President’s Update: Reversing the Down Escalator

Wendy Nickel

October 28, 2022

Earlier this month, HCIF held our annual Partnership for Patient Care Leadership Summit – HCIF’s first in-person event since 2019. It was also HCIF’s first-ever hybrid event and we were delighted to welcome over 100 people both virtually and IRL (in real life). The Summit’s theme was “Achieving Health Equity through Community Engagement” and featured keynote speaker, Dr. Somava Saha, a health equity expert from Well-Being and Health Equity in the World, as well as Victor Murray, Senior Director of Community Engagement and Capacity Building from the Camden Coalition.

Dr. Saha’s talk outlined the benefits of engaging communities to advance healthcare quality, safety and equity. She shared powerful images of how place-based inequities have been caused by long-standing policies intended to propagate them, such as redlining, predatory lending, and gentrification. Using a compelling metaphor, Dr. Saha likened health equity to an escalator –in communities where resources are plentiful, the up escalator represents the ease by which individuals can get to where they’re going without obstacles or being slowed down.

However, in less-resourced communities, individuals are constantly trying to go up the down escalator – each time they encounter an obstacle, such as illness, unemployment or unstable housing, it is harder and harder to get to the top. She described the importance of engaging communities to address equity at the roots of what drives health care disparities. Using this approach, for example, Cincinnati Children’s Hospital partnered with the public school system to increase third-grade reading levels. This work resulted in decreased hospital utilization and inpatient days for the targeted communities.

Victor Murray showcased Camden Coalition’s programs that advance health equity through community engagement and emphasized the power of partnership between healthcare providers and community-based organizations. His presentation began with reminding the audience about the importance of individual relationships. He led an exercise where he asked each person to write a note to someone they care about and why. This was an important reminder for tapping into the reasons we are in healthcare and despite facing challenging situations, continue to persevere for the good of communities.

The theme of health equity was carried throughout the day, including the Delaware Valley Patient and Safety and Quality Award program. Celebrating its 20th year, the award featured new criteria in 2022, including health equity and patient and family engagement. The top three winners were Temple University Hospital, Fox Chase Cancer Center and the Hospital of the University of Pennsylvania, with programs focused on: utilizing a community health worker program to improve frequency of visits by individuals with complex needs; improving crash cart readiness; and increasing breastfeeding initiation rates among African American patients in the newborn nursery.

Audience members also heard from HCIF staff about two of our signature programs. April Reilly presented about the important work of the Health Equity Data Strategy (HEDS) collaborative, which is comprises area hospitals working to improve the collection and utilization of racial, ethnicity, and language (REaL) data in order to address health care disparities. Additionally, Kelsey Salazar provided an inspiring and passionate look at the Collaborative Opportunities to Advance Community Health (COACH) program and how it fosters collaboration between a variety of stakeholders to improve food insecurity and trauma-informed care.

It was a remarkable day of learning and sharing, marked by metaphors and images for how to achieve health equity with partnership, care, and engagement of community.  It certainly felt that all of us were working to reverse the down escalators that day. Thanks to all of you who attended and if you were not able to participate, feel free to view the presentations and recordings from the Partnership for Patient Care 2022 Leadership Summit, by following this link and clicking the “Leadership Summit” tab.

President’s Update: September 2022

Wendy Nickel

September 26, 2022

Summer Should Get a Speeding Ticket

I read this quote recently somewhere and it really resonated – merely a few days into the fall, the blur of summer feels like a distant memory. It used to be that summer was a time of catch up and slow-down in professional life – fewer events, fewer meetings, and more time to savor the longer days and the sun’s reflections casting light across the office. However, the pace didn’t seem to slow this summer at HCIF, as we had a number of exciting projects and initiatives that continued to keep us busy throughout the season.

Our summer kicked off with our Health Literacy Summit in June, a 2-day virtual journey exploring concepts related to equity, inclusive care, and connection to our inner patient. It was a fascinating two-day event which highlighted and elevated patient voices in a panel discussion about how health literacy can be a catalyst for achieving health equity. It also featured a moving presentation following the journey of an individual with substance use disorder and the barriers he encountered in receiving care, until a lens of inclusion was applied to his healthcare pathway. Our next health literacy summit is coming up in just a few weeks on October 27th, and is sure to be equally as engaging.

The region’s hospitals and healthsystems achieved a major milestone with the completion of the regional Community Health Needs Assessment (rCHNA) on June 30th, 2022. Facilitated by HCIF, the rCHNA identifies a number of health issues the broader Southeastern Pennsylvania area can use to prioritize efforts and resources. Some of these priorities include: mental health conditions, access to care, chronic disease prevention and management, substance use disorders, and racism and healthcare disparities.

In July, HCIF held a quarterly Board of Directors meeting to coincide with the end of our fiscal year. During this meeting, HCIF reviewed achievements related to annual organizational and programmatic goals. One of the goals we have been working towards for the past year is the development of a vision statement to guide our work in anti-racism:

“As a collaborative partner invested in the health of diverse communities, HCIF strongly values and centers health equity, accessibility to health care, and freedom from health care harm. We firmly believe we can only achieve equity when all are ensured the right to safe, high quality, and compassionate health care.

HCIF strongly condemns racism and bigotry which are in direct opposition to equity and perpetuate poor health outcomes and disparities. HCIF commits to fighting racism by using and sharing our collective knowledge, influence, and power to advance high quality health care for all communities.”

We recognize that statements are just that….without actions, they are just words. We have worked hard since 2020 to ensure that our words are backed up with forward progress, by educating our team, participating in discussion forums, and engaging resources to support our health equity and anti-racism journey. In the coming months, we will be working on actions and commitments we can make as an organization to ensure our anti-racism work is sustained.

Beginning in August, HCIF also welcomed three new staff members over the past several weeks: Lauren Eckel (Project Coordinator), Sehrish Rashid (Project Manager), and Meghan Smith (Project Manager). We are excited to have them join HCIF and eagerly await the many ways they are sure to contribute to the important work of our organization.

The summer sped by and the fall is looking quite busy too for HCIF. We look forward to keeping you updated on our many events and milestones through future Highlights newsletters and our social media spaces. In the meantime, savor these last few warm days and longer periods of daylight before the fall becomes a distant memory.

President’s Update: June 2022

Wendy Nickel

June 29, 2022

As the Pennsylvania Health Literacy Summit kicked off earlier this month, we were introduced to A.L, a 39 year-old individual who was an intravenous drug user living on the streets. A.L. had a serious infection and required a hospital stay, but for an individual living with addiction, it was challenging for staff to understand his needs and how to address his myriad health and social challenges. We followed A.L.’s journey to find secure food resources, and then affordable housing, and then pre- and post-natal care for his partner and growing family. Through A.L.’s journey, we learned about inclusion health and how caring for excluded populations helps us to improve care for all.

A.L.’s journey teaches us that inequitable access to care, healthcare disparities, and healthcare harm is often caused by exclusion. By now, many of you have seen the graphic that shows individuals of differing heights standing on the same-sized box trying to see over a fence to view a baseball game. The graphic depicts the continuum from equality to equity. A newer addition to the graphic shows the continuum ending in inclusion, with no fence creating a barrier and the viewers now as participants in the game.

Health literacy is a mechanism to ensure all have the opportunity to be included in healthcare. Imagine an individual who is overwhelmed by a difficult diagnosis and is asked to make a healthcare decision without support or potential understanding. We are perpetuating exclusion when we don’t ensure all individuals have the ability or capacity to participate in their healthcare. Employing health literacy best practices can quite literally ensure that every member of our communities has access to an extraordinarily complex system. Health literacy isn’t just about addressing the individual who speaks English as a second language, or the person who has less than an eighth grade education. It’s also about a paradigm shift to understanding all of the factors which contribute to an individual’s understanding and experience of care.

Health literacy levels the playing field to ensure all are included in healthcare. HCIF is grateful to serve as the lead for the Pennsylvania Health Literacy Coalition and continue to prop the doors open. For more information about our work in health literacy, please visit

President’s Update: May 2022

We Need to Talk About Mental Health

Wendy Nickel

May 24, 2022

My heart is heavy today as news trickles in about the mass shooting at a Texas elementary school, which so far, has claimed the lives of 19 innocent children and 2 adults. The dinner table was quiet tonight, as I thought about what to say to my own children, ages 17, 16 and 13. My oldest son was teaching science at an elementary school today as part of a high school program – he was especially quiet.

In the aftermath of the shooting, I can predict the requisite conversations about gun control and social media influences. There will be discussions about mental health and the need for better resources and tools, and suggestions about how to mend a broken system. But these same discussions occurred after Sandy Hook… and all of the mass shootings since, and not much has changed.

It’s time to have a serious conversation about mental health. We can’t afford NOT to talk about it. We can’t afford to lose more elementary school children or people shopping in a grocery store or people going to see a movie or people going to religious services. We can’t afford to have conversations about mental health only after mass shootings. We should be talking about it every minute of every hour of every day. This Mental Health Awareness Month, let’s pledge to keep talking about mental health long after May is over.

According to the World Health Organization, global prevalence of anxiety and depression increased by 25% during the first year of the COVID pandemic. Youth have experienced the biggest impacts: 15% of youths experienced major depressive disorder in 2019 (up 1.24% from the previous year) – over 60% did not receive any mental health treatment. In Texas, nearly 75% did not receive mental health treatment. (Source: Reinert, M, Fritze, D. & Nguyen, T. October 2021. “The State of Mental Health in America 2022” Mental Health America, Alexandria VA.). These numbers don’t account for the impact of COVID-19, which likely only exacerbated the increase in mental health disorders over the past two years.

The reasons for the growing mental health crisis are numerous and complex. They include a paucity of behavioral health providers, lack of parity in reimbursement for physical vs. mental health services, continued stigmatization of mental disorders, and a system that is only set up to address mental health crises, as opposed to preventing them in the first place. Isolation, disruption in social opportunities, and barriers to health and social services have added to pre-pandemic challenges.

It’s time to talk as a nation about solutions to the mental health crisis in America, starting with promoting mental health as essential to physical health. It’s time to talk about developing policy to ensure reimbursement parity for mental health services. We need to talk about creating a pathway for more to pursue careers in behavioral health and entertain innovative models, such as training community peers and embedding behavioral health providers in school systems. We need to talk about mental wellness and the known best practices for taking time out of your day to employ these strategies. We need to be having conversations about how to ensure individuals who are at higher risk for experiencing mental health disorders, such as BIPOC and transgender youth, have access to the services they need. We need to talk about taking care of our communities and removing the stressors that cause mental health disorders. Let’s promise to keep talking out loud about mental health and taking action to solve the complex problems that are in front of us. HCIF can be your partner in these conversations and we pledge to bring together stakeholders to find solutions. Take time to pay attention to your own mental health as we take on this challenge – we’re going to need your strength. Talk to your colleagues, your friends, your loved ones, and especially your children about the importance of mental wellness. Please feel free to reach out to me or any of our HCIF staff members if you want to talk.

A Letter from the President

“2022 Looks Pretty Pretty Pretty Good”

January 25, 2022

For those of you who may not be familiar with Curb Your Enthusiasm, there was an episode at the beginning of the 2020 season that discusses when exactly it’s too late to say “happy new year”. According to Larry David, it’s only 3 days, so I am well overdue in sending out my happy new year wishes and sentiments.  Admittedly, wishing a happy new year at the beginning of 2022 felt a bit enthusiastic with omicron weighing heavily like a thundercloud getting ready to drop torrents of rain. About three weeks later, there does seem to be a glimmer of sunlight on the horizon with predictions that omicron will peak in the next month or so. 

Despite the uncertainty surrounding the start of this year, one thing is for certain as I reflect on 2021: it brought shining examples of collaboration and innovation in healthcare. HCIF started the year planning for the 15th anniversary of the Partnership for Patient Care program. This program has offered leadership and guidance for the region in quality and patient safety since its inception. Throughout the past year, programming often reflected the needs of our partners, including discussions and resources related to COVID-19. We celebrated our milestone anniversary during the year by highlighting partners through our social media and communications channels and developing new materials, including our 15th anniversary video. The year culminated in our Annual Leadership Summit in November, which while unable to be held in person, was nonetheless compelling and educational. The theme of the summit was health equity and featured healthcare leaders discussing their equity journeys and the links to quality and patient safety.

2021 also saw the launch of our newest program – the Health Equity Data Strategy (HEDS) initiative. This program aims to reduce healthcare disparities by supporting and educating health systems in the collection and utilization of racial, ethnicity, and language (REaL) data. A comprehensive assessment was administered to eight regional health systems in September 2021 to establish a baseline for improvement efforts. This program will continue in 2022 with development of best practice recommendations, sharing of resources, and education from expert leaders.

Cities Changing Diabetes continued to change the landscape of diabetes prevention and management in Philadelphia through targeted community interventions. These include an initiative to train youth champions to support policies that prevent diabetes and obesity; a program that provides resources for individuals with disabilities and diabetes to practice healthy lifestyles; a nutrition and education program to help address obesity, diabetes and chronic conditions in a recently incarcerated population; and a program to engage youth leaders and community health workers to provide health education to a targeted community. Expansion of these initiatives, as well as additional programming through faith-based institutions, is anticipated for 2022.

Work began in earnest in 2021 for the next round of the Southeastern Pennsylvania regional Community Health Needs Assessment (rCHNA). The highly-anticipated report will be released in June 2022 and features a number of expanded areas in this new iteration, updated from 2019. In addition to quantitative data analysis, the report will highlight qualitative data collected from over 40 community discussions, and thoughtfully captures the voice of the youth and other specialized groups.

Our health literacy work continued in 2021 with the delivery of trainings to various groups and a recognition of the linkages between health equity and health literacy. With an opportunity to renew our program in 2021, HCIF engaged a health equity consultant to further pursue these linkages. The consultant will work with HCIF to develop a vision for our health equity work, help us in integrating equity principles into our health literacy materials and programming, and support the development of a health literacy leadership committee.

Other HCIF highlights from 2021 included: the launch of an innovative colorectal cancer screening program; achieving a milestone of over 18,000 cases entered in the Pennsylvania Urologic Regional Collaborative (PURC) registry, and release of patient and clinician education materials related to opioid use and management in the surgical setting.

In April 2021, we launched a comprehensive strategic planning effort which concluded in December. The culmination of this initiative is a strategic roadmap which, rather than providing a step-by-step plan, offers HCIF more flexibility in implementing three new strategic priorities. These are: 1.) develop a strategic approach to advance health equity and positive health outcomes for all, 2.) catalyze efforts to engage patient and community voices more fully, and 3.) integrate clinical improvement and population health frameworks in future programs. The strategic planning imitative also allowed us to revisit our vision and mission statements and we are excited to be guided by these in the future:

Our Vision

Healthier communities through equitable, accessible, and quality health care.  

Our Mission

Driving superior health care through collaboration and shared learning.

So despite some of the uncertainty facing us again in 2022, there is so much promise of good things to come. In fact, in the immortal words of Larry David, 2022 looks pretty pretty pretty good.

Wendy Nickel, MPH, President