Thought leadership

Board Community Health Needs Assessments

Board Community Health Needs Assessments

Board leaders have come to realize they must be more actively engaged in conducting, and acting upon, assessments of health needs in the communities they serve as tax-exempt entities. The process of defining these needs can now be better guided by data layering, and by an exciting Charrette technique to enhance community engagement.

The charitable mission of tax-exempt hospitals is a core element of their organizational identity and purpose, and the board of trustees must ensure its optimal fulfillment. In the 21st century hospital, attention to that mission and its charitable foundation can, at times, seemingly conflict or compete with many of other challenges such as contracting, physician relations, capital development, vendor management, and mergers and acquisitions, to name a few examples.1

Governing community hospitals and health systems became more complicated with the passage of the Accountable Care Act (ACA). In particular, in order to save millions of dollars for their organizations each year via their tax-exempt status, community hospital Boards must become more comfortable with overseeing the development of a comprehensive Community Health Needs Assessment (“CHNA”) at least once every three years.2

Kevin Barnett, in work with the Public Health Institute (PHI) and the Center for Disease Control (CDC) observes that in the shift toward more strategic allocation of charitable resources, hospitals are moving toward management of fewer, but larger-scale, more comprehensive programs in partnership with community stakeholders.3 This shift allows hospitals to fulfill their charitable mission while supporting their community without the organizational burden of administering many competing programs. 

Board leaders should consider these four strategic actions to ensure that positive results are actually achieved from your CHNA:

Action 1: Seek Fresh Ideas: Invite a speaker into the next Board meeting to discuss new trends in the design and successful completion of Community Health Needs Assessments (CHNAs) in partnership with at least: (a) the local County or City Department of Health4; (b) the Federally Qualified Health Centers (FQHCs)5; chambers of commerce; food bank distribution organizations; and local schools.

Action 2: Convene a Charrette: Board leaders should invite in at least 30 civic, business, faith-based, and public health leaders to join in a visioning session that defines bold interventions and investments to be shared by the hospital and other community organizations in a shared plan to address the community’s most challenging health and well being risks. This process should consider not only traditional data on health risks but on consumer buying and behavior patterns found in diverse databases such as the C2B Consumer Diagnostic and county health ratings.

Action 3: Enhance Oversight: Update the charge and membership on a standing committee of the Board to oversee community and population health partnership for health gain, not just health care.6 There should be a significant portion of at least one board meeting to review progress to the community health intervention investments. In order to fulfill the board’s fiduciaty duty, the CHNA must identify the interventions and investments to promote health in the CHNA, including an action plan and budget.

Action 4: Support Backbone Organization: Hospital and health system boards can provide staff and financial support to a small group serving as the catalyst or “backbone” for community health partnership. 7 This support helps ensure the sustainability of community collaboration in the shared journey to population health and accountable care. For additional insight into “Collaborative Governance” turn to our Gallagher Integrated Knowledge Center.

For questions and comments, email Jim Rice, Editor and Managing Director, Governance and Leadership of Gallagher Integrated or


[1] See page 76 here

[2] See CDC resources to conduct CHNAs here

[3] See: page 70 here 

[4] For National Association of Local Boards of Health, see here

[5] See National Association of Community Health Centers

[6] For practical considerations in governing community health partnerships, see here

[7] Explore this set of resources here

[8] Collaborative Governance