Community Health Needs Assessment: Beyond Compliance

The U.S. Supreme Court's decision and announcement on June 29th validated the constitutionality of the Patient Protection and Affordable Care Act of 2010. The high court's decision confirms the requirement that most non-profit hospitals must complete a comprehensive community health needs assessment every three years. Those hospitals that are required by law to complete a CHNA — but don't — will face a $50,000 fine every year they are not in compliance with the law. This legal requirement with its financial enforcement penalty is reason enough to get going; however, there are other valuable and compelling business reasons — beyond regulatory compliance — for any hospital to incorporate the CHNA process into its regular planning cycle.

Steven B. ReedThis article outlines how the CHNA process can be integrated as a foundational component into the key business functions of strategic planning and marketing, by incorporating it into the hospital's regular planning cycle. The CHNA process can be the driving mechanism for a community hospital to elevate its position in the community as the leading healthcare organization concerned with promoting the overall health status of its community. A hospital can leverage the CHNA process to foster collaboration with other health service providers and organizations in the community for purposes of promoting communication, working relationships, referral and coordination of care, thus enhancing the continuum of healthcare at all levels. Moreover, a hospital strategically engaged in the CHNA process can also enhance its image, reputation and position in the market with key stakeholders and the community at large.

The planning cycle

Every hospital should have some type of recurring planning process cycle to create strategic and other operating plans, which are then implemented. A strategic plan provides many critical components an organization needs, including strategic direction; clarity and commitment towards its mission and values; an implementation plan that breaks major strategic initiatives into a detailed work plan; and a process for reporting and accountability. Given the dynamic healthcare environment, a hospital should complete a comprehensive strategic planning process every three years — the same timeframe required for a CHNA.

Strategic marketing
Over the past decade or so, the marketing function has gained acceptance and support in the healthcare field with a growing recognition of its critical business application for hospitals. Some of the critical marketing functions for hospital leadership to utilize include:

  • Patient satisfaction
  • Pricing strategy
  • Patient access
  • Service locations
  • Patient origin and market share
  • Corporate communication
  • Advertising
  • Promotion
  • Sales
  • Public relations

Marketing intelligence

A foundational component to the marketing function is marketing intelligence, which includes having a good understanding of the hospital's service area, its demographics, consumer needs, buyer behavior, referral patterns, service availability, competitive dynamics, changes and trends.

Planning cycle integration of key business functions
As stated, there are a number of overlapping components to the comprehensive strategic planning process, the marketing function (including gathering marketing intelligence) and the CHNA process. The remainder of this article outlines these major overlapping components and how they can be seamlessly integrated into a hospital's planning cycle.

Mission, vision and values
These directional strategies set the overall framework and direction in which an organization will operate: why the organization exists, what its purpose is, what it stands for and what it wants to be in the future. The CHNA process is designed to identify unmet healthcare needs in the community and what action the hospital plans to take to address those unmet needs. It is imperative that a hospital stays true to its mission and values as it moves forward to achieve its strategic vision and meet community needs. Alignment with the directional strategies and the CHNA process is therefore essential.

Defining the hospital's service area
The physical and psychological characteristics of a market change over time as competitors enter and exit the market and other external forces create a dynamic service area. Defining the hospital's current and potential service area is important for strategic planning and marketing purposes, as well as defining needs and service availability for the CHNA process.

Service area analysis
Once a hospital's service area is defined, a major component for strategic planning, marketing and the CHNA process is a comprehensive analysis of the service area: its demographics, population health status, characteristics and other changes and trends that have implications for a variety of strategic, service and business functions.

Competitive analysis
Another major component for strategic planning, marketing and the CHNA process is an assessment of the health service providers, organizations and services offered and available in the market, along with known or anticipated changes, including possible new entrants.  

Key informant interviews
This is a major qualitative component for capturing marketing intelligence, but it also has significant value and importance for strategic planning and the CHNA process. Input from a broad cross-section of stakeholders is necessary to gain an in-depth understanding of the marketplace, its stakeholders and other dynamics.

Collaboration with other health service organizations
Most communities have numerous health service providers, as well as other organizations and agencies that play a critical role in the overall delivery of healthcare services. Work with these organizations to support and equip consumers and at-risk populations with the resources and services they need, many of which are instrumental in promoting health and health status.

Employee input and feedback
Assessing employee satisfaction using periodic surveys has been a common practice in hospitals for decades. However, going a step further has a valuable role in strategic planning, marketing and the CHNA process. Hospitals can use employee feedback to gain insight and understanding about the hospital and its strengths, weaknesses, opportunities and threats, along with intelligence about patients, families, physicians and the local marketplace.

Strategic initiatives and action plan steps
In lieu of having multiple action plans for strategic planning, marketing and the CHNA implementation strategy, management can create one plan that can be more efficiently developed, communicated, implemented and reported on periodically. Moreover, eliminating work plan fragmentation by organizing one comprehensive action plan creates an opportunity for leadership to heighten accountability for execution, thereby enhancing its potential for success. This may be the most compelling reason of all for a hospital to create a collaborative and participatory process every three years that integrates the key business functions for strategic planning, marketing and the CHNA process.

Hospitals that currently don't have a three-year strategic planning cycle and process in place should consider developing one which incorporates the strategic planning, marketing and CHNA process. Below is an example of an integrated planning cycle and timeline with major steps outlined on a quarterly basis in year one. This example assumes the hospital has a calendar fiscal year.

Year 1

1st Quarter:
  1. Identify the strategic planning committee responsible for directing and overseeing strategic planning, marketing and CHNA processes and activities.
  2. Identify and secure the services of an outside consultant, if needed, to assist in facilitating the planning process and activities.
  3. Re-affirm the hospital's mission and values, and develop the vision using a three-year planning horizon.
  4. Define the hospital's service area.

2nd Quarter:
  1. Complete the service area analysis.
  2. Complete the competitive analysis.
  3. Conduct key informant interviews.
  4. Conduct employee meetings.
  5. Draft key findings and strategic factors.

3rd Quarter:
  1. Meet with local health service agencies for purposes of dialogue and collaboration.
  2. Develop a draft of possible strategic initiatives, marketing initiatives and CHNA implementation strategies.
  3. Develop a combined draft action plan for implementing strategic initiatives, marketing initiatives and CHNA implementation strategies.
  4. Thoroughly review and discuss key findings, strategic factors and the draft action with the Strategic Planning Committee.
  5. Incorporate input and feedback from the strategic planning committee into the action plan.

4th Quarter:
  1. Make a formal board presentation and get approval for the strategic plan, marketing plan, CHNA report and the comprehensive action plan.
  2. Implement the combined action plan, providing a monthly or quarterly status report to the board and throughout the organization.
  3. Provide appropriate corporate communication with the community regarding hospital plans and actions.

Year 2

Conduct a formal review and evaluation of the comprehensive action plan, progress made and modifications to be made, and report to the strategic planning committee, then internally and externally as appropriate.

Year 3

Conduct a formal review and evaluation of the action plan, progress made and modifications to be made, and report to the strategic planning committee, then internally and externally as appropriate. Discuss plans for embarking on a comprehensive strategic planning process and organize a process for the subsequent year.

Steven B. Reed is a senior manager with Blue Consulting. He has over 23 years of experience in hospital administration in proprietary hospital systems and not-for-profit community hospitals. His leadership and consulting experience includes tertiary care and teaching hospitals, single specialty hospitals and critical access facilities. During Mr. Reed's hospital administrative career, he held senior executive positions as CEO, as well as executive vice president & COO of a two-hospital group, regional referral center.

More Articles on Community Health Needs Assessments:

Community Health Needs Assessment: 5 Phases to Compliance
10 Reasons to Combine Your Community Health Needs Assessment and Medical Staff Development Plan

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