Use your imagination for just a minute. Let’s pretend that you are a young architect with expertise in building “dream” retirement homes. You are pictured on the left below.
Your new clients on the right are Mr. and Mrs. Galloway. They plan to retire in two years and have hired you to design their “dream” retirement home.
Prior to building their “dream home,” you do not meet with them, consult with them, call them, email them, or talk to them in person. You do not gather any information from them. You make no attempt to discover their wants, needs, desires, goals, priorities, or budget. Instead, you hire a builder and tell him to build whatever and wherever he wants.
Below, I inserted a picture of the Galloway’s “dream” home. Want to see it? Ready? Set! Go! (Shout) Move that bus!!
Beautiful! I am sure that Mr. and Mrs. Galloway will weep with joy when they see it! (Not!) They may weep when they see it, but I can guarantee that their tears will not be tears of joy.
If you were really an architect and someone hired you to build their “dream” retirement home, you would first meet with them in person (probably several times) to identify their priorities, wants, desires, and needs, among other things. Correct?
Yet, when it comes to helping a priority population identify and prioritize their needs, we often work in isolation without them, as if we know best. In contrast, it is always best to use a grass roots approach and let your patients and clients identify and prioritize their own needs. They are the true experts!
Factors That Determine Our Health
Before I get into specifics of needs assessments, I need to make sure that you understand the factors that impact our health the most. I’ll let you in a secret – it is NOT access to or the quality of our medical care. Most research shows that access to and the quality of medical care only contribute only about 15% to our health. What about the other 85%?
Most of our health status is determined by our ecology!Remember Goldie the goldfish? Her health status was influenced most by the quality of the water inside her aquarium. Likewise, our health is determined by our relationship with everything in our environment both living and non-living. Our health is shaped most by the “cause of the causes” – the conditions in which we are born, grow, live, work, worship, play, and age. These conditions are called the Social Determinants of Health (SDOH). Below is how the Centers for Disease Control depicts them:
Definition of a Need
As we focus on the SDOH and help all people achieve health equity, we must first identify and meet their needs. A need is simply a gap between what is and what should be. Thus, when we do a needs assessment, we aim to identify gaps. Any new program, service, intervention, or policy that we design should then fill a specific gap. Make sense?
Another way of defining a “need,” is the difference between the present situation and a more desirable one. If asked properly, people will tell you what they want or need to achieve more desirable health and/or quality of life.
Needs can be felt/perceived or concrete/actual (i.e., based on data). They can be as concrete as the need for food and water or as abstract as the need for greater community cohesiveness. The type of need does not matter. A person’s perception is his/her reality.
Definition of a Resource
When we do a needs assessment, we also help the priority population identify resources and assets in their community. These things include individuals, organizations and institutions, buildings, landscapes, equipment – anything that can be used to improve health and/or quality of life. Examples may be the green space where kids play, the city park down the street, a walking or bike path where residents can exercise, a library that loans books and provides Internet access to everyone, a local pool, the church on the corner that provides job training to residents – all are resources that enhance and improve community life. Every individual is a potential asset, and everyone has assets that can be used for to strengthen a community.
Steps Involved in Doing a Health Needs Assessment
In general, there are six steps when doing a health needs assessment (McKenzie, Neiger, and Thackery, 2017):
Source: McKenzie, J.F., Neiger, B.L., and Thackery, R. (2017). Planning, implementing, and evaluating health promotion programs: A primer (7th edition). London: Pearson
Why a Needs Assessment Should Always Precede the Design of Something New
If we go back to the opening illustration about the architect and the couple approaching retirement, we can easily see why it is important to tailor and customize what is “built” to the needs, wants, priorities, and budget of the client.
The same is true when we want to fill a gap that may exist in services, programs, or policies for our priority population. A top-quality, health needs assessment provides you and your clients/patients with numerous benefits (McKenzie, Neiger, and Thackery, 2017):
- Before a need can be met, it first must be identified and measured.
- Helps you to prioritize and provides a focus for developing the “new” thing.
- Ensures that scarce resources are allocated where they can give maximum benefit.
- Prevents the waste of time, money, and effort due to a misplaced focus.
- Provides you with a rationale to “sell” your program to stakeholders or funders.
- Helps you achieve equity and social justice by focusing on those who are truly in need.
- Determines whether a population can identify, mobilize, and address their problems.
- Provides a reference point to which future assessments can be compared.
Source: McKenzie, J.F., Neiger, B.L., and Thackery, R. (2017). Planning, implementing, and evaluating health promotion programs: A primer (7th edition). London: Pearson
Your Primary Goal: Use the Needs Assessment As a Means Not an End
If you desire sustainability of whatever you “build” and you want to increase your impact and capacity as a leader, you must train your replacements. I guarantee that one day in the future you will leave to start a new project, a new job, or a new phase in life. Then what? Who will lead the “new” thing that you helped to build?
Therefore, an important part of the process is inviting 3-4 others from the priority population to serve as your apprentices/mentees (ENLIST). Then, you must teach your apprentices what you do and how to do it (EQUIP). After they have learned from you by observation and from your mentorship, you must gradually and incrementally relinquish responsibility and control to them, so they are doing what you were doing (EMPOWER).
This leadership development process is then repeated generation after generation. After these 3-4 apprentice leaders can do what you do, they use the same process and recruit and train their replacements. Their replacements then repeat the cycle again. Their replacements repeat it again and on and on it goes. When we have multiple generations of leaders being launched into a priority population, the knowledge, skills, and capacity of the population is greatly increased. Eventually, the population will be able to handle their own health problems and effectively advocate for change. Is this not the ultimate goal?
We Can Help
The talented team of the 1795 Group knows how to do first-class, health needs assessments. Our specialists are very skilled in the process. We can help you as we have helped others.
Please contact us if you are interested in learning more about needs assessments or if you want to brainstorm how we can collaborate.
