This BMJ Leader blog series has been produced in collaboration with the Health Equity Evidence Centre (HEEC). HEEC are dedicated to generating solid and reliable evidence about what works to address health and care inequalities. By adopting innovative methodologies, they efficiently map successful strategies for reducing health and care inequalities, and subsequently empower policymakers and practitioners to make evidence-informed decisions for all.

The blog below has been written by Dr Anna Gkiouleka, Associate Director for Research at HEEC.

Introduction

The concept of health care organisations as anchor institutions is currently gaining traction across many countries for its potential to extend the impact of health care systems beyond hospital walls. Health care organisations as anchor institutions – active drivers of social and economic wellbeing in their local areas – are uniquely positioned to address social determinants of health and health inequalities. This blog explores how health care leaders can mobilise their organisations to develop an equity-focused anchor institution strategy.

Anchor institution strategy: how health care organisations can drive equity

Implementing an anchor institution strategy that addresses health inequalities requires a wide range of initiatives. These often involve inclusive employment opportunities for people in the local area, prioritising local procurement from diverse supply chains, and co-developing solutions with disadvantaged communities. Such initiatives can have a direct impact on the living conditions of local communities and ensure that health care organisations address the drivers of good/bad health in their areas.

Leadership challenges

Transforming health care organisations into equity-focused anchor institutions requires bold, visionary, and empathetic leadership which can overcome a series of challenges:

• Resource constraints: Often health care organisations operate within tight budgets and increasing care demands which hinder the prioritisation of long-term community focused initiatives.
• Cultural resistance within organisations: The traditional clinical focus of health care systems is individual patient care instead of broader population health interventions.
• Workforce burnout: With staff often stretched to their limits, there is little interest and capacity to engage in additional anchor-related efforts.
• Conflicting regulations: Local initiatives often conflict with system regulations, procurement protocols and frameworks decided at the national level.
• Distrust between communities and organisations: Local communities, especially marginalised ones, are often reluctant to engage with anchor-related projects because they see health care organisations as disconnected from their own realities.

Key principles for equitable anchor activity

Research from the UK and the US increasingly points to a series of principles to guide health care organisations in implementing an equity-focused anchor strategy. These include:

Building mutual local partnerships

Health care organisations have a key role in establishing place-based collaborations with local authorities, universities, community organisations, and other institutional and community stakeholders. Built on mutual respect and reciprocity, local partnerships encourage a sense of shared ownership and objectives in anchor initiatives. This in turn ensures the alignment of interventions and programmes with local need and cultivates a sense of trust among the different stakeholders regardless of their differences. Alliances and networks, like the NHS Greater Manchester Anchors Network in the UK, can ensure the coordination of collective efforts and maximise their impact. They do so by enabling resource and good-practice sharing, duplication avoidance and amplification of efforts, and co-created solutions aligned with the needs and priorities of local populations, including those most disadvantaged.

Widening participation of disadvantaged groups in workforce and leadership

By widening the participation of disadvantaged groups in the health care workforce and enabling staff to undertake leadership roles, organisations can significantly influence local economies and reduce inequalities in employment and income. Inclusive employment requires simple, fast and flexible recruitment processes, consistent engagement with communities, open information events and job fairs at accessible community venues, and ongoing support, mentorship and career progression opportunities. Inclusive leadership development can ensure that people with lived experience of disadvantage are represented in decision-making. In the long-term it can create a workforce that reflects the local population and is committed in driving equitable change.

Local spending on diverse supply chains

Supporting local suppliers with the tools to meet organisational needs and simplifying procurement processes can transform health care organisations into drivers of community wealth. By reducing administrative barriers, providing user-friendly systems and guidance organisations can make it easier for small and diverse local businesses to participate in procurement opportunities while they also support them in developing their capacity and brand. Such an approach can ensure sustainable partnerships with suppliers that align with the organisation’s needs in services but also equity goals and contribute to the economic wellbeing of whole areas.

Turning estates into community assets

Leaders can use organisational spaces to serve community needs, creating opportunities for initiatives that directly address local social and economic challenges. For example, the Bon Secours Hospital in Baltimore invested in unused properties which then turned them into affordable housing for low-income residents. By collaborating with community stakeholders to understand local needs, health care organisations can ensure that their estates become a key component of the local communities’ wellbeing, whether through safe and affordable housing, hosting local social or commercial activities for small businesses, or access to green and recreational spaces.

Some practical recommendations

Integrate health equity into the central organisational mission.

• Engage all staff in anchor-related activities through training and role modelling.
• Share good practices to build resilient and community-focused partnerships.
• Innovate in recruitment and procurement to widen access and opportunities for disadvantaged groups.

Conclusion

The leadership role in shaping health care organisations as anchor institutions is both a challenge and an opportunity. By adopting a systemic population health approach and investing in meaningful non-hierarchical community alliances, health care organisations can redefine their legacies as drivers of community wellbeing.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.