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Community Health
OVERVIEW
Dignity Health’s mission mandates partnering with others to promote the broader
health of the community. In response to that mandate Dignity Health has
developed a comprehensive approach to community health promotion that
addresses not only the pressing health concerns in communities, but also the
underlying causes for health problems, including lack of affordable housing and
employment opportunities.
At the local level, each hospital conducts a comprehensive health needs
assessment and in collaboration with community stakeholders prioritizes unmet
health needs. A community benefit implementation plan is developed and
annually updated to monitor progress toward achievement of shared goals. The
community health priorities are integrated into the hospital’s strategic planning
and budgeting processes to assure adequate resources are devoted to planning,
developing, managing and reporting community benefit initiatives. A multidisciplinary Ecology Committee at each hospital sets annual goals for energy,
water efficiency and waste minimization. The Ecology Committee also identifies
opportunities to partner with the community on ecological initiatives.
System wide Dignity Health offers the following support and programs:
 Dignity Health community benefit staff plans, develops, coordinates and
oversees system community benefit policies and initiatives to ensure
compliance with federal and state mandates, and is responsible for educating
Dignity Health employees and system/local Board members about community
benefit initiatives.
 Dignity Health’s Community Grants Program encourages and helps sustain
partnerships with nonprofit organizations that are working to improve the
health status and quality of life of the communities served by Dignity Health
hospitals.
 Dignity Health’s Community Investment Program provides loans at belowmarket rate interest to non-profit organizations committed to increasing access
to jobs, housing, education, social services, and healthcare for people in lowincome communities.
 Dignity Health’s Global Mission Programs expand our ministry into
international communities.
 Dignity Health’s public policy and shareholder advocacy programs address a
range of issues that affect the broader health of the community.
 Dignity Health manages its operations in a manner demonstrably protective of
human health and Earth, and partners with others in the community to
advance ecological initiatives. An annual sustainability report is posted on
Dignity Health’s website: wwwdignityhealth.org.
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KEY DEFINITIONS
Charity Care: the provision of inpatient or outpatient services to persons who
have a health care need and are uninsured, under-insured, ineligible for a
government program and are otherwise unable to pay for their care in whole, or in
part, based on their financial situation.
Community Benefit: programs or activities that provide treatment or promote
health and healing as a response to identified community needs and meet at least
one of these objectives:
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improve access to health care services
enhance the health of the community
advance medical or health care knowledge
relieve or reduce the burden of government or other community efforts
Community Benefit Inventory for Social Accountability (CBISA): an online
web-based program used to identify, track, quantify and report a hospital’s
community benefit initiatives.
Community Grants: funds awarded to nonprofit organizations whose proposals:
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respond to priorities identified in the community health assessment and/or
community benefit plan
embody Dignity Health’s core values
provide services to underserved populations
Dignity Health hospitals contribute .05% of prior year audited expenses to the
program. Ordinarily, awards range from $5,000 to $50,000.
Community Investments: below-market interest rate loans to nonprofit
organizations that:
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develop affordable housing for low-income families and seniors
provide job training for unemployed/underemployed persons
create wealth in low-income and minority neighborhoods.
Community Need Index (CNI): a systemic measure/tool to identify barriers to
access and comparatively assess community need in a standardized manner for
purposes of operational analysis, capital allocation, community health
programming, and allocation of community grants. The CNI utilizes in aggregate
a set of five socio-economic conditions that impact health to determine which
neighborhoods, by zip code, are populated with residents who are at the greatest
risk of needing health services. The indicators, which account for the underlying
structural and personal barriers that affect overall health, include education,
employment, income, culture/language, and home ownership.
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Core Principles: to promote effective, sustainable community benefit
programming in support of Dignity Health’s mission and tax-exempt status, every
hospital will ensure that community benefit programs focus on disproportionate
unmet health-related needs, and integrate one or more of the following principles:
emphasize prevention, contribute to a seamless continuum of care, build
community capacity, and demonstrate collaborative governance.
Ecological Initiative: actions taken to protect and maintain the safety of fragile
ecosystems and the life of which they are composed. A "beginning assumption" in
the field of ecology is that Nature's living organisms (humans included) depend
on one another. Human communities are just as dependent on access to clean
water, clean air, the fruits of healthy soil, and the joys of open space, as the worm
and a sprig of crabgrass.
Food & Nutrition Services Vision Statement: “We aspire to develop a healthy
food system which is economically viable, environmentally sustainable and which
supports human dignity and justice through adopting goals consistent with this
statement such as modeling healthy food choices and programs, encouraging
labeling, maximizing locally sourced foods free of unnecessary hormones,
pesticides and antibiotics, and minimizing food waste.”
Global Mission Programs: programs developed in 2006 in response to the
increasing need for sustainable health care services in international communities.
Dignity Health’s mission, values and international heritage gives our organization
a unique opportunity to expand the mission into international communities,
especially in support of our Sponsoring Congregations’ ministries in many
countries throughout the world. Dignity Health Global Mission Programs
(formerly Catholic Healthcare West Foundation for International Health) works
closely with all in-country stakeholders, including local governments, the
Catholic Church, NGOs, and clinical and community leaders – to identify the
health needs of the community, develop sustainable programs, and advocate for
social change that meets those needs.
Shareholder Advocacy: using rights afforded shareholders to bring issues of
social and environmental concern to the attention of portfolio companies through
dialogue, shareholder proposals, proxy voting and statements at corporate annual
meetings.
Uncompensated Care: costs associated with providing charity care for those
without the means to pay, and the difference between the cost of providing patient
care to public beneficiaries (Medicare, Medicaid, etc.) and any offsetting revenue
received. These expenses are reported as the Unsponsored Community Benefit
Expense (UCBE) in the Internal Revenue Service Form 990, Schedule H for
hospitals.
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LEGAL, REGULATORY, LICENSING, ACCREDITATION
CONSIDERATIONS
Federal tax law principles apply a Community Benefit Standard to not-for-profit
organizations. Tax-exempt hospitals must be organized and operated exclusively
for charitable purposes. They must promote the health of a class of persons broad
enough to benefit the community as a whole, even though not benefiting all
persons directly. Exposure of hospital charges and aggressive billing practices by
some hospitals resulted in increased and continuing scrutiny of hospitals by
various public and private groups. Federal, state and local policymakers have
questioned the not-for-profit status of healthcare providers and have increased the
required data to be reported by hospitals to the Internal Revenue Service.
In March 2010 the Patient Protection and Affordable Care Act added a new
requirement for not-for-profit hospital organizations to conduct a community
health needs assessment (CHNA) once every three years. Reporting by every
hospital is mandated in accordance with Notice 2011-52 of the Internal Revenue
Service and requires that the CHNA must include input from persons who
represent the broad interests of the community and from persons having public
health knowledge or expertise and will be considered conducted when it has been
made publicly available. Dignity Health publishes all hospital community benefit
reports and plans online at www.dignityhealth.org.
In addition to the federal requirements of all tax exempt hospitals, both California
and Nevada have community benefit mandates:
CA State Senate Bill 697 requires California not for profit hospitals to
assess community health assets and needs on a triennial basis and to
develop a plan and budget to address unmet health needs. The hospital’s
assessment and plan, with an annual update indicating progress toward
established outcomes, must be filed with the state and be made publicly
available.
Nevada Assembly Bill 342 requires that hospitals annually report the
goods, services and resources provided to the community to address
specific needs and concerns of that community and that programs ensure
compliance with provisions to restrain the costs of healthcare.
The Joint Commission accreditation process and standards incorporate many
aspects of environmental and employee health and safety addressed by hospital
ecological initiatives.
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WHY IS COMMUNITY HEALTH IMPORTANT TO THE HOSPITAL
COMMUNITY BOARD?
Dignity Health hospitals, founded to meet the health care needs of the
communities they serve, have long histories of providing benefit to the
community. The Dignity Health Hospital Community Board bylaws charge the
Board with the following responsibilities regarding community health promotion:
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Participate in the process of establishing priorities, plans and programs to
enhance the health status of the community
Approve the community benefit plan for the local hospital
Monitor progress toward identified goals.
Key environmental trends necessitate an enhanced focus on addressing
community need. Dignity Health hospitals currently operate in an environment of
soaring healthcare costs, eroding healthcare coverage in both public and private
programs, and persistent disparities in healthcare access and outcomes.
Addressing disproportionate unmet health needs is a tangible demonstration of the
hospital’s commitment to its community and a mechanism to maintain public
trust. Given the environmental challenges facing the ministry, it is essential that
the hospital quantify the contribution it makes to improve the health of the
community.
APPLICABLE POLICIES
Standards for Mission Integration: This document identifies local and
systemwide indicators for mission integration in the areas of organizational
identity, spirituality, ethics and community health.
Dignity Health Governance Policies:
3.45 Community Benefit - This policy mandates integration of community benefit
into ongoing processes of planning, budgeting and reporting. At both system wide
and local levels, Dignity Health explicitly uses its resources to benefit our
brothers and sisters who are poor and to promote health and healing in the
community. The community benefit process addresses organizational
infrastructure, community health assessment, community-based partnerships,
resource allocation, program development, performance measurement and
reporting.
4.40 Investment Policy - This policy guides the development and implementation
of Dignity Health’s mission-based investment program, including portfolio
management and asset allocation, social screening and shareholder advocacy, and
community development initiatives.
4.43 Community Investments–Approval Authority and Criteria - This policy sets
criteria and approval levels for Dignity Health Community Investments.
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4.44 Community Grants - This policy sets criteria and approval levels for Dignity
Health Community Grants.
4.50 Patient Financial Assistance - This policy sets standards and procedures for
charity care and financial assistance to patients who are poor, uninsured and
under-insured. In accordance with this policy Dignity Health facilities proactively
inform patients of the availability of financial assistance, including posting
information at various locations in the hospitals in the primary languages spoken
in the community. Staff also makes every reasonable effort to explore appropriate
alternate sources of payment and coverage from third parties and other public and
private programs in order to assure patients access to future medical services
when needed.
Dignity Health Administrative Policies:
40.1.003 Comprehensive Chemicals Policy - The purpose of this policy is to
articulate the commitment of Dignity Health to create an environment for patients,
employees and visitors that is free from the hazards posed by chemicals that are
harmful to humans, animals and the environment. Dignity Health supports and
engages in initiatives to disclose product chemistry; assess and avoid hazards;
promote the use of chemicals, processes, and products with inherently lower
hazard potential; and advocate for public policies and industry standards that
advance a greener economy.
40.4.001 Community Benefit - This policy provides administrative guidance to
facilities in community benefit operations.
40.4.003 Community Benefit Inventory for Social Accountability (CBISA) Online
User Profile Provisioning - The purpose of this policy is to provide a standardized
process for assigning user access, creating user profiles, assigning passwords, and
disabling users in CBISA Online.
60.0.035 Accounting and Reporting Community Benefit Expense - The purpose
of this policy is to standardize community benefit expense reporting across the
Dignity Health system and outline the purposes, process, roles, responsibilities, and
deadlines involved in collecting, calculating and reporting community benefit
expenses in IRS Form 990 - Schedule H, annual audited financial statements and to
various states.
40.5.001 Environmental Policy and Statement of Principles - The purpose of
this policy is to articulate Dignity Health’s commitment to respect and protect
Earth and Dignity Health’s endorsement of the Ceres Principles for environmental
protection and conservation. The policy provides for the appointment of an
interdisciplinary environmental action committee at each facility.
40.5.002 Elimination of Mercury - The purpose of this policy is to align Dignity
Health operations in a manner demonstrating accountability for human and
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ecological resources and to enable Dignity Health hospitals to meet mercury level
standards established by the US Environmental Protection Agency and the
American Hospital Association. Products and processes containing mercury shall
not be used in any manner on Dignity Health property, including within Dignity
Health hospital and medical office buildings, unless no reasonable alternatives as
determined by Dignity Health are available.
40.5.003 Environmentally Preferable Purchasing – This policy articulates our
commitment to purchase products and services that are inherently safer to human
and environmental health and that address impacts throughout their lifecycle.
60.9.003 Capital Construction Project Development - The purpose of this policy
is to ensure an integrated and coordinated approach to capital project planning,
design and construction activities that comply with regulatory requirements for
healthcare construction and to incorporate Dignity Health’s commitment to cost
effective use of healing and sustainable designs, construction materials and
methods, and future building operations for both new and remodel projects.
REPORTS/METRICS AND EVALUATING PERFORMANCE
The Hospital Board approves the hospital’s annual community benefit plan and
reviews the annual environmental report. The Board receives periodic reports on
progress in meeting goals and measurable outcomes for both community benefit
and ecological initiatives.
QUESTIONS TO ASK
1. Are a broad range of community stakeholders engaged in the hospital’s
community health assessment and identification of priorities?
Typically representatives from the public health agency, school system, faithbased organizations, civic leaders, local employers, and other nonprofit health
and social service agencies provide input to the health assessment and
identification of priorities.
2. Are the community health priorities integrated into the hospital’s strategic
planning and budgeting processes?
Hospital strategic plans should reference community health priorities, goals
and strategies to address those priorities and measurable outcomes to gauge
success. The budget should include resources for personnel and program
development and implementation and evaluation.
3. Does the hospital’s community benefit plan focus on members/sectors of the
community with disproportionate unmet health needs?
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The Community Need Index, used in conjunction with the triennial
Community Health Assessment, will pinpoint members/sectors of the
community with disproportionate unmet health needs.
4. Do the hospital’s Community Grant awards go to organizations working to
address disproportionate unmet health needs?
The Community Need Index, used in conjunction with the triennial
Community Health Assessment, will identify the community’s
disproportionate unmet health needs. Organizations receiving grants should be
addressing those needs.
5. Are there organizations in the community that might benefit from a Dignity
Health Community Investment?
Examples include nonprofit organizations that provide affordable housing for
low-income households, job training for persons who are unemployed or
underemployed and access to capital for low-income and/or minority
communities.
6. Are there ecological initiatives in the community that the hospital might
partner with?
Examples of ecological initiatives include healthy food systems, sustainable
building, energy and water efficiency, waste management, and greenhouse gas
reduction.
SUMMARY
As Dignity Health’s Community Benefit Policy states: “A visible presence for
nearly 150 years, Dignity Health’s hospitals have a proud history of service to
communities in California, Arizona and Nevada. People’s needs prompted the
origins of the hospitals and remain the chief concern today. Benefiting the
communities we serve is an essential expression of Dignity Health’s mission to
deliver compassionate, high-quality affordable health services, serve and advocate
for our sisters and brothers who are poor and partner with others to improve the
quality of life.”