Nassau County Department of Health
Coffee With The Commissioner, Engaging the Public Health Workforce in Governance, Leadership and Organizational Culture
The Nassau County Department of Health (250 employees) serves more than 1.3 million residents on Long Island, New York. Nassau County is the immediate Eastern neighbor of New York City, and as such is a suburban community with significant health disparities, as well as socio-economic disparities. Coffee With The Commissioner is meant to energize, incentivize, and organize the public health workforce, engage the public health workforce in governance and policy-making, instill an organizational culture which places emphasis on serving our residents with innovative, evidence based, and efficient public health services, and create leaders from within. The goals of achieving a motivated workforce who have opportunity to add to the organization beyond their civil service title are achieved by giving a forum with highest departmental management for open, frank discussion and exchange of thoughts, questions, suggestions, and even complaints. When employees from different bureaus hear the stories and thoughts of colleagues in different bureaus a sense of belonging, collaboration, and organization is created. Changes that occur as a result make the workforce stronger, and a sense of organizational culture and pride is fostered. This translates to a better experience for the public and our partners in various sectors of public health. Specific goals include: 1) Instilling an organizational culture in which ALL health department employees play an active role in governance by being motivated to develop innovative ideas, address concerns, cross-train, work and learn with other department members. 2) Engage all employees in public health policy-making, and organizational and strategic planning. 3) Incentivize employees to cross-train, and consider expanding their horizons into different roles within our department. 4) Develop leaders and leadership skills within our workforce and participate in secession planning 5) Improve delivery of services to the public by having a workforce with a sense of pride and ownership of the product. Practice was implemented a few years back with meetings scheduled between the Commissioner, and 5 employees chosen randomly (based on availability.) The only non-random aspect was that no bureau would have more than one employee at each meeting, so that there would be no chilling effect by employees who work together, and learning from other Bureaus would be maximized. So far, the feedback has been extremely positive, and changes have occurred as a result of these meetings, including but not limited to the re-establishment of defunct civil-service titles, new employee recognition awards, large percentages of our employees volunteering for strategic planning sub-committees, numerous awards and accolades, and with regard to the impact of this initiative on our performance and outcomes in the community, we scored our highest ever rankings in the annual Wisconsin Health Rankings. The success of this program has been due to the willingness of senior department administration to listen, consider, and engage each and every employee along with employee willingness to speak open and freely. These meetings are non-punitive in any manner. The resulting improvement in morale and governance has improved the customer experience for our residents, improved partner relations, and helped create a sense of innovation and efficiency which in large part has led to our many NACCHO Model Practice awards. We use an internal website (webconnect) for internal communications, and many of the ideas from this initiative are listed there, including photos of employees being acknowledged for their successes! Ideas which directly impact the public go on our county website.
Coffee With the Commissioner is based on concepts present in the Assessment Protocol for Excellence in Public Health (APEX PH,) and the subsequent Mobilizing for Action through Planning and Partnerships (MAPP.) For example, main components of APEX PH include building LHD leadership, Operational Planning, Plan Development, and Assessing LHD capacity for delivering services. As addressed in the goals and objectives above, these APEX PH concepts essentially define what we aim to achieve with our initiative. The public health issue (statement) is, how can we best engage each employee in the health department to practice within the mission and goals of our department , while inspiring future leadership, innovation, efficiency, collegiality, and ultimately improved performance in the community? We have 2 targets, our workforce, and the public. Success in successfully engaging the former will translate into health outcomes in the latter. The data supports that this is occurring! While APEX PH addresses many of the issues in our problem statement, today we operate with the more modern MAPP concepts aligned. As seen in MAPP, Strategic Planning is a vital component of our department, and is a prerequisite for applying for Public Health Accreditation (we are in the process of) Our initiative invites each employee into the process, and offers them seats in strategic plan sub-committees(of their choice,) which are run by mid-managers with the hope that the absence of senior management will embolden employee participation. While the concept of agency leadership communicating with, and empowering the workforce as a whole but on small group basis may not be new, we cannot find any documentation of a Local Health Department using such a method. We hope that this can serve as a successful model which others can use to help guide their agency into the future! It has been our plan to have every single employee participate (except those on the executive staff who meet with the Commissioner very frequently.) Due to employee turnover we have a constantly changing denominator, but we have met with the majority of our employees, and we are on the verge of a point when we are on the second time around for all employees.
The main goals of the project are as follows: 1) Instilling an organizational culture in which ALL health department employees play an active role in governance by being motivated to develop innovative ideas, address concerns, and cross-train, work and learn with other department members. 2) Engage all employees in public health policy-making, and organizational and strategic planning. 3) Incentivize employees to cross-train, and consider expanding their horizons into different roles within our department. 4) Develop leaders and leadership skills within our workforce. 5) Improve delivery of services to the public by having a workforce with knowledge of, and a sense of pride and ownership of the product. The entire workforce was made aware of the process via annual departmental meetings, as well as through word from executive staff members who learned of it at schedule meetings. All NCDOH members (except executive staff members who already directly meet with the Commissioner on a bi-weekly schedule) are included and expected to attend. Groups are randomly chosen with the exception that no two employees from the same bureau are picked for each meeting. At the meetings coffee, tea, water and sometimes fruit, or other snacks are provided to make each employee feel welcomed and comfortable, and create a sense of camaraderie. 90 Minutes is the scheduled time, but the Commissioner tries to keep an extra hour available should the discussions warrant more time, or if the specific meeting members wish to continue on. While this is an internal initiative for our LHD, the discussions and subsequent understanding of the organizational culture and mission helps our employees engage the public and It empowers them to seek external collaborations. It fosters innovation which serves all of our residents and community partners. Perhaps more important, it has taken down long-standing silos within our department. We have numerous examples of bureaus within our department working together. Food-related outbreaks are now managed in collaboration by our communicable disease epidemiologists, along with our restaurant sanitarians. Early Intervention screeners frequently visit WIC sites for EI screening of WIC babies and older siblings (a NACCHO Model Practice Award Winner!), and Tuberculosis and STD staff are able to cross over an assist in potential Ebola and Zika case investigations. A great success is the number of employees who describe learning what other bureaus of our department actually do, and as a result some employees have sought to try a new job, or advance their education. This is an ongoing initiative, and one of its main merits is that there is no need to end it as long as it remains productive. Upon having every single employee meet with the Commissioner in this setting, the groups are shuffled, and meetings continue. This allows for inclusion of new employees, updates from past meetings, and continued strategic planning. As the NCDOH has approximately 250 employees, an estimated 2 year cycle is in place for the entire department to participate, Once achieved, the goal is to continue on indefinitely. Aside from negligible costs the Commissioner bears of coffee, water, cups, etc, only time is required. Time is valuable, but the time spent meeting well justifies it.
The initial stages of Coffee With the Commissioner have been successful based on responses of employees, by their cross-bureau work, and their responses to employee surveys. Our objectives (as stated above) were met including: 1) Instilling an organizational culture in which ALL health department employees play an active role in governance by being motivated to develop innovative ideas, address concerns, cross-train, work and learn with other department members. 2) Engage all employees in public health policy-making, and organizational and strategic planning. 3) Incentivize employees to cross-train, and consider expanding their horizons into different roles within our department. 4) Develop leaders and leadership skills within our workforce and participate in secession planning 5) Improve delivery of services to the public by having a workforce with a sense of pride and ownership of the product. A large number of our employees joined Strategic Planning sub-committees following Coffee With the Commissioner meetings. Others enrolled in Masters of Public Health or Certificate programs after learning how to potentially advance their careers. Employees sat for different civil service exams in different but qualifying titles to create workforce flexibility and potential upwards mobility for the employee. We have implemented numerous changes as a result of the meetings, including an employee acknowledgement program based on milestones. Many employees now participate on Strategic Planning Committees who did not before. Employees often follow-up these meetings by scheduling private meetings with the Commissioner to discuss their own advancement and any innovations, complaints or anything else they feel can better the department and themselves as providers of public health services to our residents. as part of our Public Health Accreditation application process we are surveying employees regarding their own satisfaction, and experiences within the department including this initiative. Now that the initiative has been successful, we are in the process of formally evaluating each specific aspect of the initiative. The successes of the program however are evidenced by the fact that every single coffee With the Commissioner meeting of 2016 lasted longer than its allotted time. Modifications will be made based on formal evaluation. Ultimately, we are able to show the success of our department's reach on the community by our highest score ever this year in the annual Wisconsin Health Rankings. Nassau scored 1st in all of New York in Health Factors, 2nd in Health Outcomes, and 2nd in Health Behaviors. While these statistics are admittedly multi-factorial (some of which are out of our control,) we believe the engagement of every health department employee in the ownership of delivery of preventive and public health services has had an impact on the way our work is done in the field. A certain pride, a positive approach to public health, and an owned approach has allowed NCDOH to thrive statistically and practically. We remain open to suggestions from our employees on improving the process.
We have learned much from Coffee With the Commissioner, including but not limited to: 1) The public health workforce in general wants the opportunity to participate in governance. 2) The workforce has great interest in learning about what colleagues in other bureaus within the department do. 3) The workforce wants to be challenged, engaged, and offered opportunity for improving the delivery of public health services. 4) There are a lot of innovations, concerns, and even complaints in the minds of the workforce that management was unaware of, and thus unable to correct prior to this initiative. Changes are made when possible based on employee input. Along these lines, given a direct opportunity to communicate with senior management, most employees appreciate the chance, and do participate. 5) Instilling a strong organizational culture takes work, but pays off as employees pass along the mission in their work with the public. 6) Collaboration begins at the top. By meeting with senior management with a tone of collaboration and teamwork, employees understand that collaboration (with internal and external partners) is of great value to them. They are enabled and empowered to exchange ideas, and even compromise when necessary. 7) Many leaders emerge when challenged, and it is a big mistake to passively fail to address leadership potential. 8) Perhaps most important, we have seen that the workforce can drive an LHD positively or negatively, and an engaged, involved workforce will be an LHD's strongest asset!
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