Hospital, Health System Boards Need to Find Partners for Community Health

As health care organizations and clinicians join together to address a broader spectrum of health needs, more attention is being focused on how to improve both individual and community health. For many reasons, the American Hospital Association, the Institute of Medicine, the Robert Wood Johnson Foundation and others strongly support use of collaborative models involving multiple partners for improving community health:

• Traditional approaches that focus primarily on treating individuals are insufficient to understand and sustain the health of entire communities or patient populations.
• Concerted action is needed to address the full range of factors — behavioral, educational, environmental, genetic and socioeconomic — that affect efforts to reduce health expenditures and improve health status.
• The Triple Aim — enhancing the patient experience of care, improving the health of populations and reducing per capita health care costs — is garnering growing support as a framework for improving America’s health and health care.
• Better coordination among health care organizations, the public health community and business, education, government and other stakeholders will be necessary to achieve these aims.

Success factors

Given the complexity and magnitude of the goal, the need for multisector collaborative partnerships to improve our nation’s health is clear. However, the success of these partnerships depends on overcoming longstanding barriers to their effectiveness. For example, differences in how concepts and terminology are used have hampered communication and common understanding between the public health and health care sectors.

Today, few purchasers of hospital and medical services provide financial incentives or support for multisector collaborative initiatives for improving community health. In fact, in some states, policies and regulations impede, rather than encourage, such collaboration. In addition, definitive evidence is limited about the impact of multisector collaborative arrangements. Clearer objectives, metrics and performance evaluation are needed.

Collaborative arrangements also are challenging to build and maintain. Studies across many sectors show that about half of alliances, coalitions and partnerships in which two or more independent organizations come together voluntarily do not succeed. However, success varies depending on the extent to which these partnerships exhibit certain characteristics. When it comes to community health partnerships, these include:

• A vision and mission based on high-priority community health needs and strongly supported by the partners.
• Partners who demonstrate a culture of collaboration, mutual respect and trust.
• Clear partnership goals and objectives that are broadly communicated and firmly supported by the partners, staff and community.
• A sustainable organizational structure (corporate entity, affiliation agreement, etc.) to implement the mission and goals.
• Well-qualified, dedicated leaders who manage the partnership and its programs.
• Ongoing evaluation of performance and use of results to drive improvements.

Making headway

Hospitals and health systems are clearly positioned to provide leadership in measuring, assessing and improving community health. The following issues and questions can help executives, governance and clinical leadership teams determine how their organizations can work best with other local partners to advance community health.

What impact would a commitment to improving community health have on our organization’s mission? Hospital mission statements typically focus on improving the quality and cost of care the organization delivers. What would hospitals and systems need to do differently if their mission statements also included a commitment to improve community health? What would the implications of this commitment be for capital allocation, service delivery options, staffing and other resources? How might an organization’s work change if its stated purpose was similar to that of Portland-based MaineHealth: “MaineHealth is a not-for-profit family of leading high-quality providers and other healthcare organizations working together so their communities are the healthiest in America.”

Because no single sector can accomplish this work alone, what other organizations should we partner with to improve community health and why? Successful community health partnerships often involve hospitals and health systems, public health departments and other community health providers. Many also include schools, law enforcement agencies, food banks and other organizations that can positively affect social determinants of health, such as level of education, crime and poverty — root causes of poor health outcomes that health care organizations alone are not equipped to address.

Hospitals and health systems often serve as anchors for these partnerships, contributing funding and in-kind assistance. Genesis Health System and UnityPoint Health–Trinity do so as part of the Quad City Health Initiative, which serves a five-city metropolitan area in Iowa and Illinois. In some communities, corporations such as Intel Corp. in Portland, Ore., and Campbell Soup Co. in Camden, N.J., also play a major role in supporting community health improvement.

What implications would committing to community health improvement have for our governing board’s structure and function? Some hospitals have established board community health improvement committees to coordinate oversight of such activities as community benefit and use of results from community health needs assessments. Other hospitals are spending more time on strategy development and planning that focuses beyond internal quality improvement and growth to include community health. Metrics to assess progress also are becoming part of some hospital and health system performance scorecards.

How can our health care organization’s board demonstrate to stakeholders its accountability for improving community health? Boards can play a key role in encouraging their organizations’ participation in multisector partnerships; ensuring the hospital collaborates with other community partners in conducting a community health needs assessment and using results to set priorities to improve community health; helping convene and engage stakeholders; and encouraging development of impact statements and performance metrics to show the results of partnership work.

As health policy expert Alan Weil recently stated: “What does it take to harness community resources to overcome poor health outcomes? In a word: collaboration.” Hospital and health system board members and leaders who tap into the power of collaboration with other community partners can play a key role in improving community health — the next frontier for health care governance and leadership. 

Lawrence Prybil, Ph.D. (lpr224@uky.edu), is Norton Professor in Healthcare Leadership, College of Public Health, at the University of Kentucky. Mary K. Totten (marykaytotten@gmail.com) is senior consultant for content development at AHA’s Center for Healthcare Governance.