By Dorothy Brooks

How does one design a model to manage social determinants of health that will be effective? It is all about problem-solving.

“Our hospital uses Lean. We follow plan-do-study-act [PDSA],” explains Jenna Bilinski, RN, MBA, director of health operations, social medicine, and the Kaizen promotion office at Zuckerberg San Francisco General Hospital (SFGH).

However, Bilinski notes every hospital relies on a problem-solving method for performance improvement. “The approach of using small tests of change and understanding what the problems really are before addressing some sort of solution can be replicated at any organization and in any department,” Bilinski says.

The key is putting the right people on the intervention. For example, when Bilinski and two other clinicians at SFGH created the ED Social Medicine (EDSM) concept, they started with a vision, but recognized they were not the best people to devise every intervention involved with this work.

“If there is an intervention related to pharmacy, our pharmacist comes up with that intervention,” Bilinski explains.

Likewise, social workers develop solutions relevant to their arena. “Allowing the folks who do the work to be part of that problem-solving process is really beneficial for the whole team.”

To achieve success, start small. “It is a basic tenet of the PDSA problem-solving concept,” Bilinski says.

This was a tenet Bilinski and colleagues followed rigorously when developing interventions for the EDSM team.

“We would start with one shift of workers trying [an intervention] with the patients, or we would try it with one chief complaint and not every patient who walked through the door,” she says. “This allowed us to learn from what we were testing, and then to scale up as we were adjusting and improving our intervention along the way.”