“A Bold Vision for Community Health”: Use Framework to Align Resources, Improvements

Teenage pregnancy, obesity/lack of physical activity, drug use, and student drop-out rates are all issues on which Baldrige Award recipient Charleston Area Medical Center Health System (CAMCHS) has been working directly with its community for more than 20 years, said Brenda Grant, chief strategy officer. However, such efforts to improve the population’s health weren’t always focused or forward thinking (i.e., systematic), she added during a June 2016 HealthDoers Learning Lab on Collaborative Leadership: Part III, from Population Health to Healthy Communities.

Through her health systems’ work with the Baldrige Excellence Framework, Grant said she became aware of the Communities of Excellence 2026, a nonprofit organization that is adapting the Baldrige framework for use by whole communities “to achieve and sustain the highest quality of life for their people” and to give such community efforts a framework for improvement and alignment.

“I have seen the Baldrige framework help us become a better organization by answering and responding to the questions [in the Baldrige Criteria within the framework] and making sure we have strong approaches to deployment, learning, and integration,” said Grant, “so I am excited about the framework being established for communities of excellence and really think that could be a guide for us as we move into the future for our community.”

Grant said CAMCHS’s involvement in population health started by looking at the needs in the community and developing programs around those needs. In 1994, a steering committee called the Kanawha Coalition for Community Health Improvement was formed to include other county hospitals, the United Way, the school system, behavioral and family health organizations, churches, and many others. The committee’s mission is to identify and evaluate community health risks and coordinate resources. But Grant said when they started the coalition for improvement, they realized that reacting to problems was really the process for how problems would be addressed.

“There were a lot of different people working on problems but not really in a coordinated manner,” she said. Now, the committee is moving through early systematic approaches to aligned approaches using a community needs assessment, which includes random telephone surveys, focus groups for low-income and minority populations, and targeted surveys, as well as forums where the community identifies the top issues. Using available data, the committee then comes up with 10–15 community priorities. At a community forum, education is provided on those topics, random voting is conducted, and the community selects the issues for work groups to pursue.

Rick Norling, retired CEO of Baldrige Award recipient Premier, Inc., said such work in the community reinforces “the value of a collaboratively generated community strategic plan to pull all of these efforts together as community-based priorities.” He added that health care organizations increasingly need to move toward partnering with their communities not just for compliance but for improving population health.

“I personally believe [a community health needs assessment and implementation strategy] can be a powerful driver for improving the health of our communities, so that’s why I really want to focus on taking the work that we’re currently doing and moving it even in a more substantial manner,” said Grant. “We have a long history of trust, working with the community. But the potential is still there to be a powerful driver for health. That’s why . . . the Baldrige journey has really been helpful for us. . . . One of the core values of Baldrige is a systems perspective that talks about managing all parts of your organization as a unified whole to achieve your mission. And that really was helpful to us internally as we looked at health care transformation.”

Norling defined population health management as building a partnership among a health care system and members of a community. The best hospitals and health systems, he said, are building a strategy of becoming population health managers.

“To pursue population health management, the sites of care go well beyond a traditional health system, all the way to the family home, a key site of care,” he said. “Retail pharmacy, minute clinics, grocery stores, wellness centers, senior housing, they bring a whole new dimension of complexity to the systems of care required and the need for much more collaborative leadership.”

Norling said the Communities of Excellence (COE) criteria have been created in conjunction with the Baldrige Performance Excellence Program and are currently being piloted in communities. The first pilot is Live Well San Diego, which has been adopted by the San Diego County Board of Supervisors as its strategic plan, said Norling; over 150 community organizations have become Live Well partners, agreeing to collaborate and with the county health and human services department organizing the effort. Norling said the criteria are being implemented and improved concurrently.

Live Well San Diego’s performance will be enhanced by adopting the criteria, and feedback from attempting to adopt those criteria will provide us feedback to improve them, said Norling, adding that other community pilots are taking place around the United States.

“I think what’s happening in San Diego County is a pretty exciting example of what this kind of systems thinking in a community can create,” Norling said. “It would seem that hospitals and health systems should be active participants, if not the leaders in this journey, and the culture of health requires this kind of broad perspective.”

Added Stephanie Norling, managing director, Communities of Excellence 2026, “The COE framework really represents the next logical iteration in the current population health movement. CAMCHS is a great example of a health system’s journey from clinical care to population health, and the addition of a systems-based, community-wide framework is really the next step in achieving the kind of breakthrough results we need for our communities and their residents.”

In regards to results, which are part of any Baldrige assessment, the COE framework also brings with it the element of measurement, something new to many community initiatives. “[Baldrige] provides the opportunity for us to have the framework to respond to questions that will make us a better community. It will also help us with results,” said Grant. “One of the things that we struggle with is how do you measure community health improvement, how do we know that we really are improving. . . . Having a group of communities to benchmark [that are using the COE framework] would just be invaluable to us in the future.”

Note: Brenda Grant will be speaking at the Baldrige regional conferences in Chicago on September 8 and Dallas on September 22—along with many other representatives of Baldrige Award recipients. You can access the full schedules and register from links on our website.