Gallatin City-County Health Department (GCCHD) and Bozeman Deaconess Hospital (BDH) are not new partners. In fact, they have a history of working together on community health and healthcare initiatives that serve those that live, learn, work and play in this growing and diverse community set in a Rocky Mountain valley. In late 2010, the health department began its plans to apply for the Public Health Accreditation Board's (PHAB's) national, voluntary public health department accreditation program and knew that to do so they would need to complete a community health assessment (CHA) and community health improvement plan (CHIP), to satisfy two of three PHAB prerequisites. Sarah Acker, Accreditation Coordinator and Quality Assurance Specialist at GCCHD, recalled hearing that the hospital would also need to complete a community health (needs) assessment. "I think I called the hospital in a mild panic and said, 'if you're going to be doing an assessment, we want to do it with you'," explained Acker.
Although BDH heartily agreed given that it was set to complete a community health needs assessment (CHNA) to meet the IRS requirements for non-profit hospitals to do so every three years, different service areas posed a challenge. "The differing service areas, initially could have been concerning", said Acker. BDH serves a three-county area, while the health department only serves Gallatin County. Along with the local federally-qualified health center, the agencies had to agree upon the area that would be included in their CHA and CHIP work. "Bozeman Deaconess has always considered its service areas to be greater than Bozeman. We didn't want to cut out those communities [Park and Madison Counties] and if we were going to do a comprehensive health needs assessment for our service area, we needed to do those," said Donna Cruz-Huffmaster, Planning and Business Development Manager at BDH. Through an open conversation, all three organizations agreed that the initial quantitative assessment work would cover all of Gallatin County, Park and Madison Counties, while the more broad assessment work as called for the Mobilizing for Action Through Planning and Partnerships (MAPP) process, GCCHD's and BDH's chosen improvement framework, was completed only inGallatin County. Both the health department and hospital wanted to ensure that their CHA and CHIP was not Bozeman-centric. "Bozeman is the population center of Gallatin County. We wanted to reach out to other communities to hear what they had to say", reported Acker.
Cruz-Huffmaster explained that their partnership was successful in ensuring that the CHA and CHIP covered this entire area and that this was due in part to several key attributes of their work: "I can't say enough about the leadership of the three different organizations. They were very collaborative, very open and laid-back and thinking about the best way to do this together". The history of collaboration and communication between the two agencies were also cited as a key to their success. "Open communication has also been key to the success of our collaboration. Both of our organizations were able to get what we needed out of the process. We both acknowledge that working together and sharing resources was much more effective than taking on these processes alone," said Acker.
Successfully completing a comprehensive CHA and a CHIP that would help position the GCCHD to meet PHAB's standards and BDH to meet the IRS requirements was not without challenges given that this area is rural, expansive, and comprised of diverse communities. "We didn't want to just do a focus group and get information from a community and then leave. We really wanted to leave them with something that would be valuable to them as well. In seven communities, we conducted a series of three meetings. We did an extensive amount of traveling to reach out to them. It was great. It was my favorite part of the whole process. It was also time-consuming," said Acker.
Both Acker and Cruz-Huffmaster agree that the rural nature of many communities in the area required them to be particularly thoughtful in their work. Acker explained, "Each community identifies so different than the next. They have their own individual culture and their economies are very varied…the different demographics and geography made it a little more challenging." She added, "I think that the 'smallness' of each community, even though they're separate from each other, is their strength". Cruz-Huffmaster agrees and added, "They were good at rallying and getting folks into some of the Study Circles we've done. You get an influencer in that community and that influencer can easily drum up support from key persons. That was a strength I see in many of these rural areas. "
GCCHD and BDH, together with a broad group of partners, thoughtfully applied methods and initiatives in their CHA and CHIP work to position them for action. For example, they worked with a local university to use the Study Circles methodology to assess the health of these communities, which they found time-intensive and also very successful. Using Healthy People 2020 indicators in their CHA helped them compare their local data to national benchmarks and helped assure alignment of their local health improvement goals and objectives with those of Montana's when possible.Both Cruz-Huffmaster and Acker believe that their partnership has been successful given that their agencies along with many partners are now moving forward in implementing the CHIP that was developed based on the findings of their CHA. "The transition from CHA to CHIP was interesting. I feel like during the CHA, the health department and the hospital were very involved in moving the process forward," said Acker. She added, "With the CHIP, I feel the process was a bit inverted with the key partners playing the roles of meeting conveners and facilitators, but more and different community players were much more involved in the selection of the priorities and the creation of the CHIP work plans". The group also decided on a name for their collaborative, Healthy Gallatin, to show that no single organization owned the process.
Because of this, the health department and the hospital will each have a different role than they did during the CHA. The hospital has aligned the CHIP with its Community Benefit Plan and is supporting implementation through regular participation in the Healthy Gallatin coalition meetings and the sub-committees that are charged with implementing CHIP strategies. Although both agencies co-led the conduct of the CHA and development of the CHIP, the health department sees it self as "the holder of the CHIP; where the CHIP lives", said Acker. The health department is convening the Healthy Gallatin coalition meetings and is also taking the lead in some small aspects of CHIP strategies. Cruz-Huffmaster stated that, "I see strength in the health department leading. The health department is driving it forward while the hospital is supporting it."
Although the GCCHD, BDH, and the Healthy Gallatin partnership hope to achieve their priority goals of improving health care access, increasing collaboration, and increasing healthy behaviors, both Acker and Cruz-Huffmaster reported seeing benefits of their agencies' co-leadership in the community already. Increased communication and collaboration are two important benefits already realized. "Before the process, there were several MOUs [in place between the agencies]…We don't want to go through the process again alone. There are some challenges, but the benefits outweigh the challenges," said Acker. Cruz-Huffmaster agrees and also thinks that "benefit will be seen in the community with the shared priorities and resources funneled through the same initiatives".
For more information, please refer to the Q&A with Acker and Cruz-Huffmaster.