What’s motivating your work with Health Leads these days?
We are really focused on leveraging data from health-related social needs initiatives to inform community wide decisions about social determinants of health. In the past, we focused entirely on the clinical interaction — making sure that patients were being asked about social needs and something was done about it. We are still focused there, but trying to make sure that our quality improvement efforts to reduce those needs reach into the community to improve the lives of people, whether they are patients or not. One of my favorite partnerships is with the WIC program in New York, where we have used data on barriers to enrollment from clinical referrals to make policy and programmatic changes statewide.
Who out there in your network is doing transformative work that you’re learning from, that we all could learn from?
I really love the work happening within the All Children Thrive network in Cincinnati. They have brought quality improvement methods and infrastructure to community wide challenges. They educate and empower community residents themselves on quality improvement, and they start in the neighborhoods that are most affected. They set a small number of community wide goals that motivate work across sectors, and they develop and refine policy and programmatic efforts to address social determinants. They have achieved some impressive results reducing hospitalizations and extremely preterm births that will change the trajectory of children’s lives for the better and is probably saving a few, too.
We hear a lot about what clinicians don’t like about health IT: all the clicks, the seemingly endless documentation, distracting alerts. But what do you and other clinicians want out of technology? What’s the positive vision?
The positive vision was there at the beginning but I think it’s been lost. I’ve always been intrigued by the Problem Knowledge Coupler idea – where the health record is a place to bring everyone’s knowledge together in a way that is organized to address the problems (and opportunities) of patients/clients. There is a doctor in Maine who has been using that model, with in house technology since the early 1990s.
I see EHR companies and some other health tech starting these principles more, so maybe we’ll get there. Software is eating the world, but if there is any place where the limitations of software are obvious it is in caring for and educating other humans. Businesses are often interested in cutting humans out of the picture, but the future is about closer partnerships and better teamwork among clinicians, programmers, informaticists, etc., not more specialization and not computers instead of people.
What are you reading right now for insight and inspiration?
I’ve gone back to reading a lot of fiction recently. The problems we are facing are rooted in history and too much of my world is about “fast-paced innovation” which is often ineffective for improving lives at best and automates inequity at worst, so I’m trying to counter balance that. Multi-generational novels told from a lot of different perspectives are my latest thing — There There, Homegoing, Pachinko, The House of Broken Angels.
Please share a personal ascent outside your professional life. We want to know!
I’ve recently started backpacking and last year went up to the continental divide in Bridger-Teton Wilderness in Wyoming on a 4 night trip. At the alpine lakes at the top we caught a few cutthroat trout, cleaned them, and cooked them over the fire. A high point in both the literal and abstract sense!
Damon Francis, MD is the Chief Clinical Officer of Health Leads, a national nonprofit that fosters innovative partnerships among health systems and community organizations to advance health equity. He is especially interested in the ways we can align care focused on individuals with strategies to achieve community health. Prior to joining Health Leads, Dr. Francis led population health initiatives related to HIV and homelessness in Oakland and the East Bay. He received his M.D. from the University of California, San Francisco, where he is now a member of the volunteer faculty.