Karen Minyard

Using systems thinking in state health policymaking: an educational initiative

In response to limited examples of opportunities for state policymakers to learn about and productively discuss the difficult, adaptive challenges of our health system, the Georgia Health Policy Center developed an educational initiative that applies systems thinking to health policymaking. We created the Legislative Health Policy Certificate Program – an in-depth, multi-session series for lawmakers and their staff – concentrating on building systems thinking competencies and health content knowledge by applying a range of systems thinking tools: behavior over time graphs, stock and flow maps, and a system dynamics-based learning lab (a simulatable model of childhood obesity). Legislators were taught to approach policy issues from the big picture, consider changing dynamics, and explore higher-leverage interventions to address Georgia’s most intractable health challenges. Our aim was to determine how we could improve the policymaking process by providing a systems thinking-focused educational program for legislators. Over 3 years, the training program resulted in policymakers’ who are able to think more broadly about difficult health issues. The program has yielded valuable insights into the design and delivery of policymaker education that could be applied to various disciplines outside the legislative process.

Transforming the delivery of rural health care in Georgia: state partnership strategy for developing rural health networks.

Since 1996, 19 networks covering 74 of the 117 rural counties in Georgia have emerged. This grassroots transformation of rural health care occurred through a series of partnerships launched by state government officials. These partnerships brought together national and state organizations to pool resources for investment in an evolving long-term strategy to develop rural health care networks. The strategy leveraged resources from partners, resulting in greater impact. Change was triggered and accelerated using an intensive, flexible technical assistance effort amplified by developmental grants to communities. These grants were made available for structural and organizational change in the community that would eventually lead to improved access and health status. Georgias strategy for developing rural health networks consisted of 3 elements: a clear state vision and mission; investment partnerships; and proactive, flexible technical assistance. Retrospectively, it seems that the transformation occurred as a result of 5 phases of investment by state government and its partners. The first 2 phases involved data gathering as well as the provision of technical assistance to individual communities. The next 3 phases moved network development to a larger scale by working with multiple counties to create regional networks. The 5 phases represent increasing knowledge about and commitment to the vision of access to care and improved health status for rural populations.

From theory to practice: what drives the core business of public health?

In 1994, the Public Health Functions Steering Committee proffered a description of the Essential Public Health Services (Essential Services). Questions remain, however, about the relationship between the roles defined therein and current public health practice at state and local levels. This case study describes the core business of public health in Georgia relative to the theoretical ideal and elucidates the primary drivers of the core business, thus providing data to inform future efforts to strengthen practice in the state. The principal finding was that public health in Georgia is not aligned with the Essential Services. Further analysis revealed that the primary drivers or determinants of public health practice are finance-related rather than based in need or strategy, precluding an integrated and intentional focus on health improvement. This case study provides a systems context for public health financing discussions, suggests leverage points for public health system change, and furthers the examination of applications for systems thinking relative to public health finance, practice, and policy.

Systems Thinking and Simulation Modeling to Inform Childhood Obesity Policy and Practice

Objectives: In 2007, 31.7% of Georgia adolescents in grades 9-12 were overweight or obese. Understanding the impact of policies and interventions on obesity prevalence among young people can help determine statewide public health and policy strategies. This article describes a systems model, originally launched in 2008 and updated in 2014, that simulates the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. Methods: In 2008, using information from peer-reviewed reports and quantitative estimates by experts in childhood obesity, physical activity, nutrition, and health economics and policy, a group of legislators, legislative staff members, and experts trained in systems thinking and system dynamics modeling constructed a model simulating the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. Use of the 2008 model contributed to passage of a bill requiring annual fitness testing of schoolchildren and stricter enforcement of physical education requirements. We updated the model in 2014. Results: With no policy change, the updated model projects that the prevalence of obesity among children and adolescents aged ≤18 in Georgia would hold at 18% from 2014 through 2034. Mandating daily school physical education (which would reduce prevalence to 12%) and integrating moderate to vigorous physical activity into elementary classrooms (which would reduce prevalence to 10%) would have the largest projected impact. Enacting all policies simultaneously would lower the prevalence of childhood obesity from 18% to 3%. Conclusions: Systems thinking, especially with simulation models, facilitates understanding of complex health policy problems. Using a simulation model to educate legislators, educators, and health experts about the policies that have the greatest short- and long-term impact should encourage strategic investment in low-cost, high-return policies.

Financial Management Series: RNs May Cost Less Than You Think

The health care environment is in a new era. Hospital and nursing administrators will be faced with tough decisions regarding number and skill level of staff. Productivity of various levels of nursing personnel is one parameter upon which decisions can be made. In this research, productivity is defined as the percentage of time spent in direct care, indirect care, and unit-related activities. The research indicates that the higher the level of personnel, the higher the productivity.

Selecting, Adapting, and Implementing Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples

Abstract:Objective. This paper explores how communities translate evidence-based and promising health practices to rural contexts.Methods. A descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health Policy to implement evidence-based health practices in rural settings. Findings were organized using The Interactive Systems Framework for Dissemination and Implementation.Results. Grantees broadly interpreted evidence-based and promising practices, resulting in the implementation of a patchwork of health-related interventions that fell along a spectrum of evidentiary rigor. The cohort faced common challenges translating recognized practices into rural community settings and reported making deliberate modifications to original models as a result.Conclusion. Opportunities for building a more robust rural health evidence base include investments to incentivize evidence-based programming in rural settings; rural-specific research and theory-building; translation of existing evidence using a rural lens; technical assistance to support rural innovation; and prioritization of evaluation locally.

Georgia's Utilization Minigrant Program: Promoting Medicaid/CHIP Outreach

Funded community-based organizations improved utilization of childrens health services by developing innovative staffing patterns, creating new data systems for scheduling appointments and maintaining records, and forging new collaborative relationships to leverage financial support. These strategies were rooted in collaboration with community-based organizations, health care providers, and the state Medicaid agency.

The Philanthropic Collaborative for a Healthy Georgia: Building a Public-Private Partnership With Pooled Funding

Introduction Partnerships can vary in size, the nature of the parties involved, and the scope of their work. But at their core, partnerships share some fundamental elements. In the philanthropic world, partnerships are usually voluntary and bring together parties with mutual goals and some level of shared responsibility. Some foundations have partnered with other private philanthropies as well as with public agencies. These arrangements show a continuum of operational collaboration.

Improving rural access to care: Recommendations for Georgia’s health care safety net

Background: In Georgia, the safety net provides health care services to vulnerable populations scattered across 74 urban and 85 rural counties. In rural communities, the safety net is challenged with longstanding gaps in service provision and persistent difficulty in making services accessible. The rural safety net in Georgia is vulnerable. Methods: An environmental scan was conducted of the Georgia rural safety net to assess who it serves, its providers, and how care is accessed in light of the Affordable Care Act (ACA). The scan included analysis of population-based census and health databases and a literature review to inform recommendations. Results: The population served by the rural safety net is typically older, poorer, and less healthy than the population in urban areas. The principal providers of care in the rural safety net are community hospitals, federally sponsored and free or charitable clinics, and some health departments. While the ACA provides an opportunity to increase insurance coverage and access to care, it poses a financial challenge to providers of the rural health safety net. As the health system evolves, the rural health safety net must adapt to shifting priorities and patient populations. Conclusions: To enhance the sustainability of the rural safety net, it is necessary for providers to focus on coordination of care through integration of services and broader health system partnerships. Providers of the Georgia rural safety net and stakeholders should focus on (a) ensuring a comprehensive assessment of all components of the safety net, (b) facilitating change through high-performing health departments and community-based organizations, (c) funding efforts to provide patient-centered medical homes for the rural uninsured, (d) emphasizing the value of technology in the provision of care and information/data exchange, and (e) rewarding innovations in rural and safety net workforce development and deployment.

Who Really Pays for Medicaid

The goal of the Medicaid intergovernmental matching grant is to stimulate state spending while achieving some level of beneficiary and taxpayer equity. This study uses the Current Population Survey data on 174,031 families to estimate federal and state Medicaid tax burdens per family, net of tax exporting. Of the total US