BY: JULIE A. WILLEMS VAN DIJK, RN, Ph.D.
The Affordable Care Act, passed in March, 2010, requires tax-exempt hospitals to conduct community health needs assessments and develop strategies to address priority needs. The federal requirements may be new, but for us they reflect a centuries-old tradition of Catholic hospitals responding to their communities' most pressing health care issues. They remind us of the Gospel messages to love our neighbor and to care for those who are poor. By assessing and responding to community needs, we demonstrate our concern for human dignity, the poor and vulnerable among us and the common good, and we live out the foundational values of our ministry.
Not-for-profit hospitals facing the new Patient Protection and Affordable Care Act community benefit requirements may feel challenged by its complexity. The new law requires a community health needs assessment to be conducted at least once every three years, using public data, engaging community stakeholders and resulting in an implementation plan that articulates both how current needs will be met and explanations of ongoing gaps.
It could be challenging enough just to collect the necessary data, but organizations clearly are being mandated to go beyond that and work together, building a collective will to positively improve health in their communities. The good news is the County Health Rankings & Roadmaps program, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, provides an excellent starting point for your community health needs assessment.
FINDING PARTNERS
It may come as a relief to realize other organizations in your community also are motivated to examine community needs. Those who may have a keen interest in this work include local public health agencies, United Ways, foundations, community health clinics, local medical societies, city and county governments, chambers of commerce and school officials. Some states' local public health departments are required by state statute to assess the community's health, working in partnership with other key stakeholders. In addition to state requirements, new voluntary national public health accreditation standards require local health departments to conduct community health assessments and to compose health improvement plans. Therefore, a call to your local health official is a great first step to identify partners.
Communities that focus on all of the factors that contribute to health help to create longer lives of higher quality for their residents. Such factors include not only access to and quality of medical care, but a strong focus on education, economics, safe neighborhoods, clean air and water and environments and policies that promote healthy behavior. By working on a community health needs assessment with a diverse cadre of partners, you will find the expertise to address a wide variety of priorities within your community. Just as importantly, by establishing a team of partners, you will build shared responsibility and commitment for making the kind of high impact changes that will truly benefit your community.
DON'T START FROM SCRATCH
There are tools and resources to guide you. The County Health Rankings (www.countyhealthrankings.org) provide nearly every county in all 50 states with a snapshot of how healthy its residents are and show where they are doing well and where they need to improve.
Based on the model below, the County Health Rankings present two summary ranks for counties within each state: Health Outcomes and Health Factors. The Health Outcomes rank describes quality and length of life and represents the current health of your county. The Health Factors rank describes health behaviors, clinical care, social and economic factors, the physical environment and represents what influences the future health of your county. The County Health Rankings site also provides county-level data for the 28 different measures used to calculate the rankings, along with comparisons to state averages and national benchmarks. This county snapshot can provide a starting point for examining the health status of your community.
The "Take Action" section of the County Health Rankings website (www.countyhealthrankings.org/take-action) links to numerous tools and resources to guide not only assessment, but also collaboration, prioritization, implementation and evaluation processes.
You can use the "Take Action" section to learn how to work together with different stakeholders to assess your community's needs and resources, pick priorities for action, find programs and policies that work, implement strategies and evaluate efforts. In many cases, there are examples and case studies that accompany step-by-step instructions so that you can envision how different processes can be applied. In addition, the site provides examples of programs and policies that have been shown to be effective in addressing specific health factors and focus areas.
TIPS AND STRATEGIES
Use the County Health Rankings as a starting point. Be sure to check out the "Exploring the Data" section (www.countyhealthrankings.org/ranking-methods/exploring-data) so that you do not miss any of the information on the site. We recommend reviewing the County Health Rankings model and the information in your community's snapshot, then identifying key areas where you may wish to look for additional data. Use the "Data Drilldown Guide" (www.countyhealthrankings.org/take-action/data-drilldown) to help determine areas for further exploration and to find links to national and state sources of additional data. Remember, the County Health Rankings are NOT a comprehensive community health needs assessment, but they provide an excellent framework for your further assessment work.
The voice of your community is another important data element — asking residents of your community about their perceptions via surveys, interviews or focus groups will also add important perspective.
Chances are you won't find answers to all your questions even after sifting through national, state and local data. No data will ever be perfect, but spending time with multiple measures will point you in the right direction for your local priorities.
Avoid "analysis paralysis." It's important that your team carefully review all the data and use it to focus on key priority areas for improvement. To help your team zero in on the most important community needs, agree in advance on the criteria you will use to determine your top priority issues. Examples of criteria might include the number of people affected by an issue, or an issue's relative contribution to serious disease, death or disability.
The "Setting Priorities" section (www.countyhealthrankings.org/take-action/pick-priorities) provides tools for conducting priority setting. This can be a difficult step in the community health needs assessment process, but, to best target your resources, it is critical that your team make decisions about which health issues are most important and move forward on actions based on this analysis. Without action, there is no chance for improvement.
Don't try to do it all. The hospital doesn't have to do everything, and, in fact, much more will be accomplished when you can work together with other stakeholders to decide who will be responsible for which action. For example, if obesity is identified as a health priority, there are different strategies for hospitals, public health agencies, schools, employers and local government that all contribute collectively to improving nutrition and physical activity, thus reducing obesity. A community's capacity for improvement grows when stakeholders work together to identify problems and generate solutions. Stay in close communication with each other and monitor progress towards your collective goal.
As part of their obligation to document their community benefit, not-for-profit hospitals face new requirements to engage key community stakeholders and use public health data to conduct community health needs assessments. Fortunately, the County Health Rankings & Roadmaps program provides not only a credible source for public health data, but also numerous tools and processes for taking action. They will add simplicity to a very complex task, and while each hospital's journey will be different, there is no need to reinvent the wheel. We believe these tools will help your organization and community find both the health needs assessment process and its outcomes rewarding indeed.
JULIE A. WILLEMS VAN DIJK is associate scientist and community engagement director, University of Wisconsin Population Health Institute, Madison, Wis.