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Norwalk Health Department Summary


Collaboration in Action

A look at a strengths-based partnership between the local health department and the hospital in Norwalk, Connecticut that embodies nearly seamless co-leadership of a community health improvement process yielding a community health (needs) assessment and community health improvement plan. For this group, their ability to recognize their strengths and limitations is the foundation of their work


A strong partnership between the Norwalk Health Department and Norwalk Hospital in this Coastal Connecticut town are not new. In fact, the agencies have worked together on multiple initiatives over the years, including a previous community health (needs) assessment (CH(N)A) over a decade ago. As staff from both organizations began to develop a plan for partnering together to complete a CH(N)A and community health improvement plan (CHIP) for Norwalk, they also had to ensure that their process to complete these would fulfill their shared goal of improving the community's health, as well as the organizations' respective requirements: Public Health Accreditation Board (PHAB) CHA and CHIP-related standards for the health department and IRS CHNA regulations for the hospital.The combination of history, collaborative leadership, and willingness to learn are salient features of this strengths-based partnership in this town situated in the Greater New York City Metropolitan area with a population of 85,000.

"For many, many years the hospital and health department have had a history of collaboration and a strong working relationship", explained Joyce Bretherton, Development Associate at Norwalk Hospital. She continued, "We think that collaborating on the most recent project [CHA/CHIP initiative] has just strengthened our relationship; it's been an extension of the relationship that we established years ago". A core team, comprised of the Director of Health,the Project Coordinator, and the Health Educator from the Norwalk Health Department and the Vice President of Public Affairs and Development Associate from Norwalk Hospital, developed the co-led community health improvement process used to conduct the CHA and complete the CHIP. Deanna D'Amore, Project Coordinator at Norwalk Health Department, recalled, "As we started the work, we began to recognize each other's strengths and capitalized on them through the project. Among the core leadership team, we were able to determine each member's roles and assign project responsibilities based on those strengths".A larger taskforce comprised of representatives from a variety of partner organizations serving the area rounded out the effort and assured partner and community voice and accountability in the process.

Deanna and Joyce served as the day-to-day contacts on the co-led project and attributed their good health department-hospital working relationship, in part, to this. "I think that it's key to have someone at each agency who is the day-to-day coordinator. I can't imagine doing this without Joyce there. We were constantly talking and e-mailing. I think that it is key to a successful partnership and co-leadership model", said Deanna. Having a staffing structure like this seemed to ensure a balance and helped divide the workload and responsibility across both organizations such that their work truly embodied a co-leadership model. The core team reported that spending the time in the planning phase of a community health improvement process to build the relationships between health department and hospital staff is critical if such relationships do not already exist and you have an interest in collaborating on CH(N)A and CHIP efforts. In Norwalk, both of these organizations brought their own assets to the table to make it a successful relationship and both respected their own and the others' work to meet their respective requirements.

The team reported that each member brought important and specific skill sets to the work, including facilitation expertise, community knowledge, data collection and analysis expertise, and more. "Mary, from the hospital [VP of Public Affairs] and Tim from the health department [Director of Health] provide important leadership that bridges all of our skills together into one cohesive team," added Joyce. The marrying of the public health and health care perspectives in the partnership has become a hallmark of the team's work in completing the CHA and developing a CHIP along with the taskforce members that they're now working to put into action. Joyce reported, "It is great to have [input] from someone on the other side who can give the public health or hospital perspective=". Staff with both organizations, but not on the core team, were pulled in at times. For example, Norwalk Hospital Foundation's communications officer handled much of the media and press outreach for events. The team also relied on consultants for some of the work because they could not devote 100% of their time to the CHA and CHIP efforts.

The team identified their strengths and then demonstrated their strengths-based co-leadership throughout the conduct of their CH(N)A and in developing their CHIP. "We made decisions about our approach to completing the CHA and CHIP based on those [strengths and limitations]," explained Deanna. For instance, the health department, knowing that its contract approval process was fairly arduous, requiring approval from several committees, thought it best that the hospital facilitate this aspect of the process and the hospital was happy to do this. The hospital was responsible for contract execution and the health department took the lead on writing the request for consultant proposals. The core team then reviewed proposals and chose the consultant together. They also split up the responsibilities for recruiting for and conducting the focus groups as part of their CHA. The hospital took the lead on certain community and stakeholder groups while the health department led the others.

Open communication and leadership support were critical components of this partnership. "The hospital CEO is very supportive, the Mayor is very supportive, and the Director of Health and hospital VP of Public Affairs are very committed and involved, and that's made it easier work together and have that partnership," said Deanna. "It's all about communication and not being afraid…," Deanna continues.Joyce finished Deanna's sentence by adding, "to ask each other for help".

This close partnership significantly impacted the scope of the CHA and CHIP work as the hospital's primary catchment area is larger than the health department's jurisdiction, involving six towns in addition to Norwalk.Deanna explained, "Our original intent was to focus on Norwalk first and then the hospital would complete a secondary CHA with the other communities. Then we realized this would be wasteful and we should include all the communities at the same time and that we wanted to work on the project at a regional level". This change required the team to modify their quantitative data collection plan and over time, it also expanded the taskforce's membership as the health directors of the other areas became involved.

Although keenly focused on the work in front of them right now, the team has already stated their intention to co-lead these efforts in the future. They have agreed to repeat the CH(N)A and CHIP efforts on a three-year cycle to ensure the hospital can fulfill its IRS CHNA requirements. For now the team is focused on implementing their recently-completed CHIP and continues their close partnership as they move forward with these activities also. The taskforce originally created to assist in completing the CHA and CHIP will continue to meet. Sub-committees of this group have been formed for each of the two CHIP priority areas and the structure to support action is taking shape.

"We decided we wanted co-leads for each [priority] area.We determined the health department would co-lead the obesity initiative with a community leader and the hospital would co-lead the mental health and substance abuse initiative with two community leaders. We met with several interested community members and have determined our co-leads for each priority area", reported Deanna. Although the core team continues to be the lead on broad strategic issues as the community move towards implementing the CHIP, they continue to be supported by a broad array of community stakeholders and partner organizations. The taskforce originally convened for the work continues its role and the hospital recently appointed a Community Health Committee to provide oversight for its community health strategic initiative, community benefit plan completion and submission, and to the larger CHIP initiative. There is significant overlap between this Committee, which includes hospital Board of Trustees' members, hospital staff, area health department directors, business leaders, community representatives, and health care providers, with the taskforce. This was intentional; the overlap in membership ensures connectivity between these strategic initiatives. The Committee will be the primary body to monitor the outcomes posited in the CHIP and to ensure accountability.

Together the core team worked to ensure alignment of their CHA and CHIP efforts with those of the state and the nation by working closely and together in connecting with the Connecticut Hospital Association, the Connecticut Association of Directors of Health, and the Connecticut Department of Public Health. Although the state began its health assessment and improvement plan process later than that of Norwalk, staying in close communication throughout helped to ensure connectivity between the two efforts. Healthy People 2020, a 10-year agenda focused on improving the Nation's health, also proved useful to their efforts. Where possible, Greater Norwalk or Fairfield County statistics were compared to the state figures and to Healthy People 2020 targets. This work also showed the team where some gaps in local data exist that will inform their CHA efforts in the future.The team also worked to ensure alignment in their CHIP efforts. To ensure that the strategies employed in their CHIP are evidence-based as PHAB requires, the team created an additional appendix listing the evidence-based strategies included in the CHIP. The County Health Rankings and the Community Guide also proved helpful in providing up-to-date evidence rating information to support a chosen strategy. This thoughtful approach has helped the team feel poised for success in terms of their respective requirements, but more importantly, in their ability to improve community health in Norwalk.

The Norwalk Health Department applied to PHAB in March 2013. As of May 24, 2013, Norwalk Hospital is still on track to submit their completed CHNA and implementation strategy in September 2013.

For more information, please refer to the Q&A with Bretherton and D’Amore.