Hall Strategic Partners · Executive guide · 2026 edition
Why CHNAs stall, and how to organize the work that follows.
A leadership perspective on connecting community priorities to ownership, resources, coordinated delivery, and evidence.
For community benefit leaders, population health teams, executives, finance leaders, trustees, and partners. Read in sequence or begin with the decision in front of your team.
The problem
Identifying a community need does not settle who will act, what they can commit, or how progress will be reviewed.
A Community Health Needs Assessment (CHNA) brings together data, community perspectives, and identified needs. An implementation strategy sets out an organization's intended response. Between that response and the work itself sit practical decisions: which contribution to make, what should happen first, who owns delivery, and what resources and partnerships are available.
Those decisions can remain unresolved even when a report is complete and programs are underway. A priority may have several contributors but no accountable owner. An initiative may have funding but insufficient staff time. Partners may support the same goal while working to different schedules or definitions of success.
The implementation gap is the distance between an identified priority and the coordinated work required to address it.HSP's working definition
This guide examines the organizational side of that distance. Funding constraints, workforce shortages, policy conditions, and community circumstances also shape what is possible. Architecture cannot remove every constraint. It can make responsibilities, choices, dependencies, and unresolved decisions more visible.
What the research shows
Burns and colleagues examined 485 strategies reported in 83 hospital CHNAs that included evaluation outcomes. System utilization was the most frequently reported outcome category, appearing in 71% of those strategies. This finding describes that study's sample; it is not a measure of how many hospitals fail at implementation. [1]
A separate study of ten community health improvement processes found variation in the development of implementation strategies and their measurement systems. The authors emphasized accountability and shared measurement. [2]
These studies inform the questions in this guide. They do not establish the effectiveness of HSP's methodology or diagnose a particular organization.
The architecture framework
An unowned decision can become a delayed handoff. A delayed handoff can become a resource problem. The connections deserve attention.
HSP uses four areas of inquiry to examine how an implementation commitment is organized. They are discussion categories, not a validated scoring model or a claim that every organization has the same weaknesses.
A broad priority label leaves room for incompatible interpretations. Define the population, place, contribution, and boundary of the work. Then identify what must precede what, including approvals and partner dependencies.
Ask: What are we committing to do first, and why?
A named lead needs a defined remit, access to decisions, and a route for escalation. Separate accountability for progress from responsibility for individual tasks, and clarify which decisions require a sponsor or governing body.
Ask: Who can resolve the next obstacle?
Money is one resource. Staff time, skills, data access, technology, and partner capacity also shape delivery. Distinguish confirmed commitments from assumptions, including work that a community organization is being asked to absorb.
Ask: What is funded, staffed, agreed, and still conditional?
Choose a rhythm for reviewing progress, resolving dependencies, and revisiting decisions. Connect measures to the decisions they should inform, and retain the reasoning behind changes so the work can survive a handover.
Ask: When will we review, learn, and adjust?
Priority: Improve behavioral health access.
Illustrative implementation question: What would it take for this facility and its partners to improve follow-through after a behavioral health referral for a defined population?
The second statement still requires local evidence and decisions. It gives the team a clearer boundary for discussing ownership, referral handoffs, capacity, and measurement.
The ISRA methodology
Implementation Architecture™ is the design of the organizational conditions that turn strategy into repeatable results.
HSP uses ISRA to organize this work: Identify, Sequence, Resource, Activate. The methodology supports implementing strategy through recurring alignment. Teams revisit these activities as priorities, capacity, partnerships, and evidence change.
Understand the organization's goals, existing actions, intended contribution, and operating context. Examine where ownership, decisions, coordination, or evidence are unclear.
Working question: What needs to move, and what is preventing it?
Arrange work around dependencies, readiness, capacity, and the people affected. Make the rationale visible, including what must wait and what can proceed together.
Working question: What needs to happen first, next, or in parallel?
Connect the work to funding, staff time, skills, information, authority, and partner commitments. Expose gaps before treating an activity as ready to deliver.
Working question: What will this work actually require?
Put responsibilities, decision routines, handoffs, and feedback into operation. Review what happens and adjust the scope, sequence, or resources when needed.
Working question: How will we carry the work and respond as we learn?
Identify · Sequence · Resource · Activate ↺ Revisit as conditions change
These are connected activities, not four gates that must be completed once in a fixed order. A funding change during delivery may require new sequencing. Community feedback may change the problem definition. Activation can reveal an authority gap that the initial review missed.
Documents record the commitment. The operating arrangements support the work.
A roadmap, ownership map, or reporting framework is useful when people have the authority, capacity, and routines to use it. The relevant question is what each document helps someone decide or do.
Back to contents ↑Coordination in practice
These are practical design recommendations for leadership teams, not claims about a proven class of high-performing hospitals.
For each selected priority, agree on a bounded contribution, an accountable owner, decision authority, and the major dependencies. Test the proposed scope against available capacity before adding more activities.
Record uncertainty explicitly. An unconfirmed partnership or pending award should not appear as a secured resource.
Boards and leaders need financial stewardship and compliance information as well as evidence of implementation progress. Connect spending and delivery to the change the organization intends to influence.
Distinguish activities, outputs, participant experience, and outcomes. Avoid attributing a community-level change to one initiative without sufficient evidence.
Define partner roles, handoffs, communication, resources, and decision responsibilities together. Involvement in an assessment does not automatically establish a commitment to implementation.
Include community perspectives in interpreting progress and adjusting delivery, with clear expectations about how feedback will influence decisions.
Keep decisions, responsibilities, and unresolved issues accessible to the people who need them. Define who steps in when a lead is absent or changes roles. This can reduce reliance on one person's memory without pretending that staffing transitions are effortless.
Reading the public record
Use a filing to develop questions. Use additional evidence to understand how the organization operates.
Schedule H (Form 990) reports financial assistance, certain other community benefits, and facility information. Its categories cover more than individual CHNA initiatives. Total community benefit spending should not be treated as a discretionary implementation budget. [3]
Read the relevant filing alongside the facility's CHNA, implementation strategy, reporting period, and internal evidence. A short narrative, unchanged spending, or an absent detail does not by itself establish weak performance. The questions below are HSP's interpretive prompts, not IRS tests or a predictive model.
| What you notice | What to ask next | Evidence to seek |
|---|---|---|
| Activities are described without clear progress measures. | How does the team review delivery and intended change? | Internal reports, indicator definitions, review notes, and decisions. |
| The link between selected priorities and activities is difficult to trace. | Where is the facility's contribution to each priority documented? | Implementation strategy, program mapping, and scope decisions. |
| Partners are named but responsibilities are unclear. | What has each organization actually agreed to contribute? | Agreements, resource commitments, and coordination routines. |
| The narrative changes little between filings. | Does this reflect continuity, reporting practice, timing, or unresolved work? | Reporting periods, delivery records, and explanations from responsible staff. |
| Targets and governance arrangements are described. | How are those arrangements operating in practice? | Current results, decision records, and partner or community feedback. |
This is an organizational review approach. Facility-specific reporting and tax questions belong with the organization's finance, tax, and legal advisers.
Back to contents ↑Leadership reflection
Use these questions to surface decisions, differences in understanding, and evidence the team still needs.
Bring together community benefit, population health, finance, operational leadership, and relevant partners. Answer with examples from the current cycle. This is a conversation guide, not a scored assessment.
Identify the questions that matter most now. Record what is known, what needs verification, who will resolve it, and when the team will return to the decision. Differences in answers are a reason to investigate, not proof of an organizational failure.
How HSP engages
Hall Strategic Partners works on what happens after the strategy is approved.
For CHNA implementation, the starting conversation is about the organization's intended contribution, the conditions supporting delivery, and the decisions that remain unresolved. The scope should follow those needs.
A focused entry point for examining an implementation concern and discussing where deeper attention may be useful.
A structured engagement to examine implementation conditions and develop a prioritized roadmap for the work ahead.
Support for identifying, sequencing, resourcing, and activating work, with recurring alignment as organizational conditions change.
The appropriate engagement, deliverables, responsibilities, timing, and fees are agreed before work begins.
Planned learning opportunities
Begins May 2027.
Full program planned for Fall 2027.
Program details will be shared separately. A consultation booking is not enrollment.
Your next conversation
Discuss the priorities, ownership questions, and coordination needs in front of your team.
Book a CHNA Implementation Strategy SessionSources & reading
The research supports specific observations about evaluation and coordination. HSP's framework and practical recommendations are identified separately throughout the guide.