Editor's note: Anthony Stanowski is the director of planning and market research for Main Line Health, a four-hospital chain located in suburban Philadelphia. Ann Danish is the director of social work at Lankenau Hospital, a Main Line Health member.

Main Line Health is a 1,197 bed, four-hospital chain located in the western suburbs of Philadelphia (known as the Main Line). The three acute care hospitals and one rehabilitation hospital of Main Line Health serve an extremely diverse patient population, ranging from impoverished urban neighborhoods to one of the wealthiest areas in the nation.

As the first phase of a community benefits initiative within its strategic plan, Main Line Health was to address community health needs within its primary service area. Considering its service area's population size (over 1 million people), socioeconomic diversity, and geographical length (25 miles) and breadth (15 miles), the first question was "Where do we start?"

Lower Merion township's 62,859 population has an overall household income of $74,151. The township has its own health department. Also, Lower Merion is served by two Main Line Health hospitals. The Lankenau Hospital is a 475-bed center for medical care, education, research and community health education. Founded in 1860, Lankenau moved to its current site in 1953. The Bryn Mawr Hospital is a 393-bed teaching hospital with a 100-year tradition of serving the community. Both hospitals provide a full complement of medical, psychiatric and surgical services.

Coincidentally, three independent health and social service entities within the township were grappling with similar concerns over the population's health. The Board of Health of Lower Merion Township wished to evaluate public health needs of township residents. The Long Term Care Consortium of the Main Line had initiated a survey of the adequacy of long term care services, but wanted a more valid, objective assessment. Community Health Affiliates, a non-profit home health organization, wanted to develop outreach programs to poor elderly in need of home care. Through a community organizing strategy by Main Line Health, these three organizations were brought together and encouraged to sponsor an assessment in partnership with Main Line Health.

Main Line Health wanted to understand the health status and needs of all of the communities it serves, but needed a place to start. With a ready group of partners and a service area that was small enough to be manageable but large enough to offer a diversity of people, Main Line Health felt that Lower Merion would be a good place to start, using its experience there as a prototype for other communities that it served.

A steering committee organized and crafted a request for proposal (RFP). This article details the components of the RFP, necessary proposal elements, and suggested guidelines in vendor selection.

Vendor contacts

We asked two vendors to speak with us informally. Both have experience with health needs assessments in the region. One of the two also provides direct health and social services in the community and designs and implements disease prevention and promotion programs. These two vendors provided the necessary background and information to help us in drafting the RFP.

Possible vendors were identified by polling members of the committee to learn if they knew qualified and interested people or firms to handle the project. The list was a compendium of names, ranging from unaffiliated Ph.D.'s in the community to established consulting firms. We sent out eight RFPs and received three replies.

RFP structure

The objectives defined in our RFP were to (1) identify current and emerging health problems of Lower Merion Township, (2) provide direction for program or resource development to address identified needs, (3) adopt or develop measures to understand the impact on health status of new programs and services, and (4) to foster cooperation among providers, civic organizations and government.

We were careful to ensure that the RFP would not be a request for a strategic plan for our facilities. It was designed to be as pure a needs assessment as possible, a true study of the needs of the community regardless of our own strengths and weaknesses.

The RFP defined a suggested methodology. It required the selected organization to use both primary and secondary research methods, leveraging the value of established sources when possible. The general approach is as follows:

  • Assess health status and use of services by township residents. This may be accomplished by using household surveys, focus groups and existing data sources.
  • Determine existing and future health needs.
  • Develop solutions/recommendations, including programs and services, facilities and funding approaches.
  • Ongoing health status measurement and monitoring. The report will detail the necessary steps and costs to accomplish monitoring recommendations.

Although the above represented a broad list of data analysis, we required thoughtful analysis with recommendations, not a "data dump." The selected organization was instructed to display exemplary capabilities for data analysis and synthesis.

The RFP also alluded to keeping costs low, and expected the vendor to use the data resources of the participating organizations. These resources included Nashville-based Inforum's Mediedge product for demographic and health utilization, the capabilities inherent in a regional inpatient database, and the information service departments of the hospitals for other patient data.

We requested the vendor to meet a four-month turnaround. This period was felt to be appropriate, and the vendor selected met the specifications in both the proposal and in the ultimate report.

Proposal responses

One proposal was a joint effort by two health care consulting companies. They produced a 200-page proposal defining background, detailed methodology, survey tools, and resumes of key project staff.
The second proposal was from a Ph.D. on the faculty of a local university. The proposal was about as thick as the total pages dedicated to the résumés of a competitive proposal, yet was comprehensive enough to address all of our requirements.

The third proposal was received from a health care consulting firm which had experience with a local county's board of health in defining community health needs. Their proposal also produced the detailed information necessary to conduct the assessment.

Analysis of proposals

We judged the proposals against 11 key areas:

1. Clarity. The extent to which the proposal made its case indubitably. We used the writing of the proposal as a predictor for how the writing of the report will look. Did the author state his/her methodology clearly? Did the author succinctly address each item of our suggested approach? Did the author define the resources he/she will use? Did the author organize the action steps with proposed costs as stated in the directions?

2. Oversight/participation. The proposals were examined to determine if the author provided for the right amount of work for the committee to do. The committee was willing and able to participate in the study to keep costs low, but did not want to do the study itself. One vendor's approach seemed to want us to define too much; another seemed as if they were saying they did this often -- we should leave it all to them.

3. Provider interviews. Both the quantity of interviews the vendor would provide, and the methodology used in interviewing the providers was examined.

4. User interviews. One consultant felt that we should conduct user interviews. We felt this was important enough to examine separately.

5. Survey methodology. We expected the consultant to have a survey instrument tool. We did not want to create an instrument, but we did want to have the instrument modified to meet our needs.

6. Survey sample. The quantity of surveys proposed.

7. Survey cost. The total cost, and the extent to which the vendor enabled us to decrease this cost by using established vendor relationships.

8. Focus groups. The cost for conducting focus groups.

9. Vendor experience. Did the vendor have experience in conducting an assessment?

10. Vendor resources. What resources was the vendor able to bring to get the project completed in the time allotted?

11. Overall cost. Was the study able to meet our budgetary constraints and still meet our goals?

Conclusion

We defined the criteria for vendor selection within our RFP. The final selection of a vendor was a tough choice, with two vendors displaying full capabilities. Ultimately, the selection of a vendor was unanimous within the committee. The vendor best met the criteria we established and kept within our cost and time frames.

The project was completed in the time frame specified, with results that led to the establishment of a local group, the Lower Merion Health Consortium. This consortium is developing programmatic responses to the community's needs by soliciting participation not just from the initial study team, but from community leaders and other health providers.