The Challenge: To uncover health disparities hidden by geographic divisions and data challenges as part of a joint CHNA for two major hospitals serving Washington, DC.
The Background:
For more than a decade, Community Health Needs Assessments (CHNAs) in the nation’s capital were organized by DC Health Matters, a collaborative of nearly a dozen hospitals, health clinics, and other nonprofits. When that effort ended, several of the hospital partners wanted to continue working together, and they chose Ascendient as their CHNA firm.
Our Work:
The DC healthcare market is unusual in several ways. First, a core part of the CHNA process is to establish benchmarks for health outcomes, based on data from similar states and counties. But DC is neither a state nor a county, making it difficult to set benchmarks using standard data sources. We invested significant time in collecting and analyzing data in a way that was both transparent and useful, focusing heavily on the differences between and among the city’s eight Wards.
Secondly, DC is overseen directly by federal officials, with no additional layers of county and state government. This means that DC Council members, elected mostly at the Ward level, function more like state legislators, with broad authority over local governance, budgets, and policymaking. Within the Wards, neighborhood groups are actively involved in civic discussions to ensure their communities’ needs are represented. These unique geographic realities required extra intentionality in designing research that was representative on every important level.
Finally, DC is an unusually diverse jurisdiction, with a rich tapestry of churches, mosques, community centers, mutual aid networks, and other nonprofits meeting the needs of hard-to-reach populations and sub-groups. In this environment, it was especially important to leverage authentic community connections in order to meaningfully engage with those most affected by poor health access.
The Outcome:
Working with our clients to navigate the distinctive challenges of the DC market, we adapted our CHNA process to yield the most accurate and actionable insights. For instance, we organized focus groups by Ward and leveraged the hospitals’ deep relationships to help get the right voices in the room for each neighborhood.
This geographic focus yielded some surprising insights in the completed CHNA. Looking at the District as a whole, DC appears to score well on healthcare access, but Ward-level data revealed stark disparities – particularly in neighborhoods with no acute care hospitals. For instance, in neighborhoods with limited healthcare access, we found higher rates of chronic disease, fewer mothers receiving prenatal care in the first trimester, and higher rates of preterm births and low-birthweight babies when compared to the District as a whole.
Getting beyond the numbers, interviews and focus groups further sharpened our understanding of the disparities, allowing both hospitals to prioritize services in pursuit of health equity.
The Takeaway:
Many markets have hidden fault lines that mask deep disparities in health access and outcomes. Local hospitals can use their community ties to make sure that every voice is heard – but only if consulting partners are deeply committed to health equity and willing to adjust their processes accordingly.
