Since the outbreak of H1N1 in the spring 2009, it is rare that a day goes by that local health department (LHD) administrators and staff are not being confronted with new and diverse challenges. As H1N1 evolves and takes our response efforts in unforeseen directions, national discussions regarding development and implementation of health reform confound and confuse and LHDs are being forced to adapt to environments that are making it increasingly difficult to respond to issues that germinate on local, state, and federal levels. The possibility for successful service to our constituents seems dimmer than ever.
While the daily tasks that LHDs assume responsibility for might seem mundane, local health officials are in place where they cannot lose sight of who they are, what they do, and what possibilities are in front of local public health. In November 2009, the National Association of County and City Health Officials (NACCHO) released the second in a series of surveys measuring the impact of the economic downturn on LHDs. It comes as no surprise that the survey revealed that job losses in LHDs are accelerating and that budget cuts are reducing the services LHDs provide.1 How are LHDs expected to meet their daily responsibilities in light of shrinking budgets and a reduced labor force while continuing to meet the public's expectations?
As local health officials lobby leaders on all levels of government for resources needed to serve communities within static levels, we must remember that public health organizations are not the only ones who bear the responsibility of healthy communities. LHDs cannot operate in isolation. They can utilize tools offered by organizations such as NACCHO to help plan for the future as they work through the issues of today. NACCHO created a strategic map for their organization in March 2009 that resulted in an ordered approach that is helping NACCHO make the best decisions regarding future direction(s). This exercise further highlighted the need to not only plan for the future but to factor in a degree of adaptability to address unplanned events. Experiencing this planning process drove home the need to develop a strategic map not only to determine future directions but also to define the possibilities for service and partnerships for other organizations, such as the Lincoln-Lancaster County Health Department (LLCHD).
NACCHO's exercise has given LLCHD a visual display of the strategic plan and helped modify the plan to continue to pursue goals and objectives as the environment changes and provided the tools to respond to unforeseen events. Throughout the H1N1 pandemic, LLCHD has continued to move in a clear direction and has achieved consensus among staff, the board of health, and community stakeholders regarding what that direction is. It has allowed LLCHD to develop effective messaging regarding current and future strategies throughout the community and, more importantly, the final product has served as an instrument for updating strategy as issues such as H1N1 unfold.
Over time, action steps developed with the map have been flexible enough to allow LLCHD to respond to change in both the internal and external environments of our community and have given management the tools for assuring a continuing fit between the organization and the external environment. Whatever the change, yesterday's desired outcomes will not be the same as tomorrow's. The map helps management keep the LHD aligned with these changing outcomes. This is accomplished through doing what needs to be done, evaluating what was done, and doing it better the next time, while concurrently assuring continuous fit with evolving internal and external environments and desired organizational outcomes.
One can usually hear the collective groan when discussing organizational change with staff and constituents, but NACCHO and LLCHD are proof that a change in internal perspectives can help an organization adapt and stay viable.2,3 New challenges became new possibilities. As environments evolve, it is important to use available tools to help motivate staff to succeed. A leader's role includes nurturing employee's ability to make proactive choices.4 Management cultivated these choices by creating an inclusive process that involved selected staff in decision making so they would work in sync with the management team.5 This process created guiding principles that helped identify organizational attributes and desired individual behaviors.3 Additionally, the process helped create an environment where ongoing organizational conversations are held about how and why people behave as individuals and as members of an organization and how positive behavior(s) help fulfill the organizational mission.3 The outcome was an action plan for achieving organizational priorities.
Unforeseen outcomes, in addition to planned outcomes resulted in staff taking it upon themselves to eliminate barriers to success that included increasing helpfulness, professionalism, and respect for each other and constituents.5 Staff members are developing an understanding of where they fit in the organization and value the connectedness among individuals, positions, and functions. Complacency is being exchanged for initiative and a capacity has been developed for evaluation measures of service to internal and external customers.
This method is just one example of a process that administrators can utilize to do the heavy lifting so that they can focus on the tasks at hand. As administrators, we cannot be expected to have all the answers to the challenges confronting us. Part of NACCHO's mission is to provide support that enhances LHDs' ability to serve their constituents at the highest level of quality. Public health administrators across the country should use NACCHO as a resource when pursuing goals and objectives. The tools and best practices, such as those found on the NACCHO Web site (http://www.naccho.org), can serve as guides to effective program implementation and organizational change. The way you function as a leader impacts your organization; NACCHO can help develop ideas, provide insights, and expose administrators to leading practices from across the country.
1. National Association of County and City Health Officials. Research Brief—Local Health Department Job Losses and Program Cuts
. Washington, DC: National Association of County and City Health Officials; 2009.
2. Kaplan R, Norton D. How to implement a new strategy without disrupting your organization. Harvard Business Review
3. Oliver D, Jacobs C. Developing guiding principles: an organizational learning perspective. J Organ Change Manage.
4. Kouzes J, Posner B. The Leadership Challenge
. 4th ed. San Francisco, CA: Jossey-Bass; 2007.
5. Swindall C. Engaged Leadership: Building a Culture to Overcome Employee Disengagement
. Hoboken, NJ: Wiley and Sons; 2007.