Table 2 Comparison of high and low capacity local health departments (LHDs) by A-EBP domain
AEBP | High | Low | Both |
|---|---|---|---|
Workforce development | |||
Training | - Budget line item for continuing education | - No financial support to go to trainings | - Recognize the need for trainings |
- Try to send staff to all state and some national conferences | - Very few if any attended | - More are needed | |
- Use time during all staff meetings to conduct trainings | - Potential areas of focus: accreditation, webinars (as opposed to in-person training), specific topic-related conferences | ||
Leadership | |||
Skills & background of leadersa | - Physician/MPH/PhD | - Masters in Management | |
- Bachelors in SW, MSW, completing MPH | - Bachelors in nursing, certificate of grad study in fundamentals of public health | ||
- Bach in science and education | |||
Values & expectations of leaders | - 100 % supportive of use of EBPs | - Directors mostly supportive of EBPs | - Supportive of EBPs |
- Expect LHD to grow and change including use of EBPs | - Not all upper management were supportive of EBPs | - Know EBPs should be used | |
- Feel it is their job to provide direction and training for their staff in EBPs | - Poor communication of EBPs and expectations | - Want to provide quality service for the clients | |
Participatory decision-making | - Decisions often made by consensus | - State makes many decisions | - Subject matter experts at the LHD consulted |
- Ideas come up from staff to management and tested | - Decisions mostly made by upper level management team | - State and regional HDs give directives | |
- All staff meetings once a month to gather and distribute ideas | - Director makes decisions after evaluating staff ability and capacity for programs | - Involve community members and stakeholders | |
Organizational climate & culture | |||
Access and free flow of information | - University libraries | - Very little access to online or paper journals | - Internet access |
- Attendance at conferences, in-person and online trainings | - Information from state office | ||
- Some academic journal subscriptions through LHD | - National Association of County and City Health Officials | ||
Support of innovation & new methods | - Supports and encourages new ideas | - Many people in the LHD are adverse to change | - Would like staff to be open to change more |
- Uses QI to explore things that can be changed to improve LHD | - No flexibility to try anything new because many priorities are mandated by the state | ||
- Hires employees that are willing to change with the LHD | - New ideas are not well-received | ||
- “Global” instead of “Silo” approach to programs | |||
Learning orientation | - Send staff to conferences and/or conduct trainings at the LHD show support of learning | - Do not necessarily emphasize collaboration, especially multidisciplinary | - Would like to send staff to more trainings and conferences but can’t due to lack of budget |
- Many staff go back for MPH while working | |||
- More multidisciplinary collaboration within the LHD | |||
Relationships & partnerships | |||
Interorganizational relationships | - Some sharing of funding between partners including grants from the community | - Funding is only shared within the department | - Feel partners are essential to work of the health department |
- Share facilities | - Looking to community assessment to bring LHD and community partners closer | - Share staff time and resources with partners | |
- Community partners have been involved in trainings | |||
Vision and mission of partnerships | - Seems collaborative | - Many partnerships seems to be one working for the other instead of collaborative | - Come together for the good of the citizens |
Financial | |||
Allocation and expenditure of resources | - State department provides funds to the LHD to prepare for accreditation | - No funding that is not already earmarked for specific programs | - Lack of finances is major roadblock to implementing EBPs and EBDM Process |
- Line item in the budget for trainings and conferences | - Positions have been cut due to budget cuts | - Lack of funding to pay high salaries can lead to hiring of staff that has less experience and/or less education | |
- Several staff felt their LHD has the financial stability needed | - Financial situation makes even mandated programs difficult to implement |