This document reviews tools that can assist hospitals in meeting requirements for conducting community health assessments and developing implementation strategies to address identified health needs. The authors provide an in-depth rating of 9 comprehensive tools based on their coverage of key steps in the community health improvement process, including establishing partnerships, conducting assessments, creating strategies, and monitoring outcomes. The ratings indicate which tools provide the most applicable information and resources to help hospitals efficiently comply with new requirements.

1. A Review of Tools to Assist Hospitals
in Meeting Community Health
Assessment and Implementation
Strategy Requirements
Karen E. Schifferdecker, PhD, assistant professor, Department of Community and
Family Medicine, and codirector, Center for Program Design and Evaluation, Geisel
School of Medicine at Dartmouth, Hanover, New Hampshire; Dorothy A. Bazos, PhD,
RN, adjunct assistant professor, The Dartmouth Institute for Health Policy and
Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover; Kaleb A.
Sutherland, research assistant, Centerfor Program Design and Evaluation at
Dartmouth, Geisel School of Medicine at Dartmouth, Hanover; Lea R. Ayers LaFave,
PhD, RN, senior project director, The Community Health Institute, Bow, New
Hampshire; Laural Ruggles, vice president, Marketing and Community Health
Improvement, Northeastern Vermont Regional Hospital, St. Johnsbury; Rudolph
Fedrizzi, MD, director, Community Health Clinical Integration, Cheshire Medical
Center/Dartmouth-Hitchcock Keene, Keene, New Hampshire; and Jaime Hoebeke,
division head, Chronic Disease Prevention and Neighborhood Health, City of
Manchester Health Department, Manchester, New Hampshire
E X E C U T I V E S U M M A R Y
Recent changes in U.S. national policies and regulations have created an opportunity
for meaningful collaborations to take place between health systems, public health
departments, and social service organizations. For medical systems, and particularly
tax-exempt hospitals, new requirements include community health assessments
(CHAs) and implementation strategies to address identified health needs. Individu­
als and groups responsible for meeting the new CHA and implementation strategy
requirements may be unsure about the best ways to achieve specific aspects of the
CHA process. In this report, we provide an in-depth review and rating of tools
developed by public health and community experts that cover the steps necessary to
meet the new requirements. Ateam of three community and public health experts
and the authors developed a rating sheet based on a well-known community health
improvement process model and on the steps in the new requirements to identify
and systematically rate nine comprehensive tools. The ratings and recommendations
provide a guide for hospitals in choosing tools that will best assist them in meeting
the new requirements.
For more information about the concepts in this article, contact Dr. Schiffer­
decker at Karen.E.Schifferdecker@dartmouth.edu.
44

2. Tools for Community H ealth Assessments and Implementation Strategies
I N T R O D U C T I O N
Over the past 25 years, medical, public
health, and social service organizations
have collaborated in efforts to improve
the health of communities and popula­
tions (Koo, Felix, Dankwa-Mullan,
Miller, &Waalen, 2012; Lasker &Com­
mittee on Medicine and Public Health,
1997; Ockene et al., 2007). Among
those who have called for collaboration
are the Institute of Medicine (IOM,
2012) and Kania and Kramer (2011).
Unfortunately, these efforts have yielded
mixed results because of challenges
associated with incentives, finances,
regulations, and time, as well as a lack
of shared knowledge, skills, purpose,
and goals (Gale, Coburn, &Newton,
2014; Jones &Wells, 2007; Porterfield et
al., 2012).
Recent changes in U.S. national
policies and regulations have created an
opportunity for meaningful collabora­
tions to take place between health
systems, public health departments, and
social service organizations that result in
shared goals and interventions for
population health improvement (Chok-
shi, Singh, &Stine, 2014; Stoto, 2013).
For medical systems, and particularly
tax-exempt hospitals, these changes
include the 2010 Affordable Care Act's
(ACA) requirement that "tax-exempt
hospitals conduct triennial community
health needs assessments (CHNAs) with
input from public health experts and
other community stakeholders" (Gale et
al., 2014), as well as adopt an imple­
mentation strategy to address identified
population health needs (Berkery,
2013) .These requirements are not
trivial; hospitals failing to meet the CHA
requirements can incur a $50,000 excise
tax (Berkery, 2013).
Although many U.S. hospitals
conduct community needs assessments
and develop implementation plans and
have partnered with community stake­
holders (Gale et al., 2014), a recent
review of the community benefits
provided by tax-exempt U.S. hospitals
revealed that little is being spent on
community health improvement (Young,
Chou, Alexander, Lee, &Raver, 2013).
This finding suggests that many hospitals
will need to make significant invest­
ments of time and resources to meet the
new requirements and provide evidence
of meaningful partnerships and commit­
ments to the communities they serve.
Because medical practice has tradi­
tionally focused on the health of indi­
viduals rather than entire populations,
individuals and groups in hospital
settings responsible for meeting the new
CHA and implementation strategy
requirements may not know how to best
achieve specific aspects of the CHA
process, which include
• defining the community, and ensuring
that medically underserved, low-
income, and/or minority populations
are included;
• identifying and prioritizing the
significant health needs of the
community;
• obtaining community input;
• documenting the process and findings
in a CHA report that is "available to
the public via a hospital facility's
website" (Berkery, 2013);
• developing an implementation
strategy that describes how a hospital
45

3. Journal of H ealthcare Management 61:1 January/February 2016
plans to address the health needs,
including "the actions the hospital
facility intends to take, the anticipated
impacts of the actions, and a plan to
evaluate the impacts" (Berkery, 2013).
Fortunately, community and public
health efforts that have focused on the
health of populations have resulted in
the development of models and tools
from which to understand and organize
the work required by the CHA and
implementation strategy requirements.
Public health and community experts
have applied and tested these models
and tools over many years, as evidenced
by numerous examples of high-quality
assessments and plans (Community
Preventive Services Task Force, 2015;
National Association of County and
City Health Officials, 2015a).
Our aim is to assist groups and
individuals in hospital settings charged
with meeting the new CHA and imple­
mentation strategy requirements by
providing an in-depth review and
rating of tools that can assist in this
process. Specifically we (1) provide an
overview of an existing health promo­
tion model to identify common process
steps important for meeting CHA and
implementation strategy requirements;
(2) systematically identify and rate
population health tools on these
process steps and their availability and
usability (e.g., features, applicability,
and accompanying resources); and (3)
provide specific recommendations to
hospitals as they embark on commu­
nity health assessments and improve­
ment work. We believe this review will
assist hospitals in efficiently choosing
tools that have been carefully devel­
oped over time.
B A C K G R O U N D
Health improvement models can be
thought of as representations of various
theories of health promotion. One of
the most well-known is the IOM's
community health improvement
process (CHIP) model (Durch, Bailey, &
Stoto, 1997), which has been used as
the basis for development of other
models, such as the evidence-driven
CHIP (Layde et al., 2012). Two cycles of
the improvement process are depicted
in this model: (1) the problem identifi­
cation and prioritization cycle and (2)
the analysis and implementation cycle.
The CHIP model is dynamic and
iterative, with an emphasis on continu­
ous redefinition and prioritization of
health issues over time. Community
health improvement models based on
CHIP exhibit the following core pro­
cesses developed through the healthy
cities movement (Hancock & Duhl,
1988):
1. Gathering together a diverse group
of community members
2. Developing a shared vision of
community health
3. Assessing the current realities and
trends
4. Planning action
5. Performing strategically
6. Monitoring and evaluation
Given its prominence and wide­
spread use, we adopted the CHIP model
as the framework for identifying overall
process steps essential to meeting the
new CHA and implementation strategy
requirements. These steps include the
following: form a community health
coalition, prepare and analyze
4 6

4. Tools for Community H ealth Assessments and Implementation Strategies
community health profiles, identify
critical health issues, analyze the health
issue, inventory resources, develop a
health improvement strategy, identify
accountability, develop process and
performance indicator sets, implement
the strategy, and monitor the process
and outcomes (Durch et al„ 1997). We
then looked for guides, which we
defined as tools that provide informa­
tion and resources for completing each
of these steps. We describe our process
of conducting a systematic review of
these tools.
M E T H O D S
id en tificatio n of Tools
We located tools based on the CHIP
model that included practical informa­
tion for operationalizing the steps in the
model. We conducted a comprehensive
search in both peer-reviewed and
open-source outlets, including electronic
journal databases (MEDLINE, Cochrane
Library, Google Scholar, PsycINFO),
citations of published reviews, and
recommendations from colleagues in
public health and community medicine.
The review included published guide­
books, toolkits, and other instructive
resources related to the following:
community health and quality improve­
ment, community-based participatory
research and action initiatives, collab­
orative partnerships in public health
and community medicine, and action
learning collaboratives in which "mul­
tiple teams with a shared aim work
together over a fixed period of time
using quality improvement tools and
methods to bring about organizational
or systemic change" (Bazos et al„ 2013,
p. 62). We also required that the tool be
available electronically, consist of at
least one version in English, and be free
of charge.
D e v elo p m en t of Rating Sheet
We convened a review panel consisting
of four researchers (K.E.S., D.A.B.,
K.A.S., L.R.A.L.) and three community
and public health leaders (a division
head of chronic disease prevention and
neighborhood health for a city public
health department, a physician direct­
ing community health improvement
efforts between a regional healthcare
system and community-based organi­
zations, and a vice president of market­
ing and community health
improvement at a rural critical access
hospital). The makeup of this panel
ensured representation of medicine,
public health, hospital, academic, and
community perspectives. The research­
ers developed a rating sheet based on
the CHIP model and focused on key
requirements (e.g., obtaining commu­
nity input) from the CHA along with
other features indicative of the tool's
usefulness (e.g., ease of access, accom­
panying resources). We shared the draft
rating sheet with community leaders
for comments and revisions. Two
researchers (D.A.B., L.R.A.L.) and two
community leaders (L.R., R.F.) then
tested it on three tools.
The final rating sheet, which was
approved by the review panel, consisted
of the four main process steps (Assess­
ment, Planning, Implementation, and
Monitoring and Evaluation) and subcat­
egories (Table 1). The rating sheet also
listed specific features of each tool (e.g.,
case examples, sample PowerPoint
[Microsoft] slides, sample surveys).
47

5. Journal of H ealthcare M anagement 61:1 January/F ebruary 2016
T A B L E 1
F in a l R a tin g S h e e t W ith P ro c e s s S te p s an d S u b c a te g o rie s
P ro cess S tep S u b c a te g o ry
Assessment Establish a rationale for improvement
Identify potential partners and stakeholders
Engage stakeholders
Form community health coalition (e.g., team-building, meeting tips)
Prepare and analyze community health profiles
Identify and analyze critical health issues
Planning Prioritize health issues and set goals
Inventory resources: What do the coalition and community have
available to address issues?
Explore evidence and effective programs
Develop a health improvement strategy (define the intervention and
methods or steps)
Identify accountability: Who will be responsible for each piece of the
strategy?
Implementation Implement the strategy
Test the strategy (e.g., Plan, Do, Study, Act cycles)
Plan strategies for dissemination and tips for executing dissemination
Maintain gains
Monitoring/ Develop process and outcomes indicator sets and measures
Evaluation Develop instruments and strategy for collecting evaluation data
Monitor the process and outcomes
Rating Process
One researcher (K.A.S.) from the
review panel rated the tools on the
basis of the final rating sheet param­
eters. To ensure reliability of the
ratings, a second researcher (K.E.S.)
then reviewed and rated the tools
independently.
R E S U L T S
Our initial search yielded 23 tools that
included most of the characteristics of
interest. On the basis of our inclusion
criteria, we selected nine of these tools
for a full review. The most common
reasons for excluding tools were that
they focused on one or a few of the four
primary process steps, and the content
was specific to the state in which the
tool originated, limiting the generaliz-
ability to other geographical areas and
state health systems.
Table 2 provides a list of the nine
tools, as well as a brief summary of their
distinctive features, structures, and focus
areas.
Table 3 presents a summary of the
rating results for each of the nine tools
48

6. Tools for Community H ealth Assessments and Implementation Strategies
across the four main process steps
(Assessment, Planning, Implementation,
Monitoring and Evaluation). For each
subcategory, we assigned a rating of 0
(none), 1 (some), or 2 (a lot) on the basis
of the extent to which the tool provided
applicable information or resources. We
averaged the numerical ratings for each of
the four main steps and translated these
averages into overall ratings of low, mid,
or high. We also rated each tool on the
basis of whether it included specific
attributes that may affect its usability and
utility. Table 4 provides a summary of
these ratings (i.e., none, some, many), as
well as information about language,
navigability, and format.
The nine tools vary with respect to
specific process steps and features and
formats. All of the tools can be helpful
to hospitals as they embark on CHAs
and project implementation. However,
we offer these considerations for indi­
viduals in hospital settings.
T A B L E 2
Final Selected Tools and Sum m ary of Focus and Features
Tool (Author, Year) Sum m ary of Focus and Features
CHANGE
(Community Health Assessment
and Group Evaluation)
(Centers for Disease Control and
Prevention, 2010)
Community Readiness
(Tri-Ethnic Center for Prevention
Research, 2014)
The CHANGE tool centers on a method of assessment
that helps communities identify strengths and weak­
nesses in the areas of policy, systems, and environmen­
tal change strategies.
The Community Readiness tool helps users assess a
community's readiness to address a particular health
issue. This tool guides the user through an evaluative
process that ranks community readiness across six key
dimensions.
Community Tool Box
(University of Kansas Work Group
for Community Health and
Development, 2015)
County Health Rankings and Road
Maps
(University of Wisconsin
Population Health Institute, 2015)
MAP-IT
(Mobilize, Assess, Plan, Implement,
Track)
(U.S. Department of Health &
Human Services, 2015a)
The Community Tool Box is organized into units,
chapters, sections, and subsections, and is accessible
for a wide variety of audiences.
The County Health Rankings and Road Maps tool
combines step-by-step guidelines with the County
Health Rankings database resources to plan a commu­
nity health initiative.
The MAP-IT tool is designed around Healthy People
2020 objectives and resources and is intended to help
communities plan and evaluate public health interven­
tions that aim to address Healthy People 2020
objectives.
Continued
49

7. Journal of H ealthcare M anagement 61:1 Ianuary/February 2016
T A B L E 2 continued
Tool (A uthor, Y ear)
MAPP
(Mobilizing for Action through
Planning and Partnerships)
(National Association of County
and City Health Officials, 2015b)
PATCH
(Planned Approach to Community
Health)
(U.S. Department of Health &
Human Services, 2015b)
Practical Playbook
(de Beaumont Foundation, Duke
Department ofCommunity and
FamilyMedicine, &Centers for
Disease Control and Prevention,
2014)
SPF
(Strategic Prevention Framework)
(Substance Abuse and Mental
Health Services Administration,
2009, 2015)
S u m m ary of Focus and Features
The MAPP tool includes four community assessments
(Community Themes and Strengths Assessment, Local
Public Health System Assessment, Community Health
Status Assessment, and Forces of Change Assessment),
the results of which inform strategic planning and
action. MAPP has a distinctly systems-level focus.
The PATCH tool was created as a resource for individu­
als designated as PATCH local coordinators, leaders
who guide every step of a community health initiative.
This tool is a rich resource for those who hold posi­
tions of leadership in an initiative, but it may not be
widely accessible to a broader audience.
The Practical Playbook tool is designed to assist in
efforts to integrate the activities of public health and
primary care groups. Resources focus on facilitating
integrative efforts and encouraging collaboration as key
to successful population health efforts.
The SPF tool is intended for use in creating interven­
tions targeting substance abuse, and it is specifically
designed for states, tribes, and jurisdictions seeking
funding through the Center for Substance Abuse
Prevention stmctures.
C o m m u n ity T o o l B o x
The Community Tool Box is the most
comprehensive of the nine tools. Each
process step is covered in depth, and
numerous resources and references are
provided to guide users in even the most
specific aspects of an initiative. However,
the navigability and, thus, usability of the
Community Tool Box is limited by the
large volume of information provided
and the number of external links. Because
of its size and the time required to
navigate it, we do not recommend the
Community Tool Box for hospitals just
starting to conduct CHAs or that have
limited experience in navigating the
process steps. However, for hospitals
already engaged in these activities or
looking for particular resources in one
area, we highly recommend the Commu­
nity Tool Box.
C o u n ty H e a lth R a n k in g s a n d R o a d
M a p s T o o l
The County Health Rankings and Road
Maps tool is comprehensive and acces­
sible. The instructions and resources are
extensive enough to provide a strong
project foundation, and the format is
manageable for a wide range of users.
We recommend that hospitals just
beginning to explore these resources
50

8. Tools for Community H ealth Assessments and Implementation Strategies
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11. Journal of H ealthcare M anagement 61:1 Ianuary/F ebruary 2016
and those with limited experience first
review the road maps tool to determine
if it meets their needs.
Some hospital employees working
on the CHA and implementation
requirements may have expertise related
to one or more of the four main process
steps (e.g., evaluation) and do not
require as much information in those
areas. We recommend that they use the
ratings tables (Tables 3 and 4) to deter­
mine which tools most effectively
address the process steps for which they
need assistance.
Practical Playbook
Organizations interested in solidifying
long-term partnerships with public
health and community organizations
that include and extend beyond the CHA
and implementation planning require­
ments will benefit from the Practical
Playbook. The Playbook was developed
with healthcare providers in mind and
outlines a process for creating sustained
partnerships with public health depart­
ments on community health efforts.
D I S C U S S I O N A N D
R E C O M M E N D A T I O N S
The ACA's CHA and implementation
strategy requirements provide an
opportunity for hospitals to begin or
build on population health efforts for
the communities they serve by partner­
ing strategically with public health and
social service agencies. Fortunately for
hospitals, public health and community
health experts have developed a solid
platform of models and tools to jump-
start the work related to these require­
ments. In addition, by understanding
and using these tools, hospital leaders
acknowledge the expertise of commu­
nity and public health partners, which
provides an opportunity to establish or
enhance collaborative relationships.
L im itation s of R eview
The list of tools in this review was
comprehensive, but we excluded some
tools that may be helpful for certain
users. For instance, we omitted some
tools because they focused only on one
of the four primary process steps. These
less-comprehensive tools do not include
the resources necessary to guide a user
through the entire community health
initiative process, but some may find
such tools helpful for obtaining in-
depth information about a particular
step (e.g., assessment).
Other excluded tools were from
statewide public health agencies and
departments. These tools include
content that is particular to the state in
which they originated and to the state-
specific health system structures and
regulations. However, individuals
responsible for conducting a CHA can
contact their state or county health
departments to inquire about tools
designed for their particular contexts.
Finally, we included only those tools
that are available electronically, so we
may not have captured some that would
be helpful. However, given the depth
and breadth of the tools located, we feel
confident that users will find them more
than adequate for meeting their needs.
C O N C L U S I O N
Collaborative partnerships between
public health, community stakeholders,
and medicine are essential for healthcare
reform. The models and tools reviewed
54

12. Tools for Community Health Assessments and Implementation Strategies
in this report givethose tasked with
meeting the newCHA and implementa­
tion strategyreqLiirements aportfolio of
resources to use. We also hope that use
ofthese tools brings health systems
closerto realizingthe opportunities and
rewards that comewith sustained,
collaborative partnerships with public
health departments and community
agencies. As the IOM (2012) noted:
Byworking together, primary care and
public health can each achieve their
own goals and simultaneously have a
greater impact on the health of
populations than either of them would
have working independently. Each has
knowledge, resources, and skills that
can be used to assist the other in
carrying out its roles (p. 5).
R E F E R E N C E S
Bazos, D. A., Schifferdecker, K. E., Fedrizzi, R.,
Hoebeke, J., Ruggles, L., &Goldsberry, Y.
(2013). Action-learning collaboratives as a
platform for community-based participa­
tory research to advance obesity preven­
tion. Journal ofHealth Carefor the Poorand
Underserved, 24(2), 61-79.
Berkery, M. R. (2013). Summary ofthe Internal
Revenue Service's April5, 2013, notice of
proposedrulemakingon community health
needs assessmentsfor charitable hospitals.
Adanta, GA: Centers for Disease Control
and Prevention. Retrieved from http://www
.cdc.gov/phlp/docs/summary-irs-mle.pdf
Centers for Disease Control and Prevention.
(2010). Community Health Assessment and
Group Evaluation (CHANGE) action guide:
Building afoundation ofknowledge to
prioritize community needs. Retrieved from
http://www.cdc.gov/nccdphp/dch
/programs/healthycommunitiesprogram
/tools/change/pdf/changeactionguide.pdf
Chokshi, D. A., Singh, P„ &Stine, N. W. (2014).
JAMAforum: Using community health
trusts to address social determinants of
health. Retrieved from http://newsatjama
.jama.com/2014/04/16/jama-forum-using
-community-health-trusts-to-address-social
-determinants-of-health/
Community Preventive Services Task Force.
(2015). The community guide in action:
Stories from the field. Retrieved from
http://www.thecommunityguide.org
/CG-in-Action/index.html
de Beaumont Foundation, Duke Department
of Community and Family Medicine, &
Centers for Disease Control and Preven­
tion. (2014). Apractical playbook. Retrieved
from https://practicalplaybook.org/
Durch,J., Bailey, L. A., &Stoto, M. A. (1997).
Improving health in the community: A rolefor
performance monitoring. Washington, DC:
National Academy Press.
Gale, J., Cobum, A., &Newton, H. (2014).
Collaborativecommunity health needs
assessments: Approaches and benefitsfor critical
access hospitals. (Policybrief No. 36).
Portland, ME: FlexMonitoringTeam.
Retrieved from http://www.flexmonitoring
.org/wp-content/uploads/2014/05/pb36.pdf
Hancock, T„ &Duhl, L. J. (1988). Promoting
health in the urban context. Copenhagen,
Denmark: FADLPublishers.
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care and public health: Exploring integration
to improve population health. Retrieved from
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/media/Files/Report%20Files/2012
/Primary-Care-and-Public-Health/
Primary%20Care%20and%20Public
%20Health_Revised%20RB_FINAL.pdf
Jones, L., &Wells, K. (2007). Strategies for
academic and clinician engagement in
community-participatory partnered
research. Journal oftheAmerican Medical
Association, 297(4), 407-410.
Kania, J., &Kramer, M. (2011). Collective
impact. Stanford Social Innovation Review,
9(1), 36-41.
Koo, D., Felix, K., Dankwa-Mullan, I., Miller, T.,
&Waalen, J. (2012). Acall for action on
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202(Supplement 3), S307-S309.
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Guse, C. E., Maurana, C. A., &Branden­
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evidence-based interventions into
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Public Health, 102(4), 617-624.
55

13. Journal of H ealthcare Management 61:1 January/F ebruary 2016
National Association of County and City
Health Officials. (2015a). Community
health assessments and community health
improvement plans for accreditation
preparation demonstration sites. Retrieved
from http://www.naccho.org/topics
/infrastructure/chachip/accreditation
-demo-sites.cfm
National Association of County and City
Health Officials. (2015b). MAPPframework.
Retrieved from http://www.naccho.org
/topics/infrastructure/mapp/framework
/index.cfm
Ockene, J. K., Edgerton, E. A., Teutsch, S. M.,
Marion, L. N., Miller, T„ Genevro, J. L.,. . .
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Home, J., McAleer, K., & Roussel, A.
(2012). Linkages between clinical practices
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Stoto, M. A. (2013). Community health needs
assessments: An opportunity to bring public
health and the healthcare delivery system
together to improve population health.
Retrieved from http://www.improving
populationhealth.org/blog/2013/04
/community-health-needs-assessments-an
-opportunity-to-bring-public-health-and
-the-healthcare-delivery.html
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Administration. (2009). Identifying and
selecting evidence-based interventions:
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Retrieved from http://store.samhsa.gov
/product/SMA09-4205
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(2014). Community readiness for community
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(2015a). MAP-IT. Retrieved from http://
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(2015b). Planned approach to community
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Y., & Raver, E. (2013). Provision of
community benefits by tax-exempt U.S.
hospitals. New England Journal of Medicine,
368(16), 1519-1527.
P R A C T I T I O N E R A P P L I C A T I O N
Kathryn W. Zavaleta, FACHE, principal health systems engineer, Mayo Clinic,
Rochester, Minnesota
The authors of this study provide a comprehensive resource to help healthcare
executives implement new Internal Revenue Service regulations requiring commu­
nity health assessments and improvement plans.
Certainly, how best to address community health needs is a relevant topic for
hospital leaders and their governing boards. However, one wonders if the magnitude
56

14. Tools for Community H ealth Assessments and Implementation Strategies
of change will be as significant as we might hope. Governing boards of nonprofit
organizations function, at least in part, to provide accountability to the community
at large. Few healthcare executives would object to the intent of the requirements,
and they are aware of the profound gap between optimal community health and
current realities.
Still, the new regulations point to a real opportunity for change. Even in the case
of the dedicated hospital in a smaller community, no one organization has the
resources to address community needs in a comprehensive way. Profound structural
incentives emphasize acute and episodic healthcare, so executives need to do what
they do best: provide leadership. To make the process of assessing community health
needs more than a perfunctory exercise, healthcare executives should leverage the
tools described by Schifferdecker et al. to set priorities that will lead to significant
improvement.
Acting on plans to improve community health makes strategic, business, and
regulatory sense. Some organizations may be concerned about the trend toward
mandated disclosures of hospitals' community benefit activities to government
agencies and the public at large (Rubin, Singh, &Young, 2015). However, the new
regulations also represent an opportunity, if not a catalyst, for deliberate, thoughtful
dialog among community stakeholders. The best hospital executives work with their
boards to achieve community health improvement objectives. They explore synergies
with population health initiatives and other strategic concerns. Exemplary hospital
leaders understand that healthier communities translate not only to healthier popu­
lations in medical practices, but also to healthier employees and their dependents.
They maintain the visibility of community outreach and implementation plans as
part of leadership meetings, and work to engage care teams and staff in a broader
expression of the organization's mission.
Some organizations choose to go further. Progressive academic medical centers
can and do advance the science of population health, seek innovative ways to pro­
vide care to vulnerable populations, and collaborate on community-engaged
research. In the community hospital setting, I had the privilege to work for an
organization that was part of a national collaborative of 13 tithing healthcare sys­
tems. The hospital board designated funds to create community-benefit initiatives,
without regard for the potential to generate revenue or achieve a marketing advan­
tage. The impact of this initiative on workforce morale was palpable. The hospital's
commitment to the community generated pride and spawned countless volunteer
efforts, enriching both the work environment and the surrounding community.
The underperformance of our health system at the national and local levels is
well-recognized. Each of us, individually and collectively, must act on the desire and
need for improvement in care delivery, even before incentives for community-
centered care solidify.
R E F E R E N C E
Rubin, D. B., Singh, S. R„ &Young, G. J. (2015). Tax-exempt hospitals and community benefit: New
directions in policy and practice. Annual Review ofPublic Health, 36(1), 545-557.
57

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