What are true community benefits?

Not-for-profit healthcare organizations have increasingly recognized the need to document their community benefit services, but not all healthcare services should be included in a community benefits report. Some services are reasonably expected of any high-quality healthcare organization, regardless of its tax status. Others are provided as part of a commitment to the community, but they cannot or should not be quantified. A third group of services, however, can be counted and reported in an inventory of benefits. To qualify as a true community benefit, an activity must respond to a particular health problem in the community, especially one involving special populations. In addition, it must be financed through philanthropic contributions, volunteer efforts, or an endowment; generate a low or negative margin; or be a service that would be discontinued if the decision were made on a purely financial basis. Once an organization has determined that an activity is a community benefit and not a basic service or promotional program, organizational leaders must decide whether to include the service in a quantitative inventory or in a more general narrative without assignment of specific financial benefit. The community benefit services might be further broken down according to the intended recipient, whether it is the poor or the broader community.     

A blueprint for community benefit. A CHA-AAHA (Catholic Health Association-American Association of Homes for the Aging) document helps long-term care providers plan for and implement needed services

A collaborative effort of the Catholic Health Association (CHA) and the American Association of Homes for the Aging, The Social Accountability Program: Continuing the Community Benefit Tradition of Not-for-Profit Homes and Services for the Aging helps long-term care organizations plan and report community benefit activities. The program takes long-term care providers through five sequential tasks: reaffirming commitment to the elderly and others in the community; developing a community service plan; developing and providing community services; reporting community services; and evaluating the community service role. To help organizations reaffirm commitment, the Social Accountability Program presents a process facilities can use to review their historical roots and purposes and evaluate whether current policies and procedures are consistent with the organizational philosophy. Once this step is completed, providers can develop a community service plan by identifying target populations and the services they need. For facilities developing and implementing such services, the program suggests ways of measuring and monitoring them for budgetary purposes. Once they have implemented services, not-for-profit healthcare organizations must account for their impact on the community. The Social Accountability Program lists elements to be included in community service reports. It also provides guidelines for evaluating these services' effectiveness and the organization's overall community benefit role.     

Lourdes wins 1995 McGaw Prize. Camden, N.J., hospital receives coveted award for excellence in community service

Once a year, the prestigious Foster G. McGaw Prize for Excellence in Community Service is presented to a hospital. This year's award, presented Aug. 21 at the American Hospital Association's 1995 convention in San Francisco, was awarded to Our Lady of Lourdes Medical Center in Camden, N.J. Camden, N.J., is a city awash in negative statistics. It is considered the most economically depressed city of its size in the United States. A Rand Corp. study considers it one of the three worst areas in the country (placed in the "disaster" class). Not surprisingly, the problems extend to healthcare indicators as well. In the middle of Camden and in the middle of the statistics in Our Lady of Lourdes Medical Center. Their efforts and their commitment to the community is driven by its mission and vision, which states that working collaboratively, Lourdes "...will be both a catalyst and major participant in the revitalization of the city...in community benefit programs and community activities that give meaning, dignity and hope to all." Our cover story this issue examines the many and varied programs that enabled Our Lady of Lourdes to win the coveted prize, awarded "to a healthcare organization that demonstrates commitment to community service through a range of innovative programs that expand access to healthcare." And if your healthcare organization plans to enter the competition next year, we've included a bonus: Some helpful hints from this year's winner on putting the application together.     

Developing community health promotion interventions: selecting partners and fostering collaboration

Although an often desired goal, true partnership between community members and university researchers can be difficult to achieve. Strategies implemented in a diabetes prevention and control program in a Latino community may be effective in overcoming hurdles to collaborative research. The development of selection criteria can be useful for objectively choosing a community organization as a partner agency. The implementation of formal partnership principles is proposed as a strategy for building a successful partnership. Partnership principles are a powerful mechanism to assure ethical relations between collaborators. As a strategy for process evaluation, they can help organize data on the extent to which intent has translated into action. They provide a structure for project stability that can outlast individual commitments and a mechanism to keep project commitment on course and maintain active engagement.     

Comparing Hospital Mission Statement Content in a Changing Healthcare Field

Mission statements are key elements of how an organization communicates its purpose and priorities to its community. This study considers how mission statements from Ohio, Florida, and Texas hospitals approach key concepts in healthcare – access, cost, and quality. It also considers the concept of community benefit, given its recent prevalence in policy changes.

The analysis found quality represented within hospital mission statements at a rate of 65%, compared to 21% for access, 21% for cost, and 24% for community benefit. Investor-owned hospitals emphasize quality and cost at significantly higher rates while not-for-profit hospitals emphasize access and community benefit at significantly higher rates than other organization types.     

Cancer program development: is your hospital ready?

According to a recent survey of 1,779 U.S. hospitals, nearly 50 percent intend to expand their oncology programs in the next two years (Sandrik 1990). Also, the membership of the Association of Community Cancer Centers (ACCC), an organization of community-based oncology programs, has quadrupled in the last decade (ACCC 1991). These facts indicate that a growing number of community hospitals are continuing to develop organized cancer programs. This two-part article answers the questions, "Why should a hospital consider expansion of oncology programs?" "When is a hospital ready for a major commitment to oncology?" "How does a hospital go about such a development?" "What components should be considered in the development process?" Part I will address the first three questions and part II will address the final one.     

基于SWOT分析的军队医院危机管理策略

本文利用SWOT方法分析军队医院实施危机管理所具备的内部优势和劣势,以及来自外部的机会和威胁,提出军队医院在实施危机管理时所采取的策略选择,并从建立危机管理组织体系,加强危机管理制度建设;培育医院危机文化,提高全体人员的危机意识;构建危机预警机制,增强危机识别和预防能力;畅通利益相关网络,强化和提升危机公关能力等方面阐述了工作要点。     

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.     

Hospital social work and discharge planning: an exploratory study in East Anglia

An exploratory research study in one district health authority demonstrates the significant impact of the NHS and Community Care Act 1990 on hospital-based social workers. Their work is overwhelmingly concerned with the discharge planning process, in which they have developed patterns of collaboration with a range of other professional groups while retaining a specific commitment to the interests of the patient and carers. The social workers interviewed differ in the degree to which they feel a sense of corporate identity with the hospital and the healthcare system. The study identifies five practice elements in the social worker's range of responsibilities: interdisciplinary collaboration, assessment, providing a link between hospital and community, networking and negotiation, and the use of financial acumen. Two areas of debate and dissonance are identified: counselling is not now something that looms large in the social worker's daily round; while the defence of patient rights sometimes involved the social worker in conflicting relationships with other professional groups.     

Repurposing Waste Streams: Lessons on Integrating Hospital Food Waste into a Community Garden

There have been increasing efforts in recent decades to divert institutional food waste into composting programs. As major producers of food waste who must increasingly demonstrate community benefit, hospitals have an incentive to develop such programs. In this article, we explain the emerging opportunity to link hospitals’ food services to local community gardens in order to implement robust composting programs. We describe a partnership model at our hospital in central Pennsylvania, share preliminary outcomes establishing feasibility, and offer guidance for future efforts. We also demonstrate that the integration of medical students in such efforts can foster systems thinking in the development of programs to manage hospital waste streams in more ecologically-friendly ways.     

The Health Care-Child Welfare Partnership: Transitioning Medically Complex Children to the Community

There is a growing number of medically complex children residing in hospitals who could benefit from home care This paper describes a unique federally funded grant project designed to develop alternative home resources for those medically complex children whose parents are unable to provide the requisite home care Building on an innovative partnership between a pediatric hospital and a community child welfare agency, this project recruited trained, and supported foster parents to care for those children Problems, solutions, and strategies for developing alternative home care resources for this population are presented.     

Hospital nurses' intentions to remain: exploring a northern context

Retaining nurses is of significant concern to all hospitals but even more of a concern to northern and rural hospital managers. This study provides insights into factors related to nurses' intentions to remain. A sample of 122 nurses from 13 northern hospitals in Western Canada participated in the study. The nurses completed questionnaires and participated in structured interviews. A model was proposed which suggested that work experiences (job and decision latitude, feedback, perceptions of how viewed and treated by others, fairness of policies, and safety of the job environment) would be related to job satisfaction and then affective commitment. Age and tenure, and ties to the community were proposed as predictors of continuance commitment. Both affective and continuance commitments were expected to be related to intention to remain in the hospital. The model was partially supported by regression analyses. Work experiences predicted job satisfaction and affective commitment. Affective commitment, continuance commitment, and ties to the community are related to nurses' intentions to remain. Supplemental analyses indicated that the strongest relationships were found for management's views and treatment of nurses, knowledge and ability utilization, safe environment, and fairness of organizational policies.     

医院文化管理对医务人员组织承诺的影响探讨

随着医改进程的加快,特别是公立医院改革的深化,公立医院传统的人事管理模式将发生根本性的改变。介绍了医院文化管理对医务人员组织承诺的影响,提出从培养共同的价值观与目标愿景、完善＂以人为本＂的管理模式、发挥领导者的重要作用三个方面提高医务人员组织承诺。     

Seeing Community Benefit broadly. Everybody wins when hospitals collaborate with others to serve their communities

Community benefit is an opportunity for hospitals and health systems to affirm their community-focused missions and to ensure implementation of those missions in their organizations. There are four key themes of community benefit: community health improvement, underserved populations and unmet needs, collaboration outside the hospital, and coordination and strategic management inside the hospital. Together, these constitute a broader perspective, one in which community benefit is of strategic value to both the community and the hospital, and serves as a departure point for some of the hospital's most fruitful contributions to health and well-being. The community benefit function can be organized and managed to achieve specific priorities with measurable objectives, just like any other hospital activity. There are innumerable examples of creative and successful models for community benefit programs that incorporate the principles of community health improvement, unmet needs, collaboration externally, and strategic management internally. These are models that hospital leaders should create and pursue, because they demonstrate the value of a broad view of community benefit that fully realizes the potential of hospitals' charitable purpose.     

The Sub-Acute Center

Both researchers and practitioners have become increasingly concerned with the plight of elderly mental hospital patients who are often inappropriately confined in state hospitals and then discharged form these facilities with little preparation for survival or attention given to the quality of community resources. This paper proposes the establishment of a new community care setting, a sub-acute center (SAC), which is designed to meet present inadequacies in the mental care system for the aged and combines elements of a foster home and a protective setting with a mental health aftercare component for more effectively preparing the elderly for independent community living. the SAC combines at least three concepts which are discussed: (a) the receiving staiton; (b) continuity of care; and (c) advocacy. The professional SAC staff and aides have many potential roles to play as practitioners, spokesmen, educators, consultants, and researchers.     

The sub-acute center: a proposal for relocating elderly mental patients.

Both researchers and practitioners have become increasingly concerned with the plight of elderly mental hospital patients who are often inappropriately confined in state hospitals and then discharged from these facilities with little preparation for survival or attention given to the quality of community resources. This paper proposes the establishment of a new community care setting, a sub-acute center (SAC), which is designed to meet present inadequacies in the mental care system for the aged and combines elements of a foster home and a protective setting with a mental health aftercare component for more effectively preparing the elderly for independent community living. The SAC combines at least three concepts which are discussed: (a) the receiving station; (b) continuity of care; and (c) advocacy. The professional SAC staff and aides have many potential roles to play as practitioners, spokesmen, educators, consultants, and researchers.     

Developing a community health promotion agenda for a managed care organization

Coordination and collaboration between organizations interested in promoting the health of the populations they serve can potentially help to ensure that key services are provided as well as augment the efforts beyond that which could be accomplished by each organization alone. Understanding the perspectives of each organization can facilitate development of health promotion initiatives that will be of mutual benefit. In Maryland, when a Medicaid managed care program was initiated, Memoranda of Understanding were signed between each managed care organization (MCO) and each of the 24 local health departments; many stipulated that the parties will coordinate on community health issues. This report describes a telephone survey of the health departments that was performed by one MCO to better understand the interests and expectations of the health departments and discusses a process for developing a community health promotion agenda for an MCO.     

我国医院与社区卫生资源互动整合模式与政策研究

通过系统归纳和描述了目前我国大型医院与社区医疗资源互动整合的几种典型模式：以政府推动为基础的模式,以社区为基础的模式,以医院为主体的模式,医院和社区双向配合的模式,以疾病管理为基础的模式和以资产整合为基础的模式等。分析了大型医院与社区医疗资源互动整合中存在的问题与面临的挑战：互动整合的法规制度不协调;互动整合存在利益冲突;分级医疗制度不完善;互动整合的运行机制不配套;医疗资源配置机制存在缺陷。提出了相关的政策建议：统筹规划,建立政府主导机制;明确权责,建立利益平衡机制;完善分级医疗服务制度,构建战略伙伴关系;发挥医院核心作用,形成资源共享机制;改善社区卫生服务质量,建立质量控制和监督评价机制;鉴于区域发展不平衡的现实,鼓励采取不同形式的互动整合模式。     

Preventing harm from high-alert medications

BACKGROUND: One of the 12 interventions that the Institute for Healthcare Improvement (IHI) recommends for its 5 Million Lives Campaign is "Prevent Harm from High-Alert Medications . . . starting with a focus on anticoagulants, sedatives, narcotics, and insulin." EXECUTING SYSTEM-LEVEL CHANGES: Three essential elements are needed to execute system-level changes in an organization: will, ideas, and execution. Will is developed by examining the status quo in an organization and agreeing that it is no longer acceptable. Ideas-changes that will make the system safer-can be found in the literature and in the experience of other hospitals and are the basis for the recommended general interventions to reduce errors and harm associated with high-alert medications. Execution, the process of making those changes real, requires commitment from senior leaders and clinical leaders, along with the organizational capacity to improve. The steps in the medication system are so interrelated that a change in one area will affect others' ability to complete their work. In addition, senior leadership and clinical leadership must visibly support the effort, connecting the reduction in high-alert medication-related harm to the overall hospital goal of harm reduction is essential. CONCLUSION: The campaign's goal is to achieve a 50% reduction in harm related to high-alert medications. Employing strategies such as standardization and simplification will provide the foundation for improved medication safety.     

Revitalized commitment to community. A community benefit plan helps a hospital be a good neighbor

Three years ago St. John Hospital and Medical Center, Detroit, made a commitment to strengthen its community relationships and reaffirm its mission of serving those in need by following the Catholic Health Association's Social Accountability Budget. While implementing the program, administrators were surprised to learn the hospital was already participating in many community programs for which it received little or no reimbursement. They also discovered that the hospital had no formal, written charity care policy even though St. John provided more than $14 million in uncompensated care annually. To learn what the needs of the surrounding community were, the hospital went to the clergy, who overwhelmingly identified the needs of the elderly as the number-one priority. A close second was supporting the basic family unit. Other concerns included basic family needs, safe neighborhoods and schools, and teen pregnancy. Although the hospital realized it could not do all that was needed, it felt obliged to be a leader in seeing that the needs were met and drew up a community benefit plan that documented the problems and the solutions. The hospital did what it could and worked with other organizations to address needs such as housing for the elderly, affordable and accessible healthcare, neighborhood improvement and safety, and family services.