ment that makes use of performance monitoring tools will help them achieve their goals.


The committee proposes a community health improvement process (CHIP) 1 as a basis for accountable community collaboration in monitoring overall health matters and in addressing specific health issues. This process can support the development of shared community goals for health improvement and the implementation of a planned and integrated approach for achieving those goals.

A CHIP would operate through two primary interacting cycles, both of which rely on analysis, action, and measurement. The elements of a CHIP are illustrated in Figure 4-1. Briefly, an overarching problem identification and prioritization cycle focuses on bringing community stakeholders together in a coalition, monitoring community-level health indicators, and identifying specific health issues as community priorities. A community addresses its priority health issues in the second kind of CHIP cycle—an analysis and implementation cycle. The basic components of this cycle are analyzing a health issue, assessing resources, determining how to respond and who should respond, and selecting and using stakeholder-level performance measures together with community-level indicators to assess whether desired outcomes are being achieved. More than one analysis and implementation cycle may be operating at once if a community is responding to multiple health issues. The components of both cycles are discussed in greater detail below.

The actions undertaken for a CHIP should reflect a broad view of health and its determinants. The committee believes that the field model (Evans and Stoddart, 1994), discussed in Chapter 2, provides a good conceptual basis from which to trace the multifactorial influences on health in a community. A CHIP must also


The CHIP acronym adopted for this report is not unique to the community health improvement process. In a health context, others use it to refer to community health information programs/partnerships/profiles. See, for example, the discussion of MassCHIP—the Massachusetts Community Health Information Profile—in Chapter 5. The committee anticipates that communities will adopt their own designations for their local community health improvement process.

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