Developing comprehensive, multifaceted strategies to address the community health needs prioritized in your assessment is crucial to driving health equity. Regardless of whether you have been doing community health improvement work for many years or are new to this process, your community health assessment gives you the foundation to base your community health improvement strategies on collaboratively identified, evidence-based priorities and needs.
Engage strategic partners inside and outside the hospital. Refer to the “Types of CHA Partners” box to learn more about these partners. Actively encourage involvement in your implementation planning to ensure widespread buy-in, increase opportunities for equitable outreach and service provision and, overall, optimize the impact on community health.
You can consider specifically applying human-centered design principles to your planning and implementation. Both this AHA webinar and the article Design for Health: Human-Centered Design Looks to the Future by Global Health: Science and Practice offer an opportunity to learn more about taking this approach. Leveraging resources such as these can help establish an asset-based foundation to your strategy.
View additional resources to futher your CHA journey.
Individuals and departments across the hospital or health system may be able to integrate and align community health strategies and their implementation across the organization and engage clinicians who focus on needs identified in your CHA. The support of hospital leadership can be crucial for securing funding and resources to implement desired strategies. Engage with C-suite executives and hospital trustees to share the CHA findings and discuss intervention approaches.
Your early engagement of community stakeholders starting in Step 2 will give you a solid foundation to garner support and ongoing involvement in implementation efforts. Some hospitals engage their CHA advisory committee to form an implementation subcommittee that includes individuals who participated in previous stages as well as new stakeholders who can offer fresh insight and resources. To help ensure your plans are culturally appropriate, consider intentionally focusing on communities that face health disparities and have experienced historic marginalization. Many hospitals reach out to local and state health departments in developing their CHA implementation strategies. Not only does this reinforce and strengthen important relationships, but this coplanning also helps ensure against duplicating efforts.
Engage hospital or health system leadership in a discussion about how the implementation plan aligns with your organization's population health management strategy and how the two efforts may be mutually reinforcing. Do the same with community stakeholders to identify how their current efforts may align as well. These and other conversations will build and strengthen a coalition to greatly impact improvements to community health.
Developing a Population Health Driver Diagram tailored to each priority health area in your CHA can be useful for identifying primary and secondary drivers — as well as specific interventions to which different community stakeholders can contribute — that will achieve improvement in the priority area. A program logic model helps guide the theory and assumptions underlying the implementation strategies. It is a systemic way to visualize the relationships among the resources, activities, inputs and projected changes that you hope to achieve.
The Population Health Driver Diagram framework can be thought of as an actionable logic model. This framework details the aim you are striving for along with specific goals, primary drivers and secondary drivers. In addition, the driver diagram can help multiple stakeholders identify contributions they can make to improve the priority health area and begin aligning their efforts with other stakeholders.
Develop a strategy for each need prioritized in your CHA. Hospitals and health systems can select strategies that impact the health needs of their population — such as improved access to care or chronic disease management — and/or social drivers of the priority needs — such as poverty, education or community safety. Both types of strategies are appropriate for a CHA. In determining strategies overall, consider the advantages of creating a balanced portfolio, intentionally selecting interventions that work together to address short- and long-term outcomes that are mutually reinforcing in delivering impact. Below are some considerations to be aware of as you develop the approach for your implementation strategies.
You can pursue multiple approaches to address the identified need. From the start, define whether your strategy is a way of approaching many types of projects or a specific intervention. Both are valuable and have the potential to make a significant impact on community health; however, instituting a practice or protocol may have longer-term sustainability as it becomes part of the daily workflow.
Think critically about the level at which you are intervening and how your efforts can make the most impact. Will your strategy be clinically based, or will it take place in the community — or both? Will you address the specific needs of individuals or the community as a whole? Will your strategy contribute to a measurable reduction in health disparities? The following questions can help you define your strategy.
Interventions to address population and community health can take place at a variety of levels, both in terms of aim and strategy. In addition to considering the level of intervention for your coproduced community health improvement plan, you may want to look at the domain(s) your work aims to impact. The Pathways to Population Health approach identifies four portfolios of population and community health and explicitly places equity at the core (Figure 4). Much of your CHA implementation will be centered on the right side, focused on community health and well-being and communities of solution. However, as implied by the infinity loop in the figure, these portfolios of work are designed to be self-reinforcing so that a community’s well-being strategies inform a hospital or health system’s population health management activities and vice-versa.
The CDC’s 6|18 Initiative conceptualizes prevention types into three buckets 1 :
To move the needle on community health, develop a comprehensive strategy that addresses multiple facets of each CHA priority. This requires thinking “big picture” about health and the hospital’s or health system’s role in improving it.
A comprehensive approach includes:
1. Hester, J., Auerbach, J., Seeff, L., Wheaton, J., Brusuelas, K., and Singleton, C. (2016). CDC’s 6|18 Initiative: Accelerating evidence into action.