Advice from the Experts on How to Successfully Complete Your CHNA
2022 will be a big year for Community Health Needs Assessments (CHNAs). With the requirement that they are conducted every three years, this is the year for many hospitals to undergo a systematic collection, analysis, and dissemination of information about the health of their community.
With this in mind, we recently gathered some of the brightest minds we know - all experts on how to successfully conduct a CHNA: Dr. Stephanie Bailey, Amanda Ables and Carol Quest. Each of these industry healthcare leaders have been there, struggled with and come out the other side of at least one CHNA. (You can read full bios for each of our panelists at the end of this post. We also recorded the session, and you can listen to it here.)
Question 1: How can you ensure the maximum number of individuals within a community participate in a CHNA by filling out a consumer survey for the purpose of public health planning?
Especially right now, this can be challenging. So much of this work is being done online because of COVID restrictions and concerns, and that can mean lower participation.
Pre-COVID, you could garner a lot of responses by putting the survey questions on 3x5 cards and placing them in places where there are waiting rooms, such as community clinics that will allow you to leave a dropbox. This way, people could fill out answers while they were waiting to be seen. This has shown to be a good way to engage people who are not internet savvy, who prefer to do things in a handwritten format, and particularly “elder” populations.
During COVID, as these surveys are being conducted online, it’s been critical to find a community connector who has a large personal Rolodex - someone who can connect with members of their community and who will share the survey or reach out with a phone call to encourage participation. This can be a business leader with a larger number of employees. This strategy can be particularly important in rural communities.
A simple email often doesn’t work. The deeper you want to go into your community, the more important a community connector becomes. This is someone who may be able to go door to door, make street-level connections, or attend community gatherings where face-to-face interaction is possible.
Posting a link to the survey in places where there are community computers can be a smart strategy as well. When someone logs into those computers, there can be an icon for the survey so that community members can easily and directly access the survey. It provides a reminder, encouragement, and invitation for people to fill out the survey. This provides a way to engage people who may not otherwise think about filling out a community survey.
In summary, here are some of our top recommendations for getting more people to fill out a community survey:
- Make a personal connection through community connectors
- Get “on the ground” with people in the community, potentially at a community gathering
- Consider going door to door to ask survey questions
- Make it easy by putting links in public places where people have access to computers
Question 2: How do you feel about incentives for completing a survey? Especially with virtual surveys?
Incentives can be great motivators! Consider how much time you are asking of someone for their participation. If it’s more than an hour, then incentives as simple as food or a gift card as a thank you can go a long way. If it’s for a very short amount of time, less than half an hour, an incentive can still be motivating. You’re still asking someone to take time out of their day, often driving to your survey location. So it helps to reward their effort.
Most people do care and feel a sense of obligation. They want to participate to support and improve their community. There’s a natural desire to gather and discuss the issues that concern them. But even still, incentives can be the extra encouragement that secures their participation, especially when you’re asking for a lot of their time.
Question 3: In today’s pandemic world, how is indigenous community data being collected? What approaches are being used to assess capacity and readiness within these communities?
The community needs assessment process has been happening for more than 20 years. Public health departments have been doing community assessments long before it was mandated by the government to do so. Because of that, most CHNA facilitators know how to reach out to and collect information from hard to reach groups. Whether they are indigenous groups or other special populations within a community, in most cases, that data is being collected in the same way as it was before the pandemic. One consideration is to not get too granular with the data you collect from these often smaller groups, as that could make it possible to identify a specific person with a specific disease.
While there’s no unique process for connecting with these segments of the population, it can be helpful to review the suggestions outlined in response to question number one, as they would be applicable here as well. Additionally, you could:
- Host a listening session in their native language
- Find a facilitator or community partner who has access to a language line or language services
- Identify someone who can translate a community listening session
- These community sessions are key opportunities to offer incentives. Hosting them during a lunch hour, where food is provided, can lead to a greater turnout.
- Listening sessions can be a great opportunity to hear directly from the community and can lead to intelligence gathering that would otherwise be missed.
Question 4: What are some examples of best practices for getting a Community Health Improvement Plan (CHIP) moving forward and how can you best track progress?
Every small step that can be made in the direction of community health improvement is valuable. A CHIP provides a way to track and measure whether or not your CHNAs are moving the needle and making an impact on your community’s health.
Determining your metrics and how you will measure progress is key. Start listing goals, identify a strategy lead, build program outputs and outcomes so you have a starting point to identify whether or not you’re seeing change. Starting with something as simple as keeping meeting agendas and minutes can be a small way to start building momentum and tracking movement in the right direction. Keep a “progress, not perfection,” mindset as you go.
It is critical that implementers are identified during the community health summit, and dates are set before the summit is over, for follow-up meetings to begin the tracking process. A clear delineation of who is in charge of tracking efforts is a must. One scenario that’s proven to be successful is for a hospital to work with their local health department to have their community health council be the lead in coordinating implementation. From there, the hospital can work alongside the health council to support and bolster implementation efforts. This keeps the work focused in the community and not just in the hospital.
If you’re just starting the process of tracking, look for examples of what’s already out there and build upon the work of someone who has already begun this work. The Catholic Healthcare Association website, for example, has some great resources for tracking.
Another great resource is Bill Barberg and his company, Insight Formation Inc. When the community assessment process began many years ago, Bill was a pioneer in developing a tool that embraces collective impact, each agency’s commitment or responsibility, how everything fits together to align with the mission and vision, and tracks overall CHIP implementation. Over the years, Bill and his company have worked to improve and perfect their process for tracking a CHIP. They now offer free webinars and collective impact tools which are extremely helpful.
Question 5: Can you provide any tips for connecting with health facilities for focus groups in the virtual world?
For starters, check out our related blog: How to Conduct a Virtual CHNA. Stratasan has worked with several hospitals recently to do completely virtual CHNAs, so we know it can be done! It may not be the ideal situation, but it is doable.
Some key tips for completing a CHNA virtually:
- Conducting interviews is still important, but when doing them virtually, you’ll want to do them with smaller groups for better interaction and communication. Keep these to 30 minutes each, or possibly up to an hour with a small group of 3-4 people.
- Similarly, consider having a virtual Community Health Summit, rather than the typical in-person event. This meeting is an opportunity to present all the data collected to the community (secondary data, primary data, survey results, and focus group results) so they can hear firsthand what insights were collected. This also gives the community members the opportunity to prioritize which health needs should be addressed.
- Small breakout groups with community members for future planning and implementation may still be best facilitated in person, with proper COVID protocols in place (as needed). An alternative option would be to use Zoom breakout rooms for these conversations.
- Consider something like Padlet, an online tool that simulates a virtual post-it note exercise, for some of these interactive conversations.
Question 6: What are some strategies for effective community engagement to get the most diverse range of survey responses and participation?
Utilize a community connector, particularly someone at a community organization who may be connected to people of color, a Latin chamber of commerce, or a similar group where you can get the survey transmitted to the widest group possible. This can be a low effort, high results strategy for tapping into a large range of minority groups.
Another idea to consider (if you have the time and capacity to make it happen) is to stagger methodologies so you can know where your gaps are. For example, send the online survey first, review the demographic data coming back from that survey, and then based on those results, pivot your next attempt to connect with groups who were not reached through the online approach.
Also, always find opportunities for direct connection with the community - go where they gather and where they are comfortable. Remember, this can be different for different groups!
Question 7: What are some tactics/success stories in engaging the community around the implementation plan?
If you have a public health consult, or a large collaborative group in your community who is helping with the implementation plan, make sure this group is diverse and representative of your community. Be thoughtful about who is part of this group, ensuring the right people from the right organizations are included. It’s important for the members of your implementation team to be engaged in this effort and energized around the work that needs to be done. This work can be hard work and you may not see progress right away. It’s key to have people involved who are passionate about staying the course for the long haul. Having short-term goals (alongside your long-term goals) will enable your implementation team to see progress and feel like the work they are doing is making an impact.
Question 8: What are some strategies for tracking and reporting on progress over the next three years?
Measuring and tracking are so important, especially in order to show progress and to keep people energized around your priorities. The key is to have goals and measures, both short-term and long-term. You can gather these measurements by hand, or find tools, referenced earlier in this post, that can help you collect, track, and measure your data.
But, if you don’t have access to these tools discussed, don’t hesitate to use something like Excel. Report into this file every month your notes of how many people you saw and what was accomplished. Then be sure to share it across your organization to keep everyone in the loop. What is used to track progress is not as important as simply ensuring that a tracking system is in place. Just start somewhere!
Another consideration - make it as easy as possible for the community members on the Health Council to get their work done at the Council meetings. Commit a small portion of each Council meeting to break out into work groups to get updates about what progress is happening. Doing this can make things even easier for the community members.
Question 9: Who should be involved in the implementation planning group to discuss and inform initiatives?
The summit is the best time to kick off implementation planning. Make sure that the community summit includes a wide representation of the members of your community. There needs to be policymakers, decision-makers, people who will allocate resources and be supportive of this work. You need people who are willing and able to do the work themselves, or who can identify people in their organizations who have the capacity to help with implementation. Make sure you have a lead person responsible to follow up on each priority. Spread the responsibilities and get commitments from several different stakeholders. The summit is a key time to get this buy-in from your community and to ensure the right people are in the loop.
Question 10: Are professionals part of a summit, or only community members?
Both! Professionals, physicians, hospitals employees, and health department employees can and often do attend. The public is invited, but often not many will come unless they are stakeholders or somehow invested in this discussion. Leaders from non-profits, government representatives, public safety officials, fire and police department representatives, and church leaders are typically who attend.
How many will attend? It ranges! We’ve hosted summits that had 150 people and others that had 30. The same kinds of people who you invited to your focus groups/or who you sent surveys to are the same people who you’ll invite to your summit, there will just be a larger group at the summit.
Ultimately, there is usually a core group of people who should be at the summit - the ones who will resource the issues or have a stake in different programs that are impacted. Just ensure you get a good sampling of the different groups/people in your community.
Question 11: Tips for making the CHNA report digestible, accessible, and understandable by everyone - not just the professionals who create the document.
This is critical and so important. Community members should be able to pick it up and read it. Including an executive summary can be helpful - something that provides an “at a glance” summary of what the full report includes. Also, plan to include more visuals and infographics that can be easier to review and understand.
Question 12: What’s the reimbursement outlook for telehealth?
This is a tough one! But likely, it depends on what CMS continues to do in the future. If CMS continues to pay for it, then insurance companies will too, and hospitals will continue to provide it on a larger scale. As CMS goes, so go the payers.
If CMS and health plans do continue to reimburse, then it could be hard to go back to life before telehealth.
Question 13: If you work with the health department, can the hospital have the same community health improvement plan?
The short answer is yes. Each organization may personalize it a bit (giving it a new cover, for instance), but all partners can be acknowledged and work from the same document.
Going about it this way can allow several hospitals to meet the IRS requirement. It often will also be a catalyst for a group of traditionally competitive hospitals to work together as collaborative partners.
In summary, here are some key points to keep in mind and you work to complete your next CHNA:
- Identifying someone who will take the lead on each of your initiatives is key to ensuring that change does indeed happen based on your CHNA findings.
- Collaboration with your community is also so important to actually make a difference.
- Finally, consider using a consultant to help you execute and complete your CHNA. This is an activity you complete only every three years, so you likely don’t need an expert on staff at all times for something you do so infrequently. It may be the better strategy to bring in help for this! That way, your internal resources can stay focused on what they do every day - helping the community.
If your team would like to engage with Stratasan in completing your next CHNA, please let us know! Contact me, Lee Ann Lambdin, directly at email@example.com or call 615-310-8244.
About our Panelists
Thank you to these panelists, who provided detailed, thoughtful questions to each of these CHNA questions!
Lee Ann Lambdin, SVP Healthcare Strategy at Stratasan, with 30 years in healthcare strategic planning and 10 years working on community health assessments. Her previous experience working for large health systems and critical access hospitals.
Stephanie Bailey, MD, CEO and founder of the Coursey Institute, an enterprise focusing on translating public health skillsets to everyone in transformative leadership. Before this, she has held numerous leadership roles, including Senior Associate Dean for Public Health Practice at Meharry Medical College, Dean of the College of Health and Science at TSU, Chief of Public Health Practice at the CDC in Atlanta, Director of Health for the City of Nashville/Davidson County.
Amanda Ables, Community Health and Benefits Manager for Ascension Tennessee hospitals. Her previous experience was with the Metro Nashville Health Department in the Population Health bureau on CHNA and CHIP-related work.
Carol Quest, Health Officer/Director of the Watertown Department of Public Health in Watertown, WI. She has more than 20 years of experience as the director of a health department and collaborates with two hospitals in her area on CHNAs.