Since the passage of the Affordable Care Act in 2010, not-for-profit hospitals, like Maryland-based Meritus Health, have been required to complete a community health needs assessment every three years. However, despite its promise, we believe there has been little progress in the use of the CHNA to improve health outcomes in our community. Recently, Meritus began using the CHNA as a tool to drive measurable change in our community with early, positive impact.
We propose the following steps to ensure that the CHNA becomes the process and improving community health becomes the outcome.
1. Collaborate with your local health department and community partners to review the CHNA together and identify one or two measures to improve for the health of the community. We know from experience involving these partners can help reduce barriers, lead to meaningful ideas to help achieve the goal and focus efforts on outcomes.
2. Set one key aim (i.e., outcome) that is bold, measurable and to be met over a specific time frame. The aim provides the team and community with a clear objective to achieve.
3. Create annual goals for the aim that are aligned with the goals of the health system and reflect community needs.
4. Connect these community health goals to the health system's true north metrics and financial incentives so that the goals align with other measures of success. Financially incentivize the community health goals with leaders and the organization as you would other incentive measures such as operating margin, staff turnover and patient experience.
5. Report on the community health measure frequently and implement actions to improve. Transparency helps spread the word of the aim and can engage others to join the initiative.
As an example, Meritus Health began using these steps in 2019. At the beginning, Meritus leaders met with over 25 community partners to discuss the 2019 CHNA results. Together, we identified obesity as the measure to improve the community's health, given obesity is a direct contributor to many preventable health conditions plaguing our community. Healthy Washington County, a collective of public and private community partners that seek to improve health of the region, has taken leadership of this initiative. The aim established from our group collaborative was for the community to lose 1 million pounds by 2030!
For the first year, Meritus set a goal to lose 10,000 pounds and linked this goal to all employee incentive pay. For the second year that just started, we have set a goal to lose 35,000 pounds cumulatively. Every week, we share progress internally via digital displays, the intranet and through various meetings. Results are also shared externally via the Healthy Washington County website, bill boards, and e-mailed monthly to community partners that pledged weight-loss goals. In less than a year of the Lose 1 Million Pounds initiative, Meritus has engaged over 2,000 participants, more than 40 community partners, and the community has lost more than 11,000 pounds. Following the five steps above has led to measurable progress in losing weight as a community.
Tremendous efforts are being made in community health improvement throughout the country. However, these efforts are often small in scale and impact. We believe "going big" and treating a community health outcome measure like we do other organizational measures of success is essential to move to improvement.
There are many reasons that our approach may fail or not be enough. We are just one year in, so sustainability is still an open question. Over 11,000 pounds is impressive, but a long way to go to get to 1 million. There are many factors outside our control that impact health, but we accept the challenge and prefer to fail, rather than spend more time identifying the same community health needs three years from now.
The CHNA is important, but it is time to move from assessment to improvement; and improvement requires bold, measurable goals. Be quick about the findings of the CHNA and focus on improvement. Pick one bold goal, rally the community, focus efforts and start measuring the improvement. After all, the "end" is improved healthcare, and if we do not start somewhere, the community health needs will persist and compound into greater numbers. Assessment is important, but improvement is necessary. Our communities need our courage to go bold, go big and truly measure health improvement of a population.
