To be valuable, these audits must go to the heart of the complex relationships and expectations that exist between the community and the health care organizations in its midst. The civic audits must clarify what people can expect from the organizations and the audits must declare what the organizations are doing to live up to these expectations. The audits can be built upon six questions that represent the range of contributions these organizations can make. The provision of quality services certainly contributes to the health of the community. However, health depends on more than service.
Some organizations take too narrow a view of their role.
An organization that views health not only as a function of services but also of the community's physical, social, and economic environments as well as the lifestyles and behaviors followed by its citizens, can make a much broader contribution to health. Trustees must ensure that the organization conceives of its role in enhancing health as broadly as possible and that particulars of its efforts in pursuit of health across all of its determinants are conveyed. Health care organizations make significant economic contributions. Although Pittsburgh is home to Alcoa, Heinz, PPG, USX, and many other corporations, its health care organizations employ more people locally. Furthermore, the potential economic contributions of these organizations extend far beyond the economic ripples that paychecks spread across the community.