A stakeholder approach to community health management

Although community health management has become an important issue for health care organizations, there is little information on the roles that they and other community institutions ought to play in this area. This article develops a stakeholder approach to community health management, identifies the set of community health stakeholders, determines their salience to health care organizations, discusses the strategies they use to influence organizational involvement in community health management, and examines the responses of health care organizations. Implications for community institutions, health care managers, and researchers are discussed.     

State of intervention: community stakeholder discourse on teen childbearing in Iowa

The state of teen childbearing in Iowa (USA) is positioned by community leaders as a discursive battleground for intervention. In 2015 meetings with community stakeholders, participants framed ‘culture’ (which they defined as ethnicity and religion) as a barrier in decreasing the state’s teen pregnancy rate and increasing girls’ economic self-sufficiency. The childbearing teen body was, unsurprisingly, portrayed as a public health problem in need of organizational intervention. But how participants linked ‘culture’ to neoliberal ideals was surprising and specific. Utilizing McRobbie’s concept of the ‘real self’ and Foucault’s explication of governmentality, this study draws out the role of neoliberal self-sufficiency in grooming teens to perform adolescent femininity and self-govern. In doing so, it considers community stakeholders’ meaning-making processes. Findings show the interventionist discourse does more than attempt to prevent early pregnancy: it reinforces acceptable and unacceptable pregnant bodies and compels community leaders and practitioners to govern childbearing teen bodies in precise ways.     

Creating healthier communities: a compendium of models

Old paradigms are hard to change. Individual leaders in discreet organizations can no longer be solely responsible for the health of the populations they serve. Citizens cannot rely on outdated models of health, in which traditional healthcare played the primary part in defining and ensuring the well-being of the members of the community. Today, to achieve a "healthier community," individuals must join with organizations and stakeholders to listen to the needs of those they serve and to broaden their idea of what creates health. The concept of the healthier communities movement is based on improving the health and quality of life of communities by forming partnerships and collaborations among public, private, and voluntary agencies and organizations. To become healthy, a community must evaluate and understand its unique needs and pool its resources--whether human, organizational, or financial--in innovative ways. Strategies need to be established to deal with the issues faced by our communities--rural, suburban, or urban, whether it is healthcare for migrant workers, domestic violence prevention projects, or health clinics for inner-city schools. Programs and services must reside where the needs are, and often those needs become apparent only when all members of the community are engaged in a dialogue and each voice can be heard. The models on the following pages illustrate the success of the healthier communities movement--when citizens, government, and community leaders commit to making health a priority for all members of the population.     

Issues management: the other side of strategic planning

Most health services organizations follow a strategic planning model that emphasizes organizational changes to adapt to the environment. This limited view overlooks the possibility of changing the environment to better suit the organization's goals. Health services leaders in particular are concerned because they have not been effectively engaged in dealing with external policy matters. A strategic issues management system provides an integrated approach to this responsibility and can be established by expanding current strategic management activities. Additional resources will be required for new analyses and interpretations and for more intense interaction with stakeholders, but these costs will be significantly less than the benefits realized from operation of an effective strategic issues management system.     

The determination of organization stakeholder salience in public health.

Because interorganizational arrangements are encouraged as necessary to meet public health goals, it is critical for the managers of public health services at any level to consider stakeholder theory from an organizational perspective. Public health managers are responsible for the stakeholders in public health as well as public health as a stakeholder in other organizations. This article presents an innovative tool for the determination of organization stakeholder salience that assists managers in establishing priorities for interorganizational relationships during strategic planning and day-to-day decision making.     

Responding to a crisis: a stakeholder analysis of community health organizations

On May 11, 2001, the Bureau of Primary Health Care notified West Alabama Health Services, doing business as Family HealthCare of Alabama, that it was terminating $6 million in grants due to non-compliance and amid allegations of financial mismanagement and fraud. West Alabama Health Services, a not-for-profit organization, operated 19 community health centers that provided preventive and primary care services for 17 counties in Alabama. This disruption of health services engendered considerable stakeholder debate. Within this context, the authors examine how a small, newly established rural health center and a well-established, federally qualified community health center responded to this crisis. The authors use a stakeholder analysis framework to highlight how key relationships with stakeholders may change with the perceived credibility of the organizational leaders and the legitimacy of their actions.     

Advancing community health through community health partnerships

Improving a community's health is a key goal of health services organizations. Effectively pursuing that goal requires health services organizations to create partnerships with other organizations to help identify community health needs and to create and carry out programs that bring together community members and needed health services. Drawing on community systems concepts and a recent study of community health partnership efforts in three cities, this article provides a framework for such partnerships. Types of partnerships described include: Community action partnerships, in which the partnership forms to address a specific problem or pursue a specific opportunity. Community organization partnerships, in which a set of organizations in a similar service sector agree to collaborate for mutually agreed upon goals; and Community development partnerships, in which a partnership attempts to increase participation by people and organizations in collaborative activities that advance the community on multiple fronts or that contribute to community assets and services in multiple areas. The article also describes how the pressures to create large integrated delivery systems can affect creation of partnerships to improve community health. Increasingly, healthcare leaders are being held accountable for the health of communities they serve. When creating partnerships for community health and carrying out health-improvement activities, leaders should be aware of and respond to four key dimensions of accountability: political accountability, commercial accountability, clinical/patient accountability, and community accountability.     

Strategy development in small hospitals: stakeholder management in constrained circumstances

Small hospitals form a vital part of the health care safety net, serving communities that would often otherwise lack acute care. It is, therefore, important to understand how strategies unfold in these organizations. We used semistructured interviews to ask chief executive officers (CEOs) of seven small hospitals in Pennsylvania how they viewed their competitive environments and how their strategies evolved. Systematic semi-inductive analyses of these data reveal two major themes. First, CEOs of small hospitals perceive highly dynamic and hostile environments but do not stress complexity. Second, continual negotiations with key stakeholders facilitate the translation of CEOs' insights into organizational strategies.     

Stakeholder management in a hyperturbulent health care environment

The fast-paced change in today's health care environment presents an unsettling organizational climate within which managers must make important decisions that affect key stakeholders. This ambiguousness has resulted in the proliferation of health care organizations that are bundling together to find a sense of environmental stability in which they can achieve common goals. This means that health care managers need to view stakeholders as parts of larger bundles rather than only as individual organizations.     

Is it Time for a Sudden Infant Death Syndrome (SIDS) Awareness Campaign? Community Stakeholders’ Perceptions of SIDS

Sudden infant death syndrome (SIDS) remains a leading cause of infant death in the United States, and in Virginia. We sought to gauge the perceptions among community-identified stakeholders regarding community resource needs to reduce SIDS. Snowball sampling identified important community stakeholders to be interviewed as key informants. A semi-structured interview was delivered to determine resource needs to reduce SIDS, and whether high-risk community members were aware of SIDS risk factors. Interviews were conducted in two geographic areas with higher than average rates of infant mortality: Winchester City, VA; Page County, VA. Seventy-four interviews were completed with stakeholders in healthcare, social services, and a variety of other organizations. The majority of respondents perceive that high-risk community members are not aware of factors that can lead to SIDS (50%). Participants suggested that more “education” is needed to further reduce SIDS rates in their communities (73%). Respondents detailed that more pervasive, strategic, and multi-channelled education is necessary to reduce cases of SIDS. Community leaders perceive that high-risk community members are not fully aware of risk factors that can lead to SIDS. Maternal/child health stakeholders in these Virginia locales suggested more community-based education as a potential solution.     

2006 AHA environmental assessment

The AHAs Environmental Assessment identifies emerging trends facing health care providers, consumers and stakeholders. Health care leaders can use it to understand their environment and analyze the effects these trends will have on their organizations.     

AHA environmental assessment 2005

The AHAs 2005 Environmental Assessment identifies emerging trends facing health care providers, consumers and stakeholders. Health care leaders can use it to understand their environment and analyze the effects these trends will have on their organizations.     

Sole hospital commitment to health promotion and disease prevention (HPDP) services: does ownership matter?

Hospitals have been increasingly involved in health promotion and disease prevention (HPDP) in the last two decades. Concurrent with this trend, environmental changes and market pressures have resulted in more hospital consolidations and conversions from not-for-profit (NFP) to for-profit (FP) organizations. The emergence of a large number of sole community hospitals has attracted the attention of policy-makers and community stakeholders because sole community hospitals have more power in the local market and may discontinue unprofitable services to pursue profit maximization. This may be especially true when the sole hospital is a FP organization. On the other hand, sole community hospitals are confronted with a variety of expectations to offer community-oriented services that promote community population health, regardless of ownership. There is relatively little literature that has attempted to examine the behavior of sole community hospitals. This study depicts the profile of sole hospitals' involvement in HPDP services and estimates the possible influence of community constituencies on hospitals with respect to their providing community-oriented services. The results indicate that typically, when there is only one hospital in the community, hospital ownership has no significant influence on hospital HPDP services than their NPD counterparts. Implications for policy-makers and health care leaders are also discussed.     

Creating partnership synergy: the critical role of community stakeholders

While there are compelling reasons for professionals in health and human services administration to collaborate with other stakeholders in the community, the experience with such partnerships thus far has generated more frustration than results. Recent research on partnership synergy--a key indicator of a successful collaboration process--suggests that many of these partnerships are inadvertently compromising their own success by the way they involve community stakeholders. Applying research findings to current practice, this article shows how the ability of a partnership to understand and address complex problems--and sustain interventions over time--is related to who is involved in the partnership, how community stakeholders are involved, and the leadership and management of the partnership. The article addresses key challenges that health and human services administrators face when they seek to optimize the role of community stakeholders in partnership.     

The use of evidence by health care user organizations

Objectives To explore the use of research evidence by consumer and patient organizations and the extent to which their goals and activities are consistent with evidence-based health care and patient-centred care.
Design A mailed survey, telephone and face-to-face interviews of leaders of organizations representing health care users.
Setting Norway.
Participants Sixty-nine of 109 questionnaires that were mailed were included in our analysis and approximately 20 interviews were conducted with representatives of general consumer and patient advocacy groups and interest groups that focus on particular diseases or disabilities.
Measurements Information was collected on the goals of the organizations, the nature of their everyday work, the extent to which research information is required in this work and how research information is accessed and appraised.
Results An important focus of many user groups is peer support. They tend to emphasize experience-based knowledge. A total of 82% of the respondents said that they often or sometimes had use for research results in their work. Research-based information is most often obtained indirectly through physicians or researchers.
Conclusions Norwegian health care user organizations do not appear to promote evidence-based health care. To the extent that they help to disseminate scientific information, they appear to do so uncritically, relying on few sources and traditional authorities.     

Turning the tide: The shift to climate change mitigation

In the United States, a growing number of companies are taking progressive steps to reduce greenhouse gas (GHG) emissions. Already, more than half of all Fortune 100 companies have announced clean energy targets, signaling climate change risk reduction is becoming a top priority. Climate change is not without controversy, yet it is a real business concern among corporate executives and health care leaders alike. From fears stoked by devastating wildfires in California to a rising tide of financial hardships due to hurricane flooding in the Southeast, it seems no region is immune to Mother Nature's growing cost to business. This report addresses how health care leaders are approaching climate change initiatives across the country by examining research articles, key opinion leaders, and health care organizations on the bleeding edge of climate change reduction. In an already complex industry, health care leaders have a special responsibility to do no harm to the patients they serve and a financial responsibility to drive monetary returns for invested stakeholders. Significant cost savings, long‐term risk reduction, and improved population health are a few of the benefits health care organizations around the country can gain from building a sound climate change mitigation strategy.     

Conducting Health Research in Korean American Churches: Perspectives from Church Leaders

Korean Americans experience many challenges to obtaining adequate health care coverage and access to needed services. Because a large proportion of Korean Americans attend churches on a regular basis, churches may be a promising venue where health programs can be delivered. In order to gain an in-depth understanding of Korean American churches with respect to conducting future health intervention research, we conducted exploratory interviews and focus groups with 58 leaders from 23 Korean American churches and three community organizations. From these interviews and focus groups, we found that Korean churches and church leaders seek to meet a variety of social and health needs of their congregation and their surrounding community. Several leaders have stated that assisting with social and medical needs of their members is an important component of their current ministry. They described profound health needs of their congregations and have suggested various ways in which the university can partner with the local churches to help address these needs through research. Additionally, they described various resources churches can provide to researchers such as: their personal assistance, church volunteer base, church facility, and church network and contacts. Our findings suggest that Korean churches have a high potential to serve an important role in the health of Korean Americans. On the basis of the promising results of the present study, we are planning to conduct a cross sectional survey of Korean church leaders and members in Los Angeles County to substantiate our findings in a larger representative sample.     

Decentralized health planning: lessons from two districts in India

Drawing experiences from two case studies at two districts in India, this paper highlights several lessons for effective implementation of a district health planning policy. District plans for both groups are discussed. Though these district plans both aimed to improve maternal health care, they were different in various aspects: in their content, in the roles played by the state, how they utilized data, and the attention given to their implementation. Most items in the District A plan did not directly relate to the concern chosen for planning; decentralized planning allowed functionaries at each level to decide their own plans; used data to assess the performance on "Health for All" goals of the district, but not to identify reasons for low performance; and gave minimal attention to the implementation. On the other hand, the District B plan was more focused in its attempt to improve service delivery. The state took an active role in developing a district planning policy and used modular approach to planning and utilized data to determine factors associated with access and quality of services. District officers were directly involved in removing all implementation obstacles, gave large attention on solving implementation problems while encouraging nongovernmental organizations to play a supportive role. The contrasting experiences of these two plans indicate that the success of decentralized planning relies on the degree of administrative and implementation support provided by the state, nongovernmental organizations, the community, and stakeholders. Conclusions and policy recommendations were given.     

Rekindling the flame: routine practices that promote hospital community leadership

Because of the need of focus on their financial survival, hospitals and health systems are not the popular community-oriented institutions they once were--too many have set aside their mission to promote and protect the health of their communities. By conducting on-site interviews with CEOs, other executives, board members, and community partners in seven hospitals across the nation, we discovered 25 management and governance practices used by hospitals that excel in relating to their communities. We have grouped these practices for promoting community health into six functions: (1) identifying community needs; (2) setting goals; (3) allocating financial and human resources; (4) educating leaders, staff, and community members; (5) measuring outcomes; and (6) sustaining the mission. Specific examples are given that describe what we learned. Ultimately, we hope to engender a dialog about other management and governance practices that have proven successful in promoting hospitals' involvement in community health.     

Evaluating the effectiveness of community health partnerships: a stakeholder accountability approach

Community health partnerships (CHPs) are promoted as effective cooperative interorganizational relationships to improve community health status while conserving resources. However, relatively little is known about the effectiveness of these partnerships in achieving their goals. Using concepts from a network effectiveness framework (Provan and Milward, 2001) and a network accountability framework (Gamm, 1998), the authors propose that successful CHPs are those that are effective in multiple levels (community, network, organization/particpants) and/or accountability dimensions (political, commercial, clinical/patient, and community). The combined frameworks serve to identify a number of community health stakeholders and associated interests that vary according to accountability dimensions to which CHPs respond. Using survey data from over 400 participants in 25 Community Care Networks, the authors assess the usefulness of the conceptual framework in evaluating CHP effectiveness. The results suggest that CHP participants recognize three different levels of analysis in their evaluation of network effectiveness: community, network, and organization/participant. Furthermore, the results show that respondents distinguish between two different organization/participant benefits: enabling and client services. While respondents rated the intangible resources or enabling benefits (e.g., legitimacy and learning) of partnership participation most highly, client services resulting from CHP participation (e.g., client services and referrals) received the lowest ratings. Community benefit (e.g., improving community health status) and network effectiveness (e.g., ability to provide efficient, high quality health and human services) received ratings that fall between the enabling and client services. Given the relatively good scores (above 60%) received by CHPs on all four effectiveness dimensions considered here, it appears that the majority of respondents find at least some evidence of network effectiveness across all three levels of network effectiveness and all four dimensions of accountability.