Following the release of the Public Health Accreditation Board (PHAB) Standards and Measures Version 1.0 in July 2011, the top accreditation priorities for the Norwalk Health Department were to complete a self-assessment against the PHAB standards and measures and to identify a partner for completion of a community health assessment (CHA) and community health improvement plan (CHIP). An accreditation workgroup, consisting of 14 staff members across all divisions of the department, completed the self-assessment and implemented improvements to meet the measures identified as not fully demonstrated. At the same time, the director of health recruited Norwalk Hospital as a partner and began planning the CHA and CHIP. The health assessment was conducted from March to August 2012, and the improvement plan was completed in December 2012.1 The final prerequisite, the current agency strategic plan, was finalized in March 2013. This article describes how the Norwalk Health Department completed a CHA and CHIP for accreditation preparation, using a coleadership model with Norwalk Hospital (Table).
The Norwalk Health Department and Norwalk Hospital have a history of successfully collaborating on community projects, including the completion of a prior CHA in 2002. We formed the Norwalk Community Health Center, a Federally Qualified Health Center, established a Hospital Lecture Series, and developed a variety of community health promotion programs together. We agreed that it would be best to complete the CHA and CHIP together to share resources and expertise. Collaborating also ensured being able to engage more partners and community members in the process.
The Norwalk Health Department was awarded a grant from the National Association of County & City Health Officials in the summer of 2011 and designated a national CHA/CHIP demonstration site.2 Through this grant, the health department received funding, technical assistance, and training to develop a CHA and CHIP. Because the health department had limited financial resources to dedicate to this project, the hospital provided the majority of funding. We established a Core Team from health department and hospital staff members. The Core Team selected the Association for Community Health Improvement framework to guide the overall assessment process.3 We defined the geographic scope of the assessment to include Norwalk and the surrounding Fairfield County towns of New Canaan, Westport, Weston, Wilton, Darien, and Fairfield. We established biweekly Core Team meetings and established a timeline organized around the 6 Association for Community Health Improvement steps: (1) Identifying the Team and Resources; (2) Defining the Purpose and Scope; (3) Collecting and Analyzing Data; (4) Selecting Priorities; (5) Documenting and Communicating Results; and (6) Planning for Action and Monitoring Progress.3 On the basis of an inventory of area organizations and existing partnerships, we formed the Community Health Improvement Task Force in the fall of 2011, with members representing housing, transportation, education, business, public safety, local government, senior services, youth, social services, mental and behavioral health, health care, and public health. The Core Team selected a consultant in the winter of 2012 to assist with the project. The CHA included key informant interviews, focus groups, and quantitative secondary data. Following data analysis, the task force selected priority areas for inclusion in the CHIP. Workgroups developed the CHIP, consisting of goals, objectives, strategies, and performance measures.
The health department has increased accreditation readiness through developing 2 of the prerequisites that will satisfy PHAB requirements. Staff members have increased their knowledge and capabilities in qualitative data collection, data synthesis, community engagement, and identifying community assets and needs. They have also strengthened relationships with Norwalk Hospital and other community partners. The health department, hospital, and partners are now collectively working toward addressing identified community health needs.
The health department and the hospital are most proud of the high level of community interest and commitment to this project. We successfully engaged multiple partners and community members throughout the community health improvement process. As a result of this project, there has been improved coordination between partners and alignment of health strategies within the CHIP to other community-wide improvement plans. This project has reenergized community partners to be excited about working together and creating change to improve health.
A significant challenge was the level of time required to conduct a high-quality CHA and CHIP, which made it difficult to dedicate time to general accreditation preparation. As a result, the staff looked for ways the CHA and CHIP work could meet other PHAB measures. The health department is using the CHA process to meet measures in PHAB Standard 7.1, Assess Health Care Service Capacity and Access to Health Care Services.4 The health department staff created data profiles both to drive CHIP development and to also meet PHAB Measure 1.4.2 L.4 Another challenge was striking a balance between community-driven strategy selection and ensuring strategies were evidence-based and aligned with national recommendations, as required by PHAB. To encourage community partners and members to select strategies that met PHAB requirements, the health department staff created and provided a table of databases for identifying evidence-based strategies.
Advice for Other Health Departments
On the basis of our experience, we have several points of advice to offer other health departments and hospitals that wish to collaborate on a CHA and CHIP:
- Identify each organization's strengths and assign responsibilities and tasks accordingly to ensure balance.
- Designate a point-person from each organization to coordinate and manage daily activities.
- Establish and maintain relationships with community partners to ensure successful implementation of the improvement plan and for future CHAs.
- Draw an understanding of what needs to be accomplished to achieve both PHAB and Internal Revenue Service requirements for each organization. Be flexible in your project approach and planning.
- Keep lines of communication open between health department and hospital staff members, as well as community partners and members.
2. Wexler B. Twelve Local Health Departments Receive Grant to Focus on Community Health Improvement. Washington, DC: National Association of County & City Health Officials. http://www.naccho.org/press/releases/072511.cfm
. Published July 25, 2011. Accessed April 5, 2013.
3. Association for Community Health Improvement. ACHI Community Health Assessment Toolkit. http://www.assesstoolkit.org
. Accessed April 5, 2013.
4. Public Health Accreditation Board. Public Health Accreditation Board Standards and Measures, Version 1.0. Alexandria, VA: Public Health Accreditation Board; 2011.