What is a Health Care Environmental Scan? A Comprehensive Guide

Abstract

In the realm of public health and healthcare, the concept of environmental scanning, adapted from business and strategic planning, is increasingly recognized as a vital assessment and data collection tool. Organizations, including federal funding agencies and health-focused bodies, advocate for its use to understand complex health issues. A health care environmental scan is a multi-faceted approach that involves engaging stakeholders, analyzing policy, reviewing literature, and collecting both qualitative and quantitative data. This process helps to assess various aspects of a health issue, inform strategic decisions, and guide subsequent planning. This article will explore what a health care environmental scan is, its process, and its value in public health practice, using the example of a human papillomavirus (HPV) vaccination project to illustrate its application.

Background

Environmental scanning, a term borrowed from the business world, is a systematic process used by organizations to evaluate their internal strengths and weaknesses alongside external opportunities and threats. For decision-makers in healthcare and public health, a health care environmental scan serves as a method to gather, organize, and analyze data concerning both their internal capabilities and external factors. This information is crucial for strategic planning and informed decision-making (1–3). In business, the focus is on acquiring relevant and reliable information through diverse methods such as literature reviews, online database searches, social media analysis, policy evaluations, competitor analysis, and gathering stakeholder opinions, including customers, board members, and staff (3). When implemented effectively, this process yields evidence-based strategies that organizations can utilize to enhance their performance and strategic direction (4).

In recent years, health care environmental scans have become increasingly valuable in public health and medicine. They are employed to collect and analyze information on various health issues and practices, identify opportunities for quality improvement, establish research priorities, guide interventions, educate decision-makers, and ultimately improve health outcomes. These scans have been applied to a wide range of health topics, including chronic disease management (5), cancer care (2, 6–8), mental health (9–11), injury prevention (12), and quality improvement initiatives (13–16). A health care environmental scan integrates multiple information-gathering strategies (2, 17, 18). These can include focus groups, in-depth interviews, and surveys with patients and healthcare providers, literature reviews, medical record reviews, personal communications, internal document analysis, and policy assessments.

Figure. Timeline for developing and implementing a health care environmental scan for Kentucky’s human papillomavirus (HPV) project, illustrating the project’s phases from July 2014 to December 2015. Key abbreviations include KY (Kentucky), NCI (National Cancer Institute), and RFP (request for proposal). This timeline highlights the structured approach to conducting an environmental scan in a public health context.

While sharing similarities with traditional public health evaluation principles, health care environmental scans have distinct characteristics. Like the Centers for Disease Control and Prevention’s (CDC’s) Framework for Program Evaluation in Public Health, a health care environmental scan adheres to standards of utility, feasibility, propriety, and accuracy. It also emphasizes stakeholder engagement, program description, design focus, evidence gathering, and results sharing (19). Both the CDC framework and environmental scans prioritize using lessons learned to improve public health effectiveness and dissemination of these lessons to stakeholders. However, a key difference lies in their purpose. The primary goal of a health care environmental scan is to understand the context, gather information, and identify resources, connections, and gaps. In contrast, the CDC’s framework is designed to evaluate the merit, worth, or significance of a program or policy. CDC’s framework assesses program performance and goal achievement, while a health care environmental scan focuses on understanding the internal and external landscape of a specific health topic to inform strategic thinking, decision-making, and planning (2, 3).

Despite its growing use as an assessment tool in various healthcare settings, a consistent definition and process for a health care environmental scan in public health practice is still evolving. In some cases, it’s used informally, almost synonymously with a needs assessment (2). In other instances, it’s more closely aligned with strategic planning and quality improvement efforts (3, 7, 18, 20). Further application and critical analysis are needed to enhance the effectiveness of this tool and its methodology (5). Recognizing the value of health care environmental scans in public health and the need for more practical examples, this article outlines the steps involved in conducting a health care environmental scan. It uses a federally funded human papillomavirus (HPV) vaccination project in Kentucky as a case study. The aim is to guide public health professionals in effectively applying this methodology in public health research and practice.

7 Steps of a Health Care Environmental Scan: The Kentucky HPV Vaccination Project Example

In September 2014, the National Cancer Institute (NCI) awarded one-year grants to eighteen cancer centers, including the University of Kentucky Markey Cancer Center, to conduct health care environmental scans and foster collaborations to increase HPV vaccination rates in pediatric care settings (21, 22). The scan design comprised 7 steps applicable across various public health domains.

The Kentucky Cancer Consortium has utilized elements of the health care environmental scan process to address other public health challenges, including secondhand smoke exposure, barriers to colorectal cancer screening, obesity, cancer, and the impact of the Affordable Care Act on cancer care (23). Lessons learned from these experiences contributed to the development and execution of the health care environmental scan for the HPV vaccination project. Throughout the phases of development, implementation, evaluation, and dissemination (Figure), the process and methodology were regularly shared with Kentucky Cancer Consortium members and academic colleagues experienced in environmental scans to refine the approach (3). The following outlines the 7 steps used to conduct the health care environmental scan, with each step illustrated by its implementation in the Kentucky HPV vaccination project.

Step 1: Leverage Experience to Establish Project Leadership and Capacity

Designating a coordinator or a team leader is crucial to champion the entire health care environmental scan process, from initiation to dissemination (3). While resources may vary depending on the project and organization, dedicated leadership and clearly defined roles for each team member are essential. The project’s scope and scale must be realistically aligned with the organization’s capacity.

Example from HPV vaccination project: Two project leaders (R.C.V. and J.R.K), with expertise in public health and cancer control, utilized their experience in policy, systems, and environmental change, partnership development, community needs assessments, strategic planning, and health communication. This combined expertise was instrumental in developing the proposal for NCI funding and designing the overall health care environmental scan process. The NCI funding mandated the hiring of a full-time coordinator (A.W.) specifically for the HPV vaccination environmental scan, responsible for the daily execution of the project.

Step 2: Define the Focal Area and Purpose of the Health Care Environmental Scan

Clearly defining the purpose of the health care environmental scan is vital to anchor the process and effectively allocate the organization’s limited time, resources, and energy (3, 20). While flexibility is possible, a well-defined purpose ensures the scan remains focused and its scope remains clear.

Example from HPV vaccination project: The primary purpose of the HPV health care environmental scan was to identify all relevant public health activities, research, and information concerning HPV vaccination in Kentucky. This included establishing or strengthening connections with existing programs, synthesizing findings into a user-friendly format for stakeholder dissemination, and identifying potential applied research opportunities to enhance HPV vaccination rates. The investigative team formulated the following definition to guide their work:

A dynamic process of comprehensive assessment aimed at thoroughly exploring HPV vaccination to uncover previously unrecognized connections and highlight barriers and facilitators not previously identified. The ultimate goal is to empower stakeholders with actionable information to inform future strategic planning and decision-making.

Step 3: Develop and Adhere to a Timeline with Incremental Goals

Timelines can be dictated by funding agencies or established by organizational leadership, especially if the health care environmental scan is self-initiated. Setting a timeline at the outset is crucial. Planning activities to optimize the process and maintain focus is essential. For instance, if surveys or qualitative interviews are included, allocate sufficient time for developing survey tools and interview guides, pilot testing, obtaining institutional review board approvals, participant recruitment, data collection and analysis, and data synthesis and interpretation.

Example from HPV vaccination project: The NCI set a 1-year timeline, which helped prioritize the scan’s components. Certain activities were scheduled around stakeholder meetings, such as the Kentucky HPV Initiatives Team’s bimonthly meetings. The team planned to complete quantitative and qualitative data collection within this year (Figure). The timeline for the provider survey, conducted in August 2015, encompassed survey instrument development (in collaboration with other funded cancer centers), university institutional review board approval, pilot testing with 6 clinicians, data collection from 231 healthcare professionals (physicians, midlevel clinicians, nurses, pharmacists), and preliminary data analysis.

Step 4: Determine the Information Scope for the Health Care Environmental Scan

Brainstorm all relevant topics and resources that could inform the health care environmental scan (2, 3, 7, 18, 20). While not all desired information may be accessible, it’s crucial to initially include everything ideally relevant to the scan. It is better to cast a wide net and discover information unavailability than to risk overlooking vital data. Unlike Step 2, the list of information needs in this step is dynamic, evolving as stakeholder engagements develop and new resources are identified.

Example from HPV vaccination project: The project began with broad areas related to HPV vaccination activities in Kentucky: state cancer registry and immunization data, media coverage, policy landscape, public health practice and research environments, literature review, Kentucky Cancer Action Plan update, other states’ HPV vaccination initiatives, 14 key informant interviews, and identification of research priorities. As the health care environmental scan progressed, some areas proved richer than others. For instance, the Kentucky Department for Public Health’s Division of Immunization was funded by the CDC for a multimedia HPV vaccination campaign during the back-to-school period. In other cases, unique sources were needed. For example, as the Kentucky Immunization Registry did not mandate HPV vaccination data entry, alternative data sources were used, such as the CDC’s Comprehensive Clinical Assessment Software Application, to assess immunization coverage and practices in clinics and immunization sites.

Step 5: Identify and Engage Key Stakeholders

Stakeholders and their willingness to participate are critical to the success of a health care environmental scan. Develop a diverse and evolving list of individuals and organizations possessing information relevant to the topics identified in Step 4. Stakeholders can broaden the initial topic list by recommending or connecting project staff with additional stakeholders (snowball approach).

Before reaching out, clarify what information is needed from stakeholders. Prepare a plan for discussions, whether it involves questions, requests, or action items. Be ready to answer questions about the topic, the health care environmental scan process, and funding requirements. Record all suggestions, even if they seem initially irrelevant, as they might become valuable later. Be prepared to offer something in return for participation, such as access to the final scan results or promotional materials.

Example from HPV vaccination project: During the NCI application, letters of support from local and state partners were collected, which helped secure early stakeholder buy-in. The project coordinator’s prior work with the Kentucky Department for Public Health and established rapport with its immunization branch proved beneficial. The immunization branch, in turn, connected the team with previously unknown stakeholders. The stakeholder list expanded to include local immunization coalitions, a practice-based pharmacy research network, and rural Appalachian pediatricians successful in HPV vaccination.

Stakeholders were given a brief introduction to the health care environmental scan and a plan was developed to maximize their time. Some stakeholders invited project participation in their activities. For instance, the Kentucky College Health Association invited the project coordinator to present on HPV vaccination at their annual meeting. A mini-grant from the University of Kentucky’s Appalachian Center enabled the team to incentivize (with $75 gift cards) successful HPV vaccinating pediatricians to participate in in-depth qualitative interviews. These six interviews were invaluable. Another grant from the American Cancer Society supported collaboration with the University of Kentucky’s Center for the Advancement of Pharmacy Practice and a local pharmacy chain in Appalachian Kentucky to promote HPV vaccination outside traditional medical settings.

Step 6: Analyze and Synthesize Findings into a Concise Summary Report

Analyze all collected data and triangulate it based on the health care environmental scan plan (18, 20, 24). Document both quantitative and qualitative results from surveys, key informant interviews, policy and media assessments, and literature reviews. Synthesize these results into meaningful conclusions relevant to the focus area (3). Furthermore, identify evidence-based research priorities or intervention targets. Use the findings to inform decision-making and develop an action plan to guide public health research or practice projects, empowering partners to move forward.

Example from HPV vaccination project: Towards the end of the funding period, the team analyzed provider survey data, identified common themes from in-depth interviews, synthesized key informant interview data, and analyzed transcripts from the year-long HPV vaccination media scan. All these activities aimed to create an HPV vaccination research agenda, identify effective partnerships and policies for replication, and determine priority educational and interventional areas for key stakeholders.

Step 7: Disseminate Results and Conclusions to Key Stakeholders

The final output of a health care environmental scan can take various forms (3, 18). Funding agencies might provide a template for final report summarization. If not, or if self-initiated, create a template at the project start or end. The report should address how well the initial overarching question and subtopics were answered and list information sources. Make the results accessible to the funding agency, organizational leadership, and all participants.

Example from HPV vaccination project: The NCI did not provide a reporting template. The format evolved around the information sources identified in Step 4. The final report was made available in paper and poster form for the funding agency, stakeholders, and interested parties. The team also delivered six informational presentations at national, state, and local conferences.

Discussion

A health care environmental scan is a valuable tool for assessing both the external and internal landscapes of health programs. It can identify barriers and facilitators in addressing health issues within a community or national priority area. It informs strategic planning and decision-making for projects and interventions, guides the direction of new public health initiatives, raises awareness of health disparities or inequities, and can initiate projects or funding opportunities (2, 17, 18). For instance, HPV vaccination, despite being recommended for over a decade, remains relatively new to public awareness and underutilized in Kentucky and nationally for preventing HPV-related cancers (25–27). The health care environmental scan provided a strategic and innovative approach for the NCI to gain a broad understanding of HPV vaccination activities across the catchment areas of 18 cancer centers. These 18 scans provided the NCI and each grantee with vital local information on connections between cancer, immunization, and public health coalitions and programs for HPV vaccination promotion. They identified new collaborations to enhance HPV vaccination uptake through applied research and informed both research and practice agendas, all aimed at reducing HPV-related disease incidence.

Before initiating a health care environmental scan, establishing a working definition is crucial (2). This definition should include detailed yet flexible steps to achieve the desired outcome. The process must be adaptable to incorporate insights from stakeholders and address new questions that emerge.

Perhaps the most crucial step is determining how to utilize the results (18, 20). Share the final product—report or presentation—with stakeholders, especially those who contributed information. Ideally, the final product will generate research priorities, highlight funding gaps, create intervention opportunities, and foster new partnerships. Kentucky’s final report and poster presentation, shared with the NCI and stakeholders, underscored the need for robust HPV vaccination data, energized existing partners and identified new ones, and generated a list of research priorities, including a pharmacy-based vaccination study and community-clinical linkages to promote HPV vaccination.

This description of a health care environmental scan has limitations. First, a universally accepted definition and consistent approach are lacking in public health (2, 18). This ambiguity is a process limitation, and the definition and process are likely to evolve with wider adoption. The process described here may become more or less applicable over time. Second, this scan was conducted under specific conditions: federal funding and support, a full-time coordinator, established key informant relationships, and a one-year timeline. These steps may not be directly transferable to all public health environments. Despite these limitations, these steps, or adapted versions, can be applied to many public health questions, research areas, and practice settings.

Acknowledgments

The Kentucky HPV vaccination health care environmental scan was supported by an administrative supplement from the National Cancer Institute to the University of Kentucky Markey Cancer Center (3P30CA177558-02S2; Evers, principal investigator).

Author Information

Corresponding Author: Robin C. Vanderpool, DrPH, University of Kentucky College of Public Health and University of Kentucky Markey Cancer Center, 2365 Harrodsburg Rd, Ste A230, Lexington, KY 40504-2281. Telephone: 859-218-2102. Email: [email protected].

Author Affiliations: Amanda Wilburn, Jennifer R. Knight, University of Kentucky College of Public Health and University of Kentucky Markey Cancer Center, Lexington, Kentucky.

References

1. Morrison JL. Environmental scanning. In: Whitely MA, Porter JD, Fenske RH, editors. A primer for new institutional researchers. Tallahassee (FL): The Association for Institutional Research; 1992. p. 86–99.
2. Rowel R, Moore ND, Nowrojee S, Memiah P, Bronner Y. The utility of the environmental scan for public health practice: lessons from an urban program to increase cancer screening. J Natl Med Assoc 2005;97(4):527–34. PubMed
3. Thinking Futures. Holtham Hill (Australia): Doing an environmental scanning: an overview guide; 2012. http://www.sswm.info/sites/default/files/reference_attachments/CONWAY%202012%20Doing%20Environmental%20Scanning.pdf. Accessed June 8, 2016.
4. Society for Human Resource Management. Alexandria (VA): Society for Human Resource Management; 2016. https://www.shrm.org. Accessed April 2, 2016.
5. Liddy C, Mill K. An environmental scan of policies in support of chronic disease self-management in Canada. Chronic Dis Inj Can 2014;34(1):55–63. PubMed
6. Blasi PR, King D, Henrikson NB. HPV vaccine public awareness campaigns: an environmental scan. Health Promot Pract 2015;16(6):897–905. CrossRef PubMed
7. Centers for Disease Control and Prevention. Increasing quality colorectal cancer screening: an action guide for working with health systems. Atlanta (GA): Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013.
8. Patel J, Salit IE, Berry MJ, de Pokomandy A, Nathan M, Fishman F, et al. Environmental scan of anal cancer screening practices: worldwide survey results. Cancer Med 2014;3(4):1052–61. CrossRef PubMed
9. Mazade NA, Glover RW, Hutchings GP. Environmental scan 2000: issues facing state mental health agencies. Adm Policy Ment Health 2000;27(4):167–81. CrossRef PubMed
10. Reitmanova S, Gustafson DL. Primary mental health care information and services for St. John’s visible minority immigrants: gaps and opportunities. Issues Ment Health Nurs 2009;30(10):615–23. CrossRef PubMed
11. Mazade NA, Glover RW. State mental health policy: critical priorities confronting state mental health agencies. Psychiatr Serv 2007;58(9):1148–50. CrossRef PubMed
12. Kalula SZ, Scott V, Dowd A, Brodrick K. Falls and fall prevention programmes in developing countries: environmental scan for the adaptation of the Canadian Falls prevention curriculum for developing countries. J Safety Res 2011;42(6):461–72. CrossRef PubMed
13. Sorensen AV, Bernard SL. Accelerating what works: using qualitative research methods in developing a change package for a learning collaborative. Jt Comm J Qual Patient Saf 2012;38(2):89–95. PubMed
14. Weidmer BA, Brach C, Hays RD. Development and evaluation of CAHPS survey items assessing how well healthcare providers address health literacy. Med Care 2012;50(9, Suppl 2):S3–11. CrossRef PubMed
15. Sibbald SL, McPherson C, Kothari A. Ontario primary care reform and quality improvement activities: an environmental scan. BMC Health Serv Res 2013;13(1):209. CrossRef PubMed
16. Anas R, Stiff J, Speller B, Foster N, Bell R, McLaughlin V, et al. Raising the bar: using program evaluation for quality improvement. Healthc Manage Forum 2013;26(4):191–5. CrossRef PubMed
17. Graham P, Evitts T, Thomas-MacLean R. Environmental scans: how useful are they for primary care research? Can Fam Physician 2008;54(7):1022–3. PubMed
18. National Association of County and City Health Officials. Developing a local health department strategic plan: a how-to guide. http://www.naccho.org/uploads/downloadable-resources/Programs/Public-Health-Infrastructure/StrategicPlanningGuideFinal.pdf. Accessed June 20, 2016.
19. Centers for Disease Control and Prevention. CDC evaluation framework. Atlanta (GA): Centers for Disease Control and Prevention; 2016. http://www.cdc.gov/eval/framework/. Accessed June 5, 2015.
20. Public Health Foundation. The ABCs of plan-do-check-act (PDCA). Washington (DC): Public Health Foundation. http://www.phf.org/resourcestools/Pages/The_ABCs_of_PDCA.aspx. Accessed June 20, 2016.
21. National Cancer Institute, Division of Cancer Control and Population Sciences. Administrative supplements for NCI-designated cancer centers to support collaborations to enhance HPV vaccination in pediatric settings: a summary report. Silver Spring (MD): Nova Research Company; 2016.
22. National Cancer Institute. HPV vaccine uptake in cancer centers. Bethesda (MD): National Cancer Institute; 2015. http://healthcaredelivery.cancer.gov/hpvuptake/. Accessed April 2, 2016.
23. Kentucky Cancer Consortium. Lexington (KY): KCC Communications. http://www.kycancerc.org/. Access June 5, 2016.
24. Guion LA. A 10-step process for environmental scanning. J Ext 2010;48(4) http://www.joe.org/joe/2010august/iw2.php.
25. Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr 2014;168(1):76–82. CrossRef PubMed
26. Daniel-Ulloa J, Gilbert PA, Parker EA. Human papillomavirus vaccination in the United States: uneven uptake by gender, race/ethnicity, and sexual orientation. Am J Public Health 2016;106(4):746–7. CrossRef PubMed
27. Reagan-Steiner S, Yankey D, Jeyarajah J, Elam-Evans LD, Singleton JA, Curtis CR, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years — United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64(29):784–92. CrossRef PubMed