There are many reasons an organization or government agency would want to conduct a Community (or State) Health Needs Assessment. Non-profit hospitals are legally required to conduct CHNAs under the Affordable Care Act. The Public Health Accreditation Board requires that CHNAs be conducted in order for health departments to become accredited. All public health organizations and agencies benefit from creating CHNAs because they help ensure strategies and programs are guided by data rather than vague assumptions.
What is an effective CHNA? An effective CHNA fosters multi-sector collaboration, sets the stage for continuous improvement, and provides the information and research needed to create a Community (or State) Health Improvement Plan (CHIP) that measurably improves health.
The following 9 steps will help you create a better CHNA that leads to a measurable impact on community health:
Define the Community
Define a large enough population for which reliable, timely data can be collected. You will also want to consider vulnerable sub-populations. For example, if you are a state, you may consider all residents of your state to be the population in question, but you may find that “children ages 0-5” or “pregnant women” are particularly vulnerable to certain health issues. Maintaining a population and sub-population chart may be useful for communicating how the backbone organization fits into the “whole” of population health. Here is an example.
Set up a Data Storage System
**This is a key step that is often absent from other advice columns.
Data is the foundation of both the CHA and CHIP planning process. Without it, we have no way to build an accurate picture of health and wellbeing in our communities. Data also tells us how well our strategies are working and how well our programs are performing. Throughout both of these processes, you’re going to be working with a lot of qualitative and quantitative data. It’s important to set up a reliable system that allows you to easily store, organize, navigate, analyze, and share both kinds of data with partners. Excel works for data storage, but it’s generally harder to organize and navigate, and mistakes often go unnoticed.
When selecting a system, make sure it allows you to connect qualitative narratives with data measures and easily share data with partners. Clear Impact Scorecard is one option to collect, manage, and share data to inform your CHNA.
Engage Stakeholders and Identify Community Assets
It is important to understand that any single organization or government agency cannot and should not be held solely responsible for the health of any population. Complex social, economic, and environmental factors are all determinants of health. This is why multi-sector engagement in the CHNA process is critical. Residents, businesses, governments, nonprofits, community leaders, and other stakeholders all have a role to play. Be sure to identify and engage partners and stakeholders early in the process to be called on to provide support, feedback, and data.
Asset Based Community Development and Collective Impact are two frameworks that can help you to identify stakeholders, identify community assets, and engage diverse participants throughout the CHNA and CHIP processes.
Engage in Comprehensive Data Collection
There are four types of data you’ll want to gather while conducting the CHNA:
- Qualitative Primary Data
- Quantitative Primary Data
- Qualitative Secondary Data
- Quantitative Secondary Data
Including partners and residents in data collection is important because they may have access to data that your organization does not currently possess. When collecting data, you should disaggregate by race, gender, or any other relevant distinction, as this will be helpful during strategy development.
County Health Rankings offers a great data collection guide here that you can use to conduct primary research. The CDC also has helpful resources for State, Local, Tribal, and Territorial health agencies.
Develop the Story Behind the Data
Data is not enough alone to develop CHNAs and CHIP strategies. You will need to consider the “why” behind the data – or the factors that have resulted in the current state of the data. Understanding this story will help ensure CHIP strategies are designed to have maximum impact. This is similar to a diagnosis from a doctor prior to treatment.
In your analysis, include positive and negative influences (contributing and limiting factors), as well as the current and anticipated impact. This is not a re-statement of the data, but a discussion about what factors are impacting the data. Consider factors of race, gender, or other relevant demographics, as certain populations are likely to be more vulnerable to health issues.
Here is a helpful article to help guide the development of your story.
Prioritize Health Issues
At this point, you’re going to have a lot of data. Prioritizing health issues will help you avoid “data overload” and bring a more focused approach to your CHIP. Some issues may be more urgent or than others. Engage partners and community members to identify what feels most urgent to them.
We recommend choosing no more than three to five priorities to focus on within one community health improvement process cycle. This will help increase focus, maximize impact, and create alignment. If you’re having trouble figuring out how to prioritize health issues, NACCHO created this useful tip sheet.
Create a First Draft, Gather Feedback, and Make Edits
We say, the simpler the better! Draft your CHNA so that it’s easy to navigate, easy to organize, and easy to share with stakeholders and the public. One method for doing this is to create your CHNA in an electronic format (in lieu of or in addition to a paper-based document). Ideally, if you’re following our advice, you should’ve already set up a data management system that can double as a CHNA report. To learn more about the benefits of creating your CHNA and CHIP in an electronic format, check out our e-book, e-CHIPs do it Better: the Benefits of Automating Your CHA and CHIP.
Here is an example of an electronic CHNA that Swain County, North Carolina has shared with the public. *Tip: Click on the “+” next to each measure to see its graph.
Create Your CHIP
Once you’ve gathered your data, prioritized health issues, and finalized your CHIP, it’s time to work on creating strategies to improve those issues. Strategies should reflect the “story behind the data” developed in step 4 and consider the availability of resources, level of expected impact, and any disparities in sub-populations. There are two types of strategies you and your partners should create as part of the improvement process:
It is important to remember that strategies at the community level are shared strategies. Therefore, all partners should collaboratively create overarching strategies to improve each health indicator.
What we do at the organizational (or service-system) level is our contribution to community-level strategy. Partners should, therefore, develop organizational-level strategies and programs designed to achieve the community-level strategy. For the sake of brevity, you may only want to include a summary of these strategies in the CHNA.
You can learn more about this process in our blog here.
Engage in Continuous Improvement
Things don’t always go as planned. CHIP Strategies may not have the intended impact, resource availability may change, and/or new research can yield useful insights. Urgency may shift to new and emerging issues. This is why continual evaluation of the CHNA and CHIP should occur.
Readjust your community-level strategies and organizational-level strategies yearly to ensure they align with community health data, program performance data, and any other relevant discoveries. Make changes where necessary and focus resources on strategies that are working.
Stay tuned for our upcoming e-book on creating better CHNAs! Sign up for our newsletter below to be notified when it’s ready.