alcohol overuse Alcohol overuse Joint or back pain Homelessness High blood pressure High blood pressure High blood pressure Cancer Joint or Back Pain Joint or back pain Cancer Age-related diseases Cancer Cancer Alcohol overuse Texting while driving Smoking Stroke Age-related diseases Alcohol overuse Age-related diseases Smoking Teeth/oral health issues High blood pressure Stroke Asthma Smoking Environmental factors Alzheimer’s disease/ Environmental factors Environmental factors Environmental factors dementia Texting while driving Texting while driving Stroke Teeth/oral health issues Asthma Heart disease Asthma Asthma Lack of access to Teeth or oral issues Teeth/oral health issues Heart disease needed medications Crime Age-related diseases Texting while driving Stroke Alzheimer’s disease/ Heart disease Crime Child abuse and neglect dementia Alzheimer’s disease/ Lack of access to Lack of access to Lack of access to dementia medical providers healthy food medical providers Lack of access to Alzheimer’s disease/ Crime Smoking needed medications dementia Lack of access to Lack of access to Child abuse and neglect Heart disease medical providers medical providers Lack of access to Sexually transmitted Child abuse and neglect Domestic violence needed medications infections Lack of access to a Lack of access to Child abuse and neglect Domestic Violence grocery store needed medications Sexually transmitted Lack of access to Domestic violence infections needed medications Sexually transmitted Domestic violence infections

Some of these areas are out of our scope of our No hospital facility can address all the health needs current community health program expertise, and present in the community. We are committed to other non-profits in the community are providing our mission through Swedish Community Benefits robust services. However, we see the interconnected- granting program and partnering with like-minded ness of health, housing, education, and income. If we organizations in service to our community. can improve the health of our workforce, they will be better caregivers and more able to contribute to the economic vitality of our service area.

9 | CHIP Issaquah Campus — 2019-2021 COMMUNITY HEALTH IMPROVEMENT PLAN

Summary of Community Health Improvement Planning Process Swedish Medical Center, Issaquah participated in the King County Hospitals for a Healthier Community (HHC) as part of a countywide Community Health Needs Assessment. HHC is a collaborative of hospitals and/or health systems in King County and Public Health-Seattle & King County.

Data and other learnings from the Community Health initiatives with additional strategies in each area. Using Needs Assessment (CHNA) were used to develop a CHNA data, the team added Joint and Back pain as Swedish Issaquah Community Health Improvement a fifth initiative. External input from key community Plan (CHIP) for 2019-2021. A multidisciplinary team of members and PSJH leaders was critical to the evaluation Swedish Issaquah caregivers, representing inpatient and process, ensuring that CHIP goals help the community ambulatory care, formed as the CHIP Steering Team. achieve its vision while addressing needs identified in the assessment process. Through a series of weekly sessions plus additional meetings with members of the community and health- After the five initiatives were decided, the CHIP Steering care leaders, the team considered each need identified Team members selected strategies or actions and targets in the CHNA, as well as available resources and Swedish for 2019 through 2021. It is believed that adopting the system strategic priorities. After discussion of alternatives strategies will ensure successful completion of the CHIP, to address the goals, and assessing potential barriers of fulfilling the organization’s commitment to promote each alternative, the Swedish Issaquah CHIP Steering health for groups large enough to benefit the community Team agreed to focus on the four Swedish system as a whole.

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1. INITIATIVE/COMMUNITY NEED ADDRESSED: MENTAL HEALTH AND WELLNESS

Goal (Anticipated Impact): Implement a new program Develop a psychology postdoctoral fellow training that provides mental health peer support in Swedish program that provides mental health care in the Swedish emergency departments (ED). This program will be community irrespective of patient’s ability to pay, adapted from the ED Connect program implemented while creating a much needed workforce to support by Hoag Hospital Newport Beach ED in partnership integrated behavioral health (BH) care. with the National Alliance on Mental Health (NAMI). To Scope (Target Population): People in the Issaquah accomplish this goal and implement a pilot project, community Swedish will explore partnering with Navos, one of the largest providers of community mental health services in Washington State.

OUTCOME MEASURE BASELINE FY19 TARGET FY21 TARGET

Facilitate full implementation of Mental Health peer support 1 selected Swedish-wide 0 program in ED campus roll-out Integrate program at Swedish recognized clinics without N/A (new 2 clinics 2-4 Clinics behavioral health services (BHS) at a reduced cost measure) 3 school Continuation of Clinicians in Schools Program 4 school years 6 school years years

STRATEGY(IES) STRATEGY MEASURE BASELINE FY19 TARGET FY21 TARGET Develop a Swedish Complete Swedish ED Plan for Swedish- NAMI ED Connect 0 1 approved plan Connect Plan wide roll-out implementation plan Swedish ED Connect plan Plan for Swedish- Explore pilot with Navos 0 1 approved plan collaborates with Navos wide roll-out Initiate full Set up for Swedish-wide Unfold ED Connect to the 1 campus in 0 Swedish-wide system Swedish system 2019-2020 roll out in 2021 2019- Develop plan and have In 2019, develop a successful recruitment of 2 psychology postdoctoral post-doctoral candidates to TBD – but program for primary care provide services in 2020-2021 anticipate if 800-1000 that will serve anyone in Identify Swedish Primary Care program is patient visits per the Swedish community clinics in high need communities successful, we 0 postdoctoral irrespective of their ability that do not currently have access can continue to fellow per year to pay, while creating a to BH services (and have space expect 800-1000 (2020-2021) much needed workforce for them to practice) patient visits per to support integrated Visits with postdoctoral fellow fellow per year BH care will be provided free of charge for all patients

Continued on the next page...

11 | CHIP Issaquah Campus — 2019-2021 COMMUNITY HEALTH IMPROVEMENT PLAN CONTINUED

STRATEGY(IES) STRATEGY MEASURE BASELINE FY19 TARGET FY21 TARGET Adapt a workshop series that can Conduct mental be offered at hospital campuses 5 workshops per health workshops 0 5 workshops for any individual in the community year per fellow in the community to attend for free. Continued Each year postdoctoral fellows recruitment of will be trained in a system that 2 postdoctoral provides high quality BH care. Recruitment of Assemble next generation fellows per year They will be a generalist that is 5 2 postdoctoral of mental health providers (with hopes of capable of meeting the needs fellows accepting more of all patients with a behaviorally with adequate influenced concern. funding) Swedish clinicians in Issaquah Schools – # of student contacts 2535 2800 TBD maintain number of student contacts

Evidence Based Sources Key Community Partners Pingitore, D. P. (1999). Postdoctoral training in NAMI ED Connect: primary care health psychology: Duties, observations, • Navos Behavioral Health Consortium and recommendations. Professional Psychology: Research and Practice, 30(3), 283-290. http://dx.doi. • HOAG Memorial Hospital Presbyterian org/10.1037/0735-7028.30.3.283 Postdoctoral Fellow Training: Current relationships exist Larkin, K. T., Bridges, A. J., Fields, S. A., & Vogel, M. E. between the Primary Care BH team and multiple local (2016). Acquiring competencies in integrated behavioral universities. health care in doctoral, internship, and postdoctoral programs. Training and Education in Professional Resource Commitment Psychology, 10(1), 14-23. http://dx.doi.org/10.1037/ NAMI ED Connect tep0000099 • Leader and staff time to research and plan the pilot Johnstone, B., Frank, R. G., Belar, C., Berk, S., Bieliauskas, L. A., Bigler, E. D., . . . Sweet, J. J. (1995). • Time for the peer counselors Psychology in health care: Future directions. Professional (dependent on pilot plan) Psychology: Research and Practice, 26(4), 341-365. Postdoctoral Fellow Training: This program would http://dx.doi.org/10.1037/0735-7028.26.4.341 require at least a 0.5 FTE to adequately provide support, supervision, leadership, recruitment, and program Other Sources development. Additional resource commitment would include clinic space and supplies. Health Care Blog: https://thehealthcareblog.com/ blog/2019/03/14/healthcare-must-open-more-doors-to- mental-health-patients/ Hoag and NAMI: https://www.hoag.org/about-hoag/ news-publications/heart-of-hoag/categories/fall-2018/a- profound-beautiful-alliance-nami-and-hoag/

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2. INITIATIVE/COMMUNITY NEED ADDRESSED: SUBSTANCE ABUSE AND OPIOID USE DISORDER

Goal (Anticipated Impact): Initiate a pilot program at patients presenting with OUD with evidence-based the Ballard Emergency Department (ED) to transition guidelines for withdrawal management. patients with opioid use disorder (OUD) to a Suboxone Scope (Target Population): Initially, Ballard ED patients clinic for treatment. This pilot will be modeled off of the who present with OUD. After the system rollout, patients Swedish Edmonds Suboxone program, which began who present in any Swedish ED with OUD. Referral to in January 2019. The goal is to address the identified a network of suboxone Medicaid waivered clinics (both community need through enhanced treatment of Swedish and partners) will be offered to our patients.

OUTCOME MEASURE BASELINE FY19 TARGET FY21 TARGET Percent of patients that follow up from the ED to a 0% 50%* 80%* Suboxone clinic. *Targets modeled off of Swedish Edmond’s Suboxone program goals, although subject to change.

STRATEGY(IES) STRATEGY MEASURE BASELINE FY19 TARGET FY21 TARGET Ballard pilot of best-practice Continued full OUD screening, treatment, Full implementation of Full implementation N/A implementation and referral from the ED to a Ballard pilot at Ballard at Ballard Suboxone clinic Seven EDs all with Swedish-wide implementation One additional Suboxone pathway of best-practice OUD Number of campuses One ED - campus: Ballard for OUD (Edmonds screening, treatment, and with implemented Edmonds / Ballard / First Hill / referral from the ED to a best-practices Plan full Swedish- Cherry Hill / Red- Suboxone clinic wide roll out mond / Mill Creek) Full participation in Couple work with Accountable Align with Community both North Sound TBD based on ACH N/A Communities of Health (ACH) partners related to OUD and Healthier Here partnership ED related OUD work

Evidence Based Sources Resource Commitment Multiple guidelines including the WA Bree Collaborative Ballard Operations sponsored by Kasia Konieczny Opioid Guidelines (Chief Operating Officer—Swedish Ballard), Quality http://www.breecollaborative.org/topic-areas/cur- Division resources, Nursing and Social Work resources, rent-topics/opioid/ Addiction Recovery team, Swedish Family Practice Clinic at Ballard, and Clinical Transformation and Key Community Partners Simulation Services. Initial community partner for the pilot include Swedish Ballard ED, Swedish Addiction Recovery Clinic at Ballard, and Swedish Ballard Family Practice Clinic. After the Swedish-wide roll out, partners will include multiple agencies such as Federally Qualified Health Centers, Behavioral Health Organizations, and others.

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3. INITIATIVE/COMMUNITY NEED ADDRESSED: OBESITY AND DIABETES

Goal (Anticipated Impact): risk of diabetes in diverse communities • Increase awareness on the importance of healthy Scope (Target Population): Members of the community eating and exercise contacted at public events, with focused outreach in low • Reduce the prevalence of childhood obesity and income communities

OUTCOME MEASURE BASELINE FY19 TARGET FY21 TARGET Percentage of “at risk” community members (those who screen positive for diabetes, prediabetes, or with high glucose levels) who are given information 0% 50% TBD for appropriate follow-up (Primary provider, Swedish diabetes center, YMCA , other community clinics)

STRATEGY(IES) STRATEGY MEASURE BASELINE FY19 TARGET FY21 TARGET Sponsor Urban Funding: healthy living, well- Games (See $5,000 in 2018 $20,000 in 2019 TBD ness programs and outreach description below) Diabetes screening Number diabetes screening Hosted 4 tables in Host more than 4 TBD and health education and health education tables 2018 covering the tables covering the at Urban Games hosted at Urban Games following topics: following topics: 1. Prediabetes 1. Diabetes resources screening tool and prediabetes and education screening 2. Blood pressure 2. Blood pressure and CPR 3. Ask the Medical education Doctor or Registered 3. Swedish sports Nurse (brief consult medicine on site) 4. Swedish Sports Medicine 5. Expanded outreach services Prediabetes Number of community Glucose testing At least one commu- At least one screening at events where Swedish at three events nity event for three community community events participates by administering in 2018 Swedish campuses event for all prediabetes screenings and/ Prediabetes during quarters three five Swedish or glucose testing. Events screening and four community campuses will include community in 2018 outreach events 2019 during quarters outreach events and health three and four fairs, including Swedish community sponsored events, walks/ outreach events runs, races, etc. Offer monthly online # of views of monthly 745 views 1,000+ views TBD: Broaden cooking classes Facebook Live cooking class (January Increase community community through Facebook videos which are open to 2019 video) partner outreach and partner outreach Live, #SwedishEats the community and promote awareness and awareness healthy eating lifestyles Continued on the next page...

14 | CHIP Issaquah Campus — 2019-2021 COMMUNITY HEALTH IMPROVEMENT PLAN CONTINUED

Evidence Based Sources Resource Commitment Centers for Disease Control and Prevention: • Fiscal contribution $5000 https://www.cdc.gov/healthyschools/obesity/facts.htm • Hours to set-up and staff tables at Urban Games https://www.cdc.gov/prediabetes/takethetest/ https://www.cdc.gov/diabetes/pdfs/data/statistics/na- • Hours to set-up and staff tables at campus tional-diabetes-statistics-report.pdf community events American Diabetes Association: https://professional. diabetes.org/sites/professional.diabetes.org/files/media/ URBAN GAMES INFORMATION prediabetes.pdf Urban Games’ vision is a bold community en- Taking Control of Your Diabetes Conference and Health gagement initiative that seeks to build community Fair: https://tcoyd.org/tcoyd-bellevue-2019/ self-advocacy and individual self-agency centered on health and wellness. Partnering with Youth Other Sources Centric, a social purpose organization, Urban Swedish online cooking class videos (Swedish Eats): Games proposes the following goals and outcomes: https://www.facebook.com/pg/swedishmedicalcenter/ • Engage 1,000 Urban Games Youth videos/?ref=page_internal Ambassadors in year round activities and programs who are committed healthy living Key Community Partners and wellness practices. • American Diabetes Association • Develop a data-informed wellness baseline • Garfield Community Center for each of the Youth Ambassadors • Seattle Park and Recreation, City of Seattle for monitoring, coaching, and intervention, as appropriate. • Austin Foundation • Track over 10M activity hours (1,000 UG • Clean Greens and Fresh Bucks Youth Ambassadors x 30 minutes per day • Seattle Chapter Jack n Jill, Inc. x over 365 days). • Mary Mahoney Professional Nurses Association • Demonstrate through data analysis how a • iUrban Teen focused community based effort can improve health outcomes • Treehouse • Black Farmer Collaborative • Northwest Kidney Center • Asian Counseling Referral Services (ACRS) Community Farm

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4. INITIATIVE/COMMUNITY NEED BEING ADDRESSED: HOMELESSNESS

Goal (Anticipated Impact): Develop ongoing partnerships Additionally, this consortium will work to address with community-based organizations and city and county upstream health needs, such as behavioral health, and entities whose focus is homelessness and providing social determinants of health, such as employment. support for families experiencing homelessness in King Scope (Target Population): Families experiencing and Snohomish Counties. Build collaborative relationships homelessness or unstably housed (i.e. couch surfing) in to identify and develop strategies and pathways to King and Snohomish Counties. reduce homelessness and provide supportive housing.

OUTCOME MEASURE BASELINE FY19 TARGET FY21 TARGET

Develop collaborative 782 family households (2,624 individuals) strategies focused on 1 House 10% experiencing homelessness in King County (2018) House 10% + of moving a percent of of homeless homeless families the homeless families 21 family households (60 individuals) experiencing families 2 to stable housing chronic homelessness in Snohomish County (2018)

STRATEGY STRATEGY(IES) BASELINE FY19 TARGET FY21 TARGET MEASURE # of partners Meet with housing advocates and 5 community 12 community within the community partners in King and partner partner TBD campus Snohomish Counties meetings meetings communities # of individuals Fully funded housing in families with strategies align with Initial Fully integrated housing children in the Establish housing advocates conversations collaborative strategies with a point in time housing and Swedish with community focus on unhoused families count identified collaborative goals focused on partners as experiencing families experiencing homelessness homelessness Explore assets to invest in innovative ways to provide transitional housing to meet the needs of unhoused TBD TBD TBD TBD families and partner with Providence Supportive Housing Administer behavioral health services Establishing and training and education resources TBD 0 targets in TBD to transition families to stable housing 6 months 1 http://allhomekc.org/wp-content/uploads/2018/05/FINALDRAFT-COUNTUSIN2018REPORT-5.25.18.pdf 2 https://snohomishcountywa.gov/DocumentCenter/View/54339/2018-Point-In-Time-Report-PDF Evidence Based Sources Key Community Partners All Home: http://allhomekc.org/king-county-point-in- Plymouth Housing YWCA time-pit-count/ Capitol Hill Housing Congregation for Seattle/King County Coalition on Homelessness: Wellsprings the Homeless http://homelessinfo.org/ West Seattle Help Link Vision House Ballard Help Line Solid Ground City of Seattle: https://www.seattle.gov/humanservices/ Mary’s Place Seattle Chamber of Com- about-us/initiatives/addressing-homelessness Seattle King County merce – Housing Connector Resource Commitment Public Health Providence St. Joseph City of Seattle Health Swedish Community Health Investment Division United Way Others PSJH Housing Learning Collaborative

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5. INITIATIVE/COMMUNITY NEED ADDRESSED: JOINT AND BACK PAIN Joint and Back Pain Education for people in the Swedish Issaquah service area

Goal (Anticipated Impact): Joint and back pain was community, this initiative seeks to increase outreach and one of the top four problem areas identified by Swedish education for individuals impacted by joint and back Issaquah stakeholders in the Community Health Needs pain, with an emphasis on non-surgical alternatives. Assessment (CHNA) primary data survey. Due to the Scope (Target Population): For people living in the impact of joint and back pain in the Swedish Issaquah Swedish Issaquah service area.  FY19 FY21 OUTCOME MEASURE BASELINE TARGET TARGET # of people who attend Gibson EK High School fitness presentation Zero TBD TBD # of people who attend Swedish Sports Medicine Combine event Zero TBD TBD % of participants who rate top box on survey at the Be Well Resource Fair Zero TBD TBD

STRATEGY FY19 FY21 STRATEGY(IES) BASELINE MEASURE TARGET TARGET Fitness presentation at Gibson EK High School in # of presentations Zero TBD TBD Issaquah – focus on high school students and parents Swedish Sports Medicine Combine presentations in # of presentations Zero TBD TBD July – focus on the community # of handouts Joint and back pain booth at Be Well Resource Fair Zero TBD TBD distributed

Evidence Based Sources Key Community Partners Issaquah Sports Medicine Innovation Partnership Zone: Tim Dutter, Economic Development Manager / Zone https://www.issaquahwa.gov/index.aspx?nid=1703 Administrator, City of Issaquah Innovation Partnership Wellness and Health Fair Planning Guide: https://www. Zone: http://choosewashingtonstate.com/i-need-help- modahealth.com/pdfs/wellness/health_fair_planning_ with/site-selection/innovation-partnership-zones/ guide.pdf Resource Commitment Bone and Joint Initiative: https://www.usbji.org/pro- grams/public-education-programs/action-week • Physician and clinical • CHIP work team

Other Community Benefit Programs and Evaluation Plan

TARGET INITIATIVE/COMMUNITY POPULATION NEED PROGRAM NAME DESCRIPTION (Low Income or BEING ADDRESSED Broader Community) Organize a collection drive – Low Income Access Eastside Baby Corner donations of clothing, diapers, Families and baby goods, toys, books Children SHARE/WHEEL - Homeless Resources & Outreach Low Income Issaquah Tent City Issaquah Community – Outreach Community Organization Tabling Broader Community Resource Event

17 | CHIP Issaquah Campus — 2019-2021 2019 CHIP GOVERNANCE APPROVAL

This community health improvement plan was adopted on May 14, 2019 by the authorized body of the hospital on May 14, 2019. The final report was made widely available1 on May 15, 2019.

______05/14/2019 R. Guy Hudson, M.D., MBA Date Chief Executive Officer Swedish Health Services

______05/14/2019 Kristen Swanson, MSN Date Chair Board of Trustees Swedish Health Services

______05/14/2019 Joel Gilbertson Date Senior Vice President, Community Partnerships Providence St. Joseph Health

______05/14/2019 Chris Beaudoin Date Chief Operating Officer, Swedish Issaquah

CHNA/CHIP CONTACT Sherry Williams, MPA Request a copy, provide comments or view electronic Regional Director Community Health Investment copies of current and previous community health needs Swedish Health Services assessments: https://www.swedish.org/about/overview/ 206-386-3407 mission-outreach/community-engagement/communi- 206-386-6000 ty-needs-assessment/assessments-site-list [email protected]

1 Per § 1.501(r)-3 IRS Requirements, posted on hospital website

18 | CHIP Issaquah Campus — 2019-2021 APPENDIX

Definition of Terms Initiative: An initiative is an umbrella category under which a campus organizes its key priority efforts. An initiative, program or activity Community Benefit: Each effort should be entered as a program in CBISA that provides treatment or promotes health and Online (Lyon Software). Please be sure to report on healing as a response to identified community needs all your Key Community Benefit initiatives. If a campus and meets at least one of the following community reports at the initiative level, the goal (anticipated benefit objectives: impact), outcome measure, strategy and strategy a. Improves access to health services; measure are reported at the initiative level. Be sure to b. Enhances public health; list all the programs that are under the initiative. Note: c. Advances increased general knowledge; and/or All Community Benefit initiatives must submit financial d. Relieves government burden to improve health. and programmatic data in CBISA Online. Community benefit includes both services to the poor and broader community. Program: A program is defined as a program or service provided to benefit the community (in alignment To be reported as a community benefit initiative or with guidelines) and entered in CBISA Online (Lyon program, community need must be demonstrated. Software). Please be sure to report on all community Community need can be demonstrated through benefit programs. Note: All community benefit the following: programs, defined as “programs”, are required a. Community health needs assessment developed to include financial and programmatic data into by the campus or in partnership with other CBISA Online. community organizations; b. Documentation that demonstrates community Goal (Anticipated Impact): The goal is the desired need and/or a request from a public agency or ultimate result for the initiative’s or program’s efforts. community group was the basis for initiating or This result may take years to achieve and may continuing the activity or program; or require other interventions as well as this program. c. The involvement of unrelated, collaborative tax- (E.g. increase immunization rates; reduce obesity exempt or government organizations as partners prevalence.). in the community benefit initiative or program. Scope (Target Population): Definition of group being Health Equity: Healthy People 2020 defines health addressed in this initiative: specific description of equity as the “attainment of the highest level of health group or population included (or not included, if for all people. Achieving health equity requires valuing relevant) for whom outcomes will be measured and everyone equally with focused and ongoing societal work is focused. Identify if this initiative is primarily for efforts to address avoidable inequalities, historical and persons living in poverty or primarily for the broader contemporary injustices, and the elimination of health community. and health care disparities.” Outcome measure: An outcome measure is a Social Determinants of Health: Powerful, complex quantitative statement of the goal and should answer relationships exist between health and biology, genetics, the following question: “How will you know if you’re and individual behavior, and between health and making progress on goal?” It should be quantitative, health services, socioeconomic status, the physical objective, meaningful, and not yet a “target” level. environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual’s or population’s health, are known as determinants of health. Social determinants of health are conditions in the environment in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality- of-life outcomes and risks.

19 | CHIP Issaquah Campus — 2019-2021 We do not discriminate on the basis of race, color, national origin, sex, age, or 751 NE Blakely Drive disability in our health programs and activities. Issaquah, WA 98029 T 425-313-4000 www.swedish.org

© 2019 SWEDISH HEALTH SERVICES. ALL RIGHTS RESERVED. COMM-19-0205-C 5/19