On October 5, 2018, Danelle Marable, GBEN President and Senior Director for Evaluation, Assessments, and Coalitions at the Massachusetts General Hospital Center for Community Health Improvement (MGH/ICHI), discussed two community health needs assessments that her team is working on: 

In 2011, the Affordable Care Act required every hospital to conduct a community health needs assessment (CHNA), develop strategic plans, and post findings to the public.  Non-profit status would be revoked if the CHNA was not conducted.

A CHNA is a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. The goal of a CHNA is to develop strategies to address the community’s health needs and identified issues.  A CHNA is instrumental in identifying the social and environmental conditions as well as social determinants that can impact the health of these communities, such as childhood experiences, housing, income, employment, healthcare, community.  MGH identified Revere, Chelsea, Charlestown and Winthrop as primary communities to target with CHNA and a community health improvement plan (CHIP).

During the roundtable, Danelle discussed the process around the assessments, community engagement strategies, data collection efforts, and implementation. 

Process

The CHNA and CHIP is a year-long process that occurs every three years.   MGH uses the MAPP Framework (Mobilizing for Action Planning and Partnerships) for the CHNA and CHIP that in short outlines a process of engaging partners in comprehensive data collection and strategic. MGH/ICHI dedicates one year for visioning, assessment, and identification of strategic issues and then their Board of Trustees reviews and grants approval, then allowing for 100 days to develop an implementation plan. The MGH Trustees are required in MA to go to community advisory committee meetings in addition to other meetings.         

Community Engagement and Needs Assessment

MGH/ICHI engages multiple sectors during the CHNA process:  resident, local leaders, community-based organizations, educators, as well as other hospitals in the communities.  MGH/ICHI started engaging other hospitals so they don’t burden the community with repeated data collection.  Assessment and identification of needs can be a challenge as prioritization is not always straightforward.  For example, residents in the community of Chelsea spoke of issues of community violence and safety, but other data sources showed decreases in instances of violence in the community. 

Data Collection

Data collection for the CHNA involved survey data, focus groups, in-depth interviews, and secondary data sources, including the quality of life survey (addresses more social determinants such as housing, transportation, overall community). Surveys are translated and are distributed online and in print through various community networks.

Implementation and Evaluation

A crucial part of the process of a CHNA is the identification and implementation of evidence-based strategies around certain community needs and issues.  Part of this process involves community dialogue – asking key questions about what can be done, what resources are available, and is there the will to implement solutions.   This process not always leads to straightforward answers.  For example, communities identified opioid use as a crisis and access to Narcan as a response, however the community balked at increasing access to Narcan under the suspicion that it leads to increased opioid use.  The group had to take 3 steps back to educate the community regarding the benefits of Narcan.  Once strategies have been implemented, the final process is comprehensive progress monitoring, implementation evaluation, and impact measurement. 

Copies of Danelle’s PowerPoint slides can be found in the member roundtable resources section (members only!).  For questions, reach out to Danelle by email at: dmarable@partners.org.