Lisa Macon Harrison

What predicts local public health agency performance improvement? A pilot study in North Carolina.

Local public health agencies (LPHAs) are faced with many challenges in their role as an integral part of the public health system. It is important to better understand the demands on and the capacity of LPHAs to respond to these challenges. Determining what factors can improve LPHA performance is critical to helping LPHAs face their challenges.The objective of this study was to determine what factors are associated with LPHA performance improvement in North Carolina from 1999 to 2004. In North Carolina, several data sources regarding predictors of LPHA performance, including LPHA workforce, LPHA characteristics, public health expenditures, and population characteristics, are available. Improvement in LPHA performance was measured by nine indicators across diverse services that were collected over multiple years. Linear regression was used to evaluate the significance of predictor variables.Our findings indicate that workforce characteristics such as occupational classification and experience of the workforce, LPHA characteristics such as number of full-time employees, as well as population characteristics are important predictors of LPHA performance.This study provides insight into what is needed to better address LPHA performance improvement. More importantly, study findings indicate which workforce characteristics can be targeted to enhance LPHA performance improvement over time.

Development and implementation of a public health workforce training needs assessment survey in North Carolina

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.

Leading Change Through Collaborative Partnerships: A Profile of Leadership and Capacity Among Local Public Health Leaders

Collaborative partnerships have grown in prominence as vehicles for systems change and organizational development among a network of organizations, particularly in the complex field of public health. Likewise, supporting the functioning and effectiveness of collaborative partnerships has become a key interest among organizational development scholars and community psychologists alike. In the question of capacity-building, no aspect of collaborative capacity has received greater attention than that of leadership. Research on collaborative partnerships has highlighted the importance of shared leadership while at the same time acknowledging that specific individuals do and often must emerge and assume more prominent roles in the partnership in order for the work of the partnership to move forward. However, we have limited knowledge of these key individuals and the roles that they play in non-hierarchical, voluntary partnerships. The present study is a comparative case study of prominent leaders in three regional public health partnerships. The aim of this investigation is to explore the questions: (1) What does it mean to be a leader in a context where no one is “in charge?” (2) What roles do those individuals identified as leaders play?, and (3) What are the specific capacities that enable the enactment of these roles? We find that those viewed as leaders by their partnerships shared a similar profile both in the range and types of roles they play and the capacities that enable them to carry out these roles. Further, we find that while individual attributes such as passion, knowledge, and leadership skills are important, some of the most prominent capacities are rooted in the organizational and institutional contexts within which the leader is nested.

Applying Lean principles and Kaizen rapid improvement events in public health practice.

This case study describes a local home health and hospice agencys effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.

Lessons learned from building a culture and infrastructure for continuous quality improvement at Cabarrus Health Alliance.

This case study describes a local public health agencys multiyear effort to establish an infrastructure and organizational culture for continuous quality improvement, using data from interviews with the agencys senior leaders, managers, and frontline staff. Lessons learned include the importance of setting stretch goals, engaging leaders at all levels of the organization, empowering frontline staff to make changes, providing quality improvement training for staff and leaders, starting with small projects first, spreading quality improvement efforts to involve all parts of the agency, and sustaining momentum by creating a supporting infrastructure for continuous quality improvement and continually initiating new projects.

Early evaluation results from a statewide quality improvement training program for local public health departments in North Carolina.

CONTEXT Many state and local public health agencies have developed accreditation systems and are utilizing quality improvement (QI) methods and tools to improve the public health infrastructure. Development of strategies to support and build the capacity of the public health workforce to apply QI can help advance these efforts. OBJECTIVE This article describes the adaptation and creation of a standardized QI training program for local health departments (LHDs), explores the effectiveness of the program in increasing the confidence of the LHD staff to apply QI methods and tools, and discusses lessons learned from the first cohort of the program. METHODS An existing program designed for health care professionals was pilot tested, adapted, and used in 8 LHDs. A formative evaluation of the new public health QI training program was conducted through a hybrid internal and external evaluation model. Pre/postsurveys were used to measure participant satisfaction and the capacity of LHD staff to conduct QI. RESULTS Staff from 8 LHDs successfully completed the program and 94% of participants reported that they were satisfied with the overall training program. Seventy percent of participants reported a higher perceived confidence in conducting a QI project, and all participants reported sharing QI tools and methods with their coworkers. CONCLUSION These findings suggest that QI training programs using methods and tools previously applied in health care and other industries can be successfully adapted to public health. Although additional studies are needed to validate the results, this training model can be used to inform future work in developing a standardized QI training program in public health.

Using quality improvement to promote breast-feeding in a local health department.

In 2008, breast-feeding initiation and continuation rates in Beaufort County, North Carolina, were lower than statewide rates. A quality improvement (QI) project was initiated to increase breast-feeding rates by enhancing the overall environment that supports breast-feeding at the Beaufort County Health Department. This case study describes one of the first QI initiatives implemented through the North Carolina Center for Public Health Quality QI training program, conducted in 2009. The aim of this project was to improve the health and wellness of mothers and infants in Beaufort County by promoting breast-feeding among Beaufort County Health Department Women, Infants and Children (WIC) clients. Using QI tools, 4 new approaches to breast-feeding promotion were tested and implemented: creating a nurturing location to breast-feed while at the health department, actively telephoning new mothers to provide breast-feeding support, incentivizing adoption of educational messages by providing a breast-feeding tote bag, and promoting new WIC food packages. These enhancements involved staff in QI planning and implementation and correlated with improved breast-feeding initiation for WIC clients during the year following project completion.

A Tool to Cost Environmental Health Services in North Carolina Local Health Departments

Introduction: The cost of providing a basic set of public health services necessary not been well-described. Recent work suggests public health practitioners are unlikely to have the empirically-based financing information necessary to make informed decisions regarding practice. The purpose of this paper is to describe the development of a costing tool used to collect primary data on the number of services provided, staff employed, and costs incurred for two types of mandated environmental health services: food and lodging inspections and onsite water services. Methods: The tool was iteratively reviewed, revised, and piloted with local health department (LHD) environmental health and finance managers. LHDs (n=15) received technical support to estimate costs for fiscal year 2012. Results: The tool contained the following sections: Agency/Respondent Information, Service Counts, Direct Labor Costs, Direct Non-Labor Costs, and Indirect/Overhead Costs. The time required to complete the tool ranged from 2 to 12 hours (median = 4). Implications: LHDs typically did not track costs by program area, nor did they acknowledge indirect costs or costs absorbed by the county. Nonetheless, this costing tool is one of the first to estimate costs associated with environmental health programs at the LHD level and has important implications for practitioners and researchers, particularly when these limitations are recognized.

Local Health Departments' Costs of Providing Environmental Health Services

Background: A detailed understanding of the costs that local health departments (LHDs) incur in the provision of public health services plays an important role in their efforts to provide services in an effective and efficient manner. However, surprisingly little evidence exists about the key cost components that LHDs incur in the provision of services. Purpose: The purpose of this report was to provide empirical estimates of LHDs’ cost structure. Methods: Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per service provided. In a second step, total costs are decomposed into key components, including direct and indirect costs. Both data collection and analysis were conducted in 2014. Results: For the LHDs examined in this report, median cost per service amounted to

Standardizing environmental health processes at the Iowa Department of Public Health.

145 for food and lodging and