As the "giving tree" began to produce fruit the Community Health Enhacnement Committee (CHE) placed the responsibility for implementing the Community Benefit Policy into the hands of hospital and health system leadership. Memorial formed a group called the Community Health Action Group CHAG. The CHAG is made up of approximately seven (7) health system leaders including: Memorial Health System President & CEO, Vice President of Memorial Hospital and Memorial Health Foundation, Vice President of Memorial Health Foundation, Vice President of Marketing and Communications, Vice President of Community Affairs, Director of Strategic Planning, and, Grants Procurement Coordinator for Memorial Hospital and Health System. The role of CHAG is to fulfill the key objectives of Memorial's commitment to a healthy community, both inside and outside the hospital boundaries, through the Community Benefit Policy. Mark Chambers, a CHAG member and Vice President of Memorial Health Foundation, affirms that one of the things that makes CHAG a unique and productive body is its composition. He believes that, "the CHAG members come from all areas within the Hospital, Health System and the Foundation, we are really a multi-disciplinary group of individuals, coming together to function outside of our normal positions of authority. It's non-hierarchical and very 'web-like.' We understand our connection to each other and the community in general. We make decisions from that perspective."

CHAG members meet bi-monthly to review proposals, discuss resource allocation, review outcomes of funded partnerships and share information about other community health initiatives. It is often directly through CHAG members that proposals are brought to the group for possible partnerships. Organizations seeking partnership contact CHAG members or other hospital personnel to discuss their interest in applying to become a partner. Some organizations simply send in a letter outlining their request, while others write in-depth formal proposals. Currently, there are no formal application guidelines in place to direct prospective applicants through the application process or to help them understand the approval mechanism. CHAG uses the Community Benefit Policy criteria to direct their decisions regarding which proposals to approve, but there is no quantitative application approval procedure. As more and more organizations and proposals are brought to CHAG for approval several questions revolving around this issue have surfaced, they include some of the following:

1. How visible should the amount of resources be in the community?

2. How knowledgeable should community groups be about the application process?

3. How will the criteria and guidelines be interpreted?

4. How will we manage and track outcomes? Do we need a dedicated full-time staff member?

Depending upon which CHAG member you ask, you will probably be given a plethora of answers to these questions. Some believe that the flexibility of the approval process and the unstructured proposals attract very unique and interesting projects, and provide CHAG with a diverse set of organizations and ventures with which to partner. Others assert that the unstructured mechanism for proposals makes it harder for organizations to approach CHAG in an effective and efficient manner.

The issues that arose as a result of the growth of tithing and the Community Benefit Fund inspired CHAG members to reexamine their role and the role of the Community Health Enhancement committee through a formal evaluation process which started early in 1997. The evaluation process, which concluded in the fall of 1997, will help determine the next steps for both the CHE and CHAG, as well as a re-examination of the Community Benefit Policy. The questions outlined above, and other subsequent issues, are being addressed through an evaluation process coordinated by Rick Strickland, Grants Procurement Coordinator for Memorial Hospital and Health System. He describes the process as "an evaluation of the Community Benefit Fund. We are asking if there are ways in which we can improve and enhance upon a good thing." The evaluation process will help Memorial harvest and preserve the fruit of the "giving tree." Although he suspects that the process will be modified as it unfolds, he refers to the evaluation process as a "recipe from scratch."

According to Rick, there are several issues that have already surfaced with regards to the re-examination of roles and objectives. He mentioned that individuals involved in the focus groups have asked "What really is our objective? Is it to get a lot of projects going and to get the money working out in the community? Is it to build effective partnerships with other local organizations? And, how do these multiple objectives relate?" There are several additional issues and questions that have appeared as a result of the focus groups and retreat, they include some of the following:

Flexibility/Looseness vs. Structure/Order

Public Visibility - Proactive vs. Reactive

Partnership - Growth vs. Outcomes

Amount of Money - 10% vs. More

Availability of Funds - Maintain Efforts vs. Expansion

Local vs. Regional Perspective

Another challenge to implementation is a function of geography. Now serving a regional community across several counties, we see a responsibility to direct the investment of tithing dollars back into more distant communities that have generated some of those excess revenues. This means studying communities that we know even less well than St. Joseph County, Indiana. At least initially, this requires even more aggressive searching for strong partners and diverse opportunities than in our home community.

During the last four years of funding projects, CHAG and CHE members have realized that there is no simple formula for investing money intelligently. In fact, the evaluation process is helping to address that issue as well as the ones outlined above. According to Rick, "giving money away intelligently, and well, is a task. We need to realize that, and program appropriately for it. It has forced the policy setters and implementers to prepare for this by recognizing the need to evaluate and re-evaluate periodically."

The importance of the role of the CEO became apparent to several CHAG members throughout the growth and reevaluation process. Mark Chambers, VP Memorial Health Foundation, recalled that, "the role of the Health System CEO- any Health System's CEO- was critical to not only the development of the concept of 'community health' and tithing, but to its implementation as well." The Memorial Health System CEO has championed the concept of "community health" and tithing inside the hospital and within the community. His ability to get others to "buy in" and subsequently, invest in the "community health" perspective has been, and will continue to be, an important element in the success of this effort.

In August of 1997, after the initial evaluation process was complete, a newly revised was presented.

As part of the evaluation effort CHAG was asked to create an annual investment values. The investment values scale will be recreated on a yearly basis as criteria may change and the issues that affect community health evolve.