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Table 2 Comparison of high and low capacity local health departments (LHDs) by A-EBP domain

From: Implementing administrative evidence based practices: lessons from the field in six local health departments across the United States

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
  1. aSelf-reported by LHD leaders