Leadership and Innovation in Public Health


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Innovation in Public Health, the evolution of the Healthy Chicago public health agenda

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  • This is the current CDPH organizational chart. We have over 40 programs in total and they are not much different from what you’d see in many large urban health departments – emergency preparedness, maternal and children’s health, communicable disease control, etc. But this is just who we are and doesn’t adequately address what we do and what we value. To consider that, we need to consider the challenges that local public health departments are facing in their efforts to create change and innovate.
  • These are just some of our current challenges to change:In its most study of nearly 3,000 local health departments, the National Association of County and City Health Officials have found that 39,6000 public health jobs have been lost and more than half of local health departments nationally have been forced by the economy to reduce or eliminate services.In Chicago, we face a public health infrastructure that was developed over 100 years ago. There is a long history and lots of tradition. But with that can come a “That’s the way we’ve always done it” attitude, and inertia gets in the way of change efforts.In Chicago, like anywhere else, you have to consider the political landscape. CDPH is just one of more than 30 agencies demanding resources and support from City Hall. And just like anywhere else in the country, it takes more than just business as usual to keep public health in the spotlight. Also, while I report directly to the Mayor, I also am accountable to 50 City Council members. They are all elected officials and their positions are not always aligned with that of the administration, so this can be somewhat of a balancing act.Finally, we also have to balance the demands of multiple interest groups against what’s in the best interest of public health. ------For these types of challenges – sound management is not enough. I can’t just have a department that’s doing a more efficient job at what we’ve done in the past. It’s just not enough. We need to be able to manage change and drive innovation. And to do that, a framework is required. I have been applying two lenses in efforts to move CDPH from our organizational structure and the delivery of routine health services to agency that innovates.
  • I’m sure you’re familiar with this graphic of the core functions and essential public health services. . It has often been said that “public health is everything.” But if it’s everything then its really nothing. You have to be grounded in what’s distinctive about public health and how public health adds value. How we do things that nobody else does.So our vision is grounded in the essential services, which allows us to focus our work on what’s importantI am always challenging my staff to be innovative, but if someone proposes an initiative and it doesn’t logically fit within this framework, then I probably won’t support it. But even with this model, the story is not fully told. For example, there are many ways one can “monitor health.” We have traditionally done this passively by waiting to receive data from birth and death records or on reportable conditions. But we are currently waiting about 2 years to get death data from the State and historical infant mortality rates do little to inform future interventions and improve public health. In the past two years we have become much more proactive in strengthening relationships with other providers and identifying new and more timely data. For example, this year we gained access to over 80,000 student health records from the Chicago Public Schools – from this we have developed the most comprehensive report to date on childhood obesity in Chicago. Just as important, through this partnership we have established a strong foundation for future collaboration on our shared priority of children’s health.
  • The second lens that has influenced my role as a leader, comes from Tom Frieden at the CDC. This graphic builds on the Essential Services and underscores the need to focus public health efforts more broadly – not just on the health and behaviors of individuals. This framework shifts us from the old public health model of delivering services to building and monitoring system performance. By calling on public health practitioners to change the context in which decisions are made and to address socio-economic factors, this framework demands that we focus on systems, policy and environmental changes.I want to focus on this for a moment because this thinking has really re-defined the way we’re doing business at the Chicago Department of Public Health.
  • This slide focuses on our tobacco prevention efforts, but exemplifies what I am trying to achieve across the department. We receive about $1 million annually from the Illinois Public Health Department in tobacco prevention funding. Historically, those funds have been used for traditional public health interventions – education and cessation support. But these efforts are focused on individuals and small groups – and while they may make a difference with those people, we will never be able to scale it up to a level where we can make a significant public health impact. To do that requires that we operate at a policy and system level.So we have re-focused our energies and resources on creating more sustainable change that will impact not just the small numbers we were previously reaching, but on the systems that influence their behaviors and those of the larger population.
  • In my experience,Innovation has to be part of everything we do.I have worked to create a culture where people feel that it is safe to propose innovative concepts, and where managers can recognize and promote such concepts. My job is to have the vision and empower my team to generate creative solutions to longstanding problems. It is also my job not just to try new things, but to connect them to credible opportunities. Here are a few recent examplesWhile each of these examples is different, they have two critical things in common. Innovations have to be tied to resources and innovations must have political support.
  • As the City’s health commissioner, one of the most important things I can do is to serve as a primary champion of innovation.I spoke about how I’ve been able to gain support from the Mayor’s Office – which is essential to our success. But there are other partnerships that we need to both create opportunities and, in some cases, to implement them.I spend about 80% of my time selling public health and selling the Chicago Department of Public Health. It makes no sense to foster innovation internally and not promote it and gain the support that will maximize our success. Summary:- Risk takingBudgetingBuilding support
  • Leadership and Innovation in Public Health

    1. 1. Chicago Department of Public Health Leadership and Innovation in Public Health: From Silos to Systems Bechara Choucair, MD Commissioner Chicago Department of Public Health @choucair on Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
    2. 2. CDPH Organizational Chart
    3. 3. Challenges to Change• Dwindling local health department resources – 39,600 jobs lost; 57% have reduced or eliminated services.• Infrastructure developed over 100 years ago – Tradition creates inertia that impedes change efforts• Political environments – One of several City agencies – Accountable to both Mayor and City Council• Interest groups
    4. 4. Increasing Increasing IndividualPopulation Impact Counseling Effort Needed and Education Clinical Interventions Long-Lasting Protection Interventions Changing the Context to Make Individuals’ Default Decisions Healthy Socioeconomic Factors
    5. 5. Tobacco Prevention Efforts Increasing Increasing IndividualPopulation Impact Effort Needed Tobacco education to CPS Cessation students Classes Capacity building for youth service providers Increased Restrict Undercover fines and Stings Points of Enforcement Sales Smoke-free Smoke-free Smoke-free Housing Hospitals Campuses
    8. 8. HEALTHY CHICAGOChicago Department of Public Health
    9. 9. Evolution of Healthy Chicago2010 February – May August 2011 2011
    10. 10. Fostering Innovation: A Leadership Function • Innovation Loan Fund – Tobacco Enforcement • CMS – Health Care Innovation Grants – Integrated Assertive Care for homeless adults with mental health challenges • Bloomberg Challenge – Healthy Chicago Public Schools – Corner Stores – Reducing recidivism through social impact bond model
    12. 12. Linking Healthy Chicago to Budget• Vision should guide resource allocation• Focus on core public health functions• Built budget around Healthy Chicago
    13. 13. Building Support• Government – Local – State – Federal• National partnerships• Community organizations
    14. 14. Leadership and Innovation• Framework that reflects vision• Managing the political process• Fostering innovation among workforce• Taking risks• Linking budgeting to innovation• Building support
    15. 15. facebook.com/ChicagoPublicHealthGplus.to/ChiPublicHealth@ChiPublicHealth312.747.9884CityofChicago.org/HealthHealthyChicago@CityofChicago.org