Paul Kuehnert MS, RN, Executive Director. Kane County Health Department Aurora, Illinois

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1 Paul Kuehnert MS, RN, Executive Director K C t H lth D t t Kane County Health Department Aurora, Illinois

2 Background and Context Managing decline (as opposed to growth) in organizations Recession of 2008 and Cutbacks National public health impact Illinois and Kane County Case Study: Forging g a Strategic Response Summer & Fall, and beyond

3 Three key elements from generic management literature: 1. Human costs 2. Strategy 3. Organizational structure (References: Bozeman, 2010; Boyne, 2004; Levine et al, 1982; Pandey, 2010)

4 Six conditions for successful retrenchment from public administration i i literature: 1. Clear authority to make change 2. Continuity in top management 3. Rapid and accurate feedback on impact 4. Budgetary flexibility 5. Incentives: performance improvement and resource conservation 6. Targeted cuts (Reference: Levine et al, 1982)

5 Percentage of LHDs with Lower Budget in Current Year than Previous Year 53% 15% Would have lower budget were it not for one-time funding such as that from ARRA or H1N1 supplemental appropriations. 45% 47% 38% 27% Dec July 2009 Jan Anticipated next year Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2009; September 2009; January 2010). Note that sampling design varied across surveys.

6 Positions Lost to Layoffs or Attrition Staff with Reduced Hours or Mandatory Furlough Jan. Dec. Jan. June July Dec ,000 8,000 8, ,000 13,000 % LHDs that lost staff 52% 47% 46% From Jan Dec. 2009, LHDs lost a cumulative 23,000 jobs due to layoffs or attrition. Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2009; September 2009; January 2010). Note that sampling design varied across surveys.

7 KCHD Revenues

8 KCHD Workforce Analysis Seasonal # Em mployees Resources and Support Family Health Health Protection Community Health Year

9 Illinois has both cut grants and set a policy of late payment to vendors, including local government KCHD has lost $1m in state grant revenue & experienced payment delays up to 200 days

10 Target Fund Balance

11 Target Fund Balance

12 Under direct County Board supervision 26 elected board members, 1 elected chair Health Advisory Committee per state statute Public Health Committee of 7 Board members Separate tax levy, regulatory fees and state/federal grants are revenue sources Certified by Illinois Department of Public Certified by Illinois Department of Public Health every 5 years 10 Essential services (circa 1994) Focus on Assessment & Planning (IPLAN)

13 Date December, 2006 May, 2007 September, 2007 February, 2009 November, 2009 Activities 5-year Community Health Assessment/Plan Adopted Community Leaders Summit re: Health Leadership Transition: Set 2030 Vision First-ever Health Department Strategic Plan/Strategy Map Strategic Plan Update, 3-Keys Strategy Affirmed Board Commitment to Public Health Accreditation

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15 Effective Leadership Values Service, Quality, Trust, Respect Teamwork Capable Staff Missioni Protect & Promote Health Outstanding Community Health Outcomes Kane Residents are healthiest in Illinois! 2030 Vision Excellent Health Communications Active Community Partnerships Kane County Health Department s Strategic Focus

16 KCHD S KEYS TO GREATNESS STRATEGY 1. I. Attract and retain educated, committed leaders and staff who excel at public health I. II. Expertly transform data into actionable health information - communicate it effectively to diverse audiences II. III. Convene and support active community partnerships that get population health results

17 Date Activities December, 2006 Awarded d RWJF Common Ground Grant December, 2007 Summer/Fall, 2008 Agency QI/PI Initiative Committee Formed Awarded NACCHO Accreditation Preparation Demonstration Site Project Grant 2009 Awarded MLC II Funding from Illinois Public Health Institute : Collaborative QI Project re: Community Partners Board: Direction to Pursue PHAB Accreditation 2010 PHAB Standards Used as Re-org Framework Re-commitment to QI/PI and Accreditation

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19 Transform the Kane County Health Department to completely focus on population p health: Transfer direct client services to 3 FQHCs Reduction in workforce by 50% Re-organization using PHAB standards as framework

20 Date June 24, 2010 June 29, 2010 June 30, 2010 July 7, 2010 July 12, 2010 July 13, 2010 Activity Meeting with Board and Health Comm. Chairs Board Committee of the Whole Executive Session All staff and Union notified of potential layoffs Board Exec. Comm. Unanimously Passes Change Resolution National Public Health Leader Phone Focus Group County Board Tables Health Budget Amendment August 10, 2010 County Board Approves Transition voting Nov 8, 2010 Direct Services Transferred & 62 Staff Laid Off

21 1. Human Cost

22

23 1. Clearly articulate a plain-speak public health value proposition 2. Use rapid cycle improvement---specifically i ifi PDCA--- to drive and sustain re- organization

24 Restructuring Pi Principlesi Assure ability to efficiently provide essential and mandated public health services Effectively addressthe identified community health priorities Protect the most vulnerable populations Maintain a long term, strategic focus Core Public Health Services Emergency preparedness and response Communicable disease monitoring, analysis and response Evidence based interventions to improve maternal and child health and prevent chronic disease Environmental health protection: food, water, toxins such as lead Communityhealth assessment, planning andevaluation/qualityimprovement improvement Health communication and education Public policy development

25 Governmental public health departments are responsible for creating and maintaining conditions that keep people healthy. each community has a unique public health system comprising individuals and public and private entities that are engaged in activities that affect the public s health Regardless of its governance or structure, regardless of where specific authorities are vested or where particular services are delivered, everyone, no matter where they live, should reasonably expect the local health department to meet certain Standards p. 2, Operational Definition of a Functional Local Health Department

26 Public Health Accreditation Board Domains Domain A: Administrative Capacity and Governance Domain 1: Conduct and disseminate assessments focused on population p health status and public health issues facing the community Domain 2: Investigate health problems and environmental public health hazards to protect the community Domain 3: Inform and educate about public health issues and functions Domain 4: Engage with the community to identify and address health problems Domain 5: Develop public health policies and plans Domain 6: Enforce public health laws and regulations Domain 7: Promote strategies to improve access to healthcare services Domain 8: Maintain a competent public health workforce Domain 9: Evaluate and continuously improve processes, programs, and interventions Domain 10: Contribute to and apply the evidence base of public health

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28

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30 Time The New Beginning Ending, Losing, Letting Go From Managing Transitions by William Bridges

31

32 Making Change: 3 Interactive Components 1. Lead with ihthe Intellect Develop Clear Goals What looks like resistance is often lack of clarity. 2. Engage the Emotion and Passion What lookslikeresistancelike is often exhaustion. 3 H f l i i l /bl i 3. Have a successful organizational structure/blueprint What looks like a people problem Is often a situation problem.

33 Utilize KCHD s adopted Rapid Cycle Improvement process to drive change

34 Division/Team Project OCHR, CHR Section Improve response rates of employee call-down drills. DP, PHN Section OCHR, Admin Section HP, Environmental Health Section HP, Community Health Section Improve rates of initial high risk infant follow-up visits within compliance levels. Improve structured spending of grant funds. Decrease critical food inspection violations (to decrease instances of FBI). Improve pre & post meeting communication in Community Health DP, Communicable Disease Section Improve collection & reporting of immunization data DP, Immunization i Section Improve rate of immunization i i competence for PHNs KCHD Leadership Team Improve KCHD financial management

35 Community assessment & planning Organizational strategic planning Accreditation Committee Accreditation Committee Data & Quality Coordinator Entire Mgmt/Leadership Team Health Advisory Committee volunteers

36

37 Slimmer From 5 units to 3 units within the Department Flatter Eliminating more than half (20/36) management and exempt positions Focused E j b d i ti itt bi i d ti Every job description re-written: combining duties & adding public health essential service responsibilities

38 Public Health Accreditation Board Domain KCHD Organizational Unit with Lead or Secondary Responsibility Office of Community Health Resources Division of Disease Prevention Division of Health Promotion A. Administrative Capacity and Governance Lead Responsibility Secondary Responsibility Secondary Responsibility Domain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community Lead Responsibility Secondary Responsibility Secondary Responsibility Domain 2: Investigate health problems and environmental public health hazards to protect the community Secondary Responsibility Lead Responsibility Lead Responsibility Domain 3: Inform and educate about public health issues and functions Secondary Responsibility Lead Responsibility Lead Responsibility Domain 4: Engage with the community to identify and address health problems Lead Responsibility Secondary Responsibility Secondary Responsibility Domain 5: Develop public health policies and plans Domain 6: Enforce public health laws and regulations Domain 7: Promote strategies to improve access to healthcare services Lead Responsibility Secondary Responsibility Secondary Responsibility Secondary Responsibility Secondary Responsibility Lead Responsibility Secondary Responsibility Lead Responsibility Lead Responsibility Domain 8: Maintain a competent public health workforce Lead Responsibility Secondary Responsibility Secondary Responsibility Domain 9: Evaluate and continuously improve processes, programs, and interventions Lead Responsibility SecondaryResponsibility SecondaryResponsibility Domain 10: Contribute to and apply the evidence base of public health Lead Responsibility Secondary Responsibility Secondary Responsibility

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41 Council on Linkages And a big thank you to Seattle-King County! Job titles and job descriptions Every job has changed Population focus in every job Essential services in every yjob Quality improvement in every job Emergency response in every job Increased educational requirements most jobs Union role

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43 Adapt to current revenue constraints while positioning for long term growth by: 1. Develop/enhance competency in public health finance by KCHD management and staff 2. Improve the efficiency and effectiveness of KCHD practice 3. Articulate the value of public health to stakeholders of KCHD References: Costich, Honore & Scutchfield, 2009; Healthcare Financial Management Association, 2010; Honore & Costich, 2009; McGillis-Hall, 2003; Miller & Svara, 2009; Moulton et al, 2004.

44 KCHD CFY 2010 KCHD CFY 2011: $10,257,855 Revenue $5,900,516 Revenue (~50% from Grants) 31 total grants (~20% from Grants) 21 total grants 26 state grants 17 state grants 122 Full-time equivalents 60 Full-time equivalents

45 Sweet are the uses of adversity, Which, like the toad, ugly and venomous, Wears yet a precious jewel in his head. -Wm Shakespeare

Paul Kuehnert MS, RN, Executive Director Kane County Health Department

Paul Kuehnert MS, RN, Executive Director Kane County Health Department Paul Kuehnert MS, RN, Executive Director Kane County Health Department 1240 N. Highland Aurora, Illinois 60506 KuehnertPaul@co.kane.il.us 630-885-3264 KCHD CFY 2010 $10,257,855 Revenue (~50% from Grants)

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