Social “determinants” or “drivers” of health (SDOH): What are they and how to address them

For those not immersed in health care jargon, the phrases “social determinants of health” or “social drivers of health” may cause you to scratch your head. Even if you work in health care, you might have only vague familiarity with the concept. 

Increasingly, however, all of us in the health care field are called on to understand and address social drivers of health (SDOH, for short). That call is louder and more insistent every day. Hospitals, especially, are being challenged by regulators, public health professionals, advocates, and patients to consider their influence on the underlying social and economic conditions that lead to health and wellness, or lack thereof. 


So, what are SDOH?  

SDOH are the non-health care factors that influence our health and well-being. It turns out, over 70 percent1 of our health is influenced by factors outside the health care system. If we only focus on treating people when they come through our doors with illness or injury, we won’t make progress toward improving health.  

The call to action, therefore, is to better understand the underlying factors— like poverty, availability of safe housing and healthy food, education quality, and more—so that we can change the conditions that will lead to greater health and well-being.  

The World Health Organization (WHO) identifies the following as SDOH factors to be aware of:  

  • Income and social protection  
  • Education 
  • Unemployment and job insecurity  
  • Working life conditions  
  • Food insecurity 
  • Housing, basic amenities, and the environment  
  • Early childhood development  
  • Social inclusion and non-discrimination  
  • Structural conflict  
  • Access to affordable health services of decent quality 


The Difference between Social Determinants of Health and Social Drivers of Health  

For decades, public health researchers described these as “social determinants of health.” Recently, based on input from patients, some (including the team at Cynosure Health) are evolving to use “social drivers of health” to suggest that these conditions are not fixed and determinative, but indeed can be changed and improved. 

Learn more about this change to Social Drivers of Health here 


What can we do about SDOH? 

Hospitals are experiencing new requirements, pressure, and opportunities to understand and address SDOH, especially for their most vulnerable patients. The Centers for Medicare and Medicaid Services, accreditors like The Joint Commission, along with patients, advocates, and community members are urging hospitals to get serious and strategic about investing in SDOH.  

This charge to focus on underlying conditions that promote health is consistent with the mission of many hospitals and health systems. The vast majority of such institutions express a commitment to promoting to health in their communities. Arguably, one cannot promote health without seriously addressing the conditions that influence health. 

We now have alignment between decades of public health research on the importance of addressing SDOH, and incentives for hospitals and health systems to meaningfully invest in this work. And yet – the bridge between knowing what to do and how to do it is a difficult one to cross. 

At Cynosure Health, we are talking with and learning from hospitals on the frontlines of this work. We’ve hosted brainstorming sessions with hospitals who are building processes to consistently screen patients for SDOH; we’ve built hospital-based social needs indices to translate community-level data to a hospital perspective; and we’ve supported efforts to address disparities in hospital quality metrics in California hospitals. We’ve learned an incredible amount about how we can all move forward together to meaningfully understand and influence SDOH.  

  • The smartest, most efficient way to do this work is to partner with patients and community members. As hospitals develop a deeper understanding of their patients’ lives beyond the hospital walls, they are challenged to think differently about their role in addressing these needs. Hospitals should look to their most valuable partners and sources of information and insight—their own patients—to inform how they talk with patients about social needs or drivers; institute meaningful referral processes; and invest in programs or partnerships that truly meet community needs.  Learn more: Social Drivers of Health (SDOH) Screening Questions
  • This work is new, and hospitals large and small are tackling it head-on. Many hospitals are in the early planning phases, especially related to new requirements to screen patients for SDOH. It is no small undertaking to build processes that account for adequately training staff; documenting information across disparate electronic health records; and ensuring the clinicians who have conversations with patients are creating a compassionate, psychologically safe environment.  
  • Identify and integrate with other resources. Hospitals do not have to do this work alone; in fact, they most definitely should not do it alone. We’ve heard from hospitals who are aligning with and integrating with existing resources, such as health information exchanges, community-based organizations, social service organizations, and regional or state initiatives that are also focusing on SDOH. Before you begin, look around at what already exists and how you can join in and build on the work that’s already begun. 
  • Not all needs will be met, but data shines a light on challenges. We hear often that hospitals, especially when discussing screening for individual SDOH, are concerned that they will not be able to meet all of the needs they identify. This is inevitable and should not stop hospitals from working towards sustainable individual screening processes, or from gaining a deeper understanding of the systemic barriers that exist in their communities. Instead of being discouraged when we identify unmet needs, we must muster the courage to share this knowledge with others and advocate for the resources, policies, and investments that will lead to community-wide improvements in health.  Learn more: Social Drivers of Health (SDOH) Screening Tools


While some hospitals have been pioneering efforts to address SDOH for years, many are still very new at both understanding and addressing these needs. We may not get things right the first, second, or third time around, but if we focus on listening to and partnering with patients, families, and our communities, we can make progress toward more equitable health care and outcomes.  

If you’d like to keep the conversation going, we have an active group of over 2,100 members ready to learn and grow together. Join the Social Drivers of Health Community today!  


How to select a social drivers of health (SDOH) screening tool

Hospitals are increasingly called to understand and address the social drivers of health (also known as social determinants of health – SDOH for short) for their patients and communities. It is a concept we are learning more about each day. We realize that much of what affects our patients’ health happens well before they step through our doors. Properly being able to identify some of these factors can help us provide better and more efficient care that can solve the root cause of illness and not just the symptoms. Recognizing this, CMS, the Joint Commission, and others are now requiring hospitals to screen for and address SDOH.  

One way to better understand the social and economic factors that influence your patients’ health is to use a screening tool to ask individuals about their needs. Knowing where to start and what tool is right for your organization can be tricky, though. That’s why we’ve come up with this handy guide of considerations to help make the selection hopefully a little easier.  

What to consider when reviewing different SDOH screening tools 

  1. Does it align with your organization’s needs and goals? Will the tool fit with your strategy and mission? Would it help you achieve your goals related to SDOH screening for SDOH, and will it help you collect the information you need? 
  1. What resources already exist within your organization? Consider the tools that already exist in your organization—for example, some units may already be testing SDOH screening as part of pilot or grant-funded programs. Consider also whether your EHR has built-in screening tools that would meet your needs.  
  1. Does it meet CMS & Joint Commission Requirements? Many regulators, accreditors, and payers are now requiring screening for social drivers of health or health-related social needs. These requirements are similar but not exactly the same, so be sure to cross-check which questions are required, and ensure the tool you select aligns.

If you’re interested in learning more about how to select an SDOH screening tool that works for your patients and your organization, check out our FREE 5-minute mini-course on this topic. Our instructor, Natalie, walks you through different factors to consider when selecting the tool, resources for SDOH, and additional insights from other key players regarding SDOH screening tools.  

Sign up for the FREE SDOH screening tool course here 

Health Care Resilience Roundtable Recap: How we keep moving forward and lead through tough times

Our Resilience Roundtable 2023 – Leading in Tough Times: Applying Cross-Sector Lessons on Resilience in Health Care was a gathering of great minds to explore the next phase of health care. We may not have all the answers, but we (you included!) are the ones to create those answers. We are merely discovering what health care resilience means for each individual organization and team. Each of us must hypothesize, test, and rework our approaches to continually improve over time.  

While we gather different tactics and identify barriers, we hope that some of these ideas and insights help spark a new way of thinking for you and your team. Let’s do a brief recap of main topic areas that were discussed: 


In our first session, “Setting a Strategy that Promotes Resilience,” Charles Vincent, Jan Hagen, and Peter Angood reflected on: 

  • Necessary versus unnecessary resilience in health care – leaders must be attuned to underlying system and resource changes that should occur, even if team members are exhibiting resilience. We must ask - how can we recognize when resilience is not the solution? 
  • Need for better data – drawing from experiences in the airline industry, we heard a call for better data on both negative and positive patient safety events, as well as the multiple internal and external factors that influence health care.  
  • Transparency and collective improvisation – Leaders should engage their teams in planning how they will collectively improvise in the face of both acute and chronic stressors.


In our second session, Creating a Culture that Enables Resilience,” Amy Edmondson, Tim Vogus, and Sara Singer described: 

  • Psychological safety – the imperative to create an environment in which team members support each other in anticipating and addressing failures. 
  • Creating the right culture…and also fixing broken systems and processes – Simplify and standardize where possible to free up time to focus on improvement efforts.  
  • Who is on “the team”? - Family members are a crucial source of health care resilience and early detection for patient safety. Consider ways to think more broadly about who is “essential” in supporting patient safety.


In our final session of the day, “Operationalizing Systems to Respond to Unexpected Circumstances,” David Gaba, Libby Hoy, and John Chessare explored: 

  • How to narrow the gap from the front office to the frontline – transparency and improved communication can help all stakeholders understand the true nature of the challenges we face. 
  • Fantasy documents – although we spend time and resources developing emergency plans and procedures, we often know they won’t actually work. How can we improve our efforts to prepare for stressors? 


Want the full scoop from this event? Stay tuned for links to the sessions, coming soon!  

For the New Quality Manager in Health Care: Determining Where to Start

Stepping into any new role is scary, but stepping in as a new Quality Manager in health care can be particularly challenging. You may be so familiar with being on the floor or in a clinical setting and dealing with the hustle that brings, that switching to this role may feel completely overwhelming. And that’s okay.  

As a quality manager in health care, you’ll take on new acronyms, reports, leadership strategies, improvement planning, and more. Just when you thought you’d made the right career decision, you probably started to second-guess it. Yearning for the familiar is normal and expected, so we assure you that you aren’t alone in this.  

Now we aren’t saying this to imply there’s nothing you can do about it. In fact, we have a handy guide to help you navigate those first few months to help ease the transition. 


Find Other Leaders in the Organization 

Getting to know your new colleagues and their roles in the organization is a huge first step in building the foundation of your new role. As a quality manager in health care, knowing who else will be on your team to build and implement new quality measures can help you identify where to go when you run into any sticking points. 

It’s also important not only to build allies but to have a good face-to-face relationship with everyone. With that, you have more leverage – building rapport helps to make for smoother policy changes or testing suggestions.  


Identify your Champions of Change  

Your Champions of Change aren’t always leadership. These individuals that will actually help implement or test a new procedure are often your most stellar staff member. They must be highly liked and highly respected by their colleagues. If they start to change their routine for the new procedure you’re testing, often their colleagues will follow suit.  

You can find your Champions by observing the department. See how team members interact. Take note of who is speaking when everyone else is listening. Find who is already leading. If it’s hard to identify, talk to a few of the staff members or leadership team members to see what their thoughts are. Finding your champions will help make your new policies run a lot smoother.  


Small Steps, Big Rewards  

Speaking of new policies, when you jump into your new role, you might want to start by making a huge splash and improvement. However, we don’t recommend this approach. Thinking too big actually can backfire sometimes.  

We suggest you start small – start in one department, with one team, on one shift with whatever policy you’d like to test. Often we can’t see potential negative outcomes of even the best-intended new policies, and starting small can mitigate any large negative effect.  


Know When to Seek Outside Help  

Getting outside training doesn’t mean you’re a failure at your job; it means you care about your new role and organization enough to want to succeed. You recognize you may not have all the answers, but you’d like them. Finding a guiding light during this transition time is a huge asset, but not everyone is so lucky to have a colleague who’s been in their shoes.   

Thankfully, at Cynosure we’ve recognized this and created an on-demand course designed for new quality managers in health care that have been in their role for 6 months or less. New Quality Director Orientation: What I Wish Someone Had Told Me on my First 30 Days on the Job is taught by Dan Lanari, who has been exactly where you’re sitting before. He felt lost, frustrated, and like a failure at his new job. But he’s broken down everything he wishes he knew, so you don’t have to keep wondering.  


If you’re new to your role and ready to get some proper training, you can learn more about the New Quality Director Orientation: What I Wish Someone Had Told Me on my First 30 Days on the Job and sign up for the course here! 

Health Care Webinar: How Leaders Can Persevere and Inspire in Tough Times

For health care leaders, providers, and other workers, the past 3 years have been nothing less than unexpected. Between a pandemic, workforce shortages, provider and staff burnout, natural disasters and widespread financial challenges, we have certainly been put to the test.  

But through it all, some organizations have found ways to persevere and even thrive. So how do you, as a health care leader, create the conditions that will allow your teams to respond to hardships or unexpected scenarios? What skills or strategies can you use to trudge forward in tough times, and enable your team to do the same?  

In our Resilience Roundtable 2023 – Leading in Tough Times: Applying Cross-Sector Lessons on Resilience to Health Care, we’ll explore exactly those questions.  

Join us April 20, 2023 10am-1pm ET for a conversation with resilience experts from across the globe to explore the cultural, strategic, and operational factors that will allow health care organizations to preserve in challenging and uncertain times. Together, we’ll learn about what has worked in both health care organizations and other industries to promote resilience. We’ll explore how to translate theory into practice and will leave the session with actionable ideas about how to lead more effectively, no matter the challenges you face.  

Check out the range of topics covered and all-star line-up of panelists you’ll hear from in this health care webinar:  

Moderated by Bruce Spurlock, CEO, Cynosure Health and Julie Morath, Senior Advisor  


Setting a Strategy that Promotes Resilience (10 am - 11am ET) 

CHARLES VINCENT, PHD | Professor of Psychology, Oxford University  

JAN HAGEN, PHD | Professor of Management Practice, ESMT Berlin  

PETER ANGOOD, MD | President and CEO, American Association for Physician Leadership 


Creating a Culture that Enables Resilience (11 am - 12pm ET) 

AMY EDMONDSON, PHD | Professor of Leadership and Management, Harvard Business School  

SARA SINGER, MBA, PHD | Professor of Medicine, Stanford University School of Medicine  

TIM VOGUS, PHD | Professor of Management, Vanderbilt University 


Operationalizing Systems to Respond to Unexpected Circumstances (12 pm - 1 pm ET) 

DAVID GABA, MD | Associate Dean for Immersive and Simulation-based Learning, Stanford University School of Medicine  

LIBBY HOY | Founder + Chief Executive Officer, PFCCpartners  

JOHN CHESSARE, MD, MPH | President and CEO, GBMC HealthCare System 


If you’re ready to enhance your health care leadership skills, register for this resilience in health care webinar today 

When should health care workers wash their hands? And other helpful infection prevention measures

At Cynosure Health, we are taking March as an opportunity to do some “Spring Cleaning.” This year it includes sharing information on how to keep our patients and ourselves free from infection. Few things are more important to patient and workforce safety than good hand hygiene.  

In systems as complex as a hospital setting, it’s challenging for health care and ancillary professionals to see the full picture of their role in infection prevention, and how important their personal hand hygiene is to maintaining a safe environment.  As health care leaders, it’s important we convey the appropriate message of just now significant hand washing can be for each individual health care employee. Let’s take a look together at exactly why hand hygiene is so important, when health care workers should wash their hands, and what a sample clinic or hospital hand hygiene policy could look like.  


Why is hand hygiene important in health care? 

When it comes to infection prevention, there’s no greater ally than hand hygiene. Hand hygiene is our number one defense against germs. These germs can spread from patient to patient without even being in contact with each other if the health care professional isn’t adhering to proper hand hygiene guidelines. Ensuring everyone in your organization follows set hand washing policies is critical for the safety of patients, their families, your staff, and the community as a whole. 


When should health care workers wash their hands?

Unanimously and without question, health care workers should wash their hands or use approved hand sanitizing gel or foam upon entering and exiting a patient room. There are other additional times to complete hand hygiene such as after assisting a patient to the bathroom or giving them a bath, providing routine patient care, delivering or picking up meal trays, and other instances your specific clinic or facility should highlight in your hand hygiene policy. Your policy should also specify when hand sanitizing gel or foam may be used, and when soap and water must be used for hand hygiene, such as in the case of caring for patients with infections like C.difficile. 


What to consider when writing a clinic or hospital hand hygiene policy

Specific guidance for hand hygiene practices in a variety of health care settings may be found on the Centers for Disease Control (CDC) website: Hand Hygiene Guidance | Hand Hygiene | CDC. 

Your actual written hand hygiene policy will, of course, be more comprehensive and offer specific guidance for hand hygiene practices with specific populations, such as those with isolation precautions, or in settings such as surgery. 

The policy itself should be easily accessible and present for staff to understand and follow. This can be printouts on bathroom mirrors, copies at the nurses' station or in break rooms, or other places you know employees gather.  


How to enforce good hand hygiene without being forceful

There are a few ways to go about this, but we really recommend you have a peer check of sorts. Find your champion(s) in each shift, in each department, and ask them to help co-design a communication campaign. 

Your champion is someone who peers listen to and respect, who takes an expert-level of care for their patients, wants to help educate others including peers, and pays attention to hospital or clinic policy. Your champion will not be someone who is out to ridicule others or point out flaws, not necessarily someone who is in a leadership role, and is not someone who slacks when it comes to general policy following.  

When you find the person or people that embodies these characteristics, ask them to help identify barriers to proper hand hygiene, as well as ideas to test to address those barriers. Offer a script or some language around how to approach it with their peers.

One example used by some organizations is the use of the phrase “I’ve got your back.” When a supportive team member witnesses another team member forgetting to perform hand hygiene, they use the phrase “Hey I’ve got your back.” The team has been trained to understand this phrase to mean “Hey, we’re all in this together - I know you are busy and it is easy to forget hand hygiene sometimes. It looks like you have forgotten to wash your hands, so I’ve got your back while you take care of that.” It’s a respectful and safe way to hold others accountable when it comes to hand hygiene.


We know that hand hygiene is a vital part of infection prevention, but this isn’t our only defense in preventing unwanted illness and infection in our patients. Are you ready to dig deeper and broaden your understanding of infection prevention tactics? Check out the latest CLIC hub course on Infection Prevention from Lakshmy Menon and Sara Turkel, Infection Preventionists with over 15 years of experience each, ready to give you an accessible approach to IP. 

Social Determinants of Health vs. Social Drivers of Health: Are They the Same?

If you’ve been in the health care space for any time, you aren’t new to the term social determinants of health (SDOH). But we are shifting our language, and with good reason. 

Join us in exploring and explaining our reasoning behind moving to using the term social drivers of health instead, and why you should too. 


Social Determinants of Health Definition 

The definition of social determinants of health, according to the U.S. Department of Health and Human Services , is the conditions in the environments where people are born, live, learn, work, play, worship, and age that affects a wide range of health, functioning, and quality-of-life outcomes and risks.” These are broken into 5 different categories: economic stability, education access & quality, health care access and quality, neighborhood and built environment, and social and community context.  

Although the inherent definition and categories aren’t changing, we are updating the way we speak about SDOH.  


Social Determinants of Health vs. Social Drivers of Health 

Have you ever heard the phrase “it’s not what you said, it’s how you made them feel?” That’s exactly the philosophy involved in identifying the difference real difference between social determinants of health vs. social drivers of health.

Health Affairs first posted about this, but when we use the word "determinant," we insinuate that we have relegated people to a definite outcome. But in reality, we are merely using this data and background to help us better understand our patient. By using the word "driver" instead, we are implying that there are things that we in the health care community and beyond can do to help course correct and potentially overcome any setbacks. 

Just as science changes for the better, we are improving our dialog to better match the true meaning behind what we’re saying. We continually aim to keep our patients at the center of everything we do, and that includes pivoting to a better approach when it arises. 


How to Make the Switch the Social Drivers of Health 

Are you left worried you’ll mess up and use determinants still? It’s okay! Any change takes time to implement. Just try to remind yourself what the real definition of social drivers of health is portraying, and it’ll come easier.  

Want to dive deeper into social drivers of health? We have a brand new CLIC hub course covering this vital topic and how to handle SDOH more appropriately in your hospital. Sign up today to start improving the way you think about SDOH and how you can implement language that helps rather than hinders a patient’s experience.