STEP 9
Evaluate Progress

Determine your baseline to understand the impact of your strategies. This can include measuring several aspects, such as knowledge and attitudes; community norms; health behaviors like tobacco use, physical activity and eating healthy foods; health-promoting policy and system changes; and associated health disparities. The evaluation focuses on the CHA priorities and their associated goals, objectives and strategies. Use your driver diagram to review how you are addressing the primary and secondary drivers that can positively impact the CHA’s health objectives. You should also look to see what is already being measured before imposing new metrics and needs for data collection.

Although it has been mentioned in previous steps, stakeholder engagement cannot be overemphasized. Include stakeholders from your hospital and community, including those involved in program operations, those involved in previous CHA steps, those served or affected by the program and primary users of the evaluation. View the Community Engagement section to see different options for stakeholder involvement.

Design the evaluation to assess the issues identified as CHA priorities. If you developed Population Health Driver Diagrams for the priorities you have identified, once interventions associated with secondary drivers have been selected for action, your implementation team(s) can establish metrics (i.e., measures and targets) for each of the interventions. These metrics can be used for determining progress and evaluating the impact of your strategies. Consider the purpose, users, uses, questions and methods.

Ask these questions:

• What will be evaluated?
• Who has contributed to the selection of metrics? Who has reviewed it?
• What framework will be used?
• What criteria/metrics will be used? How will you ensure that those are the metrics that matter?
• What metrics will indicate success?
• What process metrics or indicators will suggest progress toward the goal?
• How will your metrics monitor improvements in health equity?
• What conclusions will you be able to draw based on the criteria/metrics being measured?
• Will the metrics collection be burdensome on those in the field who will be collecting them? Don’t assume you know the answer to this question: Ask. If the answer is yes, then streamline and simplify — or be ready to make a mid-course correction.

Accurate, high-quality data is required to strengthen your evaluation’s credibility and any recommendations that follow. These aspects of evidence-gathering typically affect perceptions of credibility: indicators, sources, quality, quantity and logistics.

Data sources for evaluation may include:

• Epidemiological community health status data
• Electronic health record (EHR) data
• Community surveys
• Program attendance
• Policies enacted
• Partnership quality assessments and other relevant data sets available from community partners

A practical, ongoing evaluation process will allow you to correct your course if the implementation is not eliciting the intended outcomes. Embedding a Plan-Do-Study-Act approach will allow your team to regularly check how the intervention is going and how it could be modified to be more effective.

Link your conclusions to the evidence gathered and judge them against agreed-upon values or standards established when you planned your implementation strategies. How do your results fit with the metrics for your Population Health Driver Diagram? Justify conclusions using documented best practices, analysis/synthesis, interpretation, judgment and recommendations.

The evaluation points to the elements of your program that are working and could be altered. Use this feedback to expand or change the program arc at any point; you do not have to wait until the next change cycle to make improvements to the implementation strategies. Look for other programs that the CHA implementation is impacting or can impact. For example, ZIP code areas in the CHA could support recruitment or procurement. In addition, the deeper understanding of the community gained through the CHA can provide insight into marketing to support engagement efforts.

Keep in mind that the CHA is one of many areas that compete for the attention of community members, hospital leaders and other stakeholders. As you share the results and lessons learned from the implementation of your intervention strategy, develop succinct messages and share regularly. When possible, solicit feedback on how different groups are receiving these results, and be prepared to alter as needed.

Prepare your messaging in a format that stakeholders and community members will be able to easily access and understand, using precise and commonly understood language. These findings can also be added to other evidence to demonstrate the impact of your interventions on community health issues and used for your next CHA.