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Ronald Deprez, Ph.D., MPH
President, Public Health Resource Group
Community health needs assessments have come under criticism in recent years. Critics charge that assessments often fail when it comes to results: a lot of effort goes into the method and measures, but not much happens.
We agree. Many community needs assessment efforts have focused more on the assessment as an outcome rather than what is going to be done with it once it is completed. This has led to reports that are stuffed with data but little or no information or thoughtful analysis for decision-making.
We have long argued that for health care needs assessments to be valuable, they must be part of a bigger picture. They must be the backbone of planning. The users must have a clear understanding of what they want out of the assessment-partnership opportunities, service delivery improvement opportunities, information to guide strategic business planning, etc. The more focused the outcome objectives the more likely the assessment process will yield results useful to healthcare improvements (the ultimate goal), whether they be community benefits or service line planning.
Community health care needs assessments are thus best viewed as part of the health services planning process. Sound planning requires sound planning tools and processes. And that is where a comprehensive healthcare needs assessment can play a pivotal role, whether for an integrated system, a single provider, or service line planning.
What is Strategic Planning Anyway?
It is not surprising that community health needs assessments are under scrutiny. Strategic planning itself, a staple in health care management for several decades, has come to mean very different things to different people.
Horak defines strategic planning as a process including: assessment, planning, implementation and evaluation (Horak, 1997). He defines the assessment phase as an opportunity to define/refine the organizational mission and vision, yielding an understanding of the stakeholders and their needs and expectations.
In our view and based on our experience, this is a preliminary step and if done properly should provide basic goals and objectives for planning. However, stakeholders are more than providers, boards and payers. The market population-consumer, customer, and clients-also represents stakeholders. Understanding their needs, expectations, and behaviors is essential to the planning process, including the implementation step. It is also the basis for evaluation and monitoring of results following implementation.
Under contract to the Health Care Finance Administration (HCFA), we created a comprehensive approach to strategic planning that we have found works well for providers and consumer. Similar to Horak, our model consists of four steps:
Population-based need and demand analysis is based on an epidemiological approach. This allows us to estimate both current and future services volumes. Specifically, this makes for more accurate estimates of the population likely to require services two, three or five years out-the at-risk population.
Need is the estimated size of the population that will require services. Demand is the subset of persons that will use or likely use services. For example, women over 50 years represent the population in need of a mammogram each year based on National Cancer Institute guidelines. Demand is based on this number but will always be smaller since need is tempered by factors such as access to and availability of services. Demand then, is best understood as projecting use patterns in light of these factors. Understanding this need and demand analysis in light of payer policies, technology and the regulatory system helps shape implementation decisions.
The next step is market opportunity analysis (MOA). That is, estimating the size of the market that you will attract if you introduce new services or re-organize existing services. Simply knowing the overall size of the market is not sufficient for planning. It is critical to success to predict how much of the market you are likely to attract over a time span-one, two, three or five years. This information is essential to financial planning, staff development and resource allocation.
How can we do this? It is accomplished though an understanding the of the provider and facility preferences of current and potential consumers of services, physician referral patterns and related market issues. The key here is to obtain service and provider preference data of both current and future users (or user decision makers) including patients, those responsible for patient decisions, family, and professional caregivers. This information, captured through provider and population surveys, focus groups or interviews, provides the necessary data for projecting your expected market share. It also tells you what you have to change in order to increase market penetration-a key piece of information.
The third step in the planning process is an operations analysis. That is we must determine what has to change in your current operation in order to provide more or different types of services. Changes may have to do with individual providers, support personal, physician alignment, or management information systems. Unfortunately, this step is often where health care strategic planning starts and ends. However if we have completed the need-demand and market share analyses accurately, the results of this third step will be more precise and far more useful.
Finally there is the financial analysis. Here the objective is to determine whether the investment and the expected returns make it profitable to engage in the new or expanded service. Again completing an accurate market opportunity analysis will make this task more precise and make it easier to make management decisions. Too often hospitals develop a service because they perceive a market that is based only on broad demographic information.
Successful completion of this four-step planning process leads the way to successful implementation. But successful implementation also requires a well thought out monitoring and performance evaluation process related to outcomes, operations, and financial reports.
In sum, successful population-based assessment is critical to an overall planning effort. It entails using a comprehensive approach, a range of methods, and appropriate data on health and medical care needs. In addition, a key to successful health care needs assessment is to organize it in a manner that reflects the current organization of healthcare services. This results in more ready application to existing service lines.
Our experience is that a well thought out and rigorous population-based assessment can help its users to focus resources on necessary and needed services. This in turn can help to improve services, improve the health status of populations and improve the financial viability of provider organizations.
Copyright PHRG, 2001; Not to be published or excerpted without written permission from Ronald D. Deprez, Ph.D., MPH and/or PHRG, Portland, ME