Indiana State Department of Health, Case Study Example

This case is fundamentally about the future strategic direction of Indiana’s State Department of Public Health. Indeed, the new commissioner of the ISDH, Dr. Bailey, has called for a strategic planning effort in order to increase the Department’s ability to play a proactive role in improving the health (and health outcomes) of Indiana results. Bailey has asked for immediate recommendations that can be implemented over the next two years.

There are three main problems that must be dealt with in the next two years: 1) external relations with local (county) public health departments; 2) internal reforms to Department culture that will improve leadership and morale; 3) financial reforms to ensure the Department can successfully complete its public mission. Of the three main problems identified, the sub-optimal relationship between the ISDH and local public health departments is the most urgent. Historical and structural reasons explain the extant problems. Indiana, as a state, has a history of local independence; that is, individuals in general are suspicious of aggregation of power above them (Caper, Ginter, and Swayne, 2002). . As a result, the ISDH essentially supervises and provides technical assistance for local public health departments; counties make their own decisions (both operational and financial) regarding what services to provide, how to provide them, and how they will be financed (Indiana State Department of Public Health, 2012). This is a fundamental problem if the ISDH wants to fulfill its mandate in ensuring equal access and outcomes across the state- there must be efforts made for the ISDH to fund and manage standardized programs across the state.

The second main problem that should be addressed is the financial situation of the ISDH. Currently, the ISDH is underfunded from a state perspective (roughly 49^th on a per-capita basis); the Department, over the past five years, received a decreasing share of a shrinking state general fund (Caper, Ginter, and Swayne, 2002). The Department has secured robust federal funding that has allowed it to meet its current responsibilities (Caper, Ginter, and Swayne, 2002). . The problem in finances is related both to the problem with local health departments (cited above) and internal reforms (that will be discussed below). With limited access to state funds and an (over) reliance on federal funds, the Department will likely face a fund shortage over the next five years. This is particularly the case if the Department undertakes needed capital expenditure for its physical facilities, IT infrastructure, and an increase in employer salaries. This money will need to come through greater cooperation with local governments to tax local tax dollars (this will not be easy), increased applications for federal co-funding, and greater support for the governor on health issues.

Internal reform is listed last not because it is unimportant, but because it can probably only be effectively tackled until the relationship with local public health boards and finances are solved. This is because the two main problems internally, lack of strategic direction and low employee morale, are a function of establishing a clear strategic direction and budgetary resources to make the adequate investments in the Department. Indeed, this should only take place once an understanding of how the issues are dealt with.

Overall, the future strategic direction of ISDH will be dependent on its ability to leverage its relationship with local public health departments to achieve common goals, secure stable budgetary resources, and reform internally. This is not to say that the number of other objectives and problems identified in the report should not be dealt with. However, a key element of any strategy is understanding what key components of the ISDH must change and be secured before taking on future challenges. Regardless of the numerous contingencies offered for future health reform, the ISDH must stabilize its fiscal and stakeholder relationships before it can accomplish its current mandate, let alone take on more complex challenges.

Resources:

Capper, S.A., Ginter, P.M., Swayne, L.E. (2002). Public health leadership and management: cases and context. Thousand Oaks, CA: Sage Publications, Inc. (Case 3: The Indiana State Department of Public Health: Managing Strategically).

Indiana State Department of Public Health Web Site.