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Hospitals face a paradigm shift: from planning service delivery to population-based community health planning. Comprehensive community health planning is a two-step process: assessment and action, in that order. Assessment identifies community problems and resources; action follows planning, which determines which of those problems should be addressed with which resources. This paper provides an overview of the community assessment process. The first challenge in launching a community health initiative is to identify and recruit partners drawn from the ranks of prominent community organizations, such as school boards, public health agencies, and elected officials. The best enlistment strategies are those that empower persons outside the hospital to take visible control. Defining the community is the first step in analyzing the community. It is important that everyone involved in the assessment process agree on the definition, which should take in those characteristics that make the community unique, including its social systems, environmental factors, and demographics. The next step in the process is developing a community health profile, a set of key community indicators or measures that will help you set priorities, document successes and failures, and monitor trends. There are a number of models available to consult in developing indicators, whether traditional, medically oriented determinants of health or broader parameters, such as housing and public safety. Criteria for selecting indicators include validity, stability and reliability, and responsiveness. Most indicators will be developed using secondary, or already existing, sources of data, such as census data, Medicare and Medicaid files, police records, and hospital admission and exit records. Conducting the community assessment involves putting together a list of problems to be solved and a list of available resources, both of which can be compiled using the same four-step process of gathering and analyzing data: obtaining community input, identifying problems already being addressed, consulting with professional experts, and analyzing existing data. Demographics are one way of analyzing data; another is using a "community scoreboard" that groups causal factors into four categories: lifestyle, environment, human biology, and health services. Once the community assessment is complete, planning and implementation of programs can begin. At the same time, it is essential to mobilize the community to support your initiative. Again, you must look beyond the hospital walls to build a constituency for change, to community leaders in education, employment, transportation and recreation, housing, and the physical environment, as well as health education and preventive services.(ABSTRACT TRUNCATED AT 400 WORDS)
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Raising the quality of life of a community is the ultimate goal of most health promotion programs. Yet such programs are commonly restricted to reducing known risks to health. It is suggested that this linkage of health promotion to disease prevention is self-defeating, and that health promotion needs community recognition and a suitable methodology of its own. To this end the traditional epidemiology of disease is extended to a potential epidemiology of health. A five-part analysis of health issues is then suggested as a basis for planning and evaluating community health programs.
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Community Health Planning (CHP) is one of the tools that states and localities use to develop health policies and programs. The author argues that, for CHP to succeed, it must include both positive/hierarchic data as well as interpretive information. To augment the discussion, the author discusses the State of Tennessee's effort to revamp its public health mission and strategies as specifically implemented in one county. The author contrasts the two types of data generated and argues that each has a legitimate claim in the CHP process: the "positive" data in the form of epidemiological statistics to inform the stakeholders and the "interpretive data" in the form of stakeholder participation for ownership of the process. The author then draws implications for states and localities to use diverse information sources as they improve services and service delivery to citizens and recipients.
When it comes to total quality management, Harvard Community Health Plan has two personalities. It's using the principles espoused by such TQM gurus as Joseph Juran to reduce costs and improve quality in its clinics and offices. But HCHP also is enhancing its image in the healthcare industry by teaching TQM principles to others for big bucks.
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