Creating an effective CHIP is all about being a great “health detective”, digging deep into root causes, creating appropriate strategies with a reasoned chance of improving things, and getting serious about continuous improvement. By following the recommended steps below, we’ll help you get on the fast track to measurable health improvements.

Some of these steps will be completed simultaneously, but all are critical parts of the process. Be sure to document your efforts throughout the process so that you have all the information you need when it’s time to publish your CHIP and share it with the world.

1. Implement a Data Management System

Data is the foundation of both the CHA and CHIP planning process. Without it, we have no way to build an accurate picture of conditions of health 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, so it’s important to set up a reliable system that allows you to easily store, organize, analyze, and share both kinds of data with partners. When done effectively, you can actually use your data management system to document the whole planning process and create an electronic version of your final CHIP. Clear Impact Scorecard is one option that can help you do this.

2. Complete Community Health Assessment

What type of community do you want to live in? You can’t plan your journey if you don’t know where you’re going. Take a look at the state of health in your community. Do research. Ask questions. What do community members want? What needs to change? What type of assets do you have access to and which ones do you need to develop? What seems to be the most troubling or pressing health issues? Make sure you disaggregate the data to see if there are inequities. You can gather all of this data a variety of ways, including through surveys, interviews, focus groups, primary quantitative sources, and secondary quantitative sources. If you’re looking for data, the CDC has a lot of helpful resources for State, Local, Tribal, and Territorial health professionals.

3. Identify and Engage Partners

You probably already engaged some partners in step two. Think about who else might have a role to play in improving your state, neighborhood, or community’s health. It is important to think “outside the box” when considering partners. Consider the role that different industries play in community health and how you can engage them. Consider engaging leaders in business, nonprofits, foundations, local government, faith-based institutions, financial institutions, community groups, schools, and others. Don’t forget to include the individual community members you are serving. Once you have enlisted partners, the following steps should be completed collaboratively whenever possible to ensure alignment and clarity of roles.

4. Develop Results Statements

Develop some results statements that describe how you want your community to look. These statements should be clear, concise, and written in language that anyone can understand. Maybe you want “Natural environments are clean and safe.” Maybe you want “Babies are born healthy.” Collaborate on these and write them down – this is the vision that is going to guide you through the rest of the process.

5. Prioritize Issues

In this step, you’re going to use the knowledge gained through the CHA process, as well as the collective knowledge of the collaborative, to prioritize health issues to bring a more focused approach to the improvement plan. According to the National Association of County and City Health Officials, prioritization helps communities focus on key issues in order to maximize impact and use their resources as efficiently as possible. It is generally recommended that a community choose no more than three to five priorities to focus on within one community health improvement process cycle. This will increase focus, maximize impact, and create alignment of individual action against community goals. If you’re having trouble figuring out how to prioritize your health issues, NACCHO created this useful tip sheet.

6. Define Indicators

How are you going to determine if your priority areas are improving? Develop some measures for each priority area. If one of your priorities is to reduce underage drinking, then  you might want to measure the “number of 13-20 year olds reporting that they’ve consumed alcohol in the last 60 days.” Develop 1 to 3 Indicators for each of your 3 to 5 focus areas.

7. Create Population-Level Strategies

Create overarching strategies to improve each Indicator. It is important to remember that strategies at the community level are shared strategies. The “Turn the Curve” thinking process is a simple 5-step process that can be used to create effective strategies to improve your Indicators. It consists of: 1) graphing a baseline for your Indicator, 2) developing the “Story behind the Baseline,” 3) Selecting Relevant Partners, 4) Exploring “What Works” to Turn the Curve, and 5) Developing an Action Plan. This process forces you to dive deep into the factors that are influencing health conditions in your community so that you can create strategies and action-plans that get results. Read our webpage here to learn more about the  Turn the Curve Process.

8. Partners Create Organizational-Level Strategies (Programs, Services, etc.)

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 example, if one of the focus areas determined in step 4 is “Cancer Reduction,” you or one of your partners may develop a cancer-screening program. This organization should “own” the implementation and performance of the program.

Traditionally, this step might be considered a part of the “quality improvement” planning process. Quality improvement planning is normally separate from community health improvement planning. We believe that these processes should be developed in tandem as part of a comprehensive health improvement strategy. Quality improvement planning will, for the most part, be an individual-level activity, but it is important to ensure that partners are on the same page BEFORE they engage in quality improvement. In other words, you and your partners should determine what programs are “appropriate” BEFORE figuring out how to improve those programs. Determining what programs are “appropriate” should stem from collaborative conversations that take place during community-level strategizing. That’s why we recommend including organizational-level strategy in your CHIP. You don’t need to include quality improvement plans themselves in the CHIP, but a general overview of each partner’s contributions (programs, strategies, actions) should be provided.

Make sure each partner understands the difference between community-level strategy and organizational-level strategy. If you’re having trouble understanding, read this.

9. Partners Define Performance Measures

How will you know if the community members served by each organization are better off? Each organization should create measures designed to evaluate the effectiveness of each program or service they are responsible for implementing. This is how they will communicate individual contributions to community well-being. If one partner’s program is designed to reduce tobacco usage, they may want to measure “% of enrollees who successfully quit using tobacco at a 7-month follow-up.” The most important performance measures are measures that tell us whether our customers are “better off” and a result of our programs and services. For more information on selecting effective performance measures, visit our website here.

10. Continually Evaluate Progress on Indicators and Performance Measures and Hold Community Convenings

Things don’t always go as planned. Strategies may not have the intended impact, resource availability may change, and/or new research can yield useful insights. This is why continual evaluation of the plan should occur. Regularly convene your partners to assess the state of community health Indicators. Go through the Turn the Curve Process to evaluate the state of each Indicator.

Organizations should also independently evaluate, using the Turn the Curve Process, their owned performance measures to assess program quality and impact. This information should be shared at community convenings.

The evaluation process should be an ongoing, iterative process at the community and organizational levels. That’s because our work to improve our communities is never done.

**Emphasis on Continuous Improvement

Throughout this process, you should continually readjust community-level strategies and organizational-level strategies 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.

Community health assessments and improvement planning should be a continual process. Revisiting plans every 3 years does not produce the data accuracy that is necessary for continual evaluation. Go through this process every year at the very least.

Community Health Improvement Plan

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