'In Closing'

Lindsay Menard, MPH

La Crosse, Wisconsin

As my final weeks of being a Wisconsin Population Health Service Fellow draw near, I have had the opportunity to reflect upon the past 22 months and recognize how much I have grown and how fortunate I am to have been part of such compassionate, innovative, and inclusive communities.  I want to use this blog post to focus on one of those communities, the La Crosse County Health Department, by highlighting one particular project I helped advance, the accreditation process.The accreditation journey has fostered my professional and personal development during my time as a Wisconsin Population Health Service Fellow.

Getting Started
Almost two years ago, the only thing I knew about national voluntary public health accreditation was that the Public Health Accreditation Board (PHAB) had released a set of standards and measures in 2011 to help state, local, and tribal health departments ensure the three core functions of public health and the ten essential health services were being met.   I had to quickly get myself up to speed on the purpose of accreditation (with the use of resources such as: the PHAB Online Orientation, Embracing Quality in Public Health: A Practitioner’s Performance Management Primer, and Developing a Local Health Department Strategic Plan: A How-To Guide), the reasons the La Crosse County Health Department was pursuing it, and how I could add value to the process. 

Lessons Learned
The first lesson I learned is that people and organizations always have room for improvement, and that it is important to introduce quality improvement efforts in a way that does not threaten staff or the good work they were already doing.  I framed this concept in many different ways.  For example, when discussing performance management and quality improvement ideas (Domain 9 in the standards and measures established by PHAB) with public health nursing staff I highlighted the fact that we are already reaching a large proportion of the community with seasonal influenza vaccinations, and then asked them to think about how we could reach even more people and improve upon the structure of community influenza clinics.

I have also learned to be open to change, to document change, and to encourage change (even if I am hesitant about it myself).  Change does not come easily to most people, including me.  Learning how to maneuver change, address change resistors, and embrace change has been important throughout the accreditation process.  We, the La Crosse County Health Department, had to overhaul and develop new systems.  Changing the infrastructure of an organization is no easy task.  It took time, patience, and various forms of training to get new or changed systems to “stick.”  And as a new employee and  Wisconsin Population Health Service Fellow, I was essentially charged with testing the status quo.  I had to learn to build rapport and earn the trust of staff.  There was a period during the transition when everyone (including me) had to adjust to the shift in the organizational structure. 

The third lesson I learned was how important communication is at all levels of an organization, not just at a local health department.  It is important for leaders to communicate on a regular basis with all staff members and it is equally important for leadership to explicitly reach out to staff for feedback.  Communicating thoughts, ideas, improvements, and questions can be extremely difficult.  Encouraging a safe environment for all to communicate is essential.  Otherwise, trust and morale break down. To communicate with staff about the new systems, plans, and policies and procedures (P&Ps) that were created, adopted, and implemented a department newsletter was created (Figures 1 and 2).  The newsletter highlights the accreditation process, discusses the twelve domains developed by PHAB, states new changes, and captures health department news.   Through the accreditation process, I have learned to develop newsletters and frame messages for staff and the media in a meaningful and concrete way. 

Figure 1:                                                  Figure 2: 

Final Thoughts
In closing, the accreditation process has increased the capacity of the La Crosse County Health Department to deliver the ten essential services AND it has made me a better public health professional.  I have increased my knowledge of public health, fostered many professional skills, learned to manage change, and recognized the value of communication throughout an organization.   I will carry the many lessons and skills I have learned throughout the Fellowship program with me for the rest of my career.  Fellowship faculty and staff explain it best, “Through this intensive process, academic health departments and their UW School of Medicine and Public Health—based partners have developed a way to take talented and highly motivated early-career professionals and transform them into confident, emerging leaders, with cutting-edge skills, competencies, and connections to improve population health outcomes and advance health equity in Wisconsin and beyond.”[i] I am proof.  I have been transformed.

[i] Ceraso, M., Swain, G.R., Vergeront, J.M., Oliver, T.O., & Remington, P.L. (2014). Academic Health Departments as Training Sites for Future Public Health Leaders: A Partnership Model in Wisconsin.  Journal of Public Health Management and Practice, 20 (3), 324-329.