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.     

What coalition factors foster community capacity? Lessons learned from the Fighting Back Initiative.

Coalitions build community capacity by encouraging local organizations to expand services, programs, or policies (i.e., organizational capacity). The aim of the study was to identify coalition factors--resources, lead agency, governance, and leadership--that foster organizational capacity. Thirteen coalitions funded by Robert Wood Johnson Foundation's Fighting Back (FB) Initiative were examined in a multiple-site case study where coalition served as the unit of analysis. Organizational capacity was measured by creating a scale for each community based on changes in programs, services, or policies among eight types of organizations. Both qualitative and quantitative analyses were conducted to identify relationships among organizational capacity and coalition factors. FB sites with greater organizational capacity shared seven characteristics: received more funds for coalition building; delayed establishing new lead agencies; were housed in agencies supportive of FB; maintained stable, participatory decision-making bodies; cultivated active involvement of local government; practiced collaborative leadership; and had effective, long-serving project directors.     

Organizational capacity for community development in regional health authorities: a conceptual model

The value of community development (CD) practices is well documented in the health promotion literature; it is a foundational strategy outlined in the Ottawa Charter for Health Promotion. Despite the importance of collaborative action with communities to enhance individual and community health and well-being, there exists a major gap between the evidence for CD and the actual extent to which CD is carried out by health organizations. In this paper it is argued that the gap exists because we have failed to turn the evaluative gaze inward-to examine the capacity of health organizations themselves to facilitate CD processes. This study was designed to explicate key elements that contribute to organizational capacity for community development (OC-CD). Twenty-two front-line CD workers and managers responsible for CD initiatives from five regional health authorities in Alberta, Canada, were interviewed. Based on the study findings, a multidimensional model for conceptualizing OC-CD is presented. Central to the model are four inter-related dimensions: (i) organizational commitment to CD, rooted in particular values and beliefs, leadership and shared understanding of CD; (ii) supportive structures and systems, such as job design, flexible planning processes, evaluation mechanisms and collaborative processes; (iii) allocation of resources for CD; and (iv) working relationships and processes that model CD within the health organization. These four dimensions contribute to successful CD practice in numerous ways, but perhaps most importantly by supporting the empowerment and autonomy of the pivotal organizational player in health promotion practice: the front-line worker.     

Roles of Community Organizations in Improving Cancer Prevention Instruction in Schools

Health education can be an important factor in the development of appropriate health behaviors in children. Community agencies that have not traditionally supported school health education can be of significant influence in improving school health education. This study examined the relationships between the involvement of the American Cancer Society (ACS) in schools and the degree of implementation of cancer prevention curricula. School health specialists from 41 metropolitan school districts in Texas were surveyed regarding the coverage of topical areas related to cancer prevention, health instructional patterns in districts, and collaborative efforts with the ACS. Tobacco use was widely covered in all levels of schools (elementary, middle, and high school), as was nutrition. Cancer detection and the concepts of cancer as a disease received most extensive coverage in high schools, and there were no significant grade level differences regarding coverage of the risks of sun exposure. School personnel had little training and felt little district support for school health education. Most respondents felt that teachers saw the ACS primarily as a resource for cancer information and resources than as a collaborative partner in health education efforts. Community organizations can play three roles in supporting school health education. First, the organizations must certainly provide diseasespecific information (in this case, cancer). They must also promote comprehensive school health education in general. Lastly, the study illustrates that community organizations must act as advocates for broader change in schools by supporting the development of organizational capacity within schools and districts to implement quality school health education, enlisting community support for quality school health education, and supporting policy initiatives that strengthen school health education activities.     

Strategies for Community/School Collaborations to Prevent Youth Substance Abuse

Within communities across the United States, collaborations have developed between community-based organizations (CBOs) and schools to plan and implement unified approaches to prevent youth substance abuse. This article describes challenges and workable strategies reported by a diverse group of 11 community-based organizations (CBOs) for developing and maintaining collaborative relationships with schools. Strategies recommended by CBOs for effective CBO/school collaborations are described within four categories: (1) establishing the collaboration; (2) maintaining cooperation with schools during program implementation; (3) addressing cultural issues; and (4) institutionalizing the collaborative programs. The need to tailor community prevention efforts to the specific context of each community is emphasized.     

Working together? Organizational and market determinants of collaboration between public health and medical care providers.

OBJECTIVES: This study examines organizational characteristics and market conditions likely to influence collaborative relationships between public health agencies and community medical care providers. METHODS: Public health directors in 60 US counties were surveyed by telephone concerning their relationships with area community hospitals (n = 263) and community health centers (n = 85). Multivariate models were used to estimate the effects of organizational and market characteristics on collaboration. RESULTS: Collaboration was reported among 55% of the hospitals and 64% of the health centers. Certain forms of collaboration were more likely in markets characterized by higher HMO penetration and lower HMO competition. CONCLUSIONS: Targeted efforts to facilitate collaboration may be required in settings where institutional and market incentives are lacking.     

Small-grants programs: lessons from community-based approaches to changing nutrition environments

Providing small grants to community organizations can be an effective way to encourage changes in the environment that support better nutrition. This is effective because these organizations can provide insights into their communities, ready-made relationships with community members, and the trust of the community. Small-grants programs are more likely to be successful when they are tailored to the needs of individual communities, led by organizations that have established reputations with the community, fully supported by the lead community organization, and engage local partners that complement the skills and resources of the lead organization. An evaluation of a small-grants program, Grants for Healthy Youth, found that grantees developed unique approaches to improving their community nutrition environments, gained experience and skills in program development, built partnerships, and received recognition for their project work. Grantees faced some common barriers, especially with program evaluation. Small-grants programs can be an effective way to improve community nutrition environments, but granting agencies need to provide effective technical assistance to communities throughout the process.     

How Community Organizations Promote Continuity of Care for Young People with Mental Health Problems

Young people between the ages of 16 and 25 who experience mental health problems experience transitions and need help from a variety of organizations. Organizations promote continuity of care by assisting young adults with developmental, service, and systemic transitions. Providers offer specific services to help transitions and also form cooperative relationships with other community organizations. Results from a survey of 100 service providers in one community describe organizational attributes and practices which are associated with continuity of care in a regional system for young adults. Data analyses show that full-service organizations which practice cultural competence offer more specific services that foster continuity of care. Larger, full-service organizations are also more likely to have more extensive and collaborative inter-organizational networks that help young adults continue care over time within the regional system of care.     

Processes of sharing issues among participating groups in the form of a food and nutrition education network: the case of the "S Network"

OBJECTIVE: To review processes of sharing issues among participating groups in the form of a food and nutrition education network and elucidate how organizations develop commitment and how individuals change their attitudes. METHODS: (1) Process regarding the form of a food and nutrition education network: After discussions by administrative public health nutritionists at public health centers and meetings with faculty members at J University, we encouraged three groups to participate in a network to share information on food and nutrition issues and gave them opportunities to interact with each other. Group A primarily provided food and nutrition information, group B primarily provided foods, and group C provided both. Specifically, these activities included two open community programs and eight volunteer activities. In the first open community program, they identified capacity to be developed through food and nutrition education and volunteers explored possible cooperation among organizations on the basis of the categorization and classification of issues. To provide feedback on the results, a workshop was held during the second open program. (2) Analysis of the process: We documented organizations involved in the form of a food and nutrition education network from 2003 through 2006, the processes and details of their activities, and activities and remarks by participants. These documents were classified by issue, broken down into categories, and listed chronologically with titles for characteristic entries, thereby reviewing the processes. On the basis of these results, we asked participants who were involved in the entire process of the construction of the food and nutrition education network to review their own activities, and we then investigated the changes in their attitudes. RESULTS: (1) A total of 63 persons in 34 organizations participated in open community programs. Local food issues included changing dietary behaviors along with diversification of lifestyle; problems with cooking, eating, and continuation of tradition because of the lack of nutritional knowledge and experience; and the uncontrolled flood of information. Participating organizations were found to engage in different activities to address nutritional issues. In addition, insufficient or low efficiency activities were identified, indicating the need for cooperation. (2) Issue-sharing processes consisted of the following three steps: identification of local nutritional issues, characterization of group activities to address food and nutritional problems, and exploration of possible cooperation among groups. Analysis of attitudes of three persons participating in the entire process of network construction revealed their interest in other organization activities and sympathy with other organizations. DISCUSSION: Factors for promotion of sharing issue include (1) our support to allow them to share food and nutrition issues in the early stages and thereafter, and (2) repeated deliberations within open community programs involving information and feedback from prior identification and analysis of problems, as well as selection of activities.     

Hospital and community health: going from stakeholder management to stakeholder collaboration

Leaders of hospitals and other health service organizations often use stakeholder management capabilities to analyze, understand, and transact business with their stakeholders in order to achieve organizational goals. When these leaders and their organizations become involved in community health improvement, they have new and different types of stakeholders than for traditional medical care. In the community health domain, these leaders should modify their approach toward stakeholders so that they collaborate with stakeholders rather than try to manage them. Recommendations for how to do this include giving up some control, building trusting relationships, and emphasizing community goals.     

Collaborative community research consortium: a model for HIV prevention.

In 1991, the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco, set out to develop a model of community collaborative research that would bring the skills of science to the service of HIV prevention and the knowledge of service providers into the domain of research. Essential elements of the model were training for community-based organizations (CBOs) in research protocol writing, partnership between CBOs and CAPS researchers, program research funding, support to implement studies and analyze results, and a program manager to oversee the effort and foster the relationships between CBOs and researchers. In this article, the authors describe the CAPS model of consortium-based community collaborative research. They also introduce a set of papers, written by researchers and service providers, that describes collaborative research projects conducted by research institutions and CBOs and illustrates how collaboration can change both HIV prevention research and service.     

The relationship between organizational culture and implementation of clinical practice guidelines: a narrative review

The context in which critical care providers work has been shown to be associated with adherence to recommendations of clinical practice guidelines (CPGs). Consideration of contextual factors such as organizational culture may therefore be important when implementing guidelines. Organizational culture has been defined simply as "how things are around here" and encompasses leadership, communication, teamwork, conflict resolution, and other domains. This narrative review highlights the results of recent quantitative and qualitative studies, including studies on adherence to nutrition guidelines in the critical care setting, which demonstrate that elements of organizational culture, such as leadership support, interprofessional collaboration, and shared beliefs about the utility of guidelines, influence adherence to guideline recommendations. Outside nutrition therapy, there is emerging evidence that strategies focusing on organizational change (eg, revision of professional roles, interdisciplinary teams, integrated care delivery, computer systems, and continuous quality improvement) can favorably influence professional performance and patient outcomes. Consequently, future interventions aimed at implementing nutrition guidelines should aim to measure and take into account organizational culture, in addition to considering the characteristics of the patient, provider, and guideline. Further high quality, multimethod studies are required to improve our understanding of how culture influences guideline implementation, and which organizational change strategies might be most effective in optimizing nutrition therapy.     

Using Academy Standards of Excellence in Nutrition and Dietetics for Organization Self-Assessment and Quality Improvement

Standards of Excellence in Nutrition and Dietetics for an Organization is a self-assessment tool to measure and evaluate an organization's program, services, and initiatives that identify and distinguish the Registered Dietitian Nutritionist (RDN) brand as the professional expert in food and nutrition. The Standards of Excellence will serve as a road map to recognize RDNs as leaders and collaborators. Standards of Excellence criteria apply to all practice segments of nutrition and dietetics: health care, education and research, business and industry, and community nutrition and public health. Given the membership's call to action to be recognized for their professional expertise, the Academy of Nutrition and Dietetics Quality Management Committee developed four Standards of Excellence in Nutrition and Dietetics for Organizations: Quality of Leadership, Quality of Organization, Quality of Practice, and Quality of Outcomes. Within each standard, specific indicators provide strategies for an organization to demonstrate excellence. The Academy will develop a self-evaluation scoring tool to assist the organization in applying and implementing one or more of the strategies in the Standards of Excellence indicators. The organization can use the self-assessment tool to establish itself as a Center of Excellence in Nutrition and Dietetics. The role examples illustrate initiatives RDNs and organizations can take to identify themselves as a Center of Excellence in Nutrition and Dietetics. Achieving the Excellence level is an important collaborative initiative between nutrition and dietetics organizations and the Academy to provide increased autonomy, supportive management, respect within peers and community, opportunities for professional development, support for further education, and compensation for the RDN. For purposes of the Standards, “organization” means workplace or practice setting.     

The Dutch heart health community intervention 'Hartslag Limburg': results of an effect study at organizational level

BACKGROUND: 'Hartslag Limburg', a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high-risk strategy to reduce CVD risk behaviours. This article presents the results of the effect evaluation study of the community intervention at the organizational level. Organizational changes were an intermediate goal of the Hartslag Limburg community intervention, as these are assumed to be a prerequisite for changes at the individual level. METHODS: A baseline-post-test control group design was used. The baseline measurement was conducted in 1998 and the post-test measurement in 2001. At baseline, 700 organizations were selected in the Maastricht region, and 577 in a control region. All organizations that were potentially significant agents in health-promoting activities were included. Data on organizational involvement in health-promoting activities were gathered by means of structured questionnaires, and sent to organization representatives by mail. RESULTS: The overall post-test percentage of organizations involved in at least one activity relating to physical activity was higher in the Maastricht region than in the control region. Furthermore, the number of activities per organization involved in activities relating to healthy eating, smoking behaviour or physical activity was higher in the Maastricht region than in the control region at post-test. CONCLUSIONS: This study provided valuable information about organizational involvement in health-promoting activities, as well as important information to consider in future research in this area. Due to the limitations of the study, the importance of measuring change at different social levels in community-based programmes, and the scarcity of effect studies of community interventions at the organizational level, further research on this subject is warranted.     

Models for community health partnerships

More so than ever, the collaborative efforts of community partnerships are considered a powerful means of improving community health. These partnerships--voluntary collaborations of diverse community organizations--can enhance organizational and personal relationships in the community and thus promote the health of residents. But when major institutions and community leaders join forces, they frequently face problems in organizing their efforts. Some leading cross-sectoral partnerships have made major strides in overcoming these problems and in demonstrating tangible results.     

Perspectives of Community- and Faith-Based Organizations about Partnering with Local Health Departments for Disasters

Public health emergency planners can better perform their mission if they develop and maintain effective relationships with community- and faith-based organizations in their jurisdictions. This qualitative study presents six themes that emerged from 20 key informant interviews representing a wide range of American community- and faith-based organizations across different types of jurisdictions, organizational types, and missions. This research seeks to provide local health department public health emergency planners with tools to assess and improve their inter-organizational community relationships. The themes identified address the importance of community engagement, leadership, intergroup dynamics and communication, and resources. Community- and faith-based organizations perceive that they are underutilized or untapped resources with respect to public health emergencies and disasters. One key reason for this is that many public health departments limit their engagement with community- and faith-based organizations to a one-way "push" model for information dissemination, rather than engaging them in other ways or improving their capacity. Beyond a reprioritization of staff time, few other resources would be required. From the perspective of community- and faith-based organizations, the quality of relationships seems to matter more than discrete resources provided by such ties.     

Understanding the relationship of maternal health behavior change and intervention strategies in a Nicaraguan NGO network

Few studies of community interventions examine independent effects of investments in: (1) capital (i.e., physical, human and social capital), and (2) management systems (e.g., monitoring and evaluation systems (M&E)) on maternal and child health behavior change. This paper does this in the context of an inter-organizational network. In Nicaragua, international non-governmental organizations (NGOs) and local NGOs formed the NicaSalud Federation. Using Lot Quality Assurance Sampling (LQAS), 14 member organizations took baselines measures of maternal safe motherhood and child health behavior indicators during November 1999 and August 2000, respectively, and final evaluation measures in December 2001. In April 2002, retrospective interviews were conducted with supervisors and managers in the 14 organizations to explore changes made to community health strategies, factors associated with the changes, and impacts they attributed to participating in NicaSalud. Physical capital (density of health huts), human capital (density and variety of paramedical personnel) and social capital (density of health committees) were associated with pregnant women attending antenatal care (ANC) 3+ times, and/or retaining ANC cards. The variety of paramedic personnel was also associated with women making post-partum visits to clinics. Physical capital (density of health huts) and social capital (density of health committees and mothers' clubs) were associated with child diarrhea case management indicators. One safe motherhood indicator (delivery of babies by a clinician) was not associated with intervention strategies. At the management level, NicaSalud's training of members to use LQAS for M&E was associated with the number of strategic and tactical changes they subsequently made to interventions (organizational learning). Organizational learning was related to changes in maternal and child health behaviors of the women (including changes in the proportion using post-partum care). As the latter result would not have occurred without NicaSalud, we conclude that this inter-organizational network provided added value by instigating organizational learning.     

Evaluation findings from the Institute for Public Health and Faith Collaborations

OBJECTIVE: The Institute for Public Health and Faith Collaborations sought to cultivate boundary leadership to strengthen collaboration across religious and health sectors to address health disparities. This article presents findings from an evaluation of the Institute and its impact on participating teams of faith and public health leaders. METHODS:. Self-administered surveys were completed by participating team members (n = 243) immediately post-Institute. Semistructured telephone interviews were conducted with at least one health and one faith leader per team six to eight months after the Institute. RESULTS: Significant self-reported improvement occurred for all short-term outcomes assessed, with the largest increases in describing organizational frames and why they are important for community change, and understanding the role of boundary leaders in community systems change. Six months after the Institute, participants spoke of inspiration, team building, and understanding their own leadership strengths as important outcomes. Leadership growth centered on functioning in groups, making a change in their work, a renewed faith in self, and a renewed focus on applying themselves to faith/health work. Top team accomplishments included planning or implementing a program or event, or solidifying or sustaining a collaborative structure. The majority felt they were moving in the right direction to reduce health disparities, but had not yet made an impact. CONCLUSIONS: Results suggest the Institute played a role in helping to align faith and health assets in many of the participating teams.