California Health Care Improvement Projects (CHIPs)
California Health Care Improvement Projects (CHIPs) are designed by CHCF Health Care Leadership Program participants with the goal of addressing meaningful challenges or opportunities in health care.
Browse CHIPs to leverage the work of CHCF alumni and find opportunities to collaborate in order to improve health for Californians.
Mandating Equity: Promoting Health Justice and Avoiding the Minority TaxDavid Tien
After issuing statements on racial justice during Summer 2020, health care institutions’ attention towards health justice has decreased substantially. Meanwhile, health equity work is often (1) uncompensated and (2) undertaken by people from under-represented communities. This combination results in a “minority tax” on these colleagues, causing ongoing professional and psychological harm.
This project aimed to set an expectation that health equity promotion should be valued similarly to other “normal” professional goals (e.g., clinical productivity, academic involvement, and Division citizenship). During FY2020-2021, “an equity mandate” was implemented in our Division of Primary Care at an academic safety net hospital in Oakland, California. Eligible faculty had 1% of total potential compensation made contingent on specifying and meeting a health equity goal in their non-clinical work. Goals were made through shared decision-making between the Division Chief and faculty members, centering on two questions: “How might your work impact health equity?” and “How might you measure the impact of your work on health equity?”June 1, 2022
Improving Job Satisfaction and Preventing Provider Burnout by Creating an Educational Program for Improved Communication Using Dialectical Behavioral Therapy PrinciplesDelphine Lee
An educational program was delivered that led to improved confidence handling difficult interactions involving resident trainees (and faculty) with patient (and others). The prototype was developed and tested in 2020, feedback was incorporated and a 2nd prototype was tested in 2021. A survey of participants showed trends of improvement in communication and facilitation, increased effectiveness with implementation of new skills, and increased self-awareness.June 1, 2022
Meeting Clients Behavioral Needs During a Global PandemicApril Torres
How do we continue to provide high quality behavioral health services to clients during a global pandemic? Research suggests that the interventions most essential for pandemics necessarily disrupt the very social processes that facilitate mental health, including social support availability, day-to-day interaction, and social influences on coping (Marroquín et al., 2017). Research on true quarantine (i.e., complete isolation to contain an illness) shows substantial effects on emotional distress and mental health including depression, generalized anxiety, insomnia, and post-traumatic stress (Brooks et al., 2020). Knowing this how we continue to provide this much needed care, while keeping our staff and community safe. Our objective was to ensure we were able to provide this essential care to our clients while keeping the clients and our staff safe. We developed systems to distribute PPE to all locations, developed safety protocols, quarantine protocols, and set aside isolation rooms in our residential programs to continue to serve COVID positive clients. We pivoted many of our in-person services to a telehealth model, which had not been previously used by our behavioral health staff. As a result, in our Southern California programs we were able to serve 2141 clients with mental health care, 2671 with outpatient substance use disorder services, 394 clients received recovery bridge housing, and we were able to serve 3513 clients in residential substance use disorder treatment services.June 1, 2022
The Road to COVID-19 Immunity: Building Trust while Combating MisinformationSarah Lopez
The politicization and circulating misinformation on the COVID-19 pandemic and vaccine has led to increased vaccine hesitancy. In particular, Black and Latino communities have suffered the burden of infections and death, yet lag in their vaccination rates. Based on experience, and research done on these local communities, we know that if information is scientifically accurate, but not adapted to the local contexts, people are less likely to trust the information and may look elsewhere for answers. Through my CHIP project I worked to develop a program where organizations trusted by the community (schools, CBOs, religious organizations etc.) could look to their local healthcare facility/system to tap into health experts that could deliver accurate information on the pandemic and vaccine. Ultimately building trust while combating misinformation.June 1, 2022
“Is this going to be on the test?” Dismantling racism in medicine– an animated shortYousef Turshani
Yousef "Dr. Yo-Yo" Turshani, witnessed the protests of summer 2020 and sensed an opportunity. He leveraged his role on the Pediatrics Exam committee of the American Board of Pediatrics to make a change that could have national implications. What is on the Board exam directly influences what residencies believe matters; what is taught or valued. That influences the students who learn from the docs and thereby all who work with pediatricians.
Dr. Yo-Yo assembled a group of physician-scholars on Racism who he led for over nine months to create the first questions specifically on race, racism, and the social determinants of health onto a national physician board exam, for pediatricians. They will first appear on exams in the fall of 2022.June 1, 2022
A Telehealth Journey: From Emergency Response to Sustainable OperationsJessica Moore
Telehealth has always interested me as a model of care to decrease barriers and increase access to care, but prior to the pandemic state of emergency there wasn’t a reimbursement model for FQHCs in primary care. We were doing some telehealth with remote specialists, bringing patients to the clinic for visits, but nothing in primary care or with remote patients. Then everything changed. Over 2 weeks in March 2020, we went from 100% in-person visits, to only 15%, the remaining 85% remote telehealth. Over the next two years, my team and I wrestled with infrastructure, workforce, and staffing for this new model and how we might implement it in ways that were equitable and meaningful to patients and their families. The objectives were constantly shifting due to a combination of internal and external forces. Ultimately, we achieved a somewhat steady state with 20% telehealth visits which are primarily integrated into our in-person clinics. The bigger issues of equity and patient experience will require continued advocacy and effort to ensure that the disparities that already exist in access do not persist in the expanded telehealth model.June 1, 2022
Maximizing the PPE Available for Los Angeles County Workforce during COVID-19Konita Wilks
My CHIP project focuses on conservation of personal protective equipment (PPE) for the 23,000 workforce members in the Los Angeles County Department of Health Services throughout the COVID-19 pandemic. The objective was to find new ways to extend our existing supply of PPE, identify safe and effective alternatives, and secure new supply that met agency standards. Emphasis is on the decontamination or re-processing of N95 respirators, as there was a critical supply shortage of N95s at the onset of the pandemic. I review the operational phases: discovery, obtaining buy-in or negotiations, and implementation; and discuss what guided our decision-making at each phase. 250,000 N95 respirators were generated to replenish the depleted emergency stockpile for our LA County healthcare workforce as a direct result of my CHIP project.June 1, 2022