Collaborating to Advance Health Equity for Families with Newborns Through Public-Private Partnerships

Abstract

This paper describes a health equity-focused partnership between an academic health center and a large metro public health department aimed at improving health care delivery in the postpartum period to reduce maternal-infant mortality. We describe our experience launching Family Connects Chicago at one of four Chicago pilot hospitals across the planning, implementation, and evaluation phases. Key sustainability factors are discussed including cooperative data-sharing, shared funding mechanisms, ongoing engagement strategies across teams, shared leadership, and interprofessional collaboration models. We share implementation strategies to overcome challenges including the commitment of a diverse interprofessional team, a focus on mutual, clear goals, an understanding of shared responsibility and accountability, shared resources, and frequent, open, and honest communication. Successful outcomes including over 1,500 virtual and in-home visits over the first 22 months highlight the need for operational best practice blueprints for meaningful and productive public-private partnerships promoting health equity.

The Chicago Department of Public Health's (CDPH) 2019 Maternal Morbidity and Mortality report¹ detailed the disparate rate of maternal morbidity, mortality, and associated factors experienced by women of color in the perinatal period, informing the planning and development of CDPH's universal nurse home visit and coordinated perinatal referral system: Family Connects Chicago (FCC). Family Connects International (FCI) is an evidence-based universal support service for families with newborns that seeks to support maternal-infant health, family well-being, and social needs through a nurse home visit and connections with community resources in the first few weeks after a baby is born.² A critical component of the FCI model is the inclusion of Community Alignment Boards which are responsive to the shifting landscape of family support services within the communities served.²

In November 2019, FCC launched at four pilot hospitals, three of which used CDPH public health nurses and one, Rush University Medical Center (RUMC), which hired two community health registered nurses (RNs) from the Rush University College of Nursing (CON). The Rush team aligned with CDPH for program implementation and technical assistance, and when patient demand exceeded Rush nursing capacity, CDPH public health nurses and Rush nurses worked in tandem to provide the service to Rush patients.

Prior to FCC, Rush and CDPH enjoyed several informal connections including a special interest task force and student training collaborations. Building on these connections, Rush and CDPH embarked on a new, formal partnership represented in FCC. Formally working with CDPH for FCC aligned with Rush's systemwide health equity strategy to reduce the life expectancy gap in areas of historical disinvestment in Chicago.³ In neighborhoods with structural health, social, and economic inequities, the Childhood Opportunity Index (COI) is lower, preterm birth and low birth weight incidence is higher, and overall infant and maternal morbidity and mortality rates are higher.^1,4 Siloes of prenatal, postpartum, and infant health care contribute to compounding needs and disparate health outcomes^5,6 (see Figure 1). Rush recognized the opportunity to work with CDPH as a pathway to embrace a relational, whole-person model of care for families that could break down silos within our own system and address the drivers of maternal-infant health outcome disparities.⁷ Working with Rush aligned with CDPH's goals to prioritize interventions for areas of high economic hardship through the medical center's existing relationship with its patient population.

The purpose of this paper is to describe the public-private partnership between CDPH and Rush during the planning, implementation, and evaluation of the FCC pilot. We offer our blueprint of building a strong public-private relationship to successfully launch this program. Key sustainability and impact factors will be discussed including cooperative data-sharing, ongoing engagement strategies across teams, shared funding mechanisms, shared leadership, and interprofessional collaboration models.

Figure 1.

Systemic nature of challenges to families in the postpartum period.

Methods

The program

Family Connects Chicago is a universal support service for families with newborns that seeks to support maternal-infant health, family well-being, and social needs through a nurse home visit and connections with indicated community resources in the first few weeks after a baby is born. Any family with a Chicago home address who gives birth at a participating Chicago hospital is eligible for Family Connects Chicago services. New mothers are typically scheduled for a home visit prior to discharge from the birth hospital and then receive a home visit by a community health registered nurse between three and five weeks postpartum. During the visit, the nurse provides a physical assessment of the new mother and baby, discusses psychosocial functioning, responds to concerns and questions, offers developmentally appropriate guidance, and provides connections to needed and desired community services for ongoing support. To evaluate a family's unique risks, the nurse assesses family needs and risks across four domains: child and family health, parenting/childcare, household and community safety, and parental well-being. The factors that are assessed across these domains are rated on a Family Support Matrix. The matrix is the tool used by the nurse to guide the home visit in an organized yet conversational manner. Using the matrix, the nurse can succinctly summarize the assessments, observations, and discussions that took place during the visit, document the family's strengths and needs, and respond accordingly to these needs with education or referrals. Based on the scores a family achieves for each factor, the nurse response can be no intervention, provide education, make a referral, or emergency intervention. See Box 1 for matrix factors and example referrals based upon identified need. One or two more nurse home visits may be scheduled if additional follow-up is needed. The model concludes with a follow-up session one month later from a staff member to evaluate the use and perceived effectiveness

Box 1. FAMILY CONNECTS ASSESSMENT MATRICES AND EXAMPLES OF REFERRALS

of the given resources and referrals. The Family Connects model is based upon Durham Family Connects.^8,9

Role distinctions

The Chicago Department of Public Health serves as the foundation of FCC through convening and coordinating health care systems, regional community alignment boards, a citywide advisory council and a provider's council; developing marketing and communication materials and outreach strategies; and providing centralized data collection and evaluation. Chicago Department of Public Health receives continuous support from FCI in establishing and meeting fidelity aims and goals, implementation support, and technical assistance. The CDPH team includes a program director, clinical leadership team, public health RNs, community alignment specialist, and data management team.

Rush was enlisted due to its geographic location and reach into community areas most heavily affected by structural inequities and maternal-infant health disparities (see Figure 2),³ the commitment of its leadership to improve health equity by addressing the social and structural determinants of health, and its ability to pilot an alternative staffing model given its academic-practice partnerships that were previously established in the College of Nursing. The Rush team coordinates and executes the program at Rush and is responsible for hiring and orienting Rush staff, offering the service to all eligible Rush patients, providing direct care delivery to Rush patients, conducting internal marketing to Rush patients, and maintaining internal Rush databases to inform quality improvement initiatives. The core Rush FCC team includes a program director, lead RN manager, community health RNs, program evaluator, and program

Figure 2.

Severe maternal morbidity and Chicago areas of high economic hardship.^a

Note:

^aThe star represents Ruch University Medical Center location.

Adapted from Chicago Dept. of Public Health Maternal Morbidity and Mortality Report, 2019.¹

Figure 3.

CDPH and Rush role distinction.

Note:

CDPH = Chicago Department of Public Health.

support specialist. See Figure 3 for a side-by-side comparison of the CDPH and Rush organizational roles.

In addition to establishing FCC service delivery and implementation support teams within each separate entity, the resources provided by each of the partner organizations had to be outlined. For example, a nurse supervisor from CDPH was engaged to serve as a liaison with Rush to ensure a strong channel of communication and the fidelity of model delivery. See Box 2 for a complete accounting of resources provided by both CDPH and Rush. Chicago Department of Public Health combines federal pass through, state, City, and philanthropic funds to support all FCC CDPH activities. This includes staffing for hospitals that depend on CDPH to staff their model, FCI database licensing, citywide marketing campaigns, and community advisory board recruitment. Rush finances the implementation of its own program through philanthropic and operational funds. This includes staffing, internal marketing, medical equipment and supplies, travel reimbursement, technology, and office space.

Staffing the model

Chicago Department of Public Health aimed to approach staffing the FCC service in two distinct but related manners: 1) Using CDPH public health nurses to deliver the home visit for families from three of the birthing hospitals; and 2) working with Rush who would hire community health nurses to deliver the home visit for families from Rush, in alignment with CDPH's training and supervisory structures, data collection and reporting mechanisms, and technical assistance. Using both staffing models would inform the potential for scale to the other 11 birthing hospitals throughout the city.

Planning for public-private partnership

Rush

Planning at Rush began by organizing a team of multi-professional maternal-child health stakeholders and developing a

Box 2. PARTNER RESOURCES FOR IMPLEMENTATION

dynamic organizational chart to capture all the players and their roles. Over time, the chart grew to include health equity leaders and administrators in the medical center, CDPH, and the Rush CON as collaborative holders of FCC at Rush; CON Office of Faculty Practice administrative team and nurses as implementers of FCC at Rush; obstetricians, pediatricians, labor and delivery/postpartum nurse leaders, and Mother Baby/NICU nurses and social workers as informers to best integrate FCC across the perinatal service spectrum; information technology specialists, representatives from the Department of Legal Affairs, the Privacy Office, risk management, and security as developers of unique electronic medical record builds and compliance measures to support FCC implementation; and CON and Rush Medical College faculty and students to support dissemination of outreach, inquiry, and quality of FCC at Rush. While each stakeholder brought a different perspective, all were committed to contributing to the goal of advancing maternal-infant health equity. This initiative also aligned with the mission and vision of the Office of Faculty Practice in the CON by strengthening the institution's reputation as a leader in public-private partnerships, serving as an educational opportunity for trainees, and increasing internal multidisciplinary collaboration and external cross-sector partnerships. Chicago Department of Public Health and the Rush team met weekly for several months during the planning phase to discuss decisions and inform all stakeholders of updates.

CDPH

Planning at CDPH to work with Rush involved establishing relationships with Rush's Health Equity leadership, RUMC's Women and Children's leadership, and developing the request for partnership in collaboration with those at Rush invested in promoting maternal-infant health equity as it aligned with public health priorities. The following sections detail structural elements across both Rush and CDPH that required these strong foundational relationships to implement FCC in its pilot phase at Rush.

Workflows

Protocols and workflows were developed based on the FCI program manual and CDPH recommendations and then applied to Rush's resources and infrastructure. Some features had to be clarified so the process would be carried out the same way by both partners, such as program eligibility criteria, for example. Some birthing families present with special circumstances such as a mother and infant who live in the suburbs but give birth at Rush and are staying with family in the city. The partners also had to agree on indicated COVID-19 precautions including the level of personal protective equipment and when to return to in-home visits.

Marketing

Marketing and communication were essential components of the success of the program. The pros and cons of Rush using the city's brochure with CDPH contact information versus developing their own flyers were discussed. To reduce confusion for patients and a possible delay in services, the decision was made to have separate marketing materials but to always include the CDPH logo on Rush FCC materials to show the collaboration.

Legal

Documentation of the nurse home visits, identified risks, service referrals, and connections made are entered by nurses and support specialists into a common data system hosted by Family Connects International. Chicago Department of Public Health contracts with FCI to purchase licenses to the system for program staff, including the nurses at Rush, with the appropriate levels of access. As the backbone for the program, CDPH administrators have access to all the information in the system for Chicago families. This information is used for quality assurance and to produce key performance indicators about the program's implementation, including program reach. Aggregated data from the system are also shared with program partners to understand the risks and needs of families at the ZIP code, regional, and citywide levels as part of the community alignment function. Understanding program reach also requires the creation of a birth record in the data system for every Chicago family delivering at partner hospitals, including those who do not participate in the FCC service.

City of Chicago and Rush legal counsel worked together to identify a solution that would allow Rush to share the protected health information collected in the data system consistent with the Health Insurance Portability and Accountability Act (HIPAA).¹⁰ The Health Insurance Portability and Accountability Act permits disclosure of protected health information to an authorized public health authority for the purpose of conducting public health interventions. City law further authorizes the Commissioner of CDPH to receive protected health information, consistent with HIPAA, for the purpose of preventing and controlling disease, injury, or disability and to use that information for public health interventions. This information is shared with patients as part of a spoken or written consent prior to a visit.

Implementation

Delivery of the service was the same between the two organizations in terms of patient recruitment, visit components, referrals, and evaluation. Rush had additional workflows to document the visits in the electronic medical record, communicate with patients via the MyChart function in the EMR, and message provider offices. When CDPH nurses began visiting Rush patients, they had to be informed about Rush workflows surrounding whom and how to contact for urgent needs during a visit and how to follow up with providers (obstetricians and pediatricians) after the visit. Rush provided the CDPH nurses with a so-called cheat sheet that included all the Rush obstetric and pediatric provider office phone numbers and fax numbers, which insurance plans they accepted, and information on how to best schedule appointments with providers. Since the CDPH nurses did not have access to the EMR and provider messaging, having this contact information was essential to the provision of efficient and effective follow-up care.

Patients with special circumstances, delivery complications that required follow-up at Rush, or a perinatal loss were most often assigned to Rush nurses as communication through the EMR would help to streamline future connections to care. Communication about these issues was also greatly facilitated through virtual weekly case conferences with all FCC nurses when only the nurses seeing Rush patients were in a separate breakout room. These case conferences allowed both teams to share resources, lessons learned, and best practices as the program evolved.

COVID-19 pandemic impact

Soon after FCC launched at Rush, the COVID-19 pandemic emerged as a public health emergency, and while CDPH RNs shifted to pandemic response, the Rush FCC team pivoted to deliver home visits virtually in the form of a person-centered supportive call. As the emergent response to COVID-19 was ending, CDPH RNs returned to FCC work and integrated their team with the Rush RNs to provide the service to Rush patients. Additionally, CDPH offers weekly guidance on whether FCC should be conducted in the home, virtually, or according to patient preference. This guidance is based upon Chicago area community transmission rates and community risk calculation. Low risk warrants an in-home visit, medium and high risk is patient preference, and very high risk warrants a virtual visit only.

Evaluation

The evaluation plan for the Rush pilot program was developed by the core FCC at Rush pilot team and is aligned with the FCC external evaluation plan. It includes an evaluation of implementation processes of the FCC pilot at Rush as well as the percentage and characteristics of families who participate in the program. Important process evaluation metrics include scheduling and completion rates, and population reach. The scheduling rate is the percent of eligible families who schedule the Family Connects visit. The completion rate is the percent of scheduled visits that were successfully completed. The population reach is the percent of all eligible families who were contacted, scheduled, and successfully completed a visit. Important outcome evaluation metrics include patient satisfaction and the rate at which patients complete referrals made during their FCC visit.

A cooperative data-sharing agreement was created between Rush and CDPH, and definitions and metric titles were standardized across both systems to ensure accuracy of reporting. As a system of check and balance, data from just the two Rush nurses were tracked manually by Rush using Microsoft Excel and via reports generated by the FCI data platform used by CDPH. These internal data are reviewed weekly by the Rush nursing team and compared with monthly key performance indicator (KPI) reports issued by CDPH. This two-level data-collection process has been helpful in identifying inconsistencies between the Rush internal data portal and the larger citywide data collection tool.

Table 1.

MATERNAL DEMOGRAPHICS OF ELIGIBLE POPULATION (N=3211)

Figure 4.

Family Connects Chicago at Rush, quarterly scheduling rate, visit completion rate, and population reach between March 2020 and December 2021.^a

Notes:

^aData reflects two Rush nurses from March 2020 to March 2021 then combined Rush/CDPH nurses from April 2021 to December 2021. Of all 3211 eligible patients, 2023 were scheduled for a supportive phone call or integrated home visit, 844 patients completed a supportive call, and 726 completed a home visit (1570 total).

The Average of Scheduling Rate is calculated by number of patients who schedule a visit divided by the number of eligible patients. The Average of Completion Rate is calculated by the number of families who completed a visit divided by the number of patients scheduled. The Average of Population Reach is calculated by the total number of patients who completed a visit divided by the total number of eligible patients.

CDPH = Chicago Department of Public Health.

Results

Between March 2020 and December 2021, the total number of Rush patients eligible for the FCC program was 3,211, 55.6% of whom were from high economic hardship ZIP codes. (See Table 1 for demographics of all eligible patients.) Education level and marital status are not captured until the in-home visit so these demographic characteristics are not available for all eligible patients. Of the eligible patients, 2,023 (64.8%) were scheduled for a supportive phone call or in-home visit when COVID-19 precautions allowed. Fifteen hundred seventy (77.1%) patients completed these scheduled calls or visits for a population reach of 49.8% (Figure 4). Fifty-nine percent (59%) of completed visits were from high economic hardship ZIP codes.

All patients who completed a supportive call or in-home visit were contacted by phone a month later to determine satisfaction with the service and use of referrals made at the time of the visit. Of these 734 post-visit connection (PVC) calls, 92.8% (n=681) found the visit with the nurse to be helpful, 5.7% (n= 44) had no opinion, .6% (n=5) said they were not helpful, and .7% (n=6) did not answer this question. Based on nurse assessments during a visit of family strengths and needs, the nurse makes recommendations and referrals to community resources. Of the 1,570 visits that occurred by a supportive call or in-home visit, 81% (n=1272) resulted in one or more referrals for patients. Of all the patients with completed visits, 46.8% (n=734) were contacted for PVC calls where referral data are collected. From PVC data, 43.6% (n=274) of patients contacted the referred agency, 87.9% (n=241) used the referred services, and 99.6% (n=336) of the referrals were reported useful. The top five services referred were for maternal postpartum visit, food and nutrition/WIC, mental health counseling, pediatric well child visit, and diapers.

Discussion

The data collected show that the overwhelming majority (93%) of patients who complete visits find the FCC program helpful with 81% of visits resulting in one or more referrals to address a family's need. Most of the population reached includes non-Hispanic/non-Latinx, African American, English-speaking Medicaid recipients from historically underserved ZIP code areas in Chicago's near West and South-side neighborhoods. This speaks to the success of the FCC program in reaching populations of economic hardship and need. High-risk families experience greater impact from the program, but it is important to note that the universality of the model is inherent to its success and wide reach. Limiting service delivery to only high-risk groups might reduce community support and penetration,⁸ and would deviate from the Family Connects International model.

For the first year of the pilot when COVID-19 restrictions were in place, the CDPH nurses were pulled to COVID-19 response efforts and the two Rush nurses made supportive phone calls to all eligible patients who agreed to participate in the program. When the two teams joined forces in the second year of the pilot, COVID-19 restrictions were lifted, and in-home visits were offered. The visit completion rate increased from an average of 74.4% to an average of 81.6% through the remainder of 2021. The rate of visits scheduled, however, fell from 68% to 60%. The overall population reach rate also fell slightly from 50.4% to 48.6%. Many factors likely played a role in these outcomes including off and on COVID-19 restrictions, vaccination status of families, seasonal influences, and the change to Rush patients receiving an outreach phone call from non-Rush personnel. At this time, no clear trend has emerged, and the program will continue to be monitored closely.

To continuously improve population reach rates, Rush is implementing several strategies to familiarize staff and patients about the FCC program. An initiative is being developed to inform patients about the program during the prenatal period as they enter their third trimester. This information is reinforced on the postpartum unit from a Family Connects Program Support Specialist who introduces the program to patients at the bedside and confirms contact information prior to discharge. The nursing staff on the Mother-Baby Unit have all been educated about the program and they also talk about it with eligible patients at discharge and document that this education was provided. Pediatricians at Rush are aware of the program and can make referrals directly to the nurses for lactation support or infant weight checks prior to the Family Connects three-week check. This helps to engage patients earlier and maintain contact with the nurse who will schedule a full Family Connects visit between the third and fifth week postpartum. In addition, quantitative and qualitative data are being collected from patients who declined the service. These data will help point to patient-perceived barriers to participation and indicate changes to increase population reach. Despite these encouraging outcomes, sustainability of the program is not guaranteed. State senators and representatives have successfully passed a House bill that mandates coverage for doulas and nurse home visits, and work is underway to implement this bill on a statewide level.

Addressing challenges

As the program evolved, the teams had to work together to resolve several issues. These included staffing issues, shared documentation tools and outcome reporting, and communication pathways.

Joining forces

When it became clear that more nurses were needed to visit all postpartum patients within the model's timeframe of three to five weeks, CDPH offered to have some of their nurses visit Rush families. The first decision to be made was the best way to combine nurses from the public and private sectors into this joint effort. Options included hiring new Rush nurses under the faculty practice model whose salary would be supported by CDPH or referring Rush patients to CDPH for the home visit. While the second option appeared more straightforward, barriers related to documentation and data collection had to be considered.

Documentation

When CDPH nurses began making visits to Rush patients in year two of the pilot, they were not able to access or document in the hospital EMR due to patient privacy regulations. For the Rush nurses, using the EMR had the added benefits of learning about patient medical and obstetrical history and events surrounding the birth, improved communication with providers using the messaging function, improved communication with patients through the MyChart function, and the ability to leverage other institutional practices that are built into the EMR such as specialized referrals and secure chat. Rush providers could readily see which of their patients had a home visit, what was discussed, and ask patients about follow-up with referrals. This difference in documentation practices for Rush patients was a concern as one could be superior to the other.

Data

Once patients were referred to CDPH, Rush nurses no longer had direct access to the process or outcome data in the FCC documentation platform for these patients. This presented a challenge in fully analyzing implementation processes such as reach and scheduling rates, and it required extensive time and labor on the part of the CDPH supervisor to share this information with Rush. Another challenge was that the Rush data collected by Rush RNs in the Excel spreadsheet did not always match CDPH data from the FCC documentation platform. Reporting structures between the partners had to be clarified and reconfigured as the Rush team grew and hired a nurse manager. The nurse manager, who assumed some of the responsibilities of the CDPH nurse supervisor, was then given full access to the full data set.

Recommendations

Recognizing there will be differences in what partners bring to the work and how the partnership is operationalized, we offer these three guiding principles described by Corbin and Mittelmark¹¹ and adapted to this partnership for groups engaging in public-private partnerships to advance health equity.

Guiding principle #1—Centering equity cannot be done alone

The Chicago Department of Public Health is committed to addressing social determinants of health including the intersection of racism and educational, economic, environmental, structural, and institutional inequities.¹ Chicago Department of Public Health is targeting systems change to improve the services supporting families as well as the broader conditions related to the social determinants of health. Convened regional and citywide stakeholders have created a framework to establish routines of collaboration, community guidance, and data practices, making positive impacts on policy and resource allocation and support. Working with CDPH meant benefitting from their connections to community resources established through the city's regional community advisory boards, which was critical to achieving successful outcomes for Rush patients. (See Box 1 for Partner Resources.)

At the level of the point of care, when the two Rush nurses initially began offering the service to all eligible postpartum patients, the response was overwhelming with over 90% of patients accepting visits. This led to visit dates at six to seven weeks rather than at the ideal time of three to five weeks postpartum. It was not until Rush began referring patients to CDPH that visits started taking place sooner and served to fill the gap between a patient giving birth and the six-week postpartum visit with the provider.

Guiding principle #2—Partnerships are hard work

When it was established that the mission and vision of the partners were aligned and that both would commit the time and capital necessary for successful program implementation, a high level of trust developed. This trust was further strengthened with frequent communication and negotiations to problem-solve challenging situations for continuous process and quality improvement. There also had to be an appreciation for differences in organizational culture between the partners. Public entities are accountable to the press, the general public, the mayor's office, and patients served, while private entities are accountable to a governing board, patients served, and philanthropic donors. These differences may lend themselves to the private entity being more comfortable taking risks and being encouraged and supported by senior leadership to take risks. Both parties needed patience to allow for enough time for such things as material and contracts to go through internal processes at both large complex institutions. Similarly, private institutions sometimes have additional requirements for program implementation that are specific to their organization such as their EMR and data-sharing requirements, that can take time to develop. Lastly, expect the unexpected. Public health team members can become part of a public health emergency response while staff from the private organizations may not.

Guiding principle #3—Shared commitment to equity-centered whole-person care

The Family Connects program is centered on the delivery of whole-person care described as the client-centered coordination of diverse health care resources to deliver the physical, behavioral, emotional, and social services necessary to improve health outcomes.² This is achieved through patient-centered programming where families lead the discussion and treatment plan, and all partners and clinicians use non-judgmental, trauma-informed care strategies. In the Rush population we found that many obstetric patients do not have a primary care provider although pregnancy is a time when physical and mental diseases such as depression, diabetes, and hypertension often emerge or are exacerbated. Thus, the Rush clinicians are caring for patients with advanced and possibly neglected physical or mental health conditions requiring an intentional and individualized health equity-focused approach to ensure all needs are met.¹² Toward this aim, the health equity and community-centric philosophy of Family Connects promotes joint identification and creative use of scarce resources to optimize care. Clinicians assess social determinants of health and their impact on families, the patient's care, and treatment plan, and then connect families to resources. On a macro level this was achieved via community advisory boards helping to identify resources and gaps in communities, clinicians identifying health systems gaps, and all parties connecting with community partners to work creatively.

Benefits

Rush

The successful partnership had benefits for both entities. For Rush, the institution was able to further meet the health and social needs of their patients with a community-centered and public health approach. It also created new educational opportunities for health profession students and positioned the College as a leader and role model in the public-private partnership model for Family Connects Chicago. Internal partnerships between the University, College of Nursing, Women and Children's Nursing Department in the Medical Center, the Departments of Pediatrics and Obstetrics & Gynecology were strengthened as well, which helps to break down the silos of care that can develop in large institutions. Lastly, the partnership strengthened the reputation of Rush in the community and led to further collaborations with the city of Chicago such as COVID-19 medical respite for people experiencing homelessness and other COVID-19 response work with the city.

CDPH

For CDPH, the successful partnership allowed for testing of two different staffing models to inform program expansion and sustainability. It strengthened the relationship between the public health department and medical center leading to further collaborations and provided CDPH with greater ability to affect the community, including residents from areas of high economic hardship, through the medical center's existing relationship with their patient population.

Conclusion

This article describes the process and outcomes achieved in a rich partnership between Rush University College of Nursing, Rush System for Health, and Chicago Department of Public Health to improve infant-maternal mortality rates on Chicago's West and South Sides. These organizations collaborated to meet the shared goals of identifying and addressing gaps in the system of maternal-newborn and family support and ensuring whole-person care and equitable access to needed supports to improve health and well-being. The partnership also provided health equity-focused learning opportunities for health science and public health students, thus helping to create future generations trained and inspired to carry on this work. Even when goals are aligned, the partnership described here was not without its challenges. These were overcome with the commitment of a diverse interprofessional team, a focus on mutual, clear goals, an understanding of shared responsibility and accountability, shared resources, and frequent, open, and honest communication. This article adds to the literature and responds to the need for operational best practice blueprints for meaningful and productive public-private partnerships.

"Looking at patient care through a health equity lens means bridging the gap between where people come from and how we see them when they come through the doors at Rush. Considering disparities sensitizes us to the real circumstances of people's lives and ensures that we build nursing interventions with the social determinants of health in mind—addressing the needs that have to be addressed in order to achieve good health." Janice Phillips, PhD, RN, FAAN, Director of Nursing, Research, and Health Equity, Rush University Medical Center