Quality Update
The Ripple Effect
By Jennifer Towne
Do community health initiatives that target women who live in underserved populations have an impact on the overall health of a community? It’s the type of question that hospital trustees confront each time they are asked to budget for a community benefit program.
Hospital-sponsored community benefit programs are designed to meet the critical needs of the community, improve health status and reduce disparities among particular subgroups. This is the definition of equity—one of the six Institutes of Medicine (IOM) goals for quality health care.
Unfortunately, hospitals are highlighted more for error rates and confusing collection practices than programs that further community health. And, as health care costs increase, the numbers of the uninsured and underinsured grow, and budgets get slashed, hospitals trustees are being asked to provide larger benefits to their communities with less available money while also being required to justify the expense in accordance with revisions to IRS Form 990. On what then, do boards base their decisions about how to allocate the organization’s limited funds?
“The long-term value of community programs may be murky,” says Larry Walker, president of The Walker Company, Lake Oswego, Ore. “Not only is it is hard to attach a dollar amount to the true value of a program, but it is also hard to determine how or even if prevention education saves future health care dollars,” he says.
“The No. 1 challenge to hospital boards is how to measure and communicate [community benefit],” says Sue Ellen Wagner, vice president of community health for the Healthcare Association of New York State and executive director of Healthcare Trustees of New York State in Rensselaer.
Measuring up
The IOM Report, “Crossing the Quality Chasm,” says that quality of care is severely hampered by lack of access to care. Hospitals are working with their communities to help them determine unmet health care needs, develop programs to fill gaps, and enable access to those programs. Community benefit is obviously going to be different for every hospital. “It is a unique opportunity for every hospital board with its [administrative] leadership team to ask, ‘What does our community need, what does it value, and where can we make a difference?’” Walker says.
Community assessments will indicate needs, but to measure the impact of efforts to meet those needs, hospital trustees must have a longer-range perspective. For example, what impact does a particular program have on crime or education, and what is its long-term economic value to the business community? “Measuring the impact is not easy and won’t happen unless trustees believe in the benefit,” says Walker. “Health care providers do more than provide health care services. They are really a broad fabric in the community.”
Communicating Up
In the face of this, it seems like hospitals are getting beaten up more and more in the media for one thing or another. “Hospital leaders just don’t tell [their community benefit] story enough,” Walker says. He suggests crafting a message and then making sure that everyone in the hospital family—employees, physicians and volunteers—are aware of it. “It will spread like wildfire,” he says.
Don Paxon, a trustee of Graham County Hospital, Hill City, Kan., agrees. “Employees are the most important conveyors of our message,” he says. In the hospital service area, informing employees goes a long way toward getting out the community benefit message.
“Trustees are the ambassadors to the community,” says Jeff Bowman, chair of the board of trustees at Scripps Health in San Diego. Scripps details the amount of uncompensated care, community programs and education and research it provides on its Web site and in its annual report. “The hospital has a tremendous reputation for providing care and benefits to the community,” Bowman says.
Other hospital trustees are using more traditional forms of communication, including mailings and other publications, television and radio ads and meetings with community leaders. Kittitas Valley Community Hospital (KVCH), Ellensburg, Wash., holds regular town hall-style meetings. For the past five years, the hospital has held dinners for 15 to 20 community leaders. First comes a hospital tour, then dinner and a series of introductions and reports from a trustee, the director of medical affairs, the CEO and the CFO. Clinical quality, financial challenges, strategy, growth and community outreach are addressed. “Many in the community don’t have a full grasp on the hospital’s contributions to the community,” says Joan Baird Glover, board of commissioners for KVCH. “These roundtables instill a great sense of ownership.”
Glover says that while the dinner/roundtables are time-consuming for the staff and trustees, they do not require much money and reaches community leaders on a personal level. They are worth the investment, she says.
Many hospitals focus on medical care and education programs. “We provide primary care services to our community, such as physician clinics,” says Shelia Fraham, vice chair of the public 25-bed critical access hospital Citizens Medical Center Inc., in Colby, Kan. The hospital experienced a 32 percent increase in uncompensated care in one year’s time due to patients choosing high-deductable/large co-pay insurance policies or not being able to afford insurance. Fraham thinks that Citizens is differently invested in its community than are hospitals in a larger or more competitive market. “We would like our hospital to be the go-to place for all health information,” she says. “We put a lot back into the community.”
Still, many of Citizens’ trustees are worried that the public doesn’t have enough information about the benefits of hospital-based community programs. “Our citizenry assumes that this [hospital care] is going to happen,” says Fraham. “We must educate the public on the extent of our services and the costs associated [with them].”—This article was provided on behalf of the AHA Quality Center, a resource designed to help hospitals accelerate their quality and performance improvement processes. Tools and articles about equity in care are available at www.ahaqualitycenter.org.
This article 1st appeared in the March 2008 issue of Trustee Magazine.
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