This section details new implications, learnings, and innovations in Local Hiring (Impact Workforce), Purchasing (Impact Purchasing), and Impact Investing (Place-based Investing) that Rush experienced in anchor mission implementation since publishing the original playbook in 2019.
Organized by Rush’s main anchor mission initiatives, sections in this playbook provide examples of tactical strategies that institutions should consider when seeking to achieve anchor mission goals.
4.1 New Learnings in Local Hiring, Purchasing, and Impact Investing
This section details new implications, learnings, and innovations that Rush experienced in anchor mission implementation since publishing the original playbook in 2019. Organized by Rush’s main anchor mission initiatives, sections in this playbook provide examples of tactical strategies that institutions should consider when seeking to achieve anchor mission goals.
4.2 Human Resources Initiatives
Engaging Recruitment and Talent Acquisition Employees in the Anchor Mission
Engaging the individuals at the forefront of recruitment efforts is critical to onboarding an increased number of anchor mission hires from focus geographies into the larger workforce. Talent acquisition managers work to build intentional pipelines of qualified applicants, and recruiters engage directly with those individuals to help navigate the application and interview process. Ensuring a seamless interaction between both departments creates a smoother flow of qualified applicants into open positions.
Training Recruiters to Advance Impact Workforce Goals
After introducing recruiters to the anchor mission framework and building buy-in around local hiring, the next step is to create resources that support recruiters and talent acquisition consultants as they seek to hire local applicants. It is important to distinguish this process as a procedural one based on equitable access to available roles rather than a preferential one that gives priority to certain applicants.
A recruiter toolkit can be added to the general training curriculum for recruiters and should cover the following areas:
Organizational Tools for Local Hiring Success
Onboarding activities provide an opportunity for hiring managers to help new employees learn about the anchor mission, get a full overview of and learn to maximize their benefits, and understand how they can leverage employee resources provided by the institution (such as childcare, transportation, tuition, and professional development benefits). Many employees are not aware of tuition assistance programs and professional development stipends or lack awareness about how to utilize them; as a result, these benefits often go unused by employees who could benefit from them the most.
Engaging the employee benefits department to leverage marketing materials for benefits available to anchor mission and other new employees is recommended. This could include sharing an employee benefit guide with new hires or with employee resource groups that can communicate the benefits process with their members. Having an anchor mission introduction on the New Employee Welcome deck that the human resources department utilizes to onboard new employees is also an easy way to educate all new employees. Rush has two slides in the New Employee Welcome with accompanying videos about Rush's anchor mission strategy and an overview of Rush's anchor mission focus geography.
Encouraging hiring managers to leverage employee survey results to learn how employees, especially those who reside in the focus geographies, perceive advancement opportunities, well-being, and safety. The surveys can also provide feedback on specific issues that can address pain points leading to turnover and decreased retention. Collecting feedback allows institutions to pinpoint how specific departments respond to the markers of employee satisfaction and employ interventions to improve engagement. Rush is creating a hiring manager toolkit to compile these learnings for hiring managers to better communicate with their employees and increase retention.
It is worthwhile to analyze parity in benefit utilization as an adjacent employee engagement intervention that aligns with the anchor mission. At Rush, creating a benefits handbook was a first step in communicating efficiently about the benefits available to Rush employees throughout their tenure. Some employees in the anchor mission focus geography often encounter barriers in accessing reimbursement-based benefits (due to their inability to pay for costs upfront) and need better options to fully leverage their benefits for increased financial security.
Tactical Tools for Local Hiring Success:
- Assess yield of applicants from workforce partners.
- Prioritize maintenance, investment, and cultivation for partners referring the most applicants and engaging with Rush HR leads.
- This saves time for talent acquisition professionals as they determine how to engage with partners and prioritizes meetings, events, and general interactions with partners that are the most effective in referring candidates that will complete an application.
- Create designations on Applicants Tracking System (ATS) to identify anchor mission applicants.
- Create website landing pages that more efficiently direct candidates to the application.
- Design webpage that describes different clinical and non-clinical roles so applicants can learn more about them.
Justice-Impacted Individuals
- Identify areas in the application process that have the potential to disqualify individuals with justice-impacted backgrounds, including language that might dissuade these individuals from applying to jobs they are qualified for.
- In collaboration with Legal and Compliance teams, determine the types of prior justice-related offenses that would disqualify an applicant and how much time may need to have lapsed before disregarding the record.
- Employ a case-by-case approach when an applicant shows justice-related offenses in their background check.
Applicants with Disabilities
- Designate a talent acquisition lead to serve as a point of contact for individuals who identify as having a disability. This person can answer questions about access as prospective applicants apply for a role and ensure that there is equity in the hiring process.
- Rush has enacted various marketing campaigns to encourage employees to feel comfortable disclosing disabilities as part of their identity at Rush, which is often an important factor for prospective applicants when deciding to join the health system as an employee.
Beyond justice-impacted individuals and individuals with disabilities, there are other residents who may face difficulty getting through the traditional recruitment process. It is important for institutions to identify opportunities for interventions that can ensure an equitable flow of all candidates through the application process. For many institutions, non-traditional applicants could be closely tied to anchor mission geographies. It is helpful to analyze application trends and observe these connections in order to increase the flow of anchor mission hires.
Formalizing Employee Volunteer Policies
Process of Establishing a Policy for Volunteer Time Off (VTO)
Shaping a volunteerism program as part of community benefit initiatives provides a way to test the idea of volunteer programming before formalizing it as a human resources or benefit policy. At Rush, we have found that aligning employee volunteerism with employee engagement and employee benefits department leads has resulted in the most coordinated approach and has provided momentum to all three initiatives. In our work, we have found that formalizing a volunteer time off policy has financial and organizational implications that should be noted before embarking on the process.
Whether a volunteer program involves a formal policy or not, it is still a worthwhile endeavor that can be coordinated efficiently as a cross-departmental effort. Rush’s volunteer program partners with community-based organizations in the anchor mission geography. Most volunteer opportunities at Rush are with food pantries or with educational organizations operating on the West Side, though Rush has ongoing efforts to expand the variety of volunteer opportunities available to employees as part of the Anchor Mission strategy plan.
Formalizing a VTO Policy
|
Pros |
Cons/Considerations |
|
|
Employing Employee Resource Groups (ERGs) in Support of the Anchor Mission
Engaging with Diversity, Equity, and Inclusion (DEI) initiatives and Employee Resource Groups (ERG) can also strengthen anchor mission initiatives related to employee engagement. At Rush, the West Side Anchor Mission Employee Resource Group was created so that Rush employees could have the opportunity to learn more about community organizations serving the West Side and volunteer to support existing community development efforts. See 6.6 Aligning with Anchor Mission-Adjacent Internal Initiatives to learn more about how to engage ERGs as a tool to advance anchor mission implementation.
4.3 Procurement and Supply Chain Initiatives
Rush has learned that local purchasing can take many forms, and the learnings in this pillar reflect the ever-evolving nature of procurement of goods and services in a large institution. Understanding the organizational structure of purchasing and the incentives of cost savings within a healthcare institution are key to employing an anchor mission lens in these complex processes. Rush’s new learnings in local purchasing over the past few years, including advancing this important work despite navigating increasing budgetary constraints, are detailed below.
Understanding an Institution’s Purchasing Process
To create an effective impact purchasing strategy, it is essential to first understand all of the entities within an institution that can conduct purchasing and how each can best be leveraged in support of the anchor mission. After mapping all the entities, it will make it easier to assess how to add an anchor mission lens to the purchasing process of the supply chain department, individual departments that may control their own procurement, or other actors that control purchasing decisions. Every organization looks a bit different. For example, some institutions house the supply chain department within the clinical operations department and others are housed within the finance department. Having a full understanding of who purchases at an institution and how it operates provides more opportunity to increase anchor mission spend.
The best place to start is with an organization's purchasing policy—this organizational document usually details the policies that individuals and departments must follow to comply with an equitable purchasing process for a good or service. For example, one can usually find the maximum amount an employee can purchase before having to enact an RFP process, and which level of seniority a departmental leader needs to have in order to approve it, both of which are helpful in determining the institutional leaders that have purchasing power across the institution.
Who Makes Purchasing Decisions at Anchor Institutions? How Do They Purchase?
Entity
Incentive
Process
Group Purchasing Organization
Bulk Cost Savings (e.g. Costco/Amazon of Medical Supplies)
RFP (sent to GPO-Approved Vendors)
Operator
Efficient Outsourced Management (e.g. Gift Shop/Dining Hall, Laundry Linen Coop)
Sourced Independently (Relationship)
Identify Need
Acknowledge Incentive
Source Vendor
Departmental
Best Product or Service (e.g. promotional items for community health department)
Sourced Independently (Relationship)
Strategic Sourcing
Cost Savings, Institutional Needs, Complex Sourcing (e.g. Infectious Diseases Department needs contact tracing software)
RFP (sent to preferred vendors only)
It is also important to consider the myriad of purchasing agents at an institution beyond the supply chain/strategic sourcing department and understand the incentives that drive those entities. Regardless of category, the individuals that drive purchasing decisions at an institution are varied and their purchasing activity may not be limited to contracts that flow through strategic sourcing and require a formal bid process. In this way, anchor mission practitioners can leverage spend that does not flow through procurement's decision-making process and engage with the purchasing agents directly. Concordance and Fooda are examples of strategic external partnerships Rush has leveraged to engage a purchasing entity in support of anchor mission spend goals, and the Rush anchor mission team continues to engage internal departments that purchase broadly in categories for which there could be a local and/or diverse supplier.
It is important to note that in many institutional purchasing policies, a department can often purchase up to $150,000 worth of goods and services without procurement ever being involved so long as they have budgeted for it and the department’s leader signs off on the contract. For example, a VP in the HR department could award a $150,000 contract to a small, local/anchor mission marketing firm in order to fund an ongoing departmental project that requires marketing support. Though it is not a million-dollar contract (like other system-wide categories such as laundry/linen and janitorial), it is still an impactful amount that can grow a small, local business. As such, these types of contract opportunities should be examined and considered in support of anchor mission purchasing.
Adding Anchor Mission Lens to Existing Purchasing Process
For spend categories that go through a Request for Proposal (RFP) process, strategic sourcing departments usually have a process for determining when contracts are coming up for bid (with contracts usually spanning 2-5 years in many categories). As such, it is efficient to add an anchor mission lens to existing purchasing incentives that drive vendor selection (like employing cost savings) when considering contract renewals. The process to incorporating an anchor mission lens to existing strategic sourcing operations can be visualized below:
- Purchasing directors analyze the contract pipeline for the next 1-2 years, identifying those that are coming up for renewal.
-
Category managers determine contracts for which other vendors are available that meet the following criteria:
- Cost Savings
- Sustainability
- Local State/City
- Anchor Mission
- Diversity
- Purchasing leaders determine implications of a potential shift, with some convening a value analysis committee or key stakeholders to determine the impact of a new vendor across the hospital system.
- Purchasing leaders make a decision about switching vendor(s) based on the criteria set for a specific bid or RFP including cost, quality, and non-monetary value.
Ensuring that the anchor mission is considered during this process is the most efficient way to enable local purchasing as part of the existing operations of shifting spend to new vendors and not as an add-on in special circumstances. In order to carry out this process, it is helpful to maintain an active meeting cadence across purchasing, anchor mission, DEI, sustainability, and other relevant departments to ensure continuity and transparency in the vendor selection process.
Turning Vendors (Big and Small) into Strategic Partners
Eventually, employing a strategy of cultivating existing suppliers and looking for areas where they can add value to the anchor mission is just as impactful as sourcing a new anchor mission vendor. The impact of Rush’s partnership with Concordance and Fooda is detailed in a separate Healthcare Anchor Network (HAN) case study, and underscores how deepening partnerships with vendors can often provide a high-impact way to support anchor mission goals. These partnerships helped Rush scale local purchasing without the need to engage multiple stakeholders in the work, though they do require support from anchor mission staff in order to help them fulfill their aligned mission to purchase or hire locally.
The same can be accomplished with smaller, local vendors. It is helpful to draw a list of all local vendors for a given year and look for opportunities to increase contract amounts with existing vendors by extending their contracts or adding stipulations to their contract that support anchor mission initiatives. Rush has implemented this tactic in support of its goal to decrease chemicals of concern in furniture purchased for Rush’s new cancer center. This process has allowed the purchasing teams to collaborate with capital projects and sustainability to ensure compliance with anchor mission requirements and the cultivation of an existing relationship with a local vendor that supplies furniture.
Leveraging Departmental Spend and Creating Transparency in the Vendor Onboarding Process
Another key factor to consider when increasing spend is leveraging existing departmental spend categories that can be shifted to local suppliers. This involves working directly with departments that may be purchasing goods and services through their own departmental purchasing agent (typically for contracts of a smaller dollar amount). For Rush, opportunities for shifting spend have emerged in the food and nutrition department (typically to shift to local and sustainable vendors) and marketing departments (local marketing and promotional item vendors) that have the capacity to work with department leaders effectively to provide goods and services (often through a purchase order, P-Card (credit card for purchasing lower cost items), check, or similar) without necessarily executing a formal contract. In both instances, the Rush team is looking for vendors to satisfy specific departmental needs that do not require formal and complex legal documentation.
On a tactical level, creating a brief slide deck to guide new suppliers through the process of filling out a general information form, uploading a W-9, and enclosing their third-party diversity certifications ensures a clear and transparent onboarding process. For institutions that use a platform for supplier management (e.g., Supplier.io or Supplier Gateway), creating a brief presentation on how to create an account and navigate the platform is helpful for suppliers. Once transparency in the onboarding process is achieved, sharing the process with community partners and departmental leaders is the most efficient way to reach prospective vendors.
Focusing on and Tracking Categories of Opportunity
When looking to increase local spend, Rush has found it important to have a target set of categories to focus on rather than considering only a larger, system-wide dollar amount of spend to be shifted. Rush has often analyzed categories of opportunity, which we define as a category for which there is a high level of spend organizationally and also a good pool of vendors available locally. In sum, a category of opportunity is one for which demand and supply are both equally strong and one in which the institution has complete control of the purchasing process (versus a category controlled by a GPO or outsourced vendor). Focusing on these categories ensures that institutions prioritize categories for which they directly control the contract.
Once those categories are prioritized, institutions are able to visualize which ones need to shift contracts (and how many contracts, and in what period of time) in order to facilitate an increase in overall anchor mission spend for the institution. For Rush, an annual spend analysis provided by an outside vendor has facilitated the identification of opportunity categories, but it is possible to conduct an informal analysis internally by obtaining lists of local vendors from local community partners, like government agencies, third-party certification agencies, business service organizations, chambers of commerce, and other community-based partners.
Once institutions have identified opportunity categories of spend over which the supply chain/strategic sourcing team has direct control of the bid process, they should create a target list of 10-15 categories of opportunity that will become a strategic priority for local/diverse spend. This will help keep the work focused and aligned with departmental purchasing priorities. See 6.3 Engaging Supply Chain Category Managers for strategies to engage category managers in tracking categorical spend once categories of opportunity have been identified.
Understanding Group Purchasing Organizations (GPOs)
As you advance in employing an anchor mission purchasing strategy, you will find that contract management for many categories of opportunity at hospitals are managed by Group Purchasing Organizations (GPOs). Today the industry has consolidated significantly, and although over 600 GPOs operate nationally, three of them significantly dominate the sector: Vizient, Premier, and HealthTrust. Although there is limited and sometimes conflicting evidence, the intent of a GPO is to work with multiple hospitals to serve as a collective buyer to drive down costs when purchasing products and services.
Thus, GPOs use economies of scale to buy items such as medicine, supplies, and services in bulk so that they can sell them back to hospitals. They make money by negotiating lower prices from the original manufacturers/suppliers and charging them a fee to sell their products. In this way, hospitals themselves do not have to negotiate, purchase, and manage contracts for every single item they need to buy. GPOs therefore lessen the complexity cost that would accompany direct ownership of multiple categories of spend for a single hospital system.
The existence of GPOs makes competition from small businesses difficult because manufacturers and businesses don’t have the ability to pay the GPOs’ fees, distribute to multiple states nationally, and/or produce the volume required for such a partnership. At least one GPO, Vizient, has started to develop tools to engage smaller, diverse suppliers through their community contracting program that connects Vizient member hospitals with local, diverse suppliers. Although other health systems have sought to work with their GPOs around increasing local and diverse spend, GPO engagement is not a strategic partnership that Rush has found successful or prioritized.
Instead, Rush has pursued direct strategic partnerships with large suppliers in support of local hiring and purchasing and has found it to be far more effective. Partnering with a large supplier that is local to a hospital’s geographic area to execute an anchor mission strategy leverages the supplier’s organizational resources while minimizing that of business leads and anchor mission staff at your institution.
Additionally, institutions could still leverage other categories for which the bid process is under the direct control of the hospital rather than under the management of a GPO (and alongside several member hospitals that also direct spending for those categories). Laundry is one such example.
Data Tracking
One important learning in tracking spend data for local purchasing initiatives involves developing the right metrics to track the reach of local spend beyond the dollar amount spent with vendors in the anchor mission geography. Focusing only on the annual amount in the entirety of an institution’s spend obscures the potential for tracking progress in opportunity categories with specific contracts and departmental spending that truly move the needle. For this reason, it is important to set a goal for specific categories of spend throughout the year.
Below are some examples of local purchasing vehicles that can be tracked and employed to shift spend instead of tracking a total amount:
- Strategic Sourcing Amount can be tracked from specific contracts and stratified to specify categories of spend
- Departmental Spend amount can be tracked by noting the annual spend and use of local and diverse suppliers in purchase orders of a specific department
- Strategic Partners Spend directed to strategic partners that buy and hire from anchor mission geography businesses and residents (like Concordance and Fooda at Rush)
- Operators Track gift shop spend with local vendors
Tracking a single indicator of local purchasing spend is a great starting point, but increasing that amount by 3 to 5% over time will typically only account for natural variations in annual spend, rather than an intentional and concerted effort to shift specific contracts to local vendors. If feasible, it is helpful to track the amount of new spend moved to local vendors each year as a way of determining how local spend shifts over time. Even if shifts do not occur regularly (especially due to the nature and timing of contract renewals), denoting an amount of spend shifted when it happens could help visualize an institution’s impact in a category.
4.4 Treasury Initiatives
Revisiting Rush’s CDFI-Centered Impact Investment Model
Rush’s current strategy of impact investing through Community Development Financial Institutions (CDFIs) has proven to be a low-risk and low-touch way to provide capital for community projects and help local CDFIs to expand their lending portfolios, particularly in high need geographies. CDFIs are mission-driven institutions that provide essential financial services in communities that are underserved by the traditional banking sector.
Investing in CDFIs is an efficient approach to impact investing because it involves underwriting one CDFI, which in turn makes multiple investments, rather than Rush underwriting and managing individual investments internally. However, this approach does limit Rush’s ability as an investor to influence the selection criteria and decisions about which projects are funded. Further, each CDFI has an area of specialty (e.g., affordable housing, small business lending), so as an investor, Rush is beholden to the focus areas of the CDFIs where it makes investments.
Rush has been successful in quantifying the impact on the West Side by assessing loan data and qualitative impact information from loan disbursements across the entire portfolios of each CDFI partner. Overall, investing through CDFI partners allows the impact investment portfolio to grow in alignment with an institution’s balance sheet and provides a low-touch way to make impact investments that do not require Rush to manage its own portfolio. The only caveat of this strategy is that quantifying impact requires close relationships with CDFI partners and reliance on the loan data they already collect.
Organizational Alignment
Rush’s impact investing strategy has grown and evolved in the five years since its inception. The focus for impact investing has turned to organizational optimization and increased engagement with the CDFIs that disburse loans as a result of Rush’s investment. For Rush, organizational optimization for impact investing involves four components:
- Recycling capital allows investors to deploy the principal plus profits from mature loans to re-invest in new borrowers and projects.
- Ensuring program sustainability by exploring new models of impact investing and innovations in traditional philanthropy: this includes aligning grants with investments, collaborating with philanthropy alongside our impact investing strategies, and exploring new models of impact investing for future investments.
- Developing a framework for data collection and impact assessment will allow Rush, alongside its West Side United investor partners, to assess the impact of loan disbursements across the anchor mission geography over time.
- Supporting CDFIs in their efforts to promote economic development: aligning with CDFIs to collaborate on a place-based approach to community development through impact investments.
Qualitative Markers and Benchmarks for Impact
Due to the structure of CDFI-centered impact investments, it is more efficient to devote time to supporting CDFIs and developing new ways of assessing impact investments rather than setting goals for the quantity and amount of loan disbursements made each year. It has proven more efficient to collaborate on a reporting system that works for all investors rather than requiring them to report into a preset structure that does not consider their individual data capacity and needs. Rush has helped to clarify its impact investing strategy by developing a framework to track outputs in terms of loan disbursements, and a framework to track collective outcomes for the entire impact investment portfolio (which includes other hospitals) that is still in development in partnership with West Side United.
Quarterly, Rush reports to leadership total capital disbursements to CDFIs and loans made in the anchor mission geography. This qualitative data is complemented by qualitative markers and benchmarks for what the future of impact investing can look like as an organizational initiative. Scheduling quarterly check-ins with Rush’s collective of CDFI partners and hosting annual reporting discussions with each of them has aligned the goals of the collective and shaped the trajectory of how Rush assesses outcomes of its impact investments beyond financial gain. The impact investment collective’s top loan-supported project sectors have included community development, healthy foods, housing, commercial retail, and facilities. From this data, it is possible to infer that many of these projects contribute to neighborhood development, and it is Rush’s goal to continue to support that growth.
Impact Assessment Framework
When executing a CDFI-centered impact investing strategy, deriving impact indicators from the quantitative data that CDFIs typically collect is not always possible. At most, investors can feasibly only rely on anecdotal success stories from individual loan recipients that CDFIs can readily share. Because of this lack of access to data that could inform the impact of loan disbursement on the development of neighborhoods, Rush partnered with West Side United (WSU) and its investors to create a new way of assessing impact from capital deployed through impact investments. This engagement addressed data collection limitations by developing a framework that reflects the impact of CDFI loans in community development.
The decision to undertake this engagement was due in part to the publication of WSU’s The Journey to Impact Investing, which was a report that detailed the progress of the impact investment collective’s efforts. The report was launched in December 2022 to provide stakeholders with an overview of how WSU’s impact investments have served as a catalyst of economic growth over time. The findings helped to catalyze the WSU impact investing committee’s efforts to prioritize communications with CDFIs about collective data reporting tools and opportunities for demonstrating impact.
Rather than burdening CDFI partners with additional requests for metrics, the impact investing committee took a collective approach in identifying a real need to align on neighborhood and community level indicators for community investment. After participating in an engagement with CLF Ventures as part of their Community Investment HealthScore™ training in 2022 and identifying success indicators for community investment as an opportunity for growth, WSU and CLF Ventures began a new engagement in September 2023. These efforts informed an impact measurement framework for investors in the WSU impact investing committee.
Rush, alongside other WSU investors, is helping to shape efforts to measure the community impacts of impact investing, which is still a relatively new field on a national level. According to the aforementioned study (The Journey to Impact Investing), “SROI [Social Return on Investment] is an emergent principles-based field in the United States. Given the relative newness of SROI analysis in the US, the ability to scope, carry out and implement SROI analysis has been limited.” Due to the dearth of public reporting on social impact initiatives, West Side United’s efforts to align investor hospitals in quantifying impact through a consistent framework will be among the first of its kind. With that in mind, Rush recognizes that this is still a developing framework and it is worthwhile to continue to explore the ways in which impact can be tracked over time.