Core Tour Practice of Harris County Public Health and Environmental Services

State: TX Type: Promising Practice Year: 2014

Harris County Public Health and Environmental Services (HCPHES) is a comprehensive local health department serving the third most populous county, Harris County, Texas, in the United States. It spans over 1700 square miles, and its land area is larger than the state of Rhode Island. The HCPHES jurisdiction includes approximately 2 million people within Harris County’s unincorporated areas and over 30 small municipalities located in Harris County (not including the city of Houston). For certain public health services such as vector control, Ryan White/Title I HIV funding, and refugee health screening, the HCPHES jurisdiction encompasses the entire county including the city of Houston, therefore providing services to over 4 million people in total.Since being charted in 1942 by Harris County Commissioners Court, HCPHES has expanded to include services ranging from disease control and clinical prevention to veterinary public health, all supported by various support functions such as finance and administration; policy and planning; health education; public information; and emergency preparedness and response. Across this broad organizational framework, HCPHES has engaged in significant departmental strategic planning activities,including the development of the HCPHES Strategic Plan 2013-2018 which is grounded in the “Essential Public Health Services” model (e.g., assessment, Policy development and education, and assurance activities). These categories allow HCPHES to engage in a variety of public health sectors including the services provided through its clinical programs. The mission statement of HCPHES is “Promoting a Healthy and Safe Community, Preventing Illness and Injury, Protecting You, HCPHES, Your Department for Life” while its clear vision is “Healthy People, Healthy Communities…a Healthy Harris County.” The over 500 staff members of HCPHES are public health professionals in the truest sense of the word and have a broad range of expertise in various public health program areas. HCPHES staff members pride themselves in upholding the organizational values which include: Excellence, Compassion, Flexibility, Integrity, Accountability, Professionalism, and Equity. With a current annual operating budget of $58 million, HCPHES is organized into four offices that apply specific skills broadly across all public health activities (Health Education and Promotion, Policy and Planning, Public Health Preparedness and Public Information); four divisions that focus on specific programmatic disciplines (Disease Control and Clinical Prevention, Environmental Public Health, Mosquito Control, Veterinary Public Health); and a state-of-the-art Operations and Finance Division that runs the business infrastructure of HCPHES (e.g. financial services, information technology, human resources, etc.). HCPHES is governed by a robust strategic plan, which is the guiding principles that shape the way HCPHES performs its work internally, with other stakeholders and with the broader public in order to effectively carry out its mission. As HCPHES works towards advancing the priorities outlined in the Strategic Plan, strategies to improve population health are currentlybeing developed and implemented around upstream solutions, leadership development for current and future leaders, leverage and share resources amongst partners, and efficiency and quality improvements.To ensure that this was done effectively, each executive team member must have a better understanding of each division, beyond a high level understanding. It was a gap that was identified and had to be filled, which ultimately produced a highly successful model practice called the HCPHES Core Tour (HCT). Goal of Practice: Enhance HCPHES senior level management staff understanding of the “practice” of each Division to assist in their ability to determine priorities for the health department. Objectives: Develop an interactive/didactic capacity building experience for senior level staff Senior level staff report increased confidence in ability to discuss and analyze health department priorities
The HCT will provide a powerful impact to the executive leadership that will empower them to, in aggregate, make better decisions for the entire department. It is not common that each member of an executive team of a large health department understands the interworking of another division/area as they are focused on running their own. At HCPHES, we make decisions in unity, as each decision we make impacts the public as a Local Health Department.Although our executive team meets two times per month, there was a gap in knowledge and understanding to allow these great minds and leaders to develop and improve on the current strategies being focused on. In order to do this, it was imperative that each member of the executive team understand the department as a whole. Not only should they understand the department as a whole from a high level, but really understand the work that is carried out from the boots on the ground all the way to the head of each division. This approach would enable the executive level team members understand risk, outcomes, and overall better decisions to support the strategic plan. The uniqueness of the HCT is that not only was the executive staff taken on a very comprehensive tour of the division but that the employees of that division were able to interact with member of the executive team. It allowed time for both the employees and the executive team member to find not only the synergies that existed but also to allow the employees to exhibit their expertise and value to the organization. How often does the entire executive team of a large business work side by side with employees down to the lowest member of the organizational chart? Other than a quick walkthrough of an area/location, it’s not common, if done at all. This approach takes the leadership of this health department to a new level of understanding the “Core” business.
Goal of Practice: Enhance HCPHES senior level management staff understanding of the “practice” of each Division to assist in their ability to determine priorities for the health department. Objectives: Develop an interactive/didactic capacity building experience for senior level staff Senior level staff report increased confidence in ability to discuss and analyze health department priorities The HCT was designed to take a full day (up to 13 hours in some cases) to take each member of the executive team, a total of 8, and allow them to experience each portion of a division from the front line employee up to the executive that lead a particular division. This was a "hands on" field experience, not a full day "classroom" type presentation. Our executive staff spent their day next to Doctors, Nurses, Technicians, Investigators, Call Center Staff experiencing their daily activities. The following is the activities each executive staff member experienced (Attached-HCT schedule -WORD document) Mosquito Control (MCD) 09:30 to 10:00 – Office: MCD Overview 10:00 to 10:30 – Office: Educational Outreach/Employee Training 10:30 to 11:00 – Lab: Mosquito Identification and Processing 11:00 to 11:30 – Lab Avian Identification, Processing, and Testing 11:30 to 12:00 – Lab: Virology – Testing of Mosquito Samples for WNV 12:00 to 12:30 – Lab Applied Research – Hands on Approach 13:00 to 14:00 – Field Mosquito Trapping and Collection 14:00 to 15:00 – Field Avian Trapping and Collection 15:00 to 16:00 – Field Collection of Mosquito Eggs for Insecticide Resistance Tests 16:00 to 17:00 – Field Neighborhood Inspection and Area Profiling 17:00 to 21:30 – Field Mosquito Spray Operations Technology Review and Ride AlongEnvironmental Public Health (EPH) 08:00 to 08:15 – Office Overview of Business Support 08:15 to 09:15 – Office Home Abatement/Lead/Occupational Health and Safety Reviews 09:15 to 09:45 – Office Regulation Compliance Review 09:45 to 12:30 – Field Pool and Public Water Supply Inspections 12:30 to 13:30 – Field Mobile Food Unit Inspection 13:30 to 15:30 – Field Food Establishment Inspection(s) 15:30 to 17:00 – Field Neighborhood Nuisance Inspections Veterinary Public Health (VPH) 07:30 to 08:00 – Shelter Euthanasia - Explanation of the process and watch the procedure 08:00 to 11:00 – Field Shadow Animal Control Officer 11:00 to 11:30 – Shelter Surgeries - Explanation of the process and watch the procedure 11:30 to 12:00 – Shelter Veterinary Evaluations - Explanation of the process and watch the procedure 12:00 to 13:00 – Shelter Zoonosis - Explanation of the program activities/responsibilities 13:00 to 14:30 – Shelter/Front Desk/Kennel Explanation of the program activities/responsibilities and shadow kennelsupervisor – Front Desk/Intake/Adoptions/Kennel Searches/Etc. 14:30 to 15:00 – Shelter Education/Outreach - Explanation of the program activities/responsibilities 15:00 to 15:30 – Shelter Unload Trucks (Animals) 15:30 to 16:00 – Shelter Phones Explanation of the program activities/responsibilities and shadow phone operators Disease Control and Clinical Prevention (DCCP) 08:00 to 09:15 – Main Office DCCP Overview Disease Control and Medical Epidemiology (DCCP) Clinical Health and Prevention (CHP) Clinical Quality Management Program (CQMP) Nutrition and Woman Infant Children Services (NWS) 09:15 to 11:00 – Field CHP School Outreach 11:00 to 13:00 – Field WIC – Certification process including intake and nutrition counseling 13:00 to 15:00 – Field Tuberculosis Directly Observed Therapy 15:00 to 15:30 – Field Refugee Program Patient Interaction 15:30 to 16:00 – Field Tuberculosis Control Program Patient Instructions 16:00 to 17:00 – Field Dental Clinic – Observe patient receiving services 17:00 to 18:00 – Field: Health Clinic – Observer patients receiving services The process to go through the four divisions took four months; each division assigned a particular month. The devotion to this exercise was so great that not one person cancelled a tour the entire four months. Although as a health department official there comes with it a hectic schedule, there was total commitment to this endeavor.
The practice objectives were achieved: Develop an interactive/didactic capacity building experience for senior level staff Senior level staff report increased confidence in ability to discuss and analyze health department priorities. HCPHES Core Tour model was developed providing an interactive field experience for senior level staff. The outcome of the HCT was an outstanding success. Qualitative methods were used to demonstrate increase staff confidence. Based on feedback from Executive staff through electronic communication and at Executive level meetings, each member of the team, regardless of tenure, gained exceptional knowledge and understanding, which in turn allowed for deeper and more robust discussions that will affect the overall outcomes to the health department. Our teams that were designed to support the strategic plan, which included the members of the executive team, are now able to understand each piece of the department and apply the intangible wealth of knowledge to gain a tangible outcome in new directions.
The HCT was such as success that it will be implementing it to the next level of management, future leaders, and used as employee recognition. The costs to maintain HCT is a sunk cost in that it is primarily time of the employee to attend with the exception of possible mileage expenses that would need to be paid, but would be very minimal. The minimal amount of costs with the intangible value that is returned is something HCPHES is willing to invest in and maintain.
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