Counting community benefits. CHA survey reveals members' commitment to providing care for the poor and other community services. Catholic Health Association

In its 1990 National Community Benefits Survey, the Catholic Health Association (CHA) found that in recent years Catholic hospitals increased the amount of uncompensated care they provided, despite growing fiscal constraints. CHA also found that, in the two years since it introduced the Social Accountability Budget, 60 percent of Catholic healthcare facilities have used either CHA's process or a similar structured approach to reinforce, measure, and plan their contributions to the community. Of the hospitals that responded to the survey, 91 percent provided nonbilled services targeted to low-income populations in 1989, more than 75 percent provided free or discounted services to other populations with special needs, and about 82 percent made free or discounted services available to the broader community. In addition, the majority of Catholic facilities can now more accurately report the dollar value of the uncompensated care they provide. In Illinois 31 of the state's 52 Catholic hospitals were able to quantify the value of the benefits they provide to the poor and the broader community. Moreover, facilities and systems throughout the nation are intensifying their efforts to plan and coordinate programs to meet community needs and the needs of the poor.     

Nontraditional services provided by nonprofit and for-profit hospitals: implications for community health

In part because of reimbursement changes in the 1980s, hospitals became involved in health promotion and disease prevention activities often to attract patients. Today, these services may have an effect on the burden of disease and on illness prevention in some communities. Given the changes anticipated in healthcare delivery, assessing the scope of these services and integrating them with other private-public efforts is of utmost importance. Here we use a 1993 survey of all 4,977 private medical and surgical hospitals in the United States to determine the scope of disease prevention, health enhancement, and palliative services provided by facility type, geographic location, and institutional ownership. We found that church-operated and other nonprofit hospitals appear to provide a spectrum of palliative and preventive health services both for their patients and those in the local community. Given their apparent scope, these services could have an effect on the burden of disease and on illness prevention in many communities. With major changes anticipated in future healthcare delivery and the recent failures reported for many community health intervention programs, healthcare administrators need to focus on ways to integrate their services with other private and public health efforts. If this could be achieved, then private hospitals could be more successful in serving their local communities and in enhancing the public's health in the new century. This article outlines several basic steps to assist administrators in achieving these goals.     

Community benefit: what it is and isn't

"Community benefit" is the measurable contribtution made by Catholic and other tax-exempt organizations to support the health needs of disadvantaged persons and to improve the overall health and well-being of local communities. Community benefit activities include outreach to low-income and other vulnerable persons; charity care for people unable to afford services; health education and illness prevention; special health care initiatives for at-risk school children; free or low-cost clinics; and efforts to improve and revitalize communities. These activities are often provided in collaboration with community members and other community organizations to improve local health and quality of life for everyone. Since 1989, the Catholic health ministry has utilized a systematic approach to plan, monitor, report, and evaluate the community benefit activities and services it provides to its communities. This approach, first described in CHA's Social Accountability Budget, was updated in the recent Community Benefit Reporting: Guidelines and Standard Definitions for the Community Benefit Inventory for Social Accountability. By using credible and consistent information, health care organizations can improve their strategic response to demands for information that demonstrates their worth.     

A threatened privilege

Because their tax-exempt status was at stake, Wisconsin hospitals joined together in 1990 to study and develop a system to better measure and quantify their provision of needed community services. The goal of a task force made up of members of the Catholic Health Association of Wisconsin (CHA-W) and the Wisconsin Hospital Association (WHA) was to develop a proactive response to potential legislative and municipal initiatives that could challenge the tax-exempt status of not-for-profit hospitals. The CHA-W/WHA Task Force on Social Accountability decided to generate data to demonstrate hospitals' tax-exempt worthiness and to show that hospitals pay for many of the direct municipal services they receive. The task force surveyed Wisconsin hospitals on the services they provide to their communities, the municipal service fees they pay, and whether any of their services compete with local businesses. The survey results showed that Wisconsin hospitals do provide needed community services. However, the hospitals do not always adequately communicate to their communities the extent of these benefits. The survey results also showed that Wisconsin hospitals pay most service fees that are quantifiable and measurable. In 1991 the task force adopted a statement of policy which emphasizes that hospitals must clearly demonstrate that they have assessed the health-care needs of their communities, implemented programs to respond to those needs, and maintained their mission to serve.     

Indigency, ethnicity, and hospital viability. The growth of racially diverse communities challenges Catholic providers and sponsors

A Catholic Health Association study analyzes correlations between the ethnic and racial composition of communities served by Catholic hospitals and these hospitals' viability and capacity to serve their communities. It also describes the extent to which Catholic hospitals serve racially homogeneous communities, on the one hand, and racially and ethnically diverse communities, on the other. For comparison, the study focuses on hospitals in two groups. Group A consists of hospitals in the top quartile based on their proportion of care for the poor and top-quartile percentages of black and Hispanic residents in their local communities. Group B consists of hospitals with bottom-quartile levels of care for the poor and bottom-quartile percentages of black and Hispanic residents. The study found that, from 1985 to 1990, group A hospitals continued to provide high levels of care for the poor (between 28 percent and 32 percent on average) while average margins fell from about 4 percent to below 1 percent. During the same period, the amount of care group B hospitals provided to the poor remained between 5 percent and 6 percent; although their margins declined, these hospitals were significantly more profitable than group A hospitals. The financial stress currently being experienced by many hospitals that serve communities with relatively high percentages of ethnic and racial minorities is troubling. Without basic reform of the healthcare system, many of these facilities may have to close, leaving many in their communities without access to adequate healthcare.     

A Pilot Study of Health Priorities of Somalis Living in Kansas City: Laying the Groundwork for CBPR

African immigrant and refugee communities remain medically underserved in the United States. Formative efforts are being directed to address the local needs of communities by researchers, community agencies, and local populations. However, there is a paucity of data and sparse documentation regarding these efforts. The objectives for this pilot study were to identify the health priorities of the Kansas City Somali community and to establish a working relationship between an academic medical university and the local Somali community. Our team used community-based participatory research principles and interviewed Somali community members (n = 11). Participants stated that chronic and mental health conditions were of primary concern. Medical system navigation and literacy struggles were identified as barriers. Participants offered possible solutions to some health issues, e.g., using community health workers and Qur’anic readers. Preliminary findings will help guide future research and inform strategies to improve the health and well-being of this community.     

Hospitals' partnerships, outreach benefit Los Angeles communities. Daniel Freeman Hospitals, Inglewood and Marina del Rey, Calif

Daniel Freeman Hospitals in in Los Angeles committed $11.2 million to its community benefits program, which includes charitable care, reimbursement shortfalls, outreach and community service programs. The Catholic hospitals are part of the Carondelet Health System. Their mission follows the example of the Sisters of St. Joseph of Carondelet who, in France in 1600, departed from the cloistered community life to go beyond the convent and care to people in their local communities. Daniel Freemen Hospitals, with campuses in Inglewood and Marina del Rey, Calif., reach out to their communities by developing partnerships to advance community health in a diverse ethnic, age and economic-level population.     

A starting point for delivery reform. Catholic healthcare providers can receive guidance from "A Time to Be Old, a Time to Flourish"

The ideal healthcare delivery system is client focused and ensures that the individual and the family receive the appropriate mix of services to meet their needs. Healthcare delivery should be presented as a coordinated continuum of care. Key integrating elements are essential to provide healthcare services on a day-by-day basis as a continuum of care. Integrating elements that form the bridge between clients and services include planning, care management, a management information system, financing, and an appropriate administrative structure. Many Catholic healthcare providers are expanding by acquiring a variety of services. However, many of these acquisitions are in response to today's competitive environment, whereas a true continuum of care must focus on the client's range of functional needs. Catholic providers must keep in mind that not all services they provide will be profitable. Although Catholic healthcare providers will be pressured to focus on fiscal strength and market position, they must put the client's holistic needs first. By doing so, they can help create a client-centered healthcare system in their communities.     

An opportunity for positive change. We have the history, experience, and will to preserve a Catholic presence in healthcare

The charitable acts of women religious in response to the needs of the communities in which they settled is one of the great chapters in the history of the Church in America. But in the past two decades providers have had to contend with extraordinary changes in the healthcare environment. The Catholic healthcare mission was rooted in concern for the poor. Should Catholic healthcare providers withdraw from this field in which they have had such a significant presence and have contributed so much, or be driven from healthcare by the fiscal consequences of fidelity to mission? Instead, through its reform proposal, the Catholic Health Association has recommended that Catholic providers become advocates of change. However, even if change, such as universal access to healthcare, is achieved, we shall still have a society in which there will be many poor people. The challenge will be to see that healthcare for the poor does not become poor healthcare. Although the changing urban environment presents enormous challenges to providers, the Catholic healthcare ministry is a significant presence in urban areas. Widespread poverty accompanied by behavioral problems and social breakdowns are significant factors affecting healthcare and healthcare costs. Drug addiction; AIDS; teenage pregnancy; homelessness; the deterioration of the family; and generations of unemployment, anomie, abuse, and violence, which are often most acute in concentrated neighborhoods of poverty, challenge the ability of Catholic hospitals to meet their community's needs. Catholic providers today have a real opportunity to bring about positive changes in healthcare. They have the history, experience, and will to preserve a Catholic presence in the provision of healthcare.     

Partnerships for the future. A new vision for the Catholic healthcare ministry

Collaboration among healthcare providers will help them more effectively meet the needs of their communities in the 1990s. San Francisco-based Catholic Healthcare West (CHW), formed in 1986, strives to provide high-quality healthcare by collaborating with Catholic and non-Catholic providers. CHW leaders believe that Catholic providers make ideal partners; however, they have found that Catholic healthcare providers often must look outside the Catholic healthcare ministry to find these partnership opportunities in order to remain viable and effectively carry out their mission. Besides system-to-system or hospital-to-hospital linkages, collaboration is also achievable with other types of healthcare providers, such as physicians. In collaborations between Catholic and non-Catholic healthcare providers, Catholic providers must strive to maintain their Catholic identity. When evaluating potential partners, they must consider issues such as corporate culture, organizational compatibility, and sponsor influence. CHW leaders believe that for any merger or affiliation to be successful, it must clearly produce market and financial advantages for the new partnership and offer the community a significant improvement in quality of care and services.     

Low-cost rapid usability engineering: designing and customizing usable healthcare information systems

It is essential that the healthcare systems we develop are usable, meet user information needs and are safe. To ensure system usability, a variety of methods have emerged from the area of usability engineering and have been adapted to healthcare. The authors have been applying methods of usability engineering, working with hospitals and companies to develop more usable healthcare information systems for over 15 years. Based on our current work at the University of Victoria, we describe how to set up a low-cost portable laboratory that can rapidly evaluate the usability and safety of healthcare information systems both in artificial mocked-up settings and in real clinical contexts (e.g., in hospital wards).     

Collaborative efforts support poor elderly. A nursing center teams up with area churches to care for the elderly in their homes

In many communities across the United States today, churches and hospitals are forming alliances to better serve the needs of the elderly. Bon Secours Hospital-Villa Maria Nursing Center in North Miami, FL, sponsors programs that deter institutionalization. Villa Maria took these efforts one step further in September 1990 with the development of Project Good Help, a church-based outreach program that provides support services to help the poor, frail elderly continue independent living in the community. Villa Maria has coordinated the project with churches because they share a sense of mission. Only churches in areas where many needy elderly persons live are selected to participate in Project Good Help. Areas that lack services are given priority. Project Good Help often coordinates with other professional social service agencies to provide assistance. Catholic Community Services, for example, focuses on nutrition, and Project Good Help focuses on assessing unmet social service needs. The two community groups refer clients to one another. Project Good Help demonstrates that the healthcare and church communities can work together in innovative ways to provide cost-effective community service when they share a mission of caring for the poor and the elderly and are mutually supportive.     

Planning for community benefit. A seven-step process helps providers define and address important needs

The Catholic Health Association's (CHA's) Standards for Community Benefit ask Catholic healthcare organizations to show their commitment to addressing community needs. The standards call on providers to stress the importance of community service in a variety of contexts--from their statements of philosophy and values to the decisions made in their board and executive staff meetings. At the heart of the Standards for Community Benefit is the requirement that an organization's governing body adopt a community benefit plan. The community benefit plan can help orient staff, physicians, and volunteers to the facility's charitable role. A provider can also use a completed plan to elicit community members' views on the organization's interpretation of community needs, its priorities, and performance. Not-for-profit healthcare organizations can prepare a community benefit plan by completing the following steps: Restate the organization's mission and commitment Define the community being served Identify unmet community needs Determine and describe the organization's leadership role Determine and describe the organization's community service role Seek public comment on the plan Prepare a formal, written community benefit plan.     

Optimizing teacher basic need satisfaction in distributed healthcare contexts

Optimizing teacher motivation in distributed learning environments is paramount to ensure high-quality education, as medical education is increasingly becoming the responsibility of a larger variety of healthcare contexts. This study aims to explore teaching-related basic need satisfaction, e.g. teachers’ feelings of autonomy, competence and relatedness in teaching, in different healthcare contexts and to provide insight into its relation to contextual factors. We distributed a digital survey among healthcare professionals in university hospitals (UH), district teaching hospitals (DTH), and primary care (PC). We used the Teaching-related Basic Need Satisfaction scale, based on the Self-Determination theory, to measure teachers’ basic needs satisfaction in teaching. We studied relations between basic need satisfaction and perceived presence of contextual factors associated with teacher motivation drawn from the literature. Input from 1407 healthcare professionals was analyzed. PC healthcare professionals felt most autonomous, UH healthcare professionals felt most competent, and DTH healthcare professionals felt most related. Regardless of work context, teachers involved in educational design and who perceived more appreciation and developmental opportunities for teaching reported higher feelings of autonomy, competence, and relatedness in teaching, as did teachers who indicated that teaching was important at their job application. Perceived facilitators for teaching were associated with feeling more autonomous and related. These results can be utilized in a variety of healthcare contexts for improving teaching-related basic need satisfaction. Recommendations for practice include involving different healthcare professionals in educational development and coordination, forming communities of teachers across healthcare contexts, and addressing healthcare professionals’ intentions to be involved in education during job interviews.

     

Do rural hospitals lag behind urban hospitals in addressing community health needs? An analysis of recent trends in US community hospitals

Objective:  This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs.
Design:  This study used a multivariate, longitudinal research design.
Research setting:  A cross-sectional survey was the setting for this study.
Participants:  The participants were rural or urban hospitals in the United States.
Main outcome measures:  The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location.
Results:  Rural hospitals improved more than urban hospitals in addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information.
Conclusions:  This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations.     

Information sources and knowledge on infant vaccination according to online communities]

OBJECTIVES: To explore the information sources and knowledge on infant vaccinations of pro-vaccination community members and anti-vaccination community members on the internet. METHODS: An online survey of 245 parents from three pro-vaccination communities and 92 parents from one anti-vaccination community was conducted from June 7 to June 23, 2006. RESULTS: Parents from pro-vaccination communities usually gained the information regarding vaccination efficacy and risk mainly from healthcare providers (49.8%) and mass media (47.7%). Pro-vaccination community members considered healthcare providers as the most credible sources of information on vaccination, whereas the anti-vaccination community members usually gained their information regarding vaccine efficiency and risk from Internet child-care cafes and online vaccination communities. Parents of the anti-vaccination community considered the internet as the most credible information source (77.6% for efficacy, 94.8% for risk). In addition, the major reason why anti-vaccination community members didn't vaccinate and, will not vaccinate, was concern about possible side effects of the vaccine. The knowledge level on infant vaccination, education and economic status was higher in the anti-vaccination community. CONCLUSIONS: On-line communities concerned with vaccination are getting popular. The influence of anti-vaccination parents on the Internet is expected to be high. The government and healthcare providers need to increase their efforts to improve the credibility of information about vaccination. Our findings suggest that online communication regarding vaccinations needs to be considered as a means to increase vaccination rates.     

Financial trends for urban Catholic hospitals

To identify some of the reasons for the declining financial health of hospitals in large urban areas, staff from the Catholic Health Association's Department of Research and Information gathered data on such factors as average total profit margins, Medicare PPS margins, payer mix, and deductions from revenue between 1982 and 1989. In addition, the study tracked such indicators as occupancy, admissions, average payment period, and days in accounts receivable. Location and local community context were also studied. Based on the data, the study classified 28 of the 125 Catholic hospitals in large urban areas as "consistently sound," another 27 as "adversely affected," and 14 as "losing ground." The study compared these groups to one another, as well as to a group of nine Catholic hospitals from large urban areas that had closed by 1988. The study revealed that, despite differences in financial performance, consistently sound and adversely affected hospitals exhibited a number of similarities. Over the period covered, for example, the two groups had similar occupancy and received similar percentages of gross patient revenue from Medicare patients, third-party payers, and self-paying patients. Adversely affected hospitals contributed a significantly greater proportion of their resources to care for the poor. Consistently sound hospitals, on the other hand, had significantly fewer families below the poverty line, lower unemployment, and fewer nonwhite residents in their local communities.     

PHC training in South Africa

South Africa's Institute of Urban Primary Health Care has developed a variety of training programs for primary health care personnel at the Alexandra Health Center. The programs are based on the belief that primary health care must provide not only medical resources but also support for community efforts to improve the quality of life. Thus, the training serves as a catalyst for enabling people to take control of their health and transform their communities. Although separate training modules have been designed for community health workers, specialized community workers (e.g., geriatric care, mental health, acquired immunodeficiency syndrome), nurses, and program managers, there is a core curriculum that covers critical thinking and problem solving abilities, assessment of local needs, socioeconomic and political influences on health and community development, state-of-the-art methods of health promotion and education, and basic knowledge of health and ill-health. The training program for managers is considered especially important given the need to transform South Africa's physician-centered, tertiary care-biased health delivery system into one concerned with individual and community empowerment.     

Youth violence prevention curriculum evaluation: outcomes of a Cook County, Illinois community based partnership

The John H. Stroger, Jr. Hospital Departments of Trauma and Emergency created a youth violence prevention curriculum for healthcare providers and staff with a community partnership of practitioners and professionals. A participatory, train-the-trainer approach was used to develop and present the curriculum. Participants were offered voluntary participation in the anonymous evaluation survey to determine their interests, work experience, expectations, knowledge, and skill development, use of, and improvement for the curriculum. Responses from 49 complete surveys were qualitatively analyzed with a response rate of 42% (49/116). The activity, and efforts of professionals and community members to engage and educate themselves through this violence prevention partnership, are an example of how healthcare providers can deploy resources to benefit communities as well as to respond to the needs of individual patients, particularly in the compelling area of youth violence prevention.     

Putting the poor first. A system's assessment project identifies community needs

To enhance its mission of promoting compassionate and high-quality holistic healthcare to all people, especially the poor and underserved, Franciscan Health System (FHS), Aston, PA, launched the Service Area Needs Assessment (SANA) project in 1990. The project focused on population segments who live in the most economically deprived ZIP codes within member hospitals' service areas. SANA coordinators surveyed FHS hospitals about their programs and services for the poor and underserved and documented the programs' scope, value, and benefit to the community. When hospital personnel learned the results of the survey, they felt encouraged to interact with one another and learn more about their facilities' contributions to care for the poor and underserved in their communities. SANA coordinators and team members then interviewed community agency representatives, physicians, other service providers, and community residents. The agencies and healthcare providers identified several unmet needs that residents verified. However, the interviews revealed a gap between what providers think the problems of the poor are and what these individuals themselves believe their problems to be. As a result of these interviews, several hospitals have established programs to meet the identified needs. Of the 33 initiatives proposed, 16 represent new activities, 10 represent expansion of existing activities, and 7 represent collaboration with other organizations on new and existing programs. FHS believes the SANA project is just the beginning of a renewed commitment to caring for the poor and underserved.