Transforming Public Health Systems in New Orleans
of city’s health department budget previously devoted to primary care clinics
of former clinic patients now receive primary care services from local partners
new program areas, expanding the city health department’s public health scope
increase in Women, Infants, and Children program participation in 2011
In recent years, the New Orleans Health Department (NOHD) in New Orleans, Louisiana, faced staggering challenges to providing public health services to its residents. The department lacked basic policies and procedures; programs operated in isolation without mechanisms for sharing resources or information; and, though all city organizations were facing major systems challenges and budget cuts, the possibility loomed of disbanding the health department.
Sixty percent of NOHD’s budget was devoted to funding struggling primary care clinics. The department housed approximately 30 years of clinic patient records that had never been systematically purged or organized chronologically, and approximately 400,000 immunization records dating back nearly 100 years. Further, NOHD lacked a clear inventory system for tracking the location or quantity of clinic supplies and equipment.
Expending extensive resources on primary care inhibited the department from performing the primary public health functions of assessment, assurance, and policy development. However, with pressing challenges in violence, behavioral health, and chronic disease, public health is a necessity for New Orleans. Beginning in 2011, NOHD developed an ambitious plan to transform itself into a 21st century model capable of addressing the serious population health challenges of modern New Orleans.
Working with local providers, as well as key department, city, and state staff, NOHD, under the leadership of a new health director, transitioned clinic patients to quality, affordable primary care sites and is coordinating with partners to address the backlog of patient records.
Using the Public Health Accreditation Board’s standards as a framework, NOHD also focused on building organizational capacity to provide excellent public health services. NOHD conducted an intensive strategic planning process to inform its transformational reorganization. With support from the new mayor, city administration, and city council, NOHD secured the funds to create new program areas (e.g., healthy lifestyles, violence prevention, behavioral health, emergency preparedness, community health improvement, policy, quality and performance management) outside the previous scope of NOHD operations.
In March 2011, a CDC strike team visited the health department to provide technical assistance in identifying skills and developing position descriptions, training in rapid-assessment methodology, and linkages to peer health departments. NOHD is currently working with City Civil Service to hire program leads in these areas.
With 98 percent of former clinic patients* (3,278) receiving primary care services from local partners, NOHD is now able to focus on protecting and promoting the health of all New Orleanians through population health initiatives. NOHD is currently in the process of a healthcare-access planning effort that will describe the total number in need of clinical health services.
From 2011 to 2012, the number of NOHD staff dropped from 137 to 75 and the budget shrank by more than 30 percent. However, with a focus on quality and performance improvement and a commitment to rethinking public health, the department has made notable advancement. The Women, Infants, and Children program increased participation by 13 percent in 2011, and the Health Care for the Homeless program successfully corrected many deficiencies to achieve full compliance with Health Resources and Services Administration requirements.
NOHD is establishing itself as a convener, working with diverse partners to facilitate, link, and leverage resources for improved health outcomes. In this role, NOHD leads partners on initiatives to eliminate childhood obesity, improve the behavioral health system, and enhance the local public health system through community collaboration and engagement.
In 2012, NOHD will focus on enhancing its performance management system, improving internal and external communication mechanisms, and updating the legal framework of rules, regulations, and ordinances to tackle new public health challenges, all while continuing to strengthen local partnerships to achieve a healthier New Orleans.
Publication date: 05/14/2012
The information in Public Health Practice Stories from the Field was provided by organizations external to CDC. Provision of this information by CDC is for informational purposes only and does not constitute an endorsement or recommendation by the US government or CDC.