Cook, David C. PhD; Nelson, Eve-Lynn PhD; Ast, Cori; Lillis, Teresa MA
Academic institutions across the nation are increasingly adopting a framework of community engagement so that academic–community partnerships can expand to address pressing economic and social challenges, including health-related issues central to academic health centers (AHCs).1 For strategic planning purposes, community engagement is broadly defined as “the collaboration between institutions of higher education and their larger communities (local, regional/state, national, global) for the mutually beneficial exchange of knowledge and resources in a context of partnership and reciprocity.”2 Community engagement cuts across the AHC’s mission—It is a mode of teaching, a method of research, an approach to clinical care, and a form of service that values teamwork between the institution and the communities.3
Consistent with the community engagement framework, adopting a community-focused mission helps ensure that an AHC provides direct benefit to citizens in the form of improved health while remaining true to its core research, education, and patient care responsibilities. A community-focused mission is particularly critical for public AHCs, which must be responsive to the interests of community members and elected officials or risk loss of public funding. In this case study, we describe the strategic planning process that was used to enhance and broaden the University of Kansas Medical Center’s (KUMC) community-focused mission. Here, we outline the planning process, implementation, and lessons learned from strategic planning around community engagement.
The Strategic Planning Process
KUMC is an AHC consisting of three separate schools—the School of Medicine, School of Nursing, and School of Health Professions—with 777 full-time faculty who educate more than 2,000 undergraduate and graduate students annually. It is located on the main campus in Kansas City, Kansas, along with the University of Kansas Hospital, but each organization operates independently. KUMC also has two satellite campuses with four-year medical education programs, one located in a major metropolitan area in southeast Kansas and the other located in a small town in the central part of the state.
As the only medical school in a predominantly rural state, KUMC has a long history of developing community-focused initiatives to enhance the health of Kansans in rural and underserved areas. However, these community-engaged activities were highly fragmented across KUMC schools, departments, centers, and campuses. KUMC operated an Office of Outreach, which was established in 2002, but the office had limited authority for tracking, coordinating, integrating, and creating efficiencies in institutional initiatives that addressed community needs. The Office of Outreach provided oversight for KUMC’s four Area Health Education Center locations, KU Center for Telemedicine and Telehealth, KUMC Continuing Education, and Rural Health Education and Services, a KUMC department designed to address health care workforce issues in rural Kansas. Although these departments had been organized to achieve economies of scale and were reaching more than 30,000 Kansans each year, many other KUMC community engagement activities remained outside the scope of the Office of Outreach. These activities included statewide work with select minority populations, several community-focused research centers, a majority of clinical department outreach, and a variety of health career pipeline development initiatives. Furthermore, the Office of Outreach was designed with a service orientation model, without an emphasis on scholarship.
Strategic planning process
With support from the executive vice chancellor (EVC), the assistant vice chancellor for outreach chaired a 15-member strategic planning committee with representatives from KUMC departments, schools, and campuses, as well as the hospital and physician practice plan. Because of the extreme internal fragmentation of community engagement and outreach at the time, only senior internal representatives were sought in these early strategic planning stages. This was by design, as KUMC needed to address immediate, high-level institutional issues before expanding capacity to address community-driven needs.
The strategic planning committee met on five occasions between April 1, 2010, and November 15, 2010, to address the EVC’s charges to conduct an assessment of the institution’s community engagement activities and provide recommendations for the vision, mission, organizational structure, and strategic direction of institutional community engagement based on lessons learned from the assessment. The KUMC strategic planning process for community engagement involved three main steps: creating an inventory of all KUMC community engagement activities and initiatives, completing a situational analysis, and drafting recommendations to enhance KUMC community engagement. First, the committee undertook an assessment process to develop a comprehensive inventory of KUMC engagement activities and initiatives categorized by the four components of the mission: education, research, clinical care, and service. The community engagement inventory revealed a broad scope of activities conducted by many different individuals, departments, schools, and campuses across the institution, underscoring the fragmentation which spurred the planning process.
The inventory informed a situational analysis identifying strengths, weaknesses, opportunities, and threats (SWOT) for KUMC community engagement (see List 1). SWOT analysis is a common and effective strategic planning tool to evaluate internal capabilities (strengths or weaknesses) and external developments (opportunities or threats).4–7 The analysis led the strategic planning committee to issue pragmatic recommendations organized as broad goals with corresponding strategies.
Strategic Planning Committee Findings
The strategic planning committee summarized KUMC’s current community engagement activity into five key themes. Although the themes relate to one institution, the lessons learned from the process may inform other AHCs considering similar strategic planning efforts.
Active community engagement activities by the AHC across the state and region
Existing community engagement activities were very broad and diverse. Education opportunities included student experiences, career recruitment and pipeline development, online degree options, continuing professional education programs, and planning for creation of a school of public health. Clinical programs included rural provider recruitment activities, temporary physician coverage programs, health/wellness screenings, telemedicine clinics, and flights for clinical care. Many community health research efforts were under way, including efforts to address health disparities and equality for vulnerable populations and community engagement activities in preparation for a National Institute of Health’s Clinical and Translational Science Award (CTSA) application. Other ongoing initiatives included government relations, communications and media relations, and alumni activities.
Fragmented and duplicative activities
The community engagement inventory highlighted many duplicative initiatives of which committee members were unaware. It was acknowledged that this was a common phenomenon across the university and AHCs in general as faculty work tends to be focused and discipline-specific. The lack of coordination also put KUMC at risk for being perceived by the public as disorganized.
Ineffective informing of key stakeholders about community engagement activities
The strategic planning process revealed that most engagement efforts by faculty and administrators are driven by a particular, identified health care need, often in a rural or underserved community. KUMC’s response to this need was often considered exceptional by the community partner—providing demonstrable benefits as the communities work with faculty and staff to address the need. However, KUMC faculty and administrators frequently failed to share these success stories in any formal fashion to stakeholders beyond those directly involved. This situation was exacerbated by the fact that there was no university-wide communication strategy to leverage these stories and inform internal and external stakeholders. Thus, many opportunities to further extend community relationships and to improve the reputation of the institution were lost.
Undervaluing of community engagement by the AHC
The group noted that, similar to many academic institutions, KUMC faculty faced many challenges in community-engaged activities and scholarship because of low prioritization of community engagement. Commonly, the value placed on community engagement was far below the emphasis placed on education, research, and clinical care missions. Key barriers to faculty participation in community engagement included uncertain financial viability of these initiatives and internal challenges with rewarding service activities in the promotion and tenure process.8 The strategic planning committee noted needs for change in policies and procedures, as well as institutional culture, to promote community engagement and resulting scholarship.
Optimal timing for leveraging outreach and service at the AHC
Although a number of improvements need to be made, the committee recognized an intense interest in and momentum for reinforcing KUMC’s mission by strengthening institutional community engagement. At the time of planning, KUMC was engaged in three key initiatives that demonstrated the institutional value of community engagement. First, KUMC was working to achieve National Cancer Institute designation, an endeavor that required creation of a collaborative network of stakeholders and communities. Researchers were also collaborating on a proposal for a CTSA, which was awarded in summer 2011. Third, KUMC began planning for the establishment of a school of public health with a community-focused mission. The strategic planning committee judged that the time was right to leverage these opportunities as KUMC looked for ways to provide long-term leadership in community engagement and public service for the people of Kansas and the region.
Strategic Planning Recommendations and Initial Implementation
The strategic planning committee considered the AHC’s community engagement needs within the next five years. The five key findings just described informed recommendations for KUMC engagement activities and scholarship. The committee made a concerted effort to consider how to address weaknesses and leverage strengths to enhance KUMC’s overall engagement strategy. The committee outlined the following four goals to achieve an innovative, creative, and future-oriented strategy for community engagement. The goals were identified with corresponding strategies, which are to be completed by 2015. After each goal, information regarding successes and challenges in implementing strategies to date is provided.
Encourage research and scholarship within community engagement activities when appropriate
Four strategies were identified to accomplish this first goal:
* Develop a mission and vision for community engagement at KUMC;
* Increase extramural funding for community engagement activities;
* Revise the promotion and tenure process across schools to place a higher value on scholarship resulting from community engagement activities; and
* Establish a cash award to recognize and reward research and evaluation related to community engagement activities.
To better integrate community engagement within the AHC, KUMC chose to incorporate “community engagement” as part of the broader mission of the institution after strategic planning. The mission statement is now “The University of Kansas Medical Center serves Kansas through excellence in education, research, patient care and community engagement.” Furthermore, the presence of “serves Kansas” acts as a prioritizing phrase for KUMC community engagement activities, should activities be in competition for funding.
KUMC has adopted several strategies to increase extramural funding for community engagement activities, although these activities are within the context of the very competitive funding environment. Funding opportunities related to research of community engagement activities have increased through internal sources, like the CTSA, with the ultimate goal that these pilots will help secure extramural funding. In addition, the Institute for Community Engagement has sought out partners who have not traditionally considered research and expanded project assistance throughout the submission and implementation process.
Currently, KUMC is revising language, including adding specific examples, within the promotion and tenure process in the University of Kansas School of Medicine to value engagement and educate faculty on how community work can be articulated more clearly as scholarship across the different academic tracks. The Institute for Community Engagement will play a critical role in the future in educating faculty and administrators on how to frame community work within existing promotion and tenure processes, rather than overhauling these guidelines.
In fall 2012, KUMC established four annual cash awards totaling $19,100 to recognize and reward community engagement and resulting scholarship. The awards, funded by the Office of the Executive Vice Chancellor, reinforce that community engagement activities are valued on par with teaching, research, and clinical activities that have long had similar awards. One of the awards is available to KUMC faculty demonstrating long-term commitment to scholarly community engagement work, and another is available to a community project working with a KUMC faculty member on a scholarly community engagement project. The other two awards are for students engaged in the community.
Revise current organizational structures to improve the coordination and effectiveness of KUMC community engagement activities
Seven strategies were outlined to ensure success of the second goal:
* Reorganize the Office of Outreach into the Institute for Community Engagement and empower it to coordinate KUMC engagement activities;
* Formalize an internal advisory board to serve as a governing body to benefit strategic planning and interprofessional activity;
* Broaden the role of School of Medicine regional medical directors to also serve as community-based medical directors for the new institute;
* Work with clinical partners to coordinate outreach and telemedicine clinics;
* Work with clinical partners to better coordinate use of university aircraft for outreach clinics;
* Build relationships and collaborations to support creation of a school of public health with an inherent community engagement mission; and
* Establish an external advisory board to ensure community input for continuing KUMC engagement activities.
In fall 2011, KUMC reorganized community engagement activities into the Institute for Community Engagement, which subsumed the Office of Outreach and was expanded to bring together all KUMC community engagement. The institute was also expanded from having a service orientation to include scholarship resulting from engagement activities. The expanded emphasis on scholarship is further supported by the institute’s 29-member internal advisory board, drawing from top leaders representing the varied interests across the AHC. In addition, institute faculty and staff have assumed expanded roles around scholarship, including supporting KUMC faculty throughout scholarship related to community engagement.
The institute is currently in the process of expanding the role of the School of Medicine regional medical directors and working with the clinical enterprise to better organize and create efficiencies for outreach clinics. An Office of Preceptor Relations, which would transcend existing school-level preceptor engagement, is also being considered. To date, two clinics have coordinated dates to share use of the aircraft, resulting in substantial cost savings for KUMC. More clinics are expected to consolidate. The institute is currently exploring the creation of an external advisory board.
Prioritize engagement initiatives that have the greatest benefit for enriching the health of our community partners
The strategic planning committee designed seven strategies to support the third goal:
* Conduct an assessment of Kansas’s health issues and determine which areas KUMC can best address on the basis of existing assets;
* Prioritize ongoing engagement activities;
* Reestablish annual visits by KUMC leadership, previously known as the Kansas Circuit Course for Physicians, to foster personal relationships with community partners across Kansas;
* Leverage technology to increase access to continuing education programming for providers across the region;
* Establish community-engagement-specific grand rounds and conferences;
* Connect engaged scholars with “Meet the Experts,” a robust directory of KUMC faculty and their scholarly accomplishments; and
* Develop a local community engagement strategy to serve the urban community where the AHC is based.9
In 2011, the Institute for Community Engagement invited more than 15,000 Kansans from across the state to participate in an online survey to identify their priorities for KUMC community engagement work. The results of this survey were used to organize existing activities into broad categories, with emphasis placed on the top-valued work: student education and health care workforce development. The institute has begun planning for a circuit course, preceded in summer 2012 by visits to 19 communities across Kansas by KUMC researchers and administrators to discuss institutional and community priorities. When the Institute for Community Engagement was formalized, identified engaged scholars at KUMC were organized into a “Meet the Experts” group for community engagement. To develop a local community engagement strategy, additional strategic planning with community leaders is needed. Initial inquiries have begun, but efforts to develop this goal have not yet been formally organized.
Improve communications about community engagement activities with internal and external stakeholders
Four strategies were designed to meet the final goal:
* Hire a dedicated communicator for KUMC community engagement initiatives;
* Conduct a communication and branding audit;
* Implement a communication strategic plan based on the findings; and
* Develop a strategic planning dashboard to measure success across goals.
An outreach communications manager was hired to support institutional community engagement work in fall 2010. The communicator conducted a communication and branding audit, identifying dozens of activities branded outside of KUMC identity guidelines. From this audit, she developed a communications strategic plan. The communications plan is currently being implemented, with to-date successes including the creation of an interactive state map that invites the general public to explore the community engagement activities of KUMC in all 105 Kansas counties, more than 200 hyper-local news releases to respond to specific needs of communities, and publication of more than 20 feature articles for KUMC target audiences. The Institute for Community Engagement has developed metrics to measure the success of these tactics and for the strategic plan; systems to collect the data, which are not currently centralized, are being developed.
The success of these goals and strategies to date has been ensured through the committee’s consensus and the individual members’ employment in key administrative positions to promote these goals over time. The continued support of AHC leadership to integrate community engagement into the overarching institutional mission while elevating the value of this work within KUMC has also contributed to the successful implementation of the recommendations.
Examining Success and Lessons Learned
Community engagement has become increasingly important across university settings, and many AHCs are looking at ways to elevate the concept alongside other key components of the academic mission.1,10,11 This case study outlines a systematic strategic planning process by which key AHC leaders acknowledged this concern and collaboratively worked together to determine how to best value and promote the role of KUMC in community engagement. The strategic planning process first brought internal stakeholders together to assess the current state of community engagement within the AHC. The strategic planning process also generated several concrete steps to accomplish the four goals enumerated by the committee and to demonstrate the accessibility of community engagement throughout the AHC. The comprehensive community engagement inventory was critical in demonstrating the already-pervasive community engagement work, but also in demonstrating a need to elevate its value while working to enhance efficiency within initiatives. The inventory also served as a solid foundation to inform future community engagement initiatives and goals.
The strategic planning process succeeded because of support by AHC leadership and the inclusion of a variety of institutional and stakeholder leaders whose primary function is to support already-existing education, clinical, and research goals. By involving high-level leaders that already had vested interest in the institutional mission and community engagement, the committee was able to develop a plan to elevate and improve community engagement within a short time frame. Economic challenges were a catalyst to ensure collaboration across departments, schools, and campuses to address long-standing outreach concerns. Similar to national strategic planning initiatives, the committee emphasized that the strategic goals should drive the budget.
The strategic planning committee reinforced the value of community engagement to support the AHC tripartite mission of research, education, and patient care by effectively overlapping engagement with the other academic missions. Therefore, more effort with community-focused research and grant pursuits is critical, as is involving health professions students with community engagement activities. Both of these are central foci for the Institute for Community Engagement. Finally, engagement must be valued through the traditional promotion and tenure process, or faculty will always view it as an inferior mission. Revision of current and long-standing policies guiding this process is under way.
Finally, most work to date has primarily been with internal audiences in addressing immediate needs to build efficient and effective systems for elevating and promoting AHC community engagement. However, it is critical that future initiatives engage the voice of the communities served by KUMC to fully understand how community engagement should move forward. A first step in this process was a survey of community stakeholders to inform priorities among engagement interests identified in the inventory. The survey findings underscored a need to develop a robust community advisory board infrastructure across Kansas that is empowered to provide feedback to the institution on community challenges, which is an important next step for the AHC. The survey results and community engagement strategic plan continues to inform goals for the Institute for Community Engagement and drive integration of community engagement in the broader AHC mission.
Other disclosures: None.
Ethical approval: Not applicable.