Screening For Social Determinants Of Health
Screening for SocialDeterminants of HealthHealth System OrganizationalSelf-Assessment and Toolkit
AcknowledgmentsThis toolkit was developed by the American Cancer Society’s Hospital Systems Capacity Building Initiative forparticipating Communities of Practice (COP) sites. Health systems can use this toolkit to identify opportunitiesto improve the systematic screening for social determinants of health within their organization.We appreciate our colleagues and partners for their contributions to this toolkit.Contributors:American Cancer Society Sarah Shafir, Managing Director, National Partnerships and InnovationMeg Fischer. Strategic Director, National Health Systems and OrganizationsDonoria Evans, Senior Data and Evaluation ManagerTracy Wiedt, Managing Director, Health EquityAshley Brown, Strategic Director, Health EquityAbt Associates Stephanie Frost, Senior Associate Ellen Childs, Health Services Research AssociateReviewers Sonia Pinal, Cancer Control Strategic Partnerships ManagerNicole Heanssler, Cancer Control Strategic Partnerships ManagerJessie Sanders, Cancer Control Strategic Partnerships ManagerShauna Shafer, Cancer Control Strategic Partnerships ManagerJosh Kellems, Senior Manager, Cancer Control Strategic PartnershipsStephanie McLean, Cancer Control Strategic Partnerships ManagerHospital Systems Capacity Building InitiativeScreening for Social Determinants of Health2
ContentsAcknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4How to Use This Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 – ACS Health System SDOH Self-Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Health System Organizational Self Assessment for Implementing Social Determinants of Health . . . . . . . . 62 – Matrix for Identifying Next Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Matrix for Identifying Next Steps in Developing an SDOH Screening Process . . . . . . . . . . . . . . . . . . . . . . . . . . 113 – Action Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 – Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Clinical Champions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Staffing and Reimbursing Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Screening and Linkages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Goal Setting and Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Workflow Process Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Example SDOH Screening and Linkage Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27EHR Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Developing EHR Functionality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28ICS-10 Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Other Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Testing Functionality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health3
IntroductionSocial determinants of health (SDOHs) are “the conditions inOn average, there is a 15-yearthe environments where people are born, live, learn, work, play,difference in life expectancy betweenworship, and age that affect a wide range of health, functioning andthe richest and poorest U.S. residents.quality-of-life outcomes and risks.”1 These social and environmentalRelatedly, location of birth is stronglyfactors greatly influence population health; addressing the socialassociated with life expectancy.determinants of health is vital for improving health and reducinghealth disparities.2 Despite being ranked as one of the 10 richestcountries in the world per capita, the U.S. experiences high rates of health disparities that are rooted in economic,social, and environmental factors. One meta-analysis found that over a third of total deaths in the U.S. in oneyear were attributable to social factors such as poverty, social supports, racial segregation, and education.3 Onaverage, there is a 15-year difference in life expectancy between the richest and poorest U.S. residents.4 Relatedly,location of birth is strongly associated with life expectancy.5, 6SDOHs are an important factor in cancer prevention, screening, and treatment. Recent evidence showsdisparities in cancer screening by age, educational status, insurance status, race/ethnicity, income andgeography.7, 8 Similarly, there are disparities in cancer treatment outcomes by SDOH.9, 10 In 2019, the AmericanCancer Society developed a blueprint for practice, research and policy to understand and address the socialdeterminants of health to improve cancer health equity in the U.S.11In recent years, health systems and clinics have identified the importance of addressing these socialdeterminants of health as a way to improve overall health.The core five SDOH factors include a patient’s:Educational levelOther important factors that affecta patient’s health include access totransportation, food security, andpersonal safety. Many health systemsare moving toward conductingSDOH screening to link individuals tosupports in the community, such astransportation passes, food banks, orhousing and employment agencies,with the goal of improving overallhealth and wellbeing.Access to healthcareThis toolkit provides health systemswith important resources to developprograms to screen for SDOH.Economic stabilityNeighborhood and builtenvironmentSocial and communitycontextHospital Systems Capacity Building InitiativeScreening for Social Determinants of Health4
How to Use This GuideThis toolkit has four main sections:ACS Health System SDOH Self-Assessment1The organizational health assessment on pages 6 to 10 will help your team identify your healthsystem’s strengths and opportunities when addressing SDOH. There are 10 questions for your teamto review. Consider sharing the assessment with members of your team prior to completing it, soeveryone has time to gather the information needed to answer the questions. Agree on a process tocollect everyone’s feedback. For example, you may want to meet to discuss and reach consensus onthe answers or you may want to collect answers and enter an average answer.Matrix for Identifying Next Steps2The matrix on pages 11 to 13 will help you identify potential next steps to improve your healthsystem’s SDOH approach. Your answers from the SDOH assessment will assist you in choosing yournext steps. The matrix is divided into three tiers – fundamental concepts, implementation resources,and system integration – to assist you with your planning efforts.3Action Planning4ToolsThe action planning template on page 16 will help you prioritize your steps. These steps can beintegrated into your team’s overall collaborative action plan.There are tools on pages 17 to 29 to assist you with selected steps in each tier of the matrix. Thereare also additional SDOH resources for your team to consider.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health5
1 – ACS Health SystemSDOH Self-AssessmentHealth System Organizational Self Assessment forImplementing Social Determinants of HealthThis assessment is a tool to identify and reflect on the areas of strength and opportunities for improvementin your health systems’ work addressing social determinants of health (SDOH). The purpose of the selfassessment is to illuminate the current processes and capacity related to SDOH screening in order to identifyareas for next steps (see: Expanding Capacity for Screening for Social Determinants of Health).Instructions: Read the statement under each domain and fill in the the answer that best reflects yourorganization’s current status.Leadership1. The commitment of leadership in this health care agency to addressing SDOH 1234 is not visible orcommunicated. is rarely visible; thecommunication around theimportance of addressingSDOH is rare andinconsistent. is sometimes visibleand sometimes discussedin meetings; or is visible insome areas and invisible inothers. fully committed to thework of screening andlinking patients to SDOH.AnswerA1System Prioritization2. Screening and addressing SDOH 12 is not a priority at thistime. is a low prioritycompared to the otherwork done in the clinicalsetting.3 is important, but thereare other initiatives thatare more important.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health4 is a central focus of thehealth system.AnswerA26
1 – ACS Health SystemSDOH Self-AssessmentChampions3. Responsibilities for supporting and implementing SDOH screening 123 have not been assignedto designated leaders(champions). have been assigned toleaders (champions), butno resources have beencommitted. have been assigned toleaders with dedicatedresources, but moresupport is needed.4Answer have been assigned.Dedicated resourcessupport protected time tosupport implementation.A3Staffing4. Staffing to support SDOH screening and referral, such as case managers or patient navigators 1234Answer does not exist. exist at the healthcenter, but are alreadyoverburdened with otherwork. exist at the health center,and have limited time tosupport SDOH screeningand referrals.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health exist at the health centerand are able to supportSDOH screening andreferrals.A47
1 – ACS Health SystemSDOH Self-AssessmentReimbursing Staff Time5. The ability to reimburse staff time for screening for SDOH and supporting linkages to services 1234Answer is not possible. has not been explored. has been explored, butchallenges remain. is currently being done.A5SDOH Screening – Topics and Tools6. The health system 1 has not selected oridentified what SDOHto screen for or whatscreening tool to use.2 has begun discussions ofwhat SDOH to screen for orwhat screening tool to use.3 has identified whatSDOH to screen for, buthas not fully integrated ascreening tool.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health4 has integrated ascreening tool into theirSDOH workflow.AnswerA68
1 – ACS Health SystemSDOH Self-AssessmentGoal Setting and Measuring7. Goals for SDOH screening and linkage to services.12 have not beendiscussed. have been discussed,but no specific goals havebeen made.3 have been discussed,and goals have beenidentified but not finalizedor are not yet SMART ormeet other goal measures.4 is documentedwith SMART (specific,measurable, attainable,realistic, time-based)measures or meet othergoal measures.AnswerA7Workflows8. Clinic workflows for screening patients for SDOH 12 do not exist. exist, but are notfollowed.3 exist, but areinconsistently followed.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health4 exist, and are fullyimplemented.AnswerA89
1 – ACS Health SystemSDOH Self-AssessmentEHR Integration9. SDOH screening tools 1 do not exist.2 are all on paper and notintegrated into the EHR.3 are inconsistentlyentered into the EHR.4 are systematicallyentered into the EHR.AnswerA9Tracking and Monitoring Patients Screened for SDOH10. The use of a system to track and monitor patients screened for SDOH 123 has not been explored or is technically possible,is not possible with existing but systems to get usefuldata systems.reports are not in place. is possible and systemsare in place to producebasic reports on a regularbasis.4 is possible, systems arein place, and reports areproduced that allow fortracking screening andlinkage.AnswerA10You have completed the assessment and will now move on to suggested next stepsbased on your answers.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health10
2 – Matrix for Identifying Next StepsMatrix for Identifying Next Steps in Developing anSDOH Screening ProcessThe matrix below will help you expand your capacity for screening social determinants of health. Based onyour answers from the ACS Health System Organizational Self-Assessment, below are ‘next steps’ withineach domain. Any domains where you reported a ‘4’ are deemed to be strong and do not require next steps.Review how you answered on the ACS self-assessment and identify the appropriate next steps by completingthe following matrix. You can find your answers on previous pages 6–10.Recommendations: Tier 1 – Fundamental ComponentsLeadership1. The commitment of leadership in this health care agency to addressing SDOH If you answered.123Answer Meet with health system and clinical leadership to explore their interest and willingness to support SDOH.A1 Pg 6System Prioritization2. Screening and addressing SDOH 1 If you answered.2 Determine whether leaders, Determine whether leaders,clinicians, and clinical staff thinkclinicians, and clinical staff believeSDOH screening and linkage toSDOH should be prioritized by theservices is important for clinical care. organization.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health3 Determine whether the currentlevel of prioritization of SDOH issufficient to effectively screen andlink patients to services.AnswerA2Pg 611
2 – Matrix for Identifying Next StepsChampions3. Responsibilities for supporting and implementing SDOH screening If you answered.12 3 Identify a potential clinical champion Work with leadership to identify resources to provide champion protectedfor the SDOH screening and linkagetime, EHR staffing support, or other project management support for theprogram.program. Use the Clinical Champion Checkliston page 19 for considerations inselecting a champion.AnswerA3Pg 7Recommendations: Tier 2 – Implementation ResourcesStaffing4. Staffing Staffing to support SDOH screening and referral, such as case managers or patientnavigators If you answered.Answer123 Explore the ability to reimburse for services through Medicaid. See the Reimbursing Staff Time for SDOH Screening and Linkage on page 20.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health A4Pg 712
2 – Matrix for Identifying Next StepsReimbursing Staff Time5. Reimbursing Staff Time The ability to reimburse staff time for screening for SDOH and supportinglinkages to services If you answered.Answer123 Explore the ability to reimburse for services through Medicaid. See the Reimbursing Staff Time for SDOH Screening and Linkage on page 20.A5Pg 8SDOH Screening – Topics and Tools6. The health system 1 If you answered.2 3 Use the Guide to Developing SMART Goals on page 24 to identify goals and metrics to track progress. Use the Screening and Linkages Checklist on page 21 to explore what SDOH components to screen for and whatservices exist for linkages.AnswerA6Pg 8 Identify what services need to be expanded. Conduct ongoing outreach to community agencies to expand services.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health13
2 – Matrix for Identifying Next StepsGoal Setting and Measuring7. Goals for SDOH screening and linkage to services.If you answered.12 3 Use the Guide to Developing SMART Goals on page 24 to identify goals and metrics to track progress.AnswerA7Pg 9Recommendations: Tier 3 – Systems IntegrationWorkflows8. Clinic workflows for screening patients for SDOH If you answered.12 3 Use the Workflow Process Map on Use the Workflow Process Map on page 26 to map the existing workflowpage 26 to develop a workflow forfor screening and linking patients to SDOH services, identify challenges,screening and linking patients toand explore potential solutions.SDOH services.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of HealthAnswerA8Pg 914
2 – Matrix for Identifying Next StepsEHR Integration9. SDOH screening tools 1If you answered.2 Meet with IT/EHR staff to explorewhether the current EHR allows forscreening for SDOH. Meet with IT/EHR staff to explorewhether the current EHR allows forscreening for SDOH. For more information, reviewIntegrating SDOH Screening intothe EHR on page 28. For more information, reviewIntegrating SDOH Screening intothe EHR on page 28. 3Answer Use theWorkflow Process Map onpage 26 to map how the screeningtool is entered into the EHR, identifychallenges, and explore potentialsolutions.A9 Pg 10 Meet with leadership to identifyresources to expand IT support forbuilding systems.Tracking and Monitoring Patients Screened for SDOH10. The use of a system to track and monitor patients screened for SDOH If you answered.12 Meet with IT/EHR staff to explorewhether the current EHR allowstracking or monitoring screening. For more information, reviewIntegrating SDOH Screening intothe EHR on page 28. 3 Meet with IT/EHR staff to explore whether the current EHR allows trackingor monitoring screening. Meet with leadership to identify resources to expand IT support for buildingsystems.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of HealthAnswerA10Pg 1015
3 – Action PlanningIn the previous table, the domains are placed in tiers that range from 1 to 3.TIER 1Likely the most essential for implementationTIER 2Needed, but are likely dependent on the completion of Tier 1 domainsTIER 3Important or good to have, but perhaps not required or essential for early program implementationUse the action plan below to list your top 3-5 priorities, prioritizing domains by Tier (starting with Tier 1). Listthe next steps from the table above, and updates on progress to date (see the example). It is recommendedthat you build capacity related to Tier 1 (until you reach a answer of 3 or 4 on the self-assessment) beforemoving on to Tier 2 activities.Example:PriorityPriorityNext StepProgress UpdateWorkflowsUse the Workflow Process Map to develop aworkflow for screening and linking patients toSDOH services.Meeting with clinical team next Tuesday to workthrough workflow process map.Next StepProgress UpdateHospital Systems Capacity Building InitiativeScreening for Social Determinants of Health16
4 – ToolsOn the following pages are tools to assist you with tiers 1, 2, and 3. These tools include:TIER 1 Clinical ChampionsTIER 2 Staffing and Reimbursing Staff Screening and Linkages Goals and MeasurementTIER 3 Workflow Process Mapping EHR IntegrationHospital Systems Capacity Building InitiativeScreening for Social Determinants of Health17
4 – ToolsTIER 1Clinical Champions“Champions” are individuals who are committed to supporting the implementation of a new intervention/process. The champion will lead or support the work of gathering and evaluating data on existing processesor on potential changes; engaging leadership, thought leaders, or others to explore the topic; seeking bestpractices; and implementing and guiding changes.Champions are often most successful when they work in collaboration with a team, including peoplein leadership, representatives from IT or other relevant parties, and support staff with time to supportimplementation. Alternatively, other models have found success with a few champions (2-3) that work closelytogether to tackle an issue.Research on the importance of champions is emerging, but several characteristics of champions have beenidentified. In determining a champion for your program, consider the following characteristics: Who has enough influence or power within the organization to make things happen? This can includeboth authority through positions of leadership, or influence through respect and reputation. Who has the available time to commit to implementation? Who is intrinsically motivated and enthusiastic about the practice they are promoting (SDOH screening)? Who is a strong communicator, with the ability to persuade and motivate to make the required changes?In addition to these characteristics, there are other characteristics that are especially helpful, but notrequired in a champion. Who has content expertise/knowledge that is relevant for SDOH screening/implementation (e.g.,behavioral health specialist/social worker, other relevant past education/experience)?Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health18
4 – ToolsTIER 1Brainstorm Potential ChampionsClinical Champion ChecklistNameReach/AvailableInfluence? time?Enthusiastic StrongContentabout SDOH? communicator? expertise?Other commentsReach out to these potential champions to gauge their interest inleading this important effort.For more information: Damschroder, L. J., Banaszak-Holl, J., Kowalski, C. P.,Forman, J., Saint, S., & Krein, S. L. (2009). The role of the“champion” in infection prevention: results from a multisitequalitative study. BMJ Quality & Safety, 18(6), /434.short Kaplan, H. C., Brady, P. W., Dritz, M. C., Hooper, D. K., Linam,W. M., Froehle, C. M., & Margolis, P. (2010). The influenceof context on quality improvement success in healthcare: a systematic review of the literature. The Milbankquarterly, 88(4), 500-559. https://pubmed.ncbi.nlm.nih.gov/21166868/Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health19
4 – ToolsTIER 2Staffing andReimbursing StaffIt may be possible for your health system to bereimbursed for your work screening and addressingSDOH through Medicaid or other sources.Below are some resources that may help you exploreyour options: Kaiser Family Foundation, State Health Facts National Academy for State Health Policy (NASHP)» States are advancing healthy food policies in2020» NASHP’s Housing and Health Resources forStates Medicaid and CHIP Payment and Access Commission(MACPAC) National Association of Medicaid Directors (NAMD) Department of Health and Human Services issuedupdated guidance in January 2021 to supportaddressing SDOH [pdf] Health Affairs Blog has an entry focused onreimbursement for SDOHBeyond the links above, consider: Contacting other health systems in your area toinvestigate if and how they reimburse for SDOHscreening and linkage to services. Medicaid managed care plans may also supportaddressing SDOH. For example, UnitedHealthcaresupports affordable housing in underservedcommunities. Contact managed care plans/insurers/payers to investigate whether they have policiesrelated to SDOH screening and linkage to services.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health20
4 – ToolsTIER 2Screening and LinkagesUse the checklist below to identify what components of SDOH you currently screen for, and identify the existingprograms and services in the community that you work with to support patients with those needs. For eachcomponent, respond whether you do screen or have an interest in expanding screening. If you respond that youdo or may want to screen for each component, please detail what services or programs in the community youhave relationships with to refer patients (e.g., food banks, employment or housing services).Consider completing this checklist in collaboration with your partners, including local state and localhealth departments.Social Determinants of Health Screening and Linkages ChecklistYes – we screenfor this.TopicIs there a plan toexpand screeningin this area in thenext year?What services/programs in the community do you workwith to support needs in this area?Economic StabilityEmploymentUtilitiesChild careFinancesFoodOther:Education Access and QualityEnglish languagecomprehensionEducation statusOther:Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health21
4 – ToolsTIER 2Social Determinants of Health Screening and Linkages ChecklistYes – we screenfor this.TopicIs there a plan toexpand screeningin this area in thenext year?What services/programs in the community do you workwith to support needs in this area?Social and Community ContextIncarceration statusImmigration statusPersonal SafetyIntimate PartnerViolenceSocial integration/socialsupportOther:Healthcare Access and QualityInsurance type/statusHealth literacyOther:Neighborhood and Built Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health22
4 – ToolsOther National Resources to ExploreCommunity Resources for Addressing Social Determinants of HealthGeneral Resources211 – Essential Community Services Linehttp://www.211.orgAunt Bertha – National social care network to connect people toresourceshttp://www.auntbertha.comCap4Kids – Linkage to community resources to improve the lives ofchildren and familieshttp://cap4kids.orgFood InsecurityFeeding America – Network of food banks and food pantrieshttp://www.feedingamerica.orgSupplemental Nutrition Assistance Program (SNAP) – Federalprogram that provides nutrition assistancehttp://www.fns.usda.gov/snapSpecial Supplemental Nutrition Program for Women, Infants, andChildren (WIC) – Federal program that provides nutrition assistancehttp://www.fns.usda.gov/wicHousingPublic Housing and Voucher Program – Federal program to providelow-income families, the elderly, and the disabled with housing in theprivate markethttp://www.hud.gov/topics/ rental assistanceLegal TopicsMedical-Legal Partnerships – provides legal services as a way torespond to social needs.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Healthhttp://medical-legalpartnership.org23
4 – ToolsTIER 2Goal Setting and MeasurementPrograms can fail because there is not a sufficient focus on goal setting and tracking. It is important to createsystems to develop and track goals, to ensure the program is having the desired impact.A useful pneumonic for developing goals is SMART – specific, measurable, attainable, relevant, time-based.SMARTSpecific:Create a goal with specific numbers and real deadlines.For example: “We want to screen 75% of patients in primary care for SDOH by the end of the year.”Measurable:Make sure your goal is actual countable and trackable.For example: If the goal is 75%, ensure you can calculate both the numerator (the number ofpatients screened) and the denominator (the number of patients; the number of active patients;the number of patients who have visited the clinic during the time period).Attainable:Select a goal that is challenging but possible.For example: A goal of 25% screening for SDOH is likely very easy; 50% is more challenging; but75% would require relatively consistent effort across clinics and clinical staff.Realistic:Be honest with yourself and your team’s capabilities. Do not make a goal too challenging.For example: A goal of 95-100% may be an ideal, but may be unattainable at the beginning.Consider setting a more realistic goal, if even for the short-term.Time-based:Give yourself a deadline. Goals that have amorphous deadlines are hard to measure and track.For example: A goal 6-12 months out provides time for ramp up, implementation, and tracking.Hospital Systems Capacity Building InitiativeScreening for Social Determinants of Health24
4 – ToolsTIER 2Other Considerations and Suggestions Consider creating short-term goals for ‘easy wins’ to gain momentum. Make sure to celebrate successes.Guide to Developing SMART GoalsIs the Goal.List Goal(s)Specific?Hospital Systems Capacity Building InitiativeScreening for Social Determinants of 5
4 – ToolsTIER 3Workflow Process MappingA process map is a useful tool for depicting the actual or intended process to ensure activities are completedin a timely and efficient manner. When thinking about screening patients for SDOH, consider the followingquestions to outline steps involved:How are patients identifiedfor screening?How does the patient completethe screening tool (on paper, ona tablet, on their phone)? Are they screened during every visit? Just If the screening to
2 - Matrix for Identifying Next Steps Matrix for Identifying Next Steps in Developing an SDOH Screening Process The matrix below will help you expand your capacity for screening social determinants of health. Based on your answers from the ACS Health System Organizational Self-Assessment, below are 'next steps' within each domain.
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