One of the major advances in population health in the US occurred when the Affordable Care Act mandated that non-profit health centers and hospitals conduct community health needs assessment every three years and generate a community health improvement plan to clearly articulate the ways that they would improve the community's health. Departments of health had been conducting them for years, but now hundreds of local hospitals across the nation were each picking up the mandate and marshaling resources focused on community health. In this module, I'm going to provide an overview of community health needs assessments. Describe several of the ways that we use to define community, and then explore six core beliefs that should be operating as a foundation for any community health needs assessment process. So what is a community health needs assessment. Well it's a systematic process. It's one that's focusing on collecting information about the community, then focusing on identifying needs and assets. It's also a great place to aggregate, analyze, and display the information that's been collected so that everybody can see. Once it's collected, one of the things that is an important part of any community health needs assessments is prioritization. What needs to be acted on first, what are the big things that stand out that need attention now. So it facilitates the planning to improve the community health as well, and then last but not least, it's a requirement of non-profit hospitals under the Affordable Care Act, and it's a requirement of public health departments for their own accreditation. There are many good guides to doing community health needs assessments. Two important ones that are put on the Center for Disease Control's main website are the Catholic Health Association of America's Guide to Planning and Reporting of Community Benefit, and Sara Rosenbaum's Principles to Consider for the Implementation of a Community Health Needs Assessment Process. Both of these are really good references to start with if you don't know anything about it. For the modules in this course, we're going to use the Catholic Health Associations Guide to Planning and Reporting Community Benefit as our main guide. What are the basic steps involved in the community health needs assessment? Well the first step is always going to be planning and preparing for the actual assessment. The second step is really determining the scope and purpose, because the community health needs assessment can be really broad, or it can be very narrow on a specific part of a community. The third step is really identifying and collecting data, and the identifying is actually a part of the main assessment itself of the community because different data resources gives you different windows into what's going on. The fourth step is analyzing and interpreting the data. So making sense of it so that you can actually go to the next level which is defining priorities, where are you going to put the efforts for the next several years in improving the community's health. Then the final step is packaging together this information, documenting what was done and communicating those results out because there are many different stakeholders that really need to know what the community health needs assessment found and presents to the community as a priority. So this brings the question; what is a community for a community health needs assessment. There are lots of different ways to define community and it's fundamental before starting the process because it serves as a compass as to what direct assessments need to be made, what planning and priorities could happen, and right now if you think of the context within what this is used for often for non-profit hospitals to focus on the community's health around them. It could be both the geographical area or it could be an area inside of that. Like an opportunity area, is the term that people use, such as a neighborhood or a specific place within that geographical area that needs special attention, but a community could also be a patient group or it could be the primary and secondary service areas of that non-profit hospital. A lot of people also think about the community organizations and the benefit programs in a particular area as something that's a part of the community, and then last but not least, community can be defined based on people's identities, race ethnicity, whether or not it's women or children, or for instance whether or not we're talking about individuals with particular diseases or challenges. There are lots of different attributes about the people that are served by a non-profit hospital or a department of health that can be used to define community for community health needs assessment. If departments of health, hospitals and community groups are working together on a community health needs assessment, the first order of business has to be defining the community and agreeing on that definition. Because community health needs assessments are often a chance for hospitals and public agencies to focus their attention on health equity issues, and to recognize their special role, and basically their unique power in these situations to help a community thrive, the Catholic Hospital Association Guide to the community health needs assessment outlines six core beliefs to help us navigate some of these upfront conversations. The first core belief is that those that live in poverty in the margins of society have a moral priority for services. It really is helping us to focus on all members of the community that should be represented in the community health needs assessment and a especial attention for low-income and other disadvantaged people so that their priorities can be put into implementation plans because their needs have to be reflected in order to be able to get the services that they need. The second core belief is that not-for-profit hospitals in healthcare has a responsibility to work towards improved health in the communities they serve. So this is the population health concept. So the community health needs assessment is not the end goal. It's really just a part of the stepping stones into an implementation plan that has to be put into action, and the third implementation plan has to be evaluated and refined in order to really see whether or not it is improving the health of the community, because the real goal here is not just the community health needs assessment, the real goal is improved community health. The third core belief is that health care facilities should actively involve community members, organizations and agencies in their community benefit program. It shouldn't just be stand alone healthcare facility figuring out everything for the community, it really has to be a partnership. So community health needs can only really be addressed when people are creating shared vision, they're collaborating across both the providers and the community partners, coordinating efforts because often the community was doing something on their side that can be a benefit to the whole effort to implement new plans to improve the community's health, and it utilizes all the different range of experiences, skills, and abilities from a wide part of the stakeholders that often aren't inside of the healthcare facility and are readily available to the community but just haven't been activated as a part of a larger plan. The fourth core belief is that healthcare organizations have to demonstrate their value of community service. They can't just say, "Oh, well we have value to the community because we're a hospital." Well that's true in many many ways but that's not valued to the community. In the community health needs assessment, one of the instrumental ways in which they do that is by indeed becoming aware of the community's needs. This demonstration of value is important to government agencies, it's important to community members and organizations also often the founders of hospitals and then many of the people that are working day in and day out to improve community health have to know that the healthcare organizations are behind them, and are a part of this whole ethic of community service. How does this happen really starts with the healthcare organizations even being aware of what is going on in their community. There's so many sad stories of where the hospital is of this thriving economics center, and right next door is some abject poverty and violence, and so this is one of these core beliefs that a community health needs assessment can start to actually build a bridge between. Another how is by ensuring that the community benefit planning takes account of the community's needs. So it has to be looking into the community and really looking at what that community needs which might be different than what the healthcare organization thinks it needs. The fifth core belief is that community benefit programs have to be integrated throughout the healthcare organization, and that includes both the community health needs assessment and the community health improvement plan. This has to be integrated into the strategic and operational plans of the organization. It can't just be in some side office, which means that the organization has to allocate the resources to carry out the processes and the programs effectively. Again, the community health needs assessment is not just an end goal, it's really just the beginning. The last core belief is that there has to be leadership commitment, but this is required for successful community benefit programs, and that it can't just be leadership in one domain. Within a community you need leadership by the charitable organizations and agencies within the community as well as the hospital board members and the chief executive officers and the senior managers. So not just the top, it also has to be the implementers within an organization. So demonstrating the organization's commitment really has to focus on healthcare access and improving community health both of those simultaneously, and prioritizing assessment planning and implementation. That's a leadership function that has to be underneath of all community health needs assessments. Even with this brief introduction, I hope that you can see that community health needs assessment is more than just a project to complete. There's an opportunity to draw people together with a common mission to gather evidence and make decisions that coordinate resources, and act collectively to help to make the world a healthier place.
