Before You Begin

Step 1

Map Development

Step 2

Build Relationships

Step 3

Develop Community Profile

Step 4

Increase Equity With Data

Step 5

Prioritize Needs and Assets

Step 6

Document and Communicate Results

Step 7

Plan Equity Strategy

Step 8

Develop Action Plan

Step 9

Evaluate Progress

Map Your CHA Development Process

Community health improvement is an ongoing process. Before beginning a new assessment, review your organization’s earlier CHAs to identify what worked well, what processes could improve and whether your implementation strategies have achieved their objectives. Follow these steps to map your CHA development process.

View additional resources to futher your CHA journey.

Step 1 Resources

Reassemble Your Team


Examine the previous CHA process. Just because a certain practice was followed in the past does not mean it must be repeated now. Although nonprofit hospitals must assess every three years, you need not start addressing a new set of priorities or abandon previously identified priorities.

Strategic questions to consider:

  • How has health equity been central to your previous assessment processes?
  • What elements of your assessment worked well?
  • What elements would you like to approach differently in this cycle?
  • Did your implementation strategies achieve their intended impact? Why or why not?
  • How successful were your community engagement efforts in the last cycle? Were you able to maintain community member partnerships throughout the assessment?
  • How involved was the community in developing the implementation strategies?
  • How effective were you in identifying and engaging all community voices?
  • How effective were you in consistently sharing information with the community?
  • What additional stakeholder organizations could you invite to the table?

Seek Feedback

Take advantage of this step as an opportunity to engage internal and external stakeholders. Stakeholder engagement starts before you identify goals, select data sets or collect qualitative information for the new assessment. Although those you seek out may be partners you have worked with before and with whom you have established ongoing relationships, it also is valuable to bring new partners to the table for dialogue and reflection. To best support equity in requesting feedback from community partners, be sure to reach out to smaller organizations that represent historically marginalized groups perhaps overlooked before. These organizations also may have new data sources or data sets to share.

The dialogue you start in reviewing the past CHA can flow into ongoing stakeholder interaction on the current process and then into collaborative planning for results.

Hospitals can provide information and seek stakeholder feedback on the following:

  • CHA findings and progress on health improvement
  • Perceived power imbalances between partners
  • Planned next steps
  • Current programs resulting from the CHA
  • Current program outcomes

Review Data Sources

Review the external and internal data used for past CHAs to determine any sources that will be valuable to the current CHA. Look for data sources that provide frequent updates on progress made. Avoid an outsized reliance on lag measures that may take many years to improve, like population-level morbidity or mortality rates. Hospital and community representatives can agree on and prioritize metrics that help them understand the impact of near-term community health efforts.

Questions to ask when evaluating past CHA data for current use:

    • What sources were used in previous years?
    • Did these sources provide new insights or confirm previous findings?
    • Did the resources address/reflect the needs of specific communities or broader regional areas?
    • Are there new or different data sources available?
    • What stakeholders were engaged in data collection?
    • Were all community voices represented?
    • During which steps of the process were they engaged?
    • Did these stakeholders provide new information or confirm previous findings?
    • Were any groups inadvertently excluded?
    • How were trends, comparisons and other methods used to identify significant health needs and their possible causes?
    • What trends or changes can you detect in the data as a result of previous CHA processes?

These questions apply to both internal and external data sources.

You can find much more detailed information on the use of data in developing and implementing the findings of a CHA in Steps 3 and 4 of the Toolkit.

Establish the Infrastructure


Building on existing infrastructures can help ensure internal resources and supports are in place to set the stage for a successful CHA process.

A strong CHA foundation generally includes these important components:

  • Buy-in from key organizational leaders
  • Financial support
  • An active, committed advisory committee that includes community members
  • A framework that includes a preliminary agreement about purpose, scope and time frame

Obtain Leadership Support


CHA developers engage hospital leaders at the initiation of the assessment and communicate with them regularly throughout the process. Be intentional and specific about who should be at the table, right through implementation planning. Consider those with expertise in governance; clinical services; business development; diversity, equity, inclusion and justice; and medical ethics. Hospital board members or trustees can be strong supporters.

Organizational leaders and trustees can do the following:

  • Lend their names to increase the credibility of the project.
  • Commit resources, including funding and staff support.
  • Attract potential assessment partners or external funding sources.
  • Help overcome any roadblocks that emerge along the way.
  • Champion the project among policymakers and elected officials.

Build Your CHA Internal Team


The internal team is the engine of the CHA, optimizing process and benefits. The CHA internal team will do the following:

  • Write and produce the CHA report and circulate it for needed approvals.
  • Provide oversight and operational management, such as monitoring timelines and budgets, contracting with consultants and managing staff.
  • Facilitate data collection and analysis.
  • Write reports and other needed communications.
  • Provide logistical and administrative support, such as sending out meeting notices and securing meeting sites.
  • Ensure a consistent focus on equity throughout the process.


Use the CHA process to increase health equity.

  • This team will look different for different hospital types.
    • A critical access hospital’s CHA team will be smaller, and leaders are likely to take on multiple roles.
    • An academic medical center may have a larger team with more specialized roles.
  • Engage your team members from a cross-section of administrative departments as well as staff who are experienced in community services and/or have existing relationships with community groups, such as serving on their boards.
  • Strategically consider the impact the CHA can have in the community and how integration with other efforts within your hospital or health system can strengthen both.
    • Include members who lead efforts on emergency preparedness/disaster planning, diversity and inclusion and those who are on the front lines of community needs.
    • In large health systems, invite colleagues from a variety of sites and settings.
  • Let your CHA process shine as a means to increase health equity, identify and scale emerging practices and promote integration throughout your hospital or health system.

Identify and Obtain Resources


The size of the budget and the nature of financial and in-kind resources will vary with the scope of each assessment. Construct a CHA budget and develop a plan for securing needed resources such as:

  • Staff time (existing staff or hired consultants)
  • Assessment design (including scope and objectives)
  • Data collection and analysis.
  • Facilitation of collaboration, planning and priority-setting exercises
  • Data visualization technology
  • Report writing, production and dissemination
  • Operational expenses, including meeting supplies and communications costs
  • Costs for community meetings, forums and focus groups and any associated honoraria for participants

Depending on your hospital's or health system’s budget guidelines, you may look to internal partners to contribute funding and in-kind support. These stakeholders have an interest in the assessment results to fulfill organizational or grant requirements and may be willing to support it in other ways.