PU550 Unit 4 Organizational Assessment Example

Eleven Direct Reports, One Empty Epidemiologist Post and Inspections Still on Paper: A Unit 4 Organizational Assessment Weighing a Composite District Health Department's Structure Against the Services It Is Required to Deliver

[Student Name]

Purdue University Global

PU550: Public Health Leadership and Administration

Unit 4 Organizational Assessment

[Instructor Name]

[Date]

The Aldermere Valley district, its structure and its figures are composite; the assessment framework and the research cited are real.

Method

Three sources: the district's position roster and organizational chart as of this month; the statutory and accreditation requirements the district must meet; and 19 interviews with managers, supervisors and three county commissioners. Each finding below names what was observed, what requirement it bears on, and what it costs the district now rather than in principle.

Finding One: Span of Control at the Top

Eleven positions report to the health officer: five program managers, the environmental health director, the nursing director, the emergency preparedness coordinator, the business manager, the public information officer and the administrative supervisor. Observed effect: the health officer spends an estimated 14 hours a week in one-to-one supervision, holds no scheduled time for board and commission work, and three managers reported waiting nine or more days for a decision that needed her signature. The requirement at stake is not a staffing standard but the governance work only she can do, including the fee ordinance campaign that failed partly for lack of sustained advocacy.

Finding Two: A Vacancy That Is a Capability Gap

The epidemiologist position has been vacant for seven months. Its effect is measurable: communicable disease investigations completed within 24 hours fell from 91 to 78 percent, the annual community health assessment is nine months late, and two grant reports were submitted with data assembled by a nurse supervisor working outside her role. Epidemiologic capacity is not a convenience in a district of this size; it is the foundation of assessment, and the workforce literature is consistent that these are the hardest positions for local agencies to fill and the most damaging to lose (Leider et al., 2018). A vacancy becomes a structural problem when the work does not stop, because then it is being done by somebody whose own work has stopped instead.

Finding Three: Paper Inspections

Food service inspections are recorded on carbon forms, entered into a database by an administrative assistant an average of eleven days later, and are not visible to the public. Three consequences follow. Repeat violations cannot be identified during an inspection, because the inspector has no history in hand. The eleven-day lag makes outbreak investigation slower, since the most recent inspections are the ones not yet entered. And 0.6 of a full-time equivalent is spent on data entry that a tablet form would eliminate. The district's own estimate for mobile inspection software is 38,000 dollars in year one and 14,000 annually.

Finding Four: Three Counties, One Agency, Three Service Patterns

Dunmoor has a staffed office five days a week, Pellworth four, Thraxton two. Interviews found that the pattern follows historical staffing rather than need or payment: Thraxton has the district's highest rate of uninsured residents and its lowest service availability. No requirement is breached, and the board's equity policy is contradicted. This is the finding most likely to be resisted, and the assessment records that two commissioners said in interview that service should follow contribution.

Finding Five: Quality Improvement Exists on Paper

The district has a quality improvement plan, adopted three years ago, with four projects listed and none completed. The performance management committee has met twice in two years. The accreditation measure requiring a functioning quality improvement process would not be met on current evidence, and the agencies that report real benefit from accreditation are those where the process is used rather than documented (Siegfried et al., 2018).

Finding Six: Supervision Without Training

Of the district's 22 supervisors, 14 were promoted from practice roles and none received management training before taking the role. Interviews surfaced the predictable consequences: three supervisors had never conducted a formal performance conversation, two were carrying full caseloads alongside supervision of six or more staff, and the district's own exit interviews name immediate supervision as the second most common reason given for leaving. The requirement at stake is the agency's workforce development plan, which exists and has funded no supervisory training in three years. This finding matters more than its size suggests, because every other recommendation in this assessment will be delivered by these 22 people.

Recommendations

1. Reduce the health officer's direct reports from eleven to six by creating a deputy director over the five program managers, funded by holding one program manager vacancy. Cost neutral in year one. Owner: health officer. Date: next budget adoption.

2. Fill the epidemiologist post at a salary benchmarked to the regional hospital system rather than to the district's own scale, and accept the 11 percent premium as the price of a capability the district cannot borrow.

3. Fund mobile inspection recording, offsetting part of the cost against the 0.6 full-time equivalent of data entry and part against faster outbreak response.

4. Bring a three-county service availability plan to the board, with the equity policy and the contribution argument stated side by side rather than resolved by the staff who cannot resolve it.

5. Fund two days of supervisory training for all 22 supervisors in the coming year, delivered regionally rather than individually, and make completion a condition of holding the role.

What the Assessment Does Not Recommend

It does not recommend a reorganization of the environmental health and nursing divisions, which several managers proposed. The reason belongs in the document: both divisions meet their service requirements, the proposed merger would save no positions, and the evidence on local health department structure does not show one configuration performing better than another once size and resources are accounted for (Hyde & Shortell, 2012). Reorganizing in response to a vacancy problem and a software problem would cost the district a year of attention and fix neither. The assessment also stops short of recommending that the district take over the two school nursing contracts that Pellworth's districts hold privately, although three managers raised it. The work would fit the agency, the funding would not follow it, and adding an unfunded service to box four of the district's program grid while the board is absorbing a county cut would be an odd use of this assessment's credibility.

Limits of This Assessment

The interviews were voluntary and no one from the two counties' commissions outside Dunmoor and Thraxton took part. The inspection timeliness figures come from the district's own database, which is the system the assessment criticizes, so the lag may be understated. No cost estimate here has been through procurement. And the assessment deliberately does not evaluate individual managers, since a structural review that becomes a personnel review stops producing honest interviews, which is the same reason the district's after action reports are written in systems language.

References

Hyde, J. K., & Shortell, S. M. (2012). The structure and organization of local and state public health agencies in the U.S.: A systematic review. American Journal of Preventive Medicine, 42(5), S29-S41. https://doi.org/10.1016/j.amepre.2012.01.021

Leider, J. P., Coronado, F., Beck, A. J., & Harper, E. (2018). Reconciling supply and demand for state and local public health staff in an era of retiring baby boomers. American Journal of Preventive Medicine, 54(3), 334-340. https://doi.org/10.1016/j.amepre.2017.10.026

Siegfried, A., Heffernan, M., Kennedy, M., & Meit, M. (2018). Quality improvement and performance management benefits of public health accreditation: National evaluation findings. Journal of Public Health Management and Practice, 24, S3-S9. https://doi.org/10.1097/PHH.0000000000000692