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.     

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.     

Retooling for community benefit

Healthcare providers today must have a mission of service both to the individual and to the community. In 1990 the Hospital Community Benefit Standards Program (HCBSP) was launched as a demonstration project to begin the process of defining the elements that constitute community benefit. The HCBSP standards are that a hospital (1) evince a significant organizational and operational commitment to a community benefit process, (2) plan and implement projects and activities that address specific community public health needs, (3) cultivate and maintain relationships with other organizations to foster community benefit, and (4) foster an internal environment that encourages everyone in the organization to participate in community benefit programs. The following elements are important to an effective community benefit program: Governing board involvement CEO understanding and commitment A key senior manager to coordinate An explicit commitment of human and financial resources An epidemiologic data base describing a defined community or population A mechanism for bringing together people in the organization interested in community benefit A mechanism for facilitating dialogue between hospital leaders and representatives from the community A method of linking community benefit processes to outcomes     

Raising the bar

In July 2002, Catholic Health West (CHW) established a policy that called for a uniform measurement and improvement of community benefit work that would preserve the flexibility of each facility to respond to the needs of its particular community. CHW's 40 member hospitals were asked to submit two community benefit goals that would be monitored for outcomes over the subsequent two years. The system's corporate office helped staff members at each facility determine the baseline for performance improvement, set realistic goals, establish measurable outcomes, and develop an effective intervention strategy for the health issue addressed. The goals, set forth in CHW's Community Benefit Policy and its Standards for Mission Integration, were included as part of each hospital president's annual performance evaluation. At the end of the third year of CHW's effort to apply greater scientific rigor to community benefit programming, more than 85 percent of its hospitals met or exceeded their stated goals.     

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.     

Catholic hospitals and community benefit activities. A comparative inventory of policies and programs reveals a wide range of services

Results from a 1990 survey of 595 acute care, short-term, U.S. Catholic hospitals help identify and describe the most and least common community benefit activities and propose ways Catholic healthcare providers can become more involved in their local communities. The response rate for this mailed, self-administered questionnaire was 72 percent (n = 429). The survey data indicated that Catholic hospitals engaged in a variety of healthcare efforts in their local communities. These efforts ranged from occasional activities (e.g., delivering food baskets to the needy at Christmastime) to sponsoring long-term programs (e.g., continuing case management). To expand involvement throughout the community, hospitals can do the following relatively low-cost tasks: Have volunteers visit area residents in their homes and report their findings. Sponsor focus groups (facilitated by graduate students from area colleges and universities) that include the various community members. Assess the human needs of the communities that surround the hospital. Graduate students may conduct preliminary studies to identify the scope and variety of community healthcare needs.     

Three factors critical for end-of-life care

Appropriate care of persons with life-threatening illnesses requires a different, perhaps higher level of response from organized healthcare than has been typical in the past. This involves three critical components: Leaders must be committed, visible advocates of high-quality end-of-life care. This enables them to plan changes, deploy resources, and integrate this commitment throughout the organization's strategic plan. Ensuring appropriate care of the dying requires adequate human and financial resources. First, the organization must fully identify the educational and service needs of patients, families, and care givers experiencing life-threatening illnesses. The organization must work well with other community-based organizations to address identified needs. Senior managers can improve care by personally commissioning teams, acknowledging success, and rewarding performance. Finally, organizational goals, strategies, and performance objectives must be shaped by a commitment to ensure appropriate care of the dying. Our commitment to the dying must be based on our values. An organizational "statement of rights and responsibilities" is one way of providing a visible expression of the mission, core values, and mutual responsibilities among care givers and patients, residents, HMO members, and clients.     

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.     

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 synergy of values. Catholic healthcare leaders must implement their organization's mission and model its values

Catholic organizations need to select, develop, and retain healthcare leaders who dedicate themselves to carrying on the Church's healing ministry and the work begun by those who have preceded them. Persons entrusted to carry on Jesus' healing mission perform their duties out of a sense of commitment to the ministry and a love for the persons with whom they work and whom they serve. They recognize a synergy between their own values and the values of the healthcare organizations they lead. Dedication to leadership in Catholic healthcare can be viewed from three perspectives: the Bible and selected documents of the Catholic Church; the transfer of responsibility for Catholic healthcare from religious congregations to evolving forms of sponsorship; and the implications for the selection, development, and retention of healthcare leaders, both lay and religious. Servant-leadership is an integral part of the religious tradition that underlies Catholic healthcare. As cooperation increases between healthcare providers, third-party payers, employers, and other healthcare agents. Catholic healthcare organizations are challenged to reassert a mission and values that will enable healthcare in the United States to be delivered both compassionately and competently.     

A nursing shortage: building organizational commitment among nurses

As a major nursing shortage threatens healthcare organizations, the views of 30 staff nurses are examined to determine factors that contribute to their commitment, or lack of commitment, to their employing hospital. Content analysis identified that organizational commitment is most related to personal factors, opportunities for learning, job satisfaction, plan for retirement, monetary benefits, patient care, coworkers, cultural factors, and job security, in that order. Lack of organizational commitment is most related to conflict with personal needs. However, lack of learning, lack of appreciation and fairness, inadequate monetary benefits, patient care situations, poor relations with coworkers, career developmental stage, and lack of job security are also discussed. Application of these findings to healthcare administration is discussed, with strategies for building organizational commitment among nurses.     

Protecting children's health. CHA's immunization program helps organizations increase vaccination rates in their communities

In response to the increasing outbreaks of vaccine-preventable diseases in the United States, the Catholic Health Association (CHA) has developed a new resource to help its members launch programs that will increase immunization rates among children in their service area. Vaccines are the building blocks of basic primary care. But society and the healthcare system have erected barriers that prevent children from being fully immunized. Impediments include missed opportunities, cost barriers, and facility and resource barriers. Catholic healthcare providers can help eliminate these barriers and ensure that all children in their service areas are vaccinated by assessing their immunization resources, seeking out unvaccinated children, and collaborating with community organizations and agencies. CHA's immunization campaign will guide Catholic healthcare providers as they protect children from preventable diseases. Immunization may help reduce the costs of emergency and acute care for conditions that could have been prevented.     

"Do good and talk about it". A CHRISTUS health study emphasizes the importance of telling our stories to the public

In a time of public scrutiny, it is paramount that Catholic health care organizations examine their commitments to their communities and effectively communicate community benefit activities to stakeholders-employees, physicians, patients, and the public. CHRISTUS Academy, a leadership development program at CHRISTUS Health, Irving, TX, conducted two studies regarding community benefit. The first researched community benefit practices at more than 20 highly respected, tax-exempt CHA- and VHA-member organizations, comparing them with the practices of about 40 publicly traded, for-profit organizations. The primary conclusion was that community benefit is not just about measuring the numbers-it is also about "telling the story." Unlike the for-profit organizations, tax-exempt health care organizations tend to struggle with adequately measuring and reporting their community contributions. In a second study, the academy surveyed CHRISTUS Health's employees and physicians regarding their knowledge of the system's commitment vis-à-vis identifying and meeting community needs. The vast majority said the system is important to the community and is actively involved in understanding and meeting the needs of the community. However, they also ranked the system lower in terms of working with other community organizations, being a leader in community health, and being known for sponsoring volunteer activities. These lower rankings indicate that the community benefit activities are not well publicized or known within the organization. Catholic health organizations must take an active approach in communicating their work to the public, the media, and each other. In doing so, they fulfill an integral part their mission.     

Establishing values-based leadership and value systems in healthcare organizations

The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system. This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers--competing or conflicting values within a unit or the entire organization. Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.     

Increasing Medicaid clients' access to care. Church, state, and private providers collaborate

Medicaid clients often have difficulty obtaining a physician referral and thus seek treatment for nonemergent conditions in hospital emergency rooms. A committee with representatives from Alexian Brothers Health System, Inc., Elk Grove Village, IL, and Catholic Charities of the Archdiocese of Chicago, Rolling Meadows, IL, has collaborated with six other organizations to put an end to this misuse of the healthcare system in Chicago's northwest suburbs. Catholic Charities Physician Referral Service came about as the result of research conducted by the committee which indicated that persons on public aid have limited resources available to secure primary healthcare. The committee also reviewed a United Way needs assessment and a survey of healthcare professionals and community leaders which substantiated that the community needed a referral service. In the past, Medicaid clients often had to make numerous futile telephone calls to locate physicians who would accept them. Through this service, however, Medicaid clients simply call Catholic Charities Physician Referral Service (which has information on participating physicians' specialty, location, and hospital affiliations) and then call the physician to whom they are referred. When physicians join the referral service, they specify the number of Medicaid patients they are willing to treat during the year. Catholic Charities will help the participating physicians secure payment from the Illinois Department of Public Aid for the health services they have provided.     

A novel resource model for underprivileged health support: Community Medical Outreach

Community Medical Outreach is a student-run organization that provides healthcare access to medically underprivileged farm workers. The program exploits the substantial energy, enthusiasm and organizational capacity of pre-medical students as they prepare to apply for medical school. All of the partners benefit from the interchange. The students gain from a unique first-hand medical experience that demonstrates their leadership, management skills, commitment to a healthcare team, and focus on care at the community level. Those in most need gain healthcare access. Volunteer staff and physicians are inspired by the students and are energized by caring for those most in need of health care. The companies, agencies, and organizations donating supplies, drugs, expertise, and sponsorship benefit from enhanced public relations. The article describes the initiation, the lessons learned, the critical importance of linkages, and the essential components such as individual and institutional liability. Community Medical Outreach is an important vehicle for shaping students in the process of becoming physicians, shaping those involved with the process of admitting students, shaping training experiences, and shaping new models of health care.     

Healthy communities: good mission, good sense. Holistic approach is the key

Catholic healthcare's mission is keeping people healthy, and providers must listen closely to determine their needs in these fast-paced, stressful times. In a society preoccupied with technology and acute care, which has the least overall impact on people's health, providers must implement more preventive strategies. The shift to promoting community health will require diverse, creative approaches. Catholic facilities must offer holistic healing, becoming community resources for children and the elderly. Religious institutes also must prepare for the laity's increasing role in the ministry. Providers must develop initiatives that define Catholic healthcare, such as the Welfare-to-Work Program in St. Louis, which offers women employment opportunities and benefits as a starting point to gain control of their lives. With increased school collaboration, nurses can help children develop good health habits. The guiding vision must be the health of the whole person and the community. Catholic providers must restore public trust and confidence by emphasizing person-centered healthcare. Only by becoming an integral part of the community can Catholic healthcare make a difference in people's lives.     

Community benefit plans and action

The tax-exempt sector in America is significant, and not-for-profit healthcare is its largest component. The basis for not-for-profit hospitals' tax exemption is not only "charity care" but the broader "community benefit." Community benefit planning and reporting offers a significant positive opportunity for not-for-profit hospitals. Such planning allows a not-for-profit institution to: differentiate from the investor-owned hospital; re-focus on the local hospital and the benefit it brings to the community; change the public's perception of the value of the hospital; and regain public support by leading many of the community benefit programs addressing community needs. As Weckwerth suggested in his paper, regaining the public's trust needs to be done through action and not just words. The most effective action a not-for-profit hospital can take is to develop a sound, logical community benefit plan; carry out that plan; achieve benefits for the community through the plan's programs; and then widely report the accomplishments of the community benefit programs throughout the community. Then, the hospital should do it again and again, year after year. Although the financial stability of the not-for-profit hospital is important, far more important at this time is regaining the public's trust through demonstration of the many community benefits gained from having a local, not-for-profit hospital.     

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.     

Developing a culture of safety in ambulatory care settings

The focus on medical error prevention has prompted forward-thinking healthcare providers to increasingly support an organizational culture that supports and promotes patient safety. A culture of safety is necessary before other patient safety practices can be introduced successfully. Various elements of a culture of safety are discussed. Some organizations have implemented survey tools to assess their safety culture. Assessing an organization's culture of safety is just the beginning. Setting priorities for action and identifying strategies to improve healthcare safety must follow with support of the organization's leaders and frontline staff. Recommendations for action are provided.