Publications: Research to Action Network

May 2012

Local Public Health Quality Improvement
Organizational Survey

Local public health departments in Minnesota (LHDs) appear to be on the forefront, as a system, in moving towards a culture that supports quality efforts and improvement. Leaders are receptive to change and see value in QI activities.

All questions related to employee buy-in or the value of QI were consistently supported by respondents. Yet it appears that fully integrating QI into Minnesota LHDs hasn’t yet occurred.

Minnesota LHDs show a high level of knowledge about QI capacity within their agencies. It appears that while there has been some training, particularly at the leadership level, staff do not have high levels of training and skills related to QI activities. These indicators will likely change in Minnesota , particularly given the high interest among LHD leadership and staff.

Executive Summary

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November 2011

Organizational Culture at the Minnesota
Department of Health

An overwhelming proportion of respondents felt that spending time and resources on QI is important and worth the effort. Additionally, almost 70 percent of respondents felt that QI efforts would lead to improvements in population health.

Yet, most respondents were unaware of formal QI activities underway within MDH or whether leaders or staff were trained in basic QI methods. There appears to be a general lack of awareness among respondents as to how QI is integrated into the work of the agency. In addition, the use of data to improve quality does not appear to be widespread.

Finally, while 84 percent of respondents understood how their work contributed to the agency’s overall goals and strategy, several barriers to employee empowerment were identified.

Executive Summary

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October 2011

Factors Associated with Local Public Health Department Performance: Literature Review

Until recently, most of the public health systems and services research related to local health department (LHD) performance relied on cross-sectional data sources that made it difficult to determine cause and effect of various factors associated with performance.

Two recent studies used longitudinal approaches to study factors related to local health department structure, financing and capacity. These studies were also unique in that they examined those factors with respect to population health outcomes. They found strong associations between LHD spending and staffing with respect to measures of morbidity and mortality.

Overall, the factors most strongly associated with LHD performance included: population size served, expenditures, funding, staffing, and organizational structure. Weaker associations were found with Director qualifications, partnerships, community characteristics and organizational leadership. Research is needed related to newly merged organizations, such as health departments joining with human services agencies, and how that has affected LHD performance.

Executive Summary

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May 2011

Authority and Positioning of Minnesota CHS Administrators and Local Health Directors

Little is known about the extent to which community health service (CHS) administrators and local health directors have key authorities related to budgeting and access to elected officials. Information on authority and organizational positioning is needed to help articulate roles of public health leadership. Issues related to authority and positioning are crucial considerations during succession planning, and when discussing changes to local public health governance and organization.

Minnesota's State Community Health Services Advisory Committee (SCHSAC) has begun to more fully articulate the expected authorities of a CHS administrator, in order to focus attention on this issue, motivate discussion and change where needed, and help assure that these authorities endure periodic changes to local public health governance and organizational structures.

This brief will examine the authorities of CHS administrators in relation to their community health boards (CHBs), and the authorities of local health directors in relation to their county boards or city councils.

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March 2011

Governance and Organization of Local Public Health Services in Minnesota

Between May 2009 and May 2010, 28% of county boards, and 28% of community health boards (CHBs) considered, proposed or decided to change their organizational or governance structure.

Almost all attention to organizational structure focused on merging with another department or division of government, and most attention on governance structure addressed adding a jurisdiction to a CHB or organizing under Statute Chapter 402 so that the Human Services Board (HSB) serves as the CHB.

Most local health directors and CHS administrators in organizations affected by potential changes reported having a role with elected officials by providing information, tools, guidance, and/or recommendations.

Some top public health officials expressed satisfaction with current structures, whereas others identified limitations with current structures or concerns about the motivation for changing structures.

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