Community Engagement in Nonprofit Hospital Community Health Needs Assessments and Implementation Plans

Abstract

Context: Nonprofit hospitals are required to provide community benefits in exchange for their tax-exempt status. This includes a community health needs assessment (CHNA) to identify community needs and an implementation plan (IP) with strategies to address top needs every 3 years. In addition, hospitals are required to engage community members in these assessments. Objective: The objective of this study was to explore community engagement and representation in CHNAs and IPs. Design: The researchers conducted a content analysis of CHNAs and IPs from a nationally representative sample of 503 nonprofit hospitals between 2018 and 2021. Main Outcome Measures: For CHNAs, a coding sheet was used to record the types of community members engaged by hospitals. For IPs, the team coded whether community engagement was reported at all and then performed an in-depth analysis to identify categories of community members, engagement methods used, and roles of community input. Finally, frequencies of categories across IPs were quantified. Results: Eighty-nine percent of hospitals (n = 449) engaged community members in their CHNA, but only 14% (n = 71) engaged community members in their IP. An in-depth look at these IPs found that hospitals engaged underserved/minority populations, low-income populations, high school students, public health experts, and stakeholder organizations. Community members were involved in multiple steps, including brainstorming ideas, narrowing down needs, developing strategies, and reacting to proposed strategies. Conclusions: Although IPs are intended to benefit the community, there is a lack of community involvement reported in IPs. Hospitals may need incentives, resources, and personnel support to ensure representation of community members throughout the entire CHNA and IP process.

An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments

“…Greater collaboration can promote greater efficiencies ( 12 ), increase hospital spending on community benefit activities ( 13 ), encourage evidence-based decision-making to address community health outcomes ( 14 ), and promote a shared understanding of community health ( 15 ). However, content analyses of CHNA and implementation plan reports reveal limited collaboration with other hospitals or public health agencies ( 16 , 17 ). This can generate duplicative data collection ( 18 ), reduce transparency ( 19 ), and foster misalignment with other community health activities ( 20 ).…”

“…At the same time, hospital leaders had limited experience with community health assessments prior to the ACA (10), and some report up to tens of thousands of hours of personnel time to comply with existing guidelines (11). Greater collaboration can promote greater efficiencies (12), increase hospital spending on community benefit activities (13), encourage evidence-based decision-making to address community health outcomes (14), and promote a shared understanding of community health (15). However, content analyses of CHNA and implementation plan reports reveal limited collaboration with other hospitals or public health agencies (16,17).…”

“…1115 waiver programs provide states with considerable flexibility to pursue fiscally conservative policies, such as imposing restrictions on Medicaid recipients and encouraging the purchase of private plans through managed care organizations (47). Texas is home to the highest proportion of state Medicaid beneficiaries enrolled in managed care contracts (15). Despite active participation in the 1115 Medicaid waiver program (48), Texas is home to the largest number and percentage of uninsured residents in the United States (49).…”