Documenting Community Need using Quantitative and Qualitative Analysis

Randy Gott, Vice President, and Kerri Kelly, Senior Consultant, Southwind, pictured at the company's management retreat in November, 2005.

The legal implications of "documenting community need" are wide-ranging and somewhat unclear. However, in light of the increased scrutiny of relationships between health systems and physicians, it is prudent business practice for health systems to go through a process of documenting its recruitment activities via community need. Recent investigations of health systems in areas such as physician recruitment, medical directorships, and compensation arrangements are bringing to light the necessity of documentation throughout the process. Documenting community need shows the intent of the health system in its recruitment activities and other relationships.

Most often health systems provide this documentation through a medical staff planning or physician needs assessment process. This process involves an understanding of the mission, goals, and strategic direction of a health system; an assessment of the needs of the community it serves; and, establishes priorities by specialty to meet the needs of the hospital and community. When done on a comprehensive basis, a physician needs assessment will strengthen the ability of a health system to meet the needs of its community through its physician affiliations. It is also an essential process in the overall hospitalâ??s strategic thinking and its overall survival.

A comprehensive plan will incorporate both quantitative and qualitative analysis. Each of these components is necessary since the quantitative analysis only provides an indication as to the statistical needs of a service area. The statistical analysis tells only part of the overall story of what is going on in a medical community. There are a multiplicity of other factors that may strongly influence a communityâ??s needs. Examples of such factors may include, but may not be limited to:

• Accessibility of physicians / specialties - timeliness and availability of physicians in a specialty for referral and consultation;
• Physician attrition - physician retirement, "slowing down", and reduced FTE due to age, family considerations, lifestyle, etc.;
• Scope of practice - lack of the full range of expected services in a specialty;
• Cultural preferences - a segment of the service area population that is best served by a physician of similar culture and background; and,
• Clinical trends - new technologies and expertise in new procedures not provided by current practitioners.

The determination of such factors may be gained primarily through a qualitative process that engages the medical community. Most often this is achieved through a well crafted survey process and/or confidential interviews of physicians. Both can be effective when done in concert. There are advantages to each one of these methodologies. The written survey can gain a wider range of responses in a short period of time. If questions are well developed, it can easily provide information related to physician / specialty accessibility, perceived strengths and weaknesses in the medical community, recommended recruitment priorities, referral patterns, perceived needs by specialty, etc. A survey process can take several weeks to complete but in the end, there should be a wide representation of specialty responses. Confidential interviews may address the same issues but it also provides the opportunity for physicians to offer deeper insights into issues related to medical staff development and physician need in a community. While the individual interviews take longer to complete, the insights can be more detailed than the written survey responses.

Our recommendation in most cases is to conduct both the interviews and survey, since the results of the two offer valuable insights. Our belief is that it is imperative to include a qualitative component to the overall assessment since it is this piece that 'customizes' the analysis to a specific organization. Using only a statistical analysis omits insights that provide further clarification to community need. The qualitative analysis can confirm the statistical needs of a community but it may also cause the organization to question what the statistical analysis is saying. For example, the statistical analysis may indicate that there is no need for additional physicians in a particular specialty. However, learning that referrals are sent out of the community due to inaccessibility or limited scope of practice issues offer insights that data can never communicate and can be the basis for recruitment of additional physicians.

Community need documentation requires a statistical analysis of the service area as well as an understanding of qualitative issues related to physician need. To effectively meet the needs of a community, there must be a thorough analysis that considers all factors impacting need. It is our view that the qualitative analysis is equally important in documenting the physician needs of a community and the documentation necessary to recruit additional physicians.

For more information, email us or call 1-888-624-9684.