Leading Through Health System Change: A Public Health Opportunity

Background: The changes inherent in the Affordable Care Act (health reform) have extensive implications for all aspects of the U.S. health system: financing, service delivery, public health, coverage and access, quality, and ultimately, well-being. During this critical period of transformation, public health has the opportunity to address both technical and adaptive challenges, think systemically, and begin to lay the groundwork for strategic action and innovation.

Program background: Leading through Health System Change: A Public Health Opportunity Planning Tool was developed in coordination with the Center of Disease Control and Prevention’s Office of Health Reform, the Georgia Health Policy Center at Georgia State University, and the National Network of Public Health Institutes. It is meant to heighten one’s learning capacity and leadership skills through two key concepts: (1) technical versus adaptive challenges and (2) a five-step learning process. The participant follows a series of steps that include defining the question, learning about the requirements of the Affordable Care Act related to a question, collecting information, selecting options, applying adaptive actions, and creating a simple implementation plan. The collaborative planning tool is currently being piloted as a webinar, introductory video, interactive PDF, and website. Dissemination has included informational webinars to federal and state agencies, state and local public health departments, and national membership organizations and associations. Further dissemination efforts may include partner communication channels (newsletters, websites, webinars, and social media); national conference presentations; flash drive distribution; and online portal resources including success stories, videos, and an online forum learning community.

Evaluation Methods and Results: Qualitative data regarding the feasibility of the tool was collected through twenty semi-structured interviews, an introduction webinar, a focus group at the ASTHO Senior Deputies meeting, and a pilot program with diverse states from around the nation. The tool was developed and revised with the assistance of adult education and course development consultants. A thematic analysis showed that overall, leaders benefited from using the tool. The flexibility of the process, working in teams or as an individual, and the mode in which the work may be completed, electronic or PDF format, were identified as key components of the ease of the tool’s usage. The process allowed for the opportunity to stay abreast of the evolving issues related to the ACA. Adaptive thinking provided leaders with a diagnostic capacity with elements in planning, building partnerships, and gathering information. As a result, participants were able to create a simplified strategic plan for their organization.

Conclusions: Practitioners have vital questions related to how health system change and the ACA will affect their organizations and want information and tools for navigating through the law. This tool provides a new conceptual framework that lays the groundwork for strategic action and innovation.

Implications for research and/or practice: During this critical period of transformation, public health has the opportunity to think systematically and begin to lay the groundwork for strategic action and innovation with a conceptual framework for leading, navigating and leveraging multiple aspects of the ACA and health systems change, to improve population health.