In late 2012 the Healthy County Health Department convened a wide range of organizations and entities in order to develop a community health improvement plan. This collaboration included community representatives from local hospitals, clinics, community-based organizations, schools, churches as well as the county public health agency. A Healthy County Community Health Council (the "Council") was established; its goal was to improve the overall health of the county's population through a community-wide health improvement plan that would prevent disease, promote physical and mental health, and better the quality of life within the community. The Council identified common community health values and a health vision for the large metropolitan population it served. In addition, a mission statement was drafted for the local public health system.

In order for the Council to obtain the necessary information for the community health improvement plan, strategies and tools from NACCHO's MAPP (Mobilizing for Action through Planning and Partnerships) process were used. MAPP includes four assessment activities:

Community Health Status Assessment, which attempts to answer the question, "How healthy are our residents?" The compilation of local health data and the examination of changes over time were assessed in comparison with local, state and national level data and with national health objectives established for the year 2010 through the Healthy People 2010 process.

Forces of Change Assessment. During this assessment a randomly selected group of participants from the community provided input as to "What is occurring or might occur that affects the health of our community or the local public health system?" As a result of this assessment, the important forces of change affecting the community as well as the potential impacts of those forces.

Local Public Health System Assessment, which attempts to answer the question, "How well are essential public health services being provided to our community?" was conducted. The collaborative used tools, consisting of standards and indicators, developed by Public Health Practice Program Office of the Centers for Disease Control and Prevention to perform this assessment.

Community Themes and Strengths Assessment, which seeks to identify "What health and health-related issues are important to our community?" Both a survey and a focus group were conducted to examine perceptions of community health and the quality of life within the community.

The Council established a subcommittee that was charged with developing an ordered list of the most important health problems and issues facing the community. The subcommittee was provided with data and information derived from the four assessments. After the compilation and analysis stages were completed, the collaborative refined the vision and mission statements for the community health improvement plan. Health problems and issues were then prioritized, and goals, objectives and workplans were formulated for the priority health needs. The end result was a community health improvement plan that identified priority community health problems and issues, and delineated plans to achieve targets identified in the plan.

Discussion Questions

This case study describes a communitywide effort to improve the health status of the county's population. It includes aspects of performance management in order to accomplish this end. The following questions focus on performance management issues involved in community health improvement efforts.

Identify the target of this performance management application. Whose or what's performance is being improved?

Describe what the performance accomplishment is this case study.

Which of the four components of performance management are evident in this case study? Which are not?

Does this case study demonstrate the use of performance standards? How?

Does this case study demonstrate the use of performance measurement? How?

Does this case study demonstrate the use of reporting performance? How?

Does this case study demonstrate the use of quality improvement? How?

Which specific performance management components in this case study could be enhanced? How?

Assume that the state health agency has required all communities in this state to complete a similar process in order for the state to develop a state health plan and state health priorities. No other statewide planning activities would be undertaken. In this scenario, what problems would you foresee from a performance management perspective? What might be done to enhance specific performance management components into a statewide health improvement initiative?

Have you been (or are you now) involved in a communitywide health improvement effort? If so, which components of comprehensive performance management were in place? What suggestions do you have for improving that effort?