A Framework for Community Health Improvement

By Frances S. Margolin

Hospital leaders must focus on five broad issues to engage more fully with their constituents.

Frances S. Margolin

Many hospital leaders recognize the need to connect with their communities to improve the health of their constituents and to influence public policy on their behalf. But the question is how: How do you make sense of a seemingly infinite list of needs? How do you think about the community? How do you choose partners with whom to work?

A recent meeting of hospital leaders, funded by the W.K. Kellogg Foundation, produced a framework for thinking about the hospital leader’s role in community engagement. This framework can be used to categorize a community’s issues, actions and partners. It can help you prioritize and make decisions about allocating resources.

Five Types of Issues

The framework suggests that there are five major types of issues, all of which must be addressed to improve the community’s health:

- community issues;
- health issues;
- equity issues;
- system barriers; and
- the community’s role.

While there is overlap among these categories, all are important. Too often hospitals consider only questions directly related to medical care, but there is a role for hospital leadership in all five areas. Let’s take a look at each one.

Community issues are those factors that are often called the “social determinants of health,” such as housing, education, employment, safety and crime. Partners in addressing community issues might include major community-based groups or institutions that address particular concerns—for example, schools, chambers of commerce and police departments.

Critical health issues include not only treatment of acute illness but also prevention of chronic disease and obesity, as well as access to mental health and oral health services. Partners in this realm include not only direct health care providers—doctors, nurses, dentists—but also pharmacies and insurers.

Equity issues concern access to, and quality of, the entire continuum of care, including preventive care, rehabilitation and long-term care, as well as reduction in disparities among racial and ethnic minority and immigrant groups. The faith community and local activists, as well as leading community-based organizations, can be of help here.

System barriers include many different challenges. A few examples are the need for care coordination, need for functional measures of community health, lack of public health infrastructure, lack of mechanisms for hospitals to work with public health and community clinics, and lack of physician engagement in community health. This is one area where health care leaders, along with public health leaders and insurers, can take a personal role.

Finally, the community’s role refers to the active participation of community members in improving the health status of the entire community—not only working through the health care delivery system but also taking responsibility for individual personal health. Here patients, service clubs, neighborhood associations and hospital board members can play a key part.

The Hospital’s Role

For each of these issues, the hospital can act as a catalyst, helping the community assess the specific actions needed, bringing together the partners and facilitating the process of setting priorities. The hospital need not take responsibility for every step of every action. Rather, the hospital can exert its leadership by providing resources (which can include meeting facilities and refreshments), by giving an example of appropriate programming and by inspiring leaders of other institutions to take responsibility for some aspect of community health improvement. As we often hear, the whole can be greater than the sum of its parts.

Frances S. Margolin, M.A., is vice president, operations, at the Health Research & Educational Trust (HRET), Chicago.

A full report, Where Do We Go From Here? The Hospital Leader’s Role in Community Engagement, is available from HRET and includes many examples of initiatives by leading hospitals. Call (312) 422-2640 or e-mail jrabideaux@aha.org.

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This article 1st appeared on August 14, 2007 in HHN Magazine online site.

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