Determinedly social

It’s no secret that health care providers need a far better understanding of social factors – like cultural differences, poverty and stigma – just to do their jobs. But to date, these essential factors have been an afterthought in their professional education.

That’s why we worked with the USC Suzanne Dworak-Peck School of Social Work to develop and launch the first graduate program in nursing oriented toward these factors and the kind of inter-professional collaboration necessary to effectively address them.

The program was shaped by findings in Health Plus Social, a publication we developed to explore the interplay of social determinants and professional education. Dean Marilyn Flynn wrote this in the foreword: “Conditions of poverty, injustice, and broken human relationships provide the etiology for gunshot wounds, delayed development, late-stage diagnosis, and lack of access to care. … Our experts here note that nursing may have more potential than other health professions in bringing power and authority to the idea of social determinants and incorporating this content into training and professional perspectives.”

As Innovator in Residence, we were part of the new graduate nursing program from its inception through the admission of the first cohort of students in August 2016. Our work continues in exploring how these social factors can inform a new research agenda for nursing science and new forms of doctoral education.

Land of the sick

When people are diagnosed with an acute disease, they enter a new world, one with unwritten rules they do not understand. At the same time as they are trying to heal, they suffer physical and psychological harm because of their inability to navigate the hidden social conflicts of being a patient.

GreenHouse took on this issue through a year-long study of a disease where these conflicts are particularly severe: ovarian cancer. Working with the Susan Poorman Blackie Foundation, we determined that ovarian cancer patients face eight fundamental social conflicts, including everything from learning and decision-making styles to how to handle their changing roles in their families.

Finally, at a symposium with patient advocates and other health care leaders, we envisioned a way to foreground the conflicts patients will experience, designing a new model to give them the social support they will need from day one.

GreenHouse was enlisted in this project by Buck Dodson, SPB’s president and executive director. The effort is part of our portfolio of work furthering the translation of social determinants of health into improvements in the health care system. Our portfolio also includes our publication Health Plus Social and the graduate nursing program at the University of Southern California’s Suzanne Dworak-Peck School of Social Work.

Social health

hplussThere is now widespread agreement that social determinants – factors like race, class and zip code – have greater influence on our health than does our biology. But the health care system has been slow to evolve, leaving providers ill-equipped to help patients and others in need.

GreenHouse has jumped into the void, developing the publication Health Plus Social to explore social determinants and the implications for the training of health care professionals. The publication is part of our efforts as Innovator in Residence to give shape to the new graduate nursing program at the University of Southern California, the first such program housed in a school of social work.

“The basic reason for the neglect of social determinants in health care is that the system is primarily set up to treat acute, biomedical problems,” wrote the report’s editor, Andrew Benedict-Nelson. “Substantial work remains if we hope to translate our understanding of social determinants into practical, specific protocols for care on the individual or community level.”

Challenges like this are now being tackled in inter-professional collaborations, such as one GreenHouse helped launch in summer 2016.

The patient protagonist

For decades, the ultimate authority in health care has been doctors or insurance companies. But research we did with a group of health entrepreneurs suggested that many of the most exciting potential developments in the future of medicine will be unlocked only when patients lead the way.

“For much of history, this was impossible because patients were – almost by definition – isolated, broken, and weak,” Andrew Benedict-Nelson wrote in our report. “But changes in the landscape of patienthood – most importantly patients’ newfound ability to act collectively – could make them the driving force behind improvements in health care in the 21st century.”

Evolving far beyond their current role as informed consumers, patients could advocate for systemic change and drive their own independent research agendas – provided the social norms of the health care system can keep up.

We’ve explored health care’s changing norms in several other projects including the launch of a nursing department at USC and our original publication Health Plus Social.

Relationship Rx

Amidst all the talk of new drugs and breakthrough technologies, many people forget that relationships are the unassailable key to medical care. We dug deep into those relationships in a couple of projects, including one profiled in Harvard Medical School News.

The subject of the story was our work with Family Van, a Harvard-based mobile health clinic serving disadvantaged neighborhoods in the Boston area. In that work, we learned that what made Family Van – and actually, all mobile health clinics – successful was not the way the vehicles traveled from community to community, but the kind of relationships they formed while they were there.

“If the systems in the medical field understand that medicine is more effective in a relationship between a caregiver and a patient,” Jeff Leitner said in the piece, “they will embrace it as a challenge they face and be more willing to utilize mobile medicine to its fullest.”

We also examined medical relationships – specifically, those driven by the patients – in our work with a health care start-up. We expanded on our work in this area through development of the advanced practice nursing program at the USC Dworak-Peck School of Social Work and in Health Plus Social, our published inquiry into the social determinants of health and professional education.

Un-endingly curious

Buck Dodson is president and CEO of the Susan Poorman Blackie Ovarian Cancer Foundation, which was created in 2013 to empower women with knowledge of ovarian cancer and to promote innovative, promising research.

Dodson said of working with us, “The GreenHouse experience is extraordinary in form, process and outcome. Strategic imagination, thoughtful design, and practical execution converge mysteriously through the team’s boardroom meets sacred space approach, and the result is nothing short of transformation. It’s a process that calls organizations and actors to go deep, be willing and courageous, and get un-endingly curious in order to manifest necessary and revolutionary change.”

We have worked with Mr. Dodson on developing the first-ever catalog of the social norms related to ovarian cancer, in an effort to ultimately improve the treatment experience for patients and their families.

Focus for good


If focused, entrepreneurs can be a singular force for good. We have provided that focus for the first two years of a gathering called 10.10.10, at which 10 successful entrepreneurs come together for 10 days to start companies that address 10 profound social challenges.

“Ultimately the effect of this gathering is to make business more humane,” Andrew Benedict-Nelson said in an interview. “Specifically, it makes it more humane in relation to matters of sickness and life and death.”

In the first two years, 10.10.10 challenges have run the gamut – from toxic stress and childhood obesity to antibiotic resistance and health information security.

We were enlisted in this effort by Tom Higley, 10.10.10’s founder and a collaborator with us on our work on venture democracy. We launch the annual ten-day gathering with training in our original framework for social innovation.

Meet them where they live


Mobile clinics could play a transformative role in the health care system — and not just as roving emissaries for hospitals.

That was the conclusion we reached in our work with Harvard Medical School and its own mobile clinic, Family Van. We concluded that the real value of mobile clinics is the way they literally meet patients where they live, upending the social norms of medicine. This helps mobile clinics improve patients’ adherence to treatment and sense of agency in their own care – precious knowledge in a shifting health care system.

“Imagine that we could assign a very attentive graduate student to every mobile clinic” Andrew Benedict-Nelson said in a GOOD Magazine article about our work. “With enough data from a variety of settings, researchers could hypothetically identify the crucial ways in which these health workers help patients feel safe, empowered, and open to medical advice.”

The insights – also captured in an article in Harvard Medical School News – informed our work in the social determinants of health, including development of the graduate nursing program at the USC Suzanne Dworak-Peck School of Social Work.