St. Joseph Health—Sonoma County is a multi-million-dollar health system anchored by two hospitals: Santa Rosa Memorial Hospital and Petaluma Valley Hospital. Its innovative program of deploying community health workers and community organizers expands the traditional role of charitable, philanthropic, and community benefit activities among hospitals. The hospital tithes, meaning that 10 percent of its net income is reinvested in Community Benefit, in the form of grants and programs that are designed to improve community health. The organization’s portfolio of community benefit programs includes three free clinics, school-based wellness programs, and community outreach.
Two of St. Joseph’s many components of the community outreach work complement each other: Promotores de Salud and Neighborhood Care Staff. Promotores consists of health workers who provide health education, conduct cooking and nutrition classes, and train volunteer health promoters. Neighborhood Care Staff identifies local assets, provides forums for dialogue, supports local leaders and the development of community groups, assists residents with strategic planning, and facilitates relationships between community members and resources. It principally engages in advocating for community participation in the issues that most affect it.
Four full-time organizers are on staff performing community organizing activities, and are on the health system’s payroll to manage these programs.
Established with the Santa Rosa Memorial Hospital in 1950, St. Joseph's subsequently expanded its not-for-profit network to include other 10 facilities in the area. Its mission remains faithful to the founders' Catholic orientation: "We advocate for systems and structures that are attuned to the needs of the vulnerable and disadvantaged, and that promote a sense of community among all persons."
St. Joseph's takes an explicitly broad view of health in its mission:
We believe that healthy communities result when illness prevention is combined with such other important factors as a clean environment, safe streets, good water, access to work and education, competitive salaries, affordable housing, a healthy lifestyle and more.
Through our extensive network of community health programs and clinics, advocacy efforts and healthy community initiatives, we continually strive to meet the health needs of our neighbors and make this a better place—for everyone—to live, work, learn and thrive.
One of the sisters of St. Josephs of Orange looked at the configuration of Santa Rosa: Highway 101 goes north and south, and highway 12 goes east and west. The southwest quadrant of Santa Rosa offered no medical or dental services, no library, and the demographic was very low income and primarily of Latino origin. The sister thought, "What a great place for us to begin to work!"
The hospital staff participated in door-knocking and surveying, and coordinated a large convention at the middle school, based on an organizing strategy that took inspiration from Northwestern University professor John McKnight’s Asset-Based Community Development, or ABCD. As a result, St. Joseph's opened a freestanding dental and medical clinic in the area, while building community capacity. Neighborhood residents began going to local government meetings, setting agendas and addressing local issues on their own.
Integrate education into health delivery: As St. Joseph's deploys federally-qualified health centers to underserved areas to provide free medical attention, its mobile units double as classrooms for those who are waiting for an appointment. Lessons on diabetes, childhood nutrition, exercise, and excessive sugar consumption are provided in concrete, interactive ways. Those who seek out more information and show interest are recruited to become volunteers for Promotores de Salud themselves.
Anchor institutions can follow through on long-term priorities: “St. Joseph’s status as a nonprofit anchor institution, which tithes 10% of net income to support its community benefit work, allows its community organizing arm to focus on the work at hand instead of fundraising. “We write grants and work with county contracts but, because of this ministry’s commitment to the mission, we have the financial stability that most nonprofits would envy,” says community benefits coordinator Matthew Ingram.
Institutionalize community voices in decision making to better guide work: Community representation is significant in the makeup of the board of directors for the community benefit arm of St. Joseph's. Sonoma Health Action, a coalition that St. Joseph's participates in, is another way the hospital connects with community voices. Health needs assessments also provide data via interviews and focus groups.
A broad conception of community health allows providers to follow the community's lead: Because St. Joseph's objective is to improve community health, the classic organizing strategies of asset mapping and consensus building around surveys and the ranking of key priorities will always have some relationship to a vibrant, healthy neighborhood. Whether the community prioritizes bullying, teen violence, school lunches, police violence, or the lack of stop lights, in one form or another, each issue addresses community health.
Quantitative metrics don't always convey the community benefit: Former community benefits director Jo Sandersfeld says that the health system's penchant for metrics at first did not allow the colleagues outside her department to adequately capture the value of the community organizing work: "I would turn in my metrics for organizing—we met with 102 people, hosted five meetings, and we finally got a stoplight at the corner, and there's now a post office there." The capacity-building and community-cohesion aspects needed further explanation.