Nonprofit hospitals in the United States are required to complete a community health needs assessment every three years and to develop corresponding improvement strategies. To elevate the effectiveness of the CHNA in the hospital and in the community, hospitals and health systems need to thoroughly engage patients, families and community members in the CHNA process. The Health Research & Educational Trust, with funding from the Patient-Centered Outcomes Research Institute, has developed a pathway for engaging patients and the community throughout the CHNA process.

The HRET's Community Health Assessment and Implementation Pathway is an eight-step approach to guide the CHNA journey. At the center of the model are patients, families and community members, who should be engaged at every step. The goal of the pathway is to support CHNA developers and hospitals seeking to strengthen patient and community stakeholder engagement efforts, as well as to guide patient and community advocates so they can contribute more effectively. 

The pathway includes a multitude of methods to bring patients and members of a hospital's community on board:

Step 1: Identify and engage stakeholders. Establishing trusting relationships early in the CHNA process encourages community stakeholders to become engaged, creating a stronger sense of joint ownership of the process. CHNA developers may consider approaching individuals currently involved in patient and family advisory councils: They are already bringing a community perspective to hospital programs and operations and are likely to be enthusiastic about improving health through the CHNA process.

Step 2: Define the community. Defining the community is a key component of the CHNA process as it determines the scope of the assessment and intervention. While scope is often determined by the hospital’s predefined service area, bringing community members and patients into the conversation can ensure that the definition of the community is inclusive.

Step 3: Collect and analyze data. Aggregating primary and secondary data, both qualitative and quantitative, will help prioritize community health needs. Patients and community stakeholders can provide perspectives to complement quantitative findings through surveys, interviews, focus groups, and community or town meetings. Asking community stakeholders to share information they have access to is an important part of data collection: Hospitals and health care systems may not otherwise be aware of or obtain these data.

Step 4: Select priority community health issues. The quantitative and qualitative data collected and analyzed in step 3 are used for prioritizing community health needs. While quantitative data can illuminate the scope and severity of particular health issues, stakeholders in the community and the health care system can explain the urgency of these issues. Including patients, families and community members in making final decisions on which health issues to prioritize will help them feel more invested in the outcome. It is also important to document the prioritization process by recording which factors were considered most important and how decisions were made, so that the assessment is transparent.

Step 5: Document and communicate. Sharing CHNA drafts before they are finalized gives stakeholders a chance to comment and provide additional feedback about how the information should be presented (length of document, language level), what format it should be in (written or audio), if it needs be translated into other languages and what forms of communication would best reach subpopulations within the community. Hospitals and health systems also can encourage community members and patients who were involved in the CHNA process to serve as community ambassadors, spreading the word about the needs assessment outcomes.

Step 6: Plan improvement strategies. It is important to keep patient, family and community stakeholders involved throughout the improvement planning process as they will have valuable feedback about the feasibility and acceptability of interventions and strategies in their communities. In addition, individuals who are invested in the process and their community will likely value the opportunity to be part of the solution.

Step 7: Implement improvement plans. Engaging patient and community stakeholders in customizing the evidence-based interventions identified in step 6 creates a sense of ownership and shared responsibility; it also fosters ongoing dialogue among the hospital, community organizations and the populations they serve. Stakeholders also can discuss what role patients and community members want to play, as there may be many opportunities for ongoing involvement.

Step 8: Evaluate progress. Patients, families and community members can be involved in determining which outcomes should be measured and in providing feedback on how the implementation is progressing so adjustments can be made. After reviewing outcomes, it is important to reflect and strategize with community members and patients to consider what worked well, what could be improved and how to scale up programs.

Making patient and community engagement a central component of the CHNA process can be mutually beneficial to hospitals and communities. Patient and community engagement allows hospitals and health systems to gain a clearer understanding of their community’s health needs and priorities, increases buy-in and a sense of shared responsibility for community health, and establishes relationships with organizations and individuals important to the community.

By participating in the CHNA process, patients and community members can gain a more comprehensive understanding of their community, including the health issues it faces, the causes of those issues and the availability of resources to address them. The CHNA process also can strengthen bonds between the community and the hospital, enhance community investment in an effective process, and foster willingness for future collaboration.

When conducted systematically with active engagement by patients and community members, the CHNA process can be a powerful tool to develop partnerships and implement evidence-based strategic interventions that address prioritized community health needs. This is an important step in improving the health of communities.

An illustrated version of the Community Health Assessment and Implementation Pathway, along with more information, is available in Engaging Patients and Communities in the Community Health Needs Assessment Process.” A companion guide, “Applying Research Principles to the Community Health Needs Assessment Process,” also is available.

Katya Seligman, M.P.H., is a program manager at the Health Research & Educational Trust.