Veronica Vela, Director of Community Health Design and Innovation at Sibley Memorial Hospital

Social Innovation to Improve Community Health with Veronica Vela, Director of Community Health Design and Innovation at Sibley Memorial Hospital transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
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Saul Marquez:
Hey, what’s up, everybody? Saul Marquez here with the Outcomes Rocket. Today I have the privilege of hosting Veronica Vela. She is a design and innovation leader focused on improving the health and well-being of communities. She serves as a Director of Community Health Design and Innovation at Sibley Memorial Hospital, where she leads Sibley’s social innovation program and other strategic design initiatives within Jan Hopkins Medicine centered on advancing health equity in Washington, D.C. Dr. Vela’s central focus is to make it easier for people to lead full and vibrant lives. Her expertise includes patient experience and the design of new care models to address the needs and values of vulnerable communities. She’s led numerous projects to create new care models for primary care, chronic conditions, HIV, mental health, women’s health, and emergency medicine. Previously, Dr. Vela led teams with Booz Allen Hamilton Strategic Innovation Group, where she worked on a portfolio of federal agency projects to improve care for vulnerable populations. She also served as a human innovation fellow within the US government, where her work ignited an enterprise-wide transformation to improve how veterans experience care at over 1200 Department of Veteran Affairs medical facilities, Dr. Vela holds a bachelor’s in Industrial and systems engineering from Georgia Institute of Technology, a master’s in industrial engineering, and also her Ph.D. in public health. And just a privilege to have her here talk about the very interesting things that she does in health care, engaging, vulnerable communities. Veronica, such a pleasure to have you here.

Veronica Vela:
Thank you so much. Nice to be here.

Saul Marquez:
Absolutely. So before we dive into the work that you do with Sibylle Johns Hopkins, I’d love to learn a little bit more about you. What inspires your work in health care?

Veronica Vela:
Yeah, well, you know, I am constantly thinking about how I can improve the health of myself and my family and social justice, and improving the health of other people and improving the lives of other people say has been a really important cornerstone to my upbringing. And so kind of combining my passion for figuring out how do I have my own health and those of the people that I love and thinking about the broader context of our world. I am deeply concerned about how we are inclusive, in particular for those who have often been excluded from our health care institutions and from services that resonate with who they are and what they believe, and how they want to receive care.

Saul Marquez:
Wow. Yeah, it’s you know, it’s definitely a challenge. There’s a lot of inequity in how care is delivered and access and overall a big gap for us to bridge. That’s awesome to know that somebody like you is focused on these problems that our entire country is faced with. How would you say what you’re doing today is helping the health care ecosystem, Veronica?

Veronica Vela:
Yeah. So the work that I do, you know, it’s kind of in two major areas. So in the first area, I’m responsible for a social innovation program called Ward Infinity that is sponsored by Sibley Memorial Hospital and Johns Hopkins Medicine. And so what we do, we actually support change agents who are looking to improve the health and well-being of their communities. And we invest in leaders who live and do their work in under-invested communities. The communities where, you know, all types of institutions, whether they be public or private, have not kind of wanted to go in to bolster the quality of life for the people who live there. So it’s as simple as not having enough grocery stores, not having enough transportations, having schools that are underperforming. All of these qualities contribute to a shorter life expectancy in Washington, D.C. And so we really wanted to partner with leaders who were there, who were interested in developing innovative solutions. And so our social innovation program is really designed to give them not only funding for some of their ideas but to work with them, to help them work for their community with their communities to shape the design of those solutions.

Veronica Vela:
So that’s kind of the first area of work. And then the second area of work is really around attuning how we deliver health care within Sibley Memorial Hospital. So Sibley sits in the most affluent part of Washington, D.C., you know. Households here make eight times the amount as households in some of the more marginalized communities that I’ve mentioned earlier and so Sibley really wanted to think about how we could better be attuned to the needs of vulnerable populations. We do have individuals, patients who come from the more marginalized communities you come to get care at Sibley and even more so I think within the last few years as we’ve made a concerted effort to do work in those communities. So some of the projects that I lead are really around. How do we attune the care better? So we have some work in telemedicine and also in maternal health care where we’re really looking at how can we improve health outcomes for patients of color, as well as those who are socially, economically vulnerable.

Saul Marquez:
But it’s really great. And you sit in the middle of kind of two worlds where you’re at and being able to connect the dots is so important. I’d love to hear from you, Veronica. Maybe an example or two of what you guys are doing that you feel is unique or different in its effectiveness.

Veronica Vela:
Yeah. So I think the work that we’ve done with Ward Infinity has been really quite remarkable. So this is work that started back in 2017. Sibley was really interested in understanding how they could partner with the community to make a difference in the health and well-being and the quality of people’s lives. Typically by requirement, hospitals are required to provide a community benefit so that means that they have to take part of their profits and part of their earning and put it back into the community. However, we have very loose legislation and regulation around what that looks like, and primarily it can look like in all kinds of ways. But typically it’s not done by asking the community how it is that they want investments to be made. And so in 2017 Sibley actually went out into the community to have a conversation with community members to understand how could we partner with them to do things differently. We talk to church groups, families, to children. I mean, you name it, we really went across to areas of Washington, D.C. called Wards Seven and Eight to really understand what their priorities were, what their challenges were, and how we could do something together. And so out of that was born Ward Infinity. That brings some of the brightest minds from Ward seven and eight with the Sibley innovation method and talent and expertise around public health to really help those change agents amplify the work that they’re doing and make sure that they have longevity and staying power within the community. So it’s really investing in the issues that they want and the priorities that they have and bolstering what they’re doing. And I think that is a huge departure from how many health care systems and particularly hospitals work with the community to improve the quality of life that’s outstanding.

Saul Marquez:
So Ward Infinity, you went out and said, hey, we’re going to mind the minds of some of these doers in the community. Let’s find out how we can resonate, not just make some stuff up and see if it sticks.

Veronica Vela:
Absolutely. Yeah. So we’ve done our program for about two years. We’re now entering the third year. And so and I actually will say that the first year it was a huge experiment because we didn’t know what was actually going to happen. And each year we’ve really evolved our program and figured out how can we do it better. And as we go into the third year, we’re doing an evaluation to say like, where did we really do great and where did we miss the mark? And so this third year, we’ll look a little bit differently. But essentially, the way that it works is we put out a call for applications. We identify a set of priority areas that we’re going to invest in. The priority areas are also defined with the community. So we go out each year. We go and have a conversation with the community to say, like, what are you concerned about this year? Where should we invest? We’re getting ready to do that in January. So I’m excited to hear in light of the pandemic, what the community has to say about where they want us to invest. But essentially, we put out a call for applications. We get a bunch of projects, ideas, and then we select some and we invest in those projects that we think hold great promise and are by leaders who have demonstrated success in being able to deliver on their ideas.

Veronica Vela:
You know, I think that’s really fantastic, Veronica. And I think about some of the things that maybe came out of that. Do you have any examples of some of the outputs or ideas? I’m just really curious about that.

Veronica Vela:
Yeah. So the first two years we’ve invested in food access, we’ve invested in housing, we’ve invested in a healing trauma, we’ve invested in patient and provider relationships, and then also solutions to use food as medicine. Some of our most promising projects have come out of food, access, healing, trauma, and food as medicine. I’ll talk a little bit about one of them.

Veronica Vela:
So one of the projects that came out was this idea that was created by Mary Blackford and her partner, Jacob Clark. Wards seven and eight are a food desert, there are only three grocery stores that serve about one hundred and sixty thousand people, you can compare that to other wards in Washington, D.C., where you have 10, 11 grocery stores that are serving ninety thousand people. So the disparity is hugely obvious. And so there’s not a lot of places to get fresh food, to get food that really represents the best of the community’s culture and health promise through heritage foods. And so Mary came with the idea of creating a food hall. You might these are popping up around lots of cities where you have kind of like food stalls. And but she also had the idea, let’s not just bring in these food halls, let’s have them represent the food from the African diaspora and the culture of our people. And so that’s thinking about food that originates from Africa, but also North America and the Caribbean. And so this food hub not only would create have these stalls but also there is going to be a community grocer. So this was an idea that she kind of came with very loosely. She went through the program, learned really about the structures that prevent her community from having access to healthy food, then went out and did research and talked to her neighbors or friends or family members to understand if we were going to create a food hall, what would it look like, what would it represent, what kind of food would be available? And through that actually came up with her concept, which is called Market Seven.

Veronica Vela:
It’s actually currently under construction. It’s going to be seventy-five hundred square feet. It’s going to include the food stalls that I mentioned, a community grocer, and she’s actually also supporting other small businesses incubate their food products and solutions within the space. She works with 60 black-owned businesses right now. She also has a partnership with Whole Foods where she’s introducing some of the food products to hold foods. And now there are several of those products that are now available in all of the Washington, D.C. Whole Foods store. So she’s really I mean, she kind of came in with the concept and she’s really blown it out of the water because it’s not only going to transform, like from a brick and mortar perspective what’s available in her community. But she’s also amplifying the economic well-being of the black-owned businesses that she’s working with. So we’re truly proud of what she’s done.

Saul Marquez:
Wow, that’s amazing. And I guess at first it was surprising when I first learned about how food plays such an important role in the lives of people, I went to do a service project in Tampa, Florida, and just incredible. A food program at a school at a high school made a difference of only 50 percent students graduating versus ninety-five percent. And it just like it’s mind-blowing, and food insecurity is very real in our country. I think it’s so great. This food hall idea is extraordinary. And I think we’re also seeing CMS also take some strides here in providing benefits as food and outside of just sick care. So I think it’s really cool to see you and your team do things in the community and see them take shape in ways that are making a difference. I appreciate you sharing that one. That’s a really neat example.

Veronica Vela:
Absolutely. And I think to your point is you talk about that example on the school, there’s a connection between food insecurity and behavior. What do people act like when they’re hungry? Even for people who don’t have food insecurity issues where they live, I mean, take anyone in your family, right. Somebody is hungry or mungry.

Saul Marquez:
Hangry.

Veronica Vela:
What you want to call it right? And so there’s a connection between this behavior Right. and your capacity to process information and your capacity to contribute in a pub in a productive way. Yeah. And your hunger. So, I mean, I think the connection is very real. And I think if you extrapolate beyond that why it’s so difficult for us to do things when we’re hungry. Imagine a child who’s trying to learn and is in an environment that might not be, you know, emotionally supportive of themselves as an individual. But take that a step further and think about violence. And so I think few people are able to connect the food to the behavior and then go a step and beyond. So we think about violence in our community. I mean, there are reasons why, you know, certain things happen in the way that they happen. It’s because some very basic needs are not being met. I’m not saying they’re all related to food, but like, just if you can extrapolate a bit further on food how food impacts behavior, we could then see how it might create a more peaceful environment, safer places for people just because you have people kind of like levels of of intensity lowered because they are physically well.

Saul Marquez:
Yeah, it’s well said, Veronica. And as you think about some of the work that you’ve done with this program or others, what would you say is a way that you’ve improved outcomes for the community?

Veronica Vela:
Yeah, so, I mean, I think today our program, this is we’re entering our third cohort, so it’s still very young. But I’ll say that the programs that we’ve invested in are well, markets have and will be providing food for people. They’ve been doing it in a pop-up style since then. But we also have solutions. So, for example, we have another innovator Toboris Robinson, who developed DMV Urban Greens, where he actually is the sole proprietor and he manages community-supported agriculture. So he is a fully organic farm in the middle of an urban center. And so he’s able to actually provide nutritious food for free and at reduced costs for people who live there. We have another group playback theatre that looks at how we bring theater and acting to healing. And so it’s a place where people come together to talk about their traumas and challenges and it gets reflected back through the theater and acting not to solve the problem, but to acknowledge the problem. And that goes that is the beginning of kind of improving those health outcomes. So I think, you know, today we’re still at our early stages of measuring that. We still have some ways to go. There are certainly other projects beyond infinity. We’re designing in an emotionally resonant and culturally competent way can deliver those outcomes. And I’m happy to share some of those if those are.

Saul Marquez:
Yeah, I’d love to. Yeah, I would love to hear about it.

Veronica Vela:
So one project that I worked on, so I was a human innovation fellow with the Department of Veterans Affairs and while I was there, the VA, this was in 2016, was really concerned about how veterans were experiencing care. In twenty fourteen there had been 40 veterans who died waiting for care because there was a huge backlog. There was a huge scandal where there were basically administrators who were falsifying the backlog and making it not look so terrible. And so as a result, it was really hard to understand that there were so many veterans waiting for care because it was all hidden and it was very, very secretive. So anyway, these veterans died. So the administration wanted to make some changes. So there are a number of things that they did. One of the things that they did is decided to integrate design and innovation to think about how we could better serve the needs of veterans. And so we ended up running a design research study where we went around the country talking to veterans, one on one in their homes or wherever they felt safe to understand what their experience was like with VA care. And that allowed us to then strategize solutions to make it better based on the problems and the challenges they were facing. Oftentimes, health care solutions kind of sit. We sit in our offices, we have all these really smart people and we come up with what we think is the problem of our patients and the problem of the communities.

Veronica Vela:
But in this case, we actually went to the patients and said, you tell us what we’re doing wrong, and then we’re going to come up with some strategies to fix that. So in 2016, we started the project, we went out. In 2017, we were able to put the findings together and to begin to share those and to bring the veterans’ voices to the front to say these are the quotes that they’re saying, this is what they’re actually describing. And by the way, here are photographs of the people that we spoke with. So to really bring it to life and out of that grew the patient experience initiative. And so that became a national initiative to attune care based on what the veterans needs were right now, the VA that that project is led by Jennifer Purdy, who’s the executive director, and they have improved trust scores between veterans in the VA since we did that project. And the patient experience measures for the VA is actually outpacing the private sector. So I think that’s a very clear, tangible example how going in and actually talking to the people that are most affected by a problem can really help shape the outcomes.

Saul Marquez:
Wow, that’s awesome. Congratulations on that. And I was just getting goosebumps, as you were telling me this, because it just, you know, these amazing people who served our country. They deserve the best. And I love the idea of showing their picture because it also brings it to life. Instead of just a name and a story, you actually have the person that’s a really great idea. And folks, as we think about how we’re innovating to reach our communities to improve outcomes, we have to talk to them. We can’t just make stuff up in the boardroom and think it’s going to work, I’m just not going to work, and Veronica and her team are a great example of how to do that. Just an incredible experience. And now the VA is outpacing traditional providers, which is amazing, a testament to the work that you guys have done and Veronica. So talk to us about setbacks. Your work is not easy. So is there a particular setback that comes to mind that you learned a ton from that you want to share?

Veronica Vela:
There are so many setbacks to this work, it’s hard to know where to start. I think ultimately, though, the most important thing is leadership backing is so essential. If you don’t have a leader, a CEO, somebody who’s out in front saying, OK, we’re going to let you go forth and talk to the community. If you don’t have people within the health care system who agree with you and want to embark on this work because it’s painful work. It’s basically going to therapy. It’s organizational therapy. Right. like, what am I not doing? Good. What can I do better? How can I improve it? You need to be willing to shine a light on that. And so you really need leadership who is willing to kind of stand out in front of that and say it’s important that we do that. So there have certainly been environments that I’ve been in where that hasn’t always been the case. There’s a really interesting project that I was able to work on where we were looking at..It was a huge study that was federally funded over twenty-three million dollars of taxpayers’ money to look at how to deliver care in a new way by using home testing technologies. And this is for HIV care. And we had this huge I mean, literally twenty-three million dollars that was already allocated to the study. And at the time I was a grad student and trying to figure out how I can contribute.

Veronica Vela:
And I just raised the question. Has anyone asked the people that we were going to create this intervention around whether or not they would be willing to take a home HIV test? And the question had not been asked. The formative research had not been asked. And so we had twenty-three million dollars riding on the assumption that they would be open to doing this. So I had the opportunity to go and actually ask some of the prospective patients that we would be engaging with their thoughts around HIV home testing. How would it compare to an in-clinic test? What did they like about in clinic? What did they prefer about home testing and vice versa? And then kind of what were some of their fears around having HIV and how would that impact their lives? And ultimately, what I found was, is that marginalized communities, the ones that I spoke with, were not open to taking an HIV test at home. Why? They’re already marginalized. They already feel like they’re on the fringes, that they don’t have enough access to health care. And then you’re asking them to take a test about a very debilitating disease that right now is a chronic condition, but also brings with it a lot of stigma in marginalized communities. Right. It becomes what did you do wrong? What actions were you taking? You know, there’s a blame piece around the fear of getting HIV that I don’t think was fully understood. And so what ended up happening was that the study did not get enough people enrolled in it and it actually was canceled. And so you can imagine they had hired all these community health workers. They had come up with the design of the interventions. They had done all this work, but nobody had raised the question. Are you willing to do this? And so this is why I say having leadership that is willing to ask that question is super important. And let’s say you’ve already have funding for this concept. Well, then if we’re going to give you this service, what do we need to do to make sure that you feel safe and comfortable and confident in partaking in that service? Right. So you can either you can reframe the question if it’s not something that they’re open to. And so I think that’s one of the big failures of our health care system, is to invest in solutions that do not resonate with the people that we want to serve. And so I think leadership is instrumental to creating those pathways. I mean, I went out and I did that study alone, and when I came back with the findings, they weren’t interested. And then a few months later, the entire study was canceled. So, yeah,

Saul Marquez:
Yeah. And I think Vranica, it’s a common problem. And but I do, though, and I’m interested in hearing your perspective on this, but I feel like there’s a bigger willingness to do this consumer focus type of work now compared to even five years ago. I feel like we’re more consumer-focused and thanks to leaders like you that are leading the charge and pushing the envelope and asking the important questions, what’s your take on that? Do you feel like we’re getting better overall?

Veronica Vela:
Yes, absolutely. I mean, I would say 10 years ago, right, there was barely anyone engaged in this work, I think where we’ve seen it really explode has been in the health care startup space because they’re competing with these mammoth institutions. And so in order to compete, they have to figure out how do you differentiate themselves? I think the challenge really is for the more established places to kind of take on that practice Right. if they want to continue to remain relevant if they want to continue to deliver health care outcomes that are really meaningful and surpass what they’ve been able to do in the past. It behooves them to really take that consumer-oriented approach. So I certainly agree that it’s getting better. I still think that we have such a long way to go. I constantly am seeing programs that are getting spun up because there’s a physician or an administrator who has a great idea. And while I’m sure it’s a great idea, it could be better attuned and adjusted if it brings the consumer to the heart of the decision-making process.

Saul Marquez:
Well said. And the takeaway here folks is, you might have a good idea, but how can you fine-tune it? How can you adjust it so that it speaks to the people that you’re looking to serve? I think Veronica just said it so well. Thank you for that, Veronica. You’re welcome. I think I mean, that’s an insight, you know, and I think it’s one that if you’re not forcing yourself to think about you’re really selling your ideas and you’re and the people you’re serving short. So, Veronica, what are you most excited about today?

Veronica Vela:
Oh, you know, what most excites me is I know this year has been so challenging for all of us and so many different ways. I think what it has done, though, it has elevated this need, and health care organizations are having to kind of describe how are you adjusting the inner workings of how you operate so we can begin to address some of these social issues that have gone on for so long. So I’m excited that people are having the conversation. I mean, I think it takes time to adapt and to change the culture and to change how we interact with each other and what our transactions look like with our patients. But I’m excited that the conversation is happening. I think we need to push the envelope in terms of what we think we’re capable of doing. But I’m quite delighted that as unfortunate as some of the things that have happened this year, I think that they have brought the conversation forward that many of us have been talking about, but that is now coming into the mainstream.

Saul Marquez:
Yeah, yeah, me too. I’m excited about it. It’s certainly been challenging for all of us. On the positive side, the silver lining to your point is that I feel like we’re more open and we’re making strides. So it is exciting. I’m right there with you, Veronica. Such a great conversation with you. I’m sure everybody’s taking notes and thinking about things in ways they could implement what you share with us today, but leave us with the closing thought. What should we be thinking about? And what would be the best place for the listeners to get in touch with you if something you said resonated and they wanted to reach out?

Veronica Vela:
Sure. Closing thoughts? So my closing thought would be, as you’re thinking about how you’re making a difference in the communities that you’re serving Right., how can you make it more meaningful? And who decides what is meaningful? Is it the organization itself that decides what it’s meaningful? Is it your patience? Is that your patients’ families? Think about where the meaning needs to reside in order to keep it relevant. Just think about that and think about how you might begin to engage with those folks who make it meaningful. In some cases, you’re going to say it’s the patients and their families, it’s their caregivers. Right. how do we bring them into the fold? In other cases? It’s actually even also thinking about your providers. But it’s not just your physicians, it’s your employees. It’s all of your tech support. Everyone has a role to play in making health care more emotionally resonant, more humanizing for the people that we want to serve, and more humanizing for the people who are delivering it. So think about who can help you create meaning in what you’re doing.

Saul Marquez:
And if the listeners wanted to get in touch, what would be the best way?

Veronica Vela:
they can feel free to either reach out to me via LinkedIn or email me. I’m at VVela1@jhmi.edu. So that’s Vvela1@jhmi.edu.

Saul Marquez:
Awesome. Well, Veronica, this has been an awesome conversation, truly thought-provoking. And I just want to give you kudos for the work that you’re doing. And it’ll be exciting to see the impact when the data starts coming in on this project that you’ve been working on. So congrats on the progress and definitely looking forward to staying in touch.

Saul Marquez:
Awesome. Thank you so much, Saul. It’s been such a wonderful conversation.

Saul Marquez:
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