Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
Currently Skimming:
3 Managing a Shared Responsibility for the Health of a Community
3 Managing a Shared Responsibility for the Health of a Community
Pages 59-76
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 59... ...
. As communities try to address their health issues in a comprehensive manner, all parties -- including individual health care providers, public health agencies, health care organizations, purchasers of health services, local governments, employers, schools, faith communities, community-based organizations, the media, policymakers, and the public -- will need to sort out their roles and responsibilities, individually and collectively.
|
From page 60... ...
This chapter begins with a discussion of the social and political realities of engaging communities in performance monitoring activities to improve community health. It proposes an approach in which responsibility for health goals is shared among community stakeholders and accountability for specific accomplishments is ascribed to individual entities.
|
From page 61... ...
Group purchasers and payers attempt to balance the needs of their covered populations against the need for predictable and minimal financial liability, protection against legal and ethical dilemmas, and administrative simplicity. Health care providers want to optimize patient interests while maximizing revenues and minimizing intrusion from third parties.
|
From page 62... ...
Although many of the entities that play an essential role in determining local health status are based in and focus their attention on the community in question, others, such as state health departments, federal agencies, managed care organizations, foundations, and national corporations, have a broader scope than a single community. For a performance monitoring effort to succeed, communities will have to do more than identify relevant parties; they will have to find effective ways to engage parties with varying needs, resources, and values; to set goals for the performance monitoring effort; to ascribe responsibility for meeting these goals; and to manage the complex process of community-wide change.
|
From page 63... ...
For the purposes of this report, the committee has distinguished stakeholders and "accountable entities" in relation to the roles they play in the process of improving community health. • Stakeholders are organizations and individuals who have an interest in the health of a community's population.
|
From page 64... ...
For example, as part of a public health reengineering initiative in Illinois called Project Health, local health agencies suggested that they should be accountable to the communities that they serve (Illinois Local Health Liaison Committee, 1994)
|
From page 65... ...
furnishing a set of measurement tools that will help communities examine changes in the health and well-being of their populations. In order to fulfill its promise, accountability needs to be conceptualized as a collaborative and cooperative process as opposed to a punitive process imposed by outside forces.
|
From page 66... ...
As mentioned above, accountable entities are the stakeholders who are responsible for accomplishing specific results as part of a community's strategy for addressing a health issue. The committee suggests that the process of ascribing accountability for particular actions to specific accountable entities will differ depending on the problem and the strategies being considered, and other circumstances specific to each community.
|
From page 67... ...
In the performance monitoring system that the committee envisions, multiple stakeholders should be involved in the change processes so that the process becomes jointly owned rather than controlled by a single or small set of stakeholders. The process should be inclusive and open to newcomers.
|
From page 68... ...
Although the authoritarian model has, in fact, been used to implement many changes, the committee suggests that it is an inappropriate approach to performance monitoring in communities. The authoritarian model creates circumstances in which important stakeholders must change to survive.
|
From page 69... ...
In today's health care delivery system, much costly "micromanagement" is a consequence of presumptions that cooperation will not be forthcoming from those whose performance is being monitored. Instead, the committee suggests that communities adopt the second model for approaching the change process, that of willing compliance with mutually established strategies.
|
From page 70... ...
Lessons from Community Coalition Building The committee's approach to using performance monitoring to improve community health assumes that a vehicle exists or will be created to bring together important stakeholders from multiple sectors, both to guide and to legitimate the process. Community coalitions, in their many forms, are one such vehicle.
|
From page 71... ...
. Preliminary findings from the Massachusetts Community Health Network Areas affirms these conclusions (D.K.
|
From page 72... ...
IMPLICATIONS FOR PERFORMANCE MONITORING TO IMPROVE COMMUNITY HEALTH Some of the attributes that are either desirable or essential for managing change as a performance monitoring system is implemented at the community level include: • will, commitment, patience, persistence, and pacing; • leadership, including the capacity to develop and include new leaders; • skills in communicating (advocating) effectively to policymakers in all sectors; • the ability to generate and mobilize existing resources; • the ability not only to access, integrate, and interpret data on system performance and on community needs, values, and preferences, but to transform data into information; • the ability to assess the value added by current resource allocations and to project future resource needs and levels; • the ability to set priorities across competing interests, concerns, and structures that link priority setting to the allocation and reallocation of resources; • cultural competence -- the ability to recognize and work with organizations, groups, and individuals from multiple cultures (including not only "ethnic" cultures but "professional" or "organizational" cultures)
|
From page 73... ...
Currently in Seattle–King County, data are available to a relatively limited technical audience, but there are hopes of providing broad community access. In King County, the local health department is a resource for essential technical and organizational services for community health assessment.
|
From page 74... ...
Central to this effort is the systematic use of health status data to inform the development of improvement strategies. The Department of Public Health has developed a set of health status indicators for each of the 27 CHNAs that provide demographic information, birth and death statistics, incidence of infectious disease, perinatal and child health indicators, hos pital discharge data, and substance abuse data in comparison with the state, the nation, and Healthy People 2000 (USDHHS, 1991)
|
From page 75... ...
These stakeholders can include health care providers, public health agencies, and community-based organizations explicitly concerned with health. They can also include other government agencies, community organizations, private industry, and other entities that do not explicitly, or sometimes even consciously, see themselves as having a health-related role -- for example, schools, employers, social service and housing agencies, transportation and justice departments, faith communities, and the media.
|
From page 76... ...
Illinois Local Health Liaison Committee.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.