PCSI Prompts Changes to Maximize Health Benefits in the Public Health Arena

PCSI Success Stories

Strengthening Collaboration and Service Integration in San Francisco

The San Francisco Department of Public Health (SFDPH) Program Collaboration and Service Integration (PCSI) initiative led the way to the reorganization of SFDPH’s Population Health and Prevention Division. For many years, the Population Health and Prevention Division consisted of 11 autonomous sections that covered separately myriad diseases and health concerns. Most of the funding and activities of SFDPH were categorical (i.e., disease-focused). This structure was highly successful in the past for SFDPH. However, with today’s rapidly changing external environments, a much more integrated infrastructure conducive to coordinating and aligning activities and rapidly responding to new and changing needs in population health is required.

Building on the foundational work that was done in the design of the PCSI initiative, SFDPH developed a comprehensive plan that included its vision, mission, and guiding principles to reach a primary goal of maximizing health benefits for persons receiving prevention services. Based on these, the SFDPH Population Health and Prevention Division reorganized to form the Population Health Division (PHD). The new PHD ensures a strong and more integrated organizational structure. The changes not only help prepare the department for evolving population health challenges, public health services, and health financing, but also provide a foundation to improve the health among populations affected by multiple diseases; increase service efficiency; and maximize opportunities to screen, test, treat, or vaccinate those in need of these services.

PCSI Steering Committee

To strengthen inter-organizational collaborations, a PCSI Steering Committee was developed in 2011. Over time, the steering committee grew to include all of the PHD Branch directors and senior managers and became a forum for discussing recommendations on systemic approaches to align services and maximize operations for the Division. The organization design principles, modified from the PCSI principals, include:

• Decide and act as one health department and one division;
• Create integrated systems that are community- and client-centered;
• Create integrated systems that maximize collective resources;
• Engage diverse stakeholders at all phases; and
• Protect and promote health equity.

Staff and Community Engagement

The SFDPH PCSI staff, a PCSI champion, coordinator, and data analyst conducted more than 25 focus groups and meetings to develop a process for staff and community engagement. The following themes were identified through the process:

• Lead SFDPH efforts in health protection, health promotion, disease prevention, and disaster preparedness;
• Be community-centered (“healthy people”);
• Promote healthy, sustainable environments (“healthy places”);
• Operationalize division-wide focus on health equity;
• Become agile, adaptive, and responsive to emerging challenges;
• Strengthen service excellence to communities, clients, and providers;
• Become a learning organization with a culture of trust, innovation, and continuous improvement;
• Strengthen culture of discovery and world class research; and
• Achieve and maintain Public Health Accreditation.

Outcomes

By utilizing PCSI as a foundational structure, SFDPH successfully reorganized the Population Health and Prevention Division into the Population Health Division (PHD), effective March of 2013. PHD’s vision is “To be a community-centered leader in public health practice and innovation.” Its mission is “Drawing upon community wisdom and science, we support, develop, and implement evidence-based policies, practices, and partnerships that protect and promote health, prevent disease and injury, and create sustainable environments and resilient communities.”

With a greater focus on integration and collaboration, changes that were implemented included:

• Integration of assessment, surveillance, epidemiology, applied research, and informatics to support division, SFDPH, and citywide efforts;
• Integration of disease prevention and control services;
• Integration of specialists in community engagement, planning, and mobilization to focus on the Spectrum of Prevention; and
• Creation of a division-wide infrastructure to support professional development, quality improvement, grant development, operations and fiscal efficiencies, and public health accreditation.

Lessons Learned

The PCSI initiative was instrumental in providing the conceptual framework for the design of the Division integration. The framework included identifying champions, forming a core team, and developing working groups that aimed to increase efficiency, maximize services, and identify sustainable solutions that would promote population health and wellness beyond communicable disease in the jurisdiction. Using the PCSI initiative as the springboard, the new structure improves the Division’s ability to meet future public health challenges.

For more information, please contact:
Israel Nieves
PCSI Coordinator Director, Policy Unit HIV Prevention Section San Francisco Department of Public Health
415-554-2655
Israel.Nieves@sfgov.org

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