Home Uncategorized Read Case 25 in the Pruitt, Smith, & Perez-Ruberte text and answer the Discussion Questions associated with the case.

Uncategorized

Read Case 25 in the Pruitt, Smith, & Perez-Ruberte text and answer the Discussion Questions associated with the case.

1. What is the most important challenge Norman Drood faces in deciding what to do next about suicide prevention in Valley County?

2. Does Valley Health have a responsibility for preventing suicides? What is Norman’s own responsibility as an ethical healthcare professional to do

something about suicide prevention in Valley County?

3. Should Drood consider revising the Valley Health CHNA to focus more on suicide prevention?

4. Why are the social care organizations in Valley County poorly coordinated? Why don’t social care organizations dedicate specific resources to

meeting the challenge of suicide prevention? What organization or individuals might make suicide prevention a priority?

5. The Valley Health community health needs assessment identified many “priorities.” How would you recommend the management team identify

the most important needs? How many strategic priorities are too many?

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Case 25:

Community Collaboration

for Suicide Prevention
Anthony Kovner, PhD, MPA Zachary Pruitt, PhD, MHA, CPH

OBJECTIVES

1. Describe the legal requirement for nonprofit healthcare organizations to assess the status of community health and create a strategy for
performance improvement.

2. Analyze the root causes of suicide among aging adults.
3. Evaluate a healthcare organization’s efforts to collaborate with community partners for the purpose of improved health and wellness of their

service areas.
4. Assess the ethical dilemma healthcare organizations face when addressing community health needs.
5. Explore how to align organizational priorities with the needs and values of the community.

INTRODUCTION

The Affordable Care Act mandated that certain nonprofit healthcare organizations covered by §501(c)(3) of the Internal Revenue Code must conduct a
community health needs assessment (CHNA) at least once every 3 years. A report of the CHNA implementation strategy, updated annually, should be based
on epidemiological data and qualitative interviews that assess the health issues in an organization’s community. The CHNA requirement is intended to
promote compliance with tax exemption enjoyed by nonprofit healthcare organizations that are supposed to provide valuable benefits to their communities
(Rosenbaum, 2015). In other words, nonprofit hospitals must justify their §501(c)(3) tax-exempt status with community benefit activities specified in their
CHNA, among other legal requirements (Kutscher, 2015).

Valley County has a population of over 540,000 people, a 9% decline over the last 10 years. Valley County experienced a decline in median household
incomes associated with a steady contraction of the state’s industrial-based economy. Many young people and college graduates have left Valley County for
higher paying job opportunities elsewhere, leaving their aging parents and grandparents to live in homes they are unable to sell due to the slumping housing
market.

Valley Health, formerly Valley Hospital, is the largest provider of hospital services in Valley County. Valley Health developed its ACA-mandated CHNA
under the guidance of chief executive officer, Norman Drood, who delegated the writing of the report to Valley Health’s administrative fellow for 2019 to
2020, Neil Maisel. The Valley Health administrative fellow program is a prestigious leadership development experience designed to transition top Master of
Health Administration (MHA) graduate students into management positions at Valley Health through focused mentoring. Maisel won the coveted
postgraduation job, mostly because of his excellent qualifications but also because he graduated from the same MHA program as the Valley Health’s CEO.

CASE SCENARIO

The Administrative Fellow’s Presentation

Maisel based his CHNA report findings on assessment of the local health metrics and feedback from community stakeholders, including patients and leaders
of community-based social care organizations. Maisel identified numerous community health needs and strategies for addressing these needs through
community collaboration. At his first big meeting as an administrative fellow, Maisel presented his CHNA report to the CEO, the chief financial officer
(CFO), and the director of Community Health Partnerships. The Valley Health CFO, Sim Peters, made him especially nervous. Peters had a reputation for
intimidating people, especially the administrative fellows. After a nerve-rattled start, Drood put Maisel at ease with encouragement and humor. “Don’t
worry; you’re doing fine,” he said. “We don’t bite. Well, Peters bites, but he’s had his shots.”

Every 3 years, Drood gave the job of writing the CHNA to the new administrative fellow. In his opinion, understanding the community was invaluable
to up-and-coming leaders of Valley Health. As Drood looks to retirement—he will turn 70 next year—his interest in developing young talent has deepened.
Plus, Drood explained, he viewed the CHNA to be a regulatory obligation, not a strategic imperative. Therefore, the CHNA made for a good assignment for
the administrative fellow.

Maisel eventually gained confidence speaking to the executives near the end of his presentation. “Finally,” Maisel said, “the last community need is
‘Lack of access to mental health and suicide prevention programs.’ Although the Healthy People 2020 targeted a reduction in suicide rates to 10.2 per
100,000 by 2020, suicide rates have steadily increased in recent years, and Valley County is no different.” Maisel presented the line chart of the trends of
suicide ranks from 2010 to 2017, the latest national data available (Figure C25.1).

“Furthermore,” Maisel continued, “suicides rank as the seventh leading cause of death in Valley County. This is also higher than national rankings”
(Table C25.1).

“Interestingly, suicides are not equally distributed in our community. Men—especially older men—are more likely than women to commit suicide. This
fact is especially pronounced in Valley County” (Table C25.2).

“In summary, Valley County faces a variety of health needs documented in our report,” Maisel concluded. “For each of these top priorities, the team
recommends a community collaboration strategy. Any questions?” Maisel presented a summary table of community health needs (Table C25.3).

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Figure C25.1 Suicide mortality, Valley County and national.

“I have a question,” Peters said. “You say these are top priorities, and yet you have, what, ten of them? Why so many ‘priorities’?”
Maisel stuttered an answer that was mostly equivocation. After letting the young man struggle on his own for a while, Drood stepped in. “Thank you,

Neil,” Drood said. “The CHNA looks good. Let Mr. Peters and me discuss the budget. We will let you know the next steps soon.” He dismissed Maisel and
the director of Community Health Partnerships.

After the CHNA Presentation

Once alone with Peters, Drood asked, “So, what do you think?”
Peters said, “I think we can integrate most of these into our strategic plans that we already developed. For example, recruiting OB/GYN and primary

care physicians is already in the works. The chronic disease and diet education programs can be executed by the Community Health Partnerships group.”
“And the rest?” Drood asked.
Peters shook his head, “I don’t see it. Suicide prevention is not our business. It loses money. We’ve been down this road before. Almost half of

individuals who commit suicide visited their doctor within 1 month of death, yet there is rarely documentation of physician inquiry or patient disclosure.
Suicide is hidden from view. If somebody wants to kill themselves, they will find a way to do it. There’s not much we can do to prevent suicide,” Peters
said.

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Table C25.3 Top Ten Valley County Community Health Needs and Strategies

PRIORITIZED COMMUNITY HEALTH
NEED COMMUNITY COLLABORATION STRATEGY

1. Growth of chronic illnesses, such as heart
disease, stroke, diabetes

1. Chronic disease prevention and management education programs

2. Need for more substance use/addiction
programs

2. Substance abuse treatment and prevention programs

3. Lack of public transportation options 3. Subsidized medical transportation program with ride-sharing services

4. Food insecurity among low-income
populations

4. Subsidize mobile food pantry provided by America’s Harvest

5. Growing obesity and associated
conditions, including diabetes

5. Develop and market “5 a Day for Better Health” diet education program

6. Need for more women’s healthcare
services, specifically breast care

6. Recruit OB/GYN physicians and expand breast imaging service line

7. Need for more community-based long-
term care for an aging population

7. Partner with Area Agency on Aging on existing programs

8. Lack of access to exercise opportunities 8. Membership to Valley Health Wellness Center for patients enrolled in weight control program

9. Growing rate of social isolation among
aging adults

9. Create “Senior Companions,” a volunteer program for 65+ at the hospital

10. Lack of access to mental health and
suicide prevention programs

10. Develop and implement program to train community facilitators (e.g., clergy, police, postal
service, barbers) to identify people at increased risk for suicide

“I know, I know. Over the last few years, we’ve had an exchange of letters with the Valley County Health Department. We all acknowledge the challenge of
suicide prevention. We commit to help, but performance expectations are never set. The Health Department is so underfunded, that we just …” Drood said.

“Can’t invest our resources?” Peters asked.
“Yes,” Drood admitted.

The Sad News

Months later, Drood received an email from his cousin Tom, who lives out of town. The email read, “Norman, it pains me to tell you that our old friend
Vince committed suicide 2 months ago. I happened to see his sister yesterday, and she told me. Apparently, his death was unexpected. He did not show any
warning signs, but I really think his family had fallen out of touch with him. I’m sorry that no one reached out to you before now. I know that you were once
very close.”

Drood was shocked. In fact, he had been in touch with Vince a while back emailing reminiscences of a backpacking trip to Europe they made together
after college. Norman wondered if there was anything he should have done to try to save Vince.

Good Advice

Drood decided to seek advice from people he respected. First, he talked with Dr. Al Woods, who has a large general medicine practice and sees many Valley
Health aging adult patients. Usually a good listener, Woods did most of the talking because Drood struggled to speak about his old friend’s suicide. Woods
gave some simple advice, “I know that thinking about suicide is common among the aging adult men I take care of,” he said “Suicide is particularly
high among those with poor physical health, depression, and anxiety and even higher among those with drug and alcohol addiction or severe mental
illness. However, restricting screening to those patients who present with these conditions may miss individuals at risk for suicide. Why don’t you extend
awareness and outreach for universal suicide screening by clinicians?”

Next, Drood sought the advice of Wanda Letts, a social work professor at Valley State College who has served on the board of a local social services
agency. Letts said, “Other than access to firearms, killing yourself is related to people living alone. Late-in-life suicide has been linked with social isolation,
such as living alone, loss of spouse, disconnection from friends and family, lack of mobility and transportation, and low social support. Imagine if you’re
broke, widowed, and alone. You lack meaning in your life and you feel like a burden on your family. It’s terribly sad.”

Letts continued, “Interventions have a greater chance of success if they utilize existing community resources and aim to build community capacity. I
work with social agencies and churches, and they have the skills to create meaning and social connectedness among those in later life. We know these things
prevent suicide, but no social care organization is focused on suicide prevention. What’s more, these agencies are weakly linked and sparsely supported.
There is no overarching entity with the wherewithal to lead a focused suicide prevention effort. Why not Valley Health?”

Community Collaboration

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Drood asked himself what he should do next. He wanted to respond to the challenge and improve mental health in the county, but didn’t want to raise
expectations that Valley Health cannot meet. He could launch a community awareness program, convening a committee of hospital board members and
local citizens. Drood thought that he could talk to the other two hospital CEOs serving Valley County and see if the hospitals can work together on this. He
should ask whether any organization or a philanthropist in the county would be interested in working on suicide prevention.

After considering his options, Drood called Maisel and told him to get some more data about the extent of the problem and to conduct a literature search
on the evidence-based practices in suicide prevention. He told Maisel to ask about potential volunteers from the local college and to interview the local
newspaper editor and emergency room and primary care physicians. Maisel should learn more about what the community is doing now and how money is
being spent on suicide prevention.

Drood also knew that he needed to convince the hospital leaders about the importance of suicide prevention. Certainly, nonprofit hospitals face increased
pressure from the government to demonstrate that they’re reinvesting in their communities. He knew that retaining their federal tax-exempt status was
crucial. However, this perspective will not motivate his team. He needed to align their organizational priorities with the needs of the community. Perhaps he
needs to make the story more personal? Shouldn’t Valley Health do the right thing for people like Vince?

DISCUSSION QUESTIONS

1. What is the most important challenge Norman Drood faces in deciding what to do next about suicide prevention in Valley County?

2. Does Valley Health have a responsibility for preventing suicides? What is Norman’s own responsibility as an ethical healthcare professional to do
something about suicide prevention in Valley County?

3. Should Drood consider revising the Valley Health CHNA to focus more on suicide prevention?

4. Why are the social care organizations in Valley County poorly coordinated? Why don’t social care organizations dedicate specific resources to
meeting the challenge of suicide prevention? What organization or individuals might make suicide prevention a priority?

5. The Valley Health community health needs assessment identified many “priorities.” How would you recommend the management team identify
the most important needs? How many strategic priorities are too many?

PODCAST FOR CASE 25

Listen to how experts approach the topic (you can access the podcast by following this url to Springer Publishing Company Connect™:
https://connect.springerpub.com/content/book/978-0-8261-4514-7/front-matter/fmatter2)

REFERENCES

Kutscher, B. (2015). Hospitals broaden scope of community-benefit work. Retrieved from
https://www.modernhealthcare.com/article/20151121/MAGAZINE/311219988/hospitals-broaden-scope-of-community-benefit-work

Rosenbaum, S. (2015). Health Affairs Blog: Additional requirements for charitable hospitals: Final rules on community health needs assessments and
financial assistance. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20150123.044073/full

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