America needs socially responsible hospitals, and many hospitals all over the country are rising to the challenge. The Lown Institute Hospitals Index–the first hospital ranking to evaluate hospitals on 50+ metrics across health equity, value, and outcomes–honors hospitals that are leading the way on social responsibility.
With our Hospital Spotlight blog series, we’re diving deeper into the performance of top hospitals and interviewing hospital leaders to find out more about the initiatives and practices behind their success.
Our latest spotlight features Mount Sinai Hospital in Chicago, which was one of the top hospitals for Fair Share Spending in the nation in 2022. They’re also one of the top-performing hospitals on the Lown Index overall, receiving “A” grades in Social Responsibility, Equity, and Value in 2022.
We spoke with Dr. Ngozi Ezike, President and CEO of Sinai Chicago, about Mount Sinai Hospital’s role in the community and their vision for the future.
Dr. Ngozi Ezike is President and CEO of Sinai Chicago, which includes Mount Sinai Hospital. Prior to coming to Sinai, she was Director of the Illinois Department of Public Health (IDPH), achieving national recognition for her leadership of the State’s response during the COVID-19 pandemic. Prior to joining IDPH, Dr. Ezike worked for 15 years for Cook County Health (CCH), addressing the needs of the residents of Cook County. She has also held leadership positions as the medical director at the Cook County Juvenile Temporary Detention Center, as well as the Austin Health Center. Dr. Ezike is a board-certified internist and pediatrician who graduated from Harvard University and the University of California, San Diego School of Medicine.
Lown Institute: Can you tell us a bit about the history of your hospital and the community that you serve?
Dr. Ezike: For 100 years, Sinai has been committed to caring for those in need. Our presence is critical to ensuring that vulnerable populations have access to quality health care. Along with Mount Sinai Hospital, the system includes two other hospitals, a network of neighborhood clinics, a research center and a social services center.
Mount Sinai Hospital was originally founded in 1919 to serve the Jewish population which had immigrated to the West Side of Chicago. The establishment of Mount Sinai Hospital gave this once disenfranchised community an opportunity to receive the quality care needed to live healthy lives. It also gave Jewish doctors and nurses a place to practice medicine, free from discrimination that confronted them elsewhere at the time.
(Editor’s note: When Dr. Bernard Lown was applying to medical schools, he faced this exact discrimination. He was rejected by all schools but one, and was told by the Harvard Dean, “We have already filled the quota allotted to your people.”)
In the second half of the 20th Century, North Lawndale’s Jewish community moved to different neighborhoods, but Sinai stayed to serve the ongoing needs of those who lived in the area. Today, the majority of the population we serve is African American and Latino. It’s a very different neighborhood now, but the Jewish concept of Tikkun Olam – “repair the world” – remains strong at Sinai.
We are the largest non-government safety-net hospital system in the State of Illinois, and we rely on government payers for nearly 90% of our revenue, with nearly 65% of patients insured by Medicaid, 25% insured by Medicare, and 9% uninsured.
Our communities carry a disproportionate burden of illness, poverty, hunger, and trauma. For example, the areas we serve have triple the national rate of diabetes, triple the overall city rate of unemployment, and 50% have food insecurity.
Violent crime and firearm-related mortality are also huge problems in Mount Sinai Hospital’s service area. While 63% of Chicago adults overall indicate they feel safe in their neighborhood most or all of the time, only 39% of people living in MSH service area feel similarly. Shockingly, one quarter of people in the communities we serve report symptoms of PTSD. For the health of our patients, we have to address the root causes of these disparities.
Mount Sinai spends much more on financial assistance than most hospitals in the country. What goes into creating and implementing a successful financial assistance policy that ensures that patients don’t have to go into debt to receive care?
Why do we invest so much in our financial assistance programs? Because our patients need these supports to ensure they have the same access to quality healthcare that is available to those living elsewhere in the city. Healthcare is a right, not a privilege, and your ability to get the care you need to live a healthy life should not be a product of the zip code you live in.
The financial assistance programs and charity care we provide are as important as the healthcare services we offer. Without this investment, many would be left to fend for themselves to find care. We know our community needs us and our mission has never been more important.
At Sinai Chicago, we make sure every patient is treated fairly and given the opportunity to apply for financial assistance. We also use a third-party system to predict the likelihood of financial needs of which allows us to pre-emptively provide financial assistance for patients that need it. It’s a model that uses regional cost of living and patient characteristics, like educational background and assets, to drive a prediction of assistance qualification and ability to pay. We also have internal policies that help us further refine our process on a case-to-case basis. We do not turn away any patient due to lack of insurance or inability to pay.
What are some of the most pressing health needs that Mount Sinai has identified in your health needs assessment, and what programs are you undertaking to address these needs? Do you have a favorite current initiative or program you’d like to highlight?
The priority health needs that we identified in the most recent health needs assessment were (1) social determinants of health, (2) community safety, (3) equitable healthcare across the lifespan, (4) chronic and infectious disease, (5) and mental health and substance abuse. And COVID-19 disproportionately impact our communities.
We’ve tailored our community health programs to address these needs. For example, we identified unemployment, poverty, and disconnection among youth as social conditions that especially impact Mount Sinai patients. We started the Population Health Career Pathway to create new career opportunities for local Hispanic/ Latinx residents and increase access to bilingual, culturally competent healthcare in Chicago via a well-trained bilingual population health workforce. We work closely with the Chicago-Cook Workforce Partnership, the largest workforce development organization in the country, as well as with West Side United (WSU) and Esperanza Health Centers.
Through our Community Health Worker Support Program, we also have community health workers screen patients in our emergency departments for social needs, referring them to community organizations that assist with housing, food access, job training, public benefit program enrollment, and more. Since July 2022, CHWs have also been present on our inpatient units to screen for social needs, support discharge planning, and follow up with patients post-discharge to support transitions in care.
What do you think is the role of hospitals in improving the social determinants of health in their communities?
At Sinai Chicago we’re working to address equity through inclusion, innovation, and investment in our community. We share a vision of all communities thriving in health — with our neighbors and patients living healthy lives, with equal opportunities and support to grow, develop and be successful. Our goal is to keep people healthy in the community, even before they come through our doors.
Our vision is to move beyond our physical walls to provide critical health and social services and form creative partnerships on community-focused initiatives to bring investment in housing, commercial space and jobs for the communities we serve on the West and South Sides. Limited financial resources within the community should not equal limited lifespans.
That sort of innovative thinking has extended into our efforts to improve housing and economic development, to create and implement violence prevention and mentoring programs, and offer education and support for mothers and families to ensure healthier babies and young children. That’s what we mean by partnering with our community residents to see our communities thriving in good health.
What do you hope to achieve for Mount Sinai Hospital in the future?
I think we all share a vision of healthy, thriving communities. The real work is about bringing down barriers and creating a better Chicago for all. I hope to see a future where safety net hospitals like Sinai get to focus on expanding and improving the care we deliver to our patients rather than spending so much effort trying to keep the lights on. I want Sinai Chicago to be THE leader for urban healthcare — the lighthouse for the nation for how care is delivered in urban settings. We want people to stay in their neighborhoods and choose nearby Sinai campuses to get the high quality, culturally competent care they need and deserve.