Reaching for Excellence
Community Vision and Voices for Western New York Health Care
One Friday: Four Futures
Learning from the Conversations
A top priority for the Reaching for Excellence effort was to capture the full range of community perspectives and priorities for health care in Western New York.
Toward this end, the project team traveled across the eight-county region between January 2008 and March 2009 to convene more than 100 community conversations with over 1,700 Western New Yorkers. Forums, primarily small groups, included block clubs, church groups, health centers, employers, schools, senior centers and community and advocacy groups.
Distilling Feedback into Priorities
From college students to seniors, residents of Niagara Falls to Jamestown, and community activists to business executives, Western New Yorkers gave health care and regional leaders a clear directive on what matters most to them for the future of health care in the region. Together, this rich body of community input was analyzed to distill cross-cutting community priorities for the region's health care future. Overall, Western New Yorkers identified 35 issues as important for the region's health care system. These issues were categorized into eight overall themes, or higher level priorities.
Reflecting a nationwide movement toward more patient-centered care, Western New Yorkers said first that they want to connect with their providers on a human level, through care that is delivered with compassion, respect and understanding (Priority #1: Make the Human Connection). Administrative hassles should be reduced through efficiency measures and coordination of care across a patient’s numerous providers (Priority #2: Lose the Hassle).
| Priorities | % of Conversations Addressing Priority |
|---|---|
| #1 Make the Human Connection | 83% |
| #2 Lose the Hassle | 73% |
| #3 Help Me Understand | 70% |
| #4 Make Healthy Choices | 65% |
| #5 Increase Access to Care | 65% |
| Control Health Care Costs | 51% |
| Improve Technical Quality | 42% |
| Enhance Quality of Coverage | 39% |
What Else is on Western New York's Mind? Though not as frequently addressed, Western New Yorkers discussed several other issues of top concern regarding the region's health care system.
Control Health Care Costs: Western New Yorkers believe the health has become extremely cost-inefficient. Consumers see it in their rising insurance bills, co-payments and related expenses, but it is being driven by a broken system with outdated reimbursement models, wasteful spending and rising malpractice suits.
Improve Technical Quality: Western New Yorkers want health care with the most up-to-date information and technology and skilled providers. Health care facilities should be safe and conducive to the best clinical experiences possible.
Enhance Quality of Coverage: Access to health care coverage is not enough - the region needs more comprehensive options that include mental, dental and vision care. The region also needs increased access to alternate plans and options and mandated coverage for care that meets our health needs.
Methodology
A framework community health care reporting based on national best practices informed Reaching for Excellence's identification of community priorities. To consistently document community feedback, the facilitator and recorder assigned to each conversation evaluated the discussion and completed a summary and evaluation form to document the top health care priorities addressed by that audience.
The conversation summary sheets were reviewed by analysts on the project team. Themes emerging from each conversation were marked on a conversation coding instrument that enabled the team to quantify the frequency with which each themes were addressed across all conversations. For instance, if the conversation summary document indicated "more individual responsibility” was a theme from the group discussion, then this theme was coded with a “+1” on the coding instrument. If patient responsibility was absent from the range of themes coming out of a conversation, this theme was coded with a “0” for that conversation. There was no limit to the number of themes generated by any one conversation, with some discussions focusing on a few issues while others addressed as many as 12. These concepts were collected, organized and classified into dozens of themes and subthemes. The classification system used to identify and code community input was guided by best practices from the research literature and input from Shoshanna Sofaer, professor and chair of health care policy at Baruch College in New York City and a qualitative health care data expert. Guidance from Lisa Payne Simon, a health care expert and consultant from Massachusetts, further informed the classification system.
Participant demographics were also tracked for each conversation via participant feedback forms, enabling the project team to quantify the frequency in which themes arose among demographic segments of the region. Where half or more of the conversation participants indicated they were a racial or ethnic minority, the conversation was marked as a “minority” conversation. Likewise, conversations were tagged where half or more of participants indicated they have a low household income ($25,000 or less) or were seniors (ages 55 and up). Conversations taking place outside the region’s metropolitan area consisting of Erie and Niagara Counties were marked as “rural.”
