Community health assessments (CHAs) and Community Health Improvement Plans (CHIPs) are great first steps to improving public health and wellbeing. Updated every 3-5 years, these reports outline and represent long-term, systematic efforts to address public health problems based on key health needs identified through comprehensive data collection and analysis (CDC, 2015). Both are particularly effective at helping organizations:
- Acknowledge the importance of multisector community partnerships and collaboration
- Prioritize community needs and identify strategies likely to result in significant improvements
- Emphasize the use of community health data and metrics to inform planning
- Provide a common vision and framework for community-level improvements
Plans and reports in all their forms are important tools; they aide our memory, provide opportunities to measure execution and accountability, and act as a compass to help keep us on course. That’s why we spend so much time creating them. But not all plans are created equal or lead to demonstrable results. It’s easy to find examples of CHIPs from around the country, but why aren’t we seeing many published success stories or data demonstrating the efficacy of these plans? How can we be sure our plans will lead to clear, measurable improvements in community health? What’s the difference between a CHIP that works and a CHIP that doesn’t?
The Don’t Forget to Include This in Your Plan
One reason we may not see many success stories is that CHIPs often leave out an important distinction between different levels of responsibility (what the collaborative is responsible for vs. what each individual partner is responsible for). In any type of community initiative, we have found that when this distinction is absent, it can cause confusion, misalignment of strategies, duplication of efforts, difficulty in moving plans forward, and/or lack of measurable results. However, when acknowledged, this is a distinction that can help turn more CHIPs into success stories.
This distinction is the difference between population-level accountability/action and performance-level accountability/action.
Population-level accountability is the accountability that many different organizations and partners share in improving community-wide indicators of wellbeing. Performance-level accountability, on the other hand, is the accountability that an organization/ service-system has for improving the performance of the services and programs it offers.
Population accountability organizes our work with co-equal partners to promote community well-being. In contrast, Performance Accountability organizes our work to have the greatest impact on our customers. What we do for our customers is our contribution to community impact.
Most CHIPs do a splendid job of outlining population-level improvement strategies, but they fail to separate these strategies from organizational-level strategies, programs, and efforts. Some fail to outline organizational-level strategies at all. Take a look at the graphics below. On the left is a simplified version of the components we normally see in the traditional CHIP. On the right is a simplified version of what we think our CHIPs should look like. In many cases, the information in red is either missing entirely or mixed in with the information in green, which is where we can start to see confusion.
Traditional CHIP (Without Performance Accountability)
Overview of Population
Prioritized Focus Areas based on CHA
Indicators/ Objectives for Each Focus Area
Overarching Strategies for Improving Each Indicator
Recommended CHIP (With Performance Accountability)
Overview of Population
Prioritized Focus Areas based on CHA
Objectives/ Indicators for Each Focus Area
Strategies for Improving Each Focus Area
How Each Partner Or Group of Partners Contributes to Each Focus Area
Organizational-Level Strategies and Programs Designed to Impact Population-Level Changes
Including both types of accountability in your CHIPs can increase their efficacy in three ways: 1) Allow for more precise planning, 2) Clarify community roles, and 3) Accelerate results.
1. Clarify Roles
Separating your strategies into the appropriate accountability categories can help increase clarity in the roles of community partners, leading to more cohesion, better communication, and more fruitful community convenings. Acknowledging this separation may also reduce fear of the “blame and shame” game. This is because every partner will have a better understanding of how their (and each other partner’s “parts” (programs, service-systems and strategies) fit into the “whole” (the desired community-wide improvements).
2. Precise Planning
Distinguishing between both levels of accountability and strategy in your plan will encourage more detailed action-planning at the organizational level. Organizations will be forced to think about how their programs and day-to-day operations contribute to the overall community-wide strategy. Rather than struggling with the interpretation of vague overarching strategies (after the CHIPs are already put into effect), your organization will be better equipped to think about the specific programs and strategies needed to contribute to community improvements, which existing programs fit into this vision, and which programs may not reflect community needs identified in the CHA.
3. Accelerate Results
Community-level strategies are the first step in improving public health; they provide the aspiration and prioritization needed to guide individual actions. We cannot make clear, measurable improvements, however, without linking individual action to overarching strategy and measuring whether it’s leading to the desired results. Getting disciplined about communicating this distinction in the plan itself will help ensure everyone is on the same page and has the level of detail they need to be efficient at all levels.
- Whether you choose to include performance level action planning in your CHIP or not, continual evaluation of the entire plan is a must. Rather than updating the plan every 3-5 years, we recommend perceiving your CHIP as a “working” document. The plan is only the beginning. To see real results, you must analyze the impact of your strategies and actions on community indicators of health and make alterations on a yearly or quarterly basis.
- Keep track of your population-level strategies and performance-level strategies using a performance management software like Clear Impact Scorecard. Using an online dashboard will allow you to make real-time updates and share data more easily to ensure everyone stays on track and is communicating effectively. Check out how Buncombe County uses a scorecard as part of their CHIP to track progress and share information.
- Results-Based Accountability (RBA) is a data-based decision-making framework that is being used to improve the well-being of communities and the performance of public sector organizations around the globe. Through a series of simple steps, RBA shows you how to select population indicators and performance measures, design effective improvement strategies, and engage in continual evaluation to create measurable impact. Some communities have used the framework to guide the development of their CHIPs (check out resources below).
Want to learn more? Stay Tuned for an Upcoming Ebook on Creating Effective Community Health Improvement Plans. Sign up for Our Newsletter Below to be Notified When it’s Available.
Check out these links to learn more:
Buncombe Community Health Improvement Plan (2016-2018) (an online living CHIP that uses Clear Impact Scorecard to share data and progress with the community)
San Antonio Metropolitan Health District and the Bexar County Community Health Collaborative 2017 Healthy Bexar Plan (uses Results-Based Accountability and Population vs. Performance Accountability principles)