Hospital-community partnership to implement community-based health improvement

Introduction

Disparities in health outcomes persist despite health system efforts to improve care. ¹ Many of the drivers of health disparities are due to underlying variation in the upstream community-based social drivers of health. ² Not-for-profit hospitals and health care systems have a moral obligation and federal mandate to address health beyond healthcare delivery and annually report on community benefits. The Affordable Care Act, section 9007, created additional requirements for hospitals to maintain charitable 501(c)(3) statis including the creation of a community health needs assessment (CHNA) and an accompanying community health improvement plan (CHIP) to address the identified needs, every 3 years. ³

This requirement for community health improvement planning is an opportunity for health systems to partner with community-based organizations to address social inequities that drive health disparities. Health systems recognize the critical importance of improving social circumstance; however, the expertise and sustained implementation capability often lies with community-based organizations.

Community partnership

Authentically engaging community-based organizations as partners in the CHNA/CHIP process yields many benefits for systems: new relationships, resource sharing, strategy building, and creative idea generation to address health issues.^4,5 Although engaging public health leaders and the community in general is required in CHNA/CHIP strategy development, no such mandate exists in implementation.

Community members in this county often perceive the larger health systems as untrustworthy and controlling. Health systems have an opportunity to engage community agencies more fully in the CHIP development and implementation. This county has intentionally prioritized community-based participatory research (CBPR) principles to help maximize bidirectional advantages including shared dissemination of results, trust building, exchange of experiential knowledge, and sharing of perspectives. ⁶ Engaging community throughout the hospital-based CHNA/CHIP process should expand the potential to solicit input from disadvantaged communities and better develop, implement, and disseminate effective interventions while building community capacity and redressing power imbalances. ⁷

Since 2000, the not-for-profit health systems in the county have partnered with the local public health department and several community-based organizations to conduct a collaborative CHNA and develop a joint CHIP every 3 years. The process has been recognized as exemplar ⁸ rising to significant community engagement with shared leadership and shared financial resources. In 2022, a CBPR approach to CHIP implementation was adopted by creating a mini-grant process. Partnership funding was established to support smaller community-based organizations working toward addressing the goals outlined in the CHIP.

Significance for public health

This county has prioritized community-based participation in its CHNA/CHIP development and now throughout implementation. Significant research supports community-based participatory research in public health and medicine, lauding its bottom-up approach that includes community members’ voices and unique perspectives.^9,10 However, authors found no published articles on community-based participation in CHIP implementation.

Roughly 60% of local public health agencies (LPHAs) reference CHIPs for grants and budgets, with 52% of LPHAs aligning their strategic planning with their associated CHIP. ¹¹ When community can help identify critical needs and co-create evidence-informed interventions the likelihood of success, sustainability and impact are compounded.

Methodology

County-wide CHNA and CHIP are developed every 3 years with significant community input through surveys, community forums and key-informant interviews. Several community agencies advise hospital and health department leadership at the Community Health Improvement Workgroup (CHIW) in CHNA/CHIP planning decisions.

The 2022–2024 county-wide CHNA/CHIP identified two priority goals, (1) Promote well-being and prevent mental health disorders, and (2) Promote healthy women, infants and children, particularly addressing disparities which are profound between races and economic status in this county. ¹²

The CHIW initiated the mini-grant process to improve community-based interventions to address the CHIP priorities. First, the CHIW established the funding limit, and added this amount to the CHIW budget which is resourced equitably by the hospitals. Funding has ranged from $5000 to $15,000 per grantee for 1 year.

The CHIW created a request for proposals (RFP) to solicit project ideas from community-based organizations to address goals in the CHIP. Care was taken to ensure that the RFP was written in plain language, and that proposals and evaluation reports were manageable for smaller, less academic organizations. For 2025, solicitation efforts expanded to include notices in the CHIW newsletter and multiple solicitations to the partners directly, including health department and community-based organizations. A reviewer team was selected from the CHIW agencies to score the proposals based on jointly established criteria and then to make recommendations to the partners who vote to select the grantees.

Results

During 2023, the first year of the mini-grant process, five applicants submitted proposals and two grantees were selected. During 2024 one grantee applied and was selected. After enhanced marketing, in 2025 there were 30 submissions and two grantees were selected. Table 1 demonstrates how the grantees projects were distributed across the two CHIP priority areas, and brief results.

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Table 1.

Community health improvement plan priority areas and grants awarded.

Prioritized goal	Mini-grant funded interventions	Results summary
1. Promote Well-Being and Prevent Mental Health Disorders	Mental Health First Aid (CG2) Behavioral Health Screening of Refugee Children (CG3)	• Expanded mental health infrastructure and awareness • Increased screening for behavioral health needs of children
2. Promote Healthy Women, Infants and Children through collaboration to address social drivers of health	Unintended Pregnancy Prevention Media Outreach (CG1) Behavioral Health Screening of Refugee Children (CG3)	• Increased reproductive health education to adolescents • Increased referral to resources for refugee children

Applicants who were not selected were offered an opportunity to receive feedback on their application and to share their project with the CHIW.

Grantees were provided funding for 1 year (up to $15,000). Each grantee discussed their project with the partnership team quarterly and received guidance, resources and networking connections to support their work. For example, CG3 was connected to information on where to refer children screening positive for behavioral health concerns; CG2 received enhanced marketing for recruiting to educational sessions. Final reports of results and lessons learned were collected from each grantee (https://www.urmc.rochester.edu/community-health/health-policy/current-policy-initiatives/mini-grant).

Discussion

Through the mini-grant process this county has created a way for health systems to partner with community-based organizations to address community health priorities. Healthcare delivery systems share financial resources, expertise, and access to academic networks. Community-based organizations assure relevance, feasibility, and sustainability of the interventions.

Together the county is building effective and meaningful hospital-community partnerships. By redistributing resources from the larger institutions to community-based organizations, health systems are placing trust in the community and supporting their existing programs. This is a change in thinking from health systems who often take the lead and create their own, often duplicative, programs. Collectively, education and screening have increased through the mini-grant process, and importantly, a foundation for a trusting relationship has been established between the health systems and grantee organizations.

A limitation of this work is that although each project has demonstrated successes individually, there is no overall community health metric that tracks the cumulative effect of the projects taken collectively. Given the diversity of mini-grant projects, and the short-term length and limited scope of the interventions, measuring statistical change in a population health metric would be unlikely.

Conclusion

This county has demonstrated that a community-based participatory approach to health system community health improvement planning and implementation can be successful in addressing community health goals as well as building trust and sustained relationships. By supporting community-based agencies to design, conduct and evaluate evidence-informed interventions, hospital systems can build strong partnerships and trust among their patient community while working together to improve health for all.