Tools are readily available to support hospitals’ community benefit activities.
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| Michael Bilton | Kevin Barnett |
Community benefit is a vital part of every nonprofit hospital’s responsibility, and there is broad agreement that this extends beyond providing charity care.
Charity care is the single largest component of most hospitals’ quantifiable community benefit, and it probably is not going away any time soon. As long as we as a country fail to cover all people--by whatever means and to whatever extent--charity care will continue to be the elephant in the room of community benefit.
Beyond charity care, the community benefit activities of your hospital or health system are driven by the particular health needs of your local population and supported by the unique human and other resources of your hospital. They are also inevitably influenced by any formal reporting requirements for which you may be accountable. With so much variation in local needs, internal resources and the external environment, it can be difficult to decide how to plan for, organize and guide your community benefit program.
Conversations taking place in the field right now reflect the search for a common, logical approach to community benefit that supports the community and the health system. These conversations also reflect a search for tangible examples of what works when planning and organizing the community benefit function.
The Public Health Institute’s Advancing the State of the Art in Community Benefit (ASACB) demonstration program--active since 2002 with six health care organizations representing more than 70 hospitals in four states--helps hospitals systematize community benefit activities using internal policies to guide programs and useful metrics to assess their impact. The Health Research and Educational Trust, an AHA affiliate, is working with the ASACB demonstration to help develop practical community benefit tools and to assist other hospitals adopt them for their own use. At its core, the project is working to help hospitals and health systems view community benefit as effective investment of charitable assets--and to put systems in place to ensure the best possible return.
Ask yourself what community benefit your hospital provides beyond charity care for those patients who show up at your door--and for those who do not. Chances are that you can answer this question with the provision of school- or employer-based preventive health education, support of local primary care centers to increase access, leadership of health coordinating councils, or even funding for community economic development campaigns.
Now, ask yourself what principles underlie these contributions of expertise and financial resources. Ask what strategy they support, and what tools you use to help ensure efficient and effective use of these scarce charitable resources.
The hospitals in the ASACB demonstration began answering these questions by adopting a simple set of core principles. The core principles focus attention on the “community” aspects of community benefit, and on the health system’s role in a larger web of organizations and people responsible for helping to ensure the public’s health. In summary, the principles are:
These community benefit principles serve to give direction to what can otherwise be an overwhelming task of sorting through myriad community health and health care issues, guided only by good will. Building a strategy around these principles is one way to create a plan with specific goals, dedicated resources, and measures of success and accountability. (See the figure below for tips on applying each of the principles.)
Adopting principles can help to focus your effort, but designing community benefit programs and “taking them to the street” requires strong organizational tools, policies and procedures. Participating ASACB hospitals and health systems adopted three major implementation goals and are developing a number of mechanisms to make fulfillment of those goals a reality. The goals address governance and decision-making, management and operations, respectively:
With respect to governance and decision-making, ASACB hospitals are establishing formal community benefit committees that include trustees, staff and other community members. These planning and oversight groups use clear documentation of committee roles and responsibilities, explicit guidelines for recruitment to ensure breadth of competencies, and explicit criteria and processes for decision-making.
Accountability is being strengthened by adopting policies that hold the senior executive directly responsible for community benefit performance, and integrating community benefit priorities into the organizational strategic plan.
Hospitals in the demonstration project also are working to strengthen the management of community benefit programs in a number of ways. A first step is often to develop a job description for the community benefit manager that specifies the responsibilities and skills required, with a minimum half-time dedicated position. These community benefit managers are typically given the authority to design, evaluate and determine whether activities meet minimum criteria and can be counted as community benefits. Beyond the community benefit office, hospitals are working to create policies that provide incentives for involvement and support from all clinical and administrative departments.
Finally, assembling these elements into a community benefit plan that outlines three- to five-year strategies can provide a road map to a successful community benefit program. Indeed, thinking of community benefit as an organized program of strategic activity can return more to the organization and the community than a collection of separately managed and separately budgeted initiatives. Connecting community benefit activities tightly to both the community’s need and to the hospital’s strengths can pay off in more effective use of limited charitable dollars.
Michael Bilton is director of community health programs, Health Research and Educational Trust. He is based in San Francisco. Kevin Barnett is principal investigator, Public Health Institute. He is based in Alamo, Calif.
More information on these principles and implementation strategies--including sample job descriptions, policy documents and other real examples from hospitals and health systems--is available online. To view these resources and to learn more about ASACB and its member hospitals, visit www.asacb.org.
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Building a strategy around five principles is one way to create a plan with specific goals, dedicated resources, and measures of success and accountability.
| Principle 1: Emphasize disproportionate unmet health-related needs |
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- Identify communities within the hospital service area that have a high prevalence of poor health or a high concentration of health-related risk factors. - Develop outreach mechanisms to inform community members of available services. - Facilitate participation of community members through program location, timing and/or transportation assistance. - Ensure that program design and content is relevant and responsive to the particular needs and characteristics of community members. |
| Principle 2: Emphasize primary prevention |
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- Educate the community about health risks and healthy behaviors. (Health Promotion) - Target specific at-risk populations with more focused interventions. (Disease Prevention) - Engage community members and local organizations as partners to address environmental factors that contribute to health risks. (Health Protection) |
| Principle 3: Build a seamless continuum of care |
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-Identify linkages between community health improvement activities and medical care service utilization. - Identify ways to measure community health improvement activities that demonstrate progress in reducing preventable and potentially uncompensated medical care utilization. - Engage providers and develop expanded protocols that use community resources to effectively manage chronic disease and minimize preventable medical care utilization. |
| Principle 4: Build community capacity |
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- Identify community assets (such as neighborhood associations and community-based organizations) that can be mobilized to address health-related problems. - Engage with community stakeholders as a full partner in comprehensive strategies to address both symptoms and underlying causes of ill health. - Focus hospital resources (including financial and in-kind support, technical assistance and advocacy) on strategies to increase the effectiveness, efficiency and sustainability of community-led health improvement efforts. |
| Principle 5: Emphasize collaborative governance |
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- Create a community benefit decision-making body that includes a breadth of skills and diversity that reflects the community being served. - Share accountability for community programs with other community partners and organizations. - Involve community stakeholders from outside the hospital in the identification of health improvement objectives, data collection and reporting. |
This article 1st appeared on April 18, 2006 in HHN Magazine online site.
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