Community health improvement is an ongoing process, and hospital trustees can play a crucial role. The community health assessment is a method used by hospitals, public health departments and other social services agencies to identify and prioritize community health needs and assets and then use the information to implement an improvement plan.

An updated toolkit from the Association for Community Health Improvement, a personal membership group of the American Hospital Association, outlines a nine-step pathway for conducting a community-engaged CHA and comprehensive implementation strategies. Trustees are key stakeholders who can be engaged throughout the process.

Looking at past assessments

Reflecting on the process of previous assessments allows CHA developers to build on strengths and address any weaknesses. Strategic questions for trustees to consider include:

  • What elements of our assessment worked well? What elements would we do differently?
  • Did the implementation strategies achieve their intended impact? Why or why not?
  • How involved was the community in developing and implementing the health improvement strategies?
  • How involved was the hospital board in the CHA process? In what ways could we, as trustees, augment our role in the process?
  • Are there additional stakeholders with whom we could partner?

It is important to gather feedback from external stakeholders — including individuals, organizations and agencies in the community — and internal stakeholders from across the hospital or health system about the previous CHA process. A strong CHA foundation generally includes buy-in from key organizational leaders, financial support, an active and committed assessment advisory committee and a framework that includes preliminary agreement about purpose, scope and time frame. Hospital trustees can help leverage the organization’s internal resources to support the process.

Prioritizing community health

A key component of the CHA is selecting community health priorities. Throughout this step of the process, trustees should participate in discussing the data collected, review community assets, and build consensus around priority health needs. Trustees and senior leaders also should make sure these community health priorities and the hospital’s population health strategy are aligned.

Developing comprehensive strategies

Once health needs are prioritized, hospitals need to identify and implement strategies to address them. A comprehensive strategy should address the determinants of each health need, such as improved access to care and chronic disease management. It should also address the social determinants of the priority need, such as poverty, education and community safety.

This calls for thinking about the big picture of health and the hospital’s or health system’s role in improving it. Trustees can help develop a comprehensive approach that includes multiple strategies, settings, targets and methods to address medical and nonmedical factors.

To support the entire community health assessment process, trustees can:

  • Lend their names to increase the credibility of the project.
  • Commit resources, including funding and staff support.
  • Attract potential assessment partners or external funding sources.
  • Help overcome any roadblocks that emerge along the way.
  • Champion the project among policymakers and elected officials.

As hospitals and health systems continue to refine their population health strategies to address clinical and social needs, trustee engagement in the CHA is vital to making progress.

The ACHI Community Health Assessment Toolkit is available here.

Julia J. Resnick, M.P.H. (, and Katya Seligman, M.P.H. (, are senior program managers at the Health Research & Educational Trust.