Statewide incubator project guides local health departments through time of change

Responding to dramatic changes in the world of local public health, the North Carolina Association of Local Health Directors’ Public Health Task Force has sponsored an extensive report intended to provide North Carolina’s local health departments with: 1) a coordinated review of important changes in the healthcare and public health context, 2) a description of opportunities that stem from these changes, and 3) a set of recommendations and next steps. The Report, A Blueprint of the Future for Local Public Health Departments in North Carolina, was undertaken as the 2012-2013 Statewide Incubator Project, for which the North Carolina Institute for Public Health (NCIPH) provided leadership and technical assistance. The North Carolina Public Health Incubator Collaboratives are funded by the North Carolina Legislature through a contract with the North Carolina Division of Public Health.

Dramatic changes in the public health landscape were first noted over a decade ago, when the Institute of Medicine published The Future of the Public’s Health in the 21st Century. The report pointed to a “radical transformation” in the context of public health practice, citing changing demographics, globalization, expanding use of health information technology, and increasing rates of chronic disease. The leaders of public health agencies are still grappling with the implications of these changes in regards to their organizations’ visions, the services they provide, and the skillsets of their staff.

Continued increases in the costs of healthcare and the passage of the ACA further altered the landscape. The ACA has led to increased access to care, dramatic investments in health information technology, a focus on quality improvement and health outcomes, and a renewed emphasis on prevention.

“Local health departments (LHDs) in North Carolina are experiencing unprecedented changes in the world around them that have an impact on the needs of communities and on the services the agencies provide,” said John Graham, PhD, Senior Investigator at NCIPH.

To examine the implications of these changes, NCIPH conducted an extensive literature review and 19 interviews with the state’s healthcare leaders and local health directors. The Public Health Task Force convened twice to discuss the findings and develop recommendations. The final report is a blue print that “brings some coherence to LHDs’ understanding of these changes and their implications,” said Dr. Graham.

The Report emphasizes that LHDs should play to their strengths as they proactively craft a role in the world of performance-based care. Such activities as coordinating evidence-based strategies in community public health interventions, leading community health assessments and health improvement planning efforts, collaborating with community healthcare providers on the provision of a range of healthcare and prevention services, and playing the role of “risk manager” in their efforts to minimize the impact of communicable diseases are all possible roles that play on the traditional strengths of LHDs. To take on these new roles, LHDs must enhance the value that they have traditionally provided and clearly demonstrate this value to partners in their healthcare community and to policymakers at all levels. ┬áIn turn, to enhance and demonstrate value, LHDs must re-emphasize the professional development of their staff and strengthen their infrastructure, particularly in regards to information technology. Becoming experts in the adaptation and evaluation of evidence-based strategies, health improvement planning, performance-based healthcare models, and expanding communicable disease assurance and surveillance capacity are all competencies targeted in the Report. In addition, LHDs need to substantially upgrade their informatics capacity both with regards to internal quality improvement efforts and external health assessments. A key informatics competency is the ability to calculate Return on Investment for various public health services, and in particular for community-based prevention interventions.

Taking advantage of the identified opportunities will require strong commitment from LHD leadership. Thus, the enthusiastic initial feedback from local health directors is promising. Terrell Jones, of Lee County, said that the report does “a great job of putting into words and organizing the numerous concepts that keep popping up whenever our Board of Health tries to update our strategic plan.”

The full report is available at the North Carolina Public Health Incubator Collaboratives Web Site.