Community Health Improvement Plans are important tools; they act as communication tools, 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. What’s the difference between a CHIP that works and a CHIP that doesn’t?

Some CHIPs don’t work because they don’t acknowledge 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 lack of measurable results.

You can help turn your CHIP into a success story by ensuring that you delegate responsibilities appropriately and acknowledge this critical distinction:

Population-level accountability/action Vs. Performance-level accountability/action

Population-level accountability is the accountability that many different organizations and partners share in improving the well-being of whole populations (eg. all children in Texas, all families in South Africa, all mothers in the City of Baltimore, etc.). Population accountability is bigger than any one program or agency or one level of government. In fact, it’s bigger than government. It requires the whole community, public and private partners to make a difference.

For example, in the case of “healthy children,” it is common for this responsibility to be pinned on just one department – the Health Department. But when we think about all the factors that influence a child’s health over their lifetime, it becomes obvious that the Health Department can’t do it alone (“it takes a village to raise a child”). The Health Department should, perhaps, take the lead in convening the partners (around a table), and organizing the process, but cannot assume full responsibility.

Performance-level accountability is the accountability that an organization/ service-system has for implementing and improving the performance of the services and programs it offers.

Programs and agencies serve client and customer groups that are (almost always) less than the total population.  It is possible to identify agency and program managers who can be held formally responsible for the performance of that program or agency.

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 outline 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 a CHIPs might look like if it included performance-level strategies.

Benefits of Including Both Types of Strategies:

Acknowledging the distinction between population-level strategy and performance-level strategy in your CHIP will help:

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.

Sample Strategies

Here’s an example of a population-level strategy that you may outline in your CHIP and examples of performance-level strategies that 3 different organizations might engage in as part of this overarching effort. In some cases, these are real strategies being employed by communities and organizations around the world.

Population-level strategy (Everyone is collectively responsible for this): Increase access to healthful foods

Performance-level strategy 1 (School District A): Apply for a Farm to School Grant from the USDA to help fund partnerships between local farmers and schools.

Performance-level strategy 2 (School District A): Train teachers and school administrators on healthy eating and nutrition—and address how these topics can be incorporated into school curricula.

Performance-level strategy 1 (Local Grocery Store B): Educate the community on healthy food options by sponsoring a bi-annual healthy food festival that showcases local food producers and healthy products carried in the store

Performance-level strategy 2 (Local Grocery Store B): launch an in-store rewards program to encourage the purchase of healthy foods where shoppers receive points for discounts on healthy food items and health services.

Performance-level strategy 1 (Organization C): Work with local food system and grocery stores to create a “food prescription” programs that provide vouchers for fruits and vegetables

Performance-level strategy 2 (Organization C): Create a healthy foods task force in your own hospital. Explore ways to promote healthier diets with employees, patients, visitors and the community.