What We Have Learned
“Winnable Battles pushes us out of our comfort zone and into action,” said Althea Grant, PhD, who led several emerging Winnable Battle programs for the agency. “We are typically researched-focused and the Winnable Battles approach is translation-focused, meaning the emphasis changes. The goal is to put into practice now what we know works to improve health.”
In 2010, Winnable Battle programs ran the gamut. Some were large, well-resourced programs with sophisticated policy and communications operations that were accustomed to utilizing many outlets to ensure their evidence-based strategies reached the field. Other Winnable Battle programs were small, research-focused offices without the resources to develop approaches that would translate their science to policies and practices that were usable in the field. The effect of being a Winnable Battle program varied depending on its starting point.
For example, having direct, regular contact with the director helped Tobacco and HIV, both of which are highly visible, large programs. The ability to discuss strategy on specific projects and obtain the leadership’s expertise and real-time feedback helped these programs avoid what could be weeks or months of work that was not optimally focused.
Other, smaller programs, such as Healthcare-Associated Infections and Motor Vehicles, were able to leverage this direct connection with CDC leaders to establish or strengthen critical relationships with the leadership of other HHS agencies and other offices across government. Once these relationships were formed and agreement about overall joint projects was established, staff were able to work across agencies much more productively.
One example of cross-agency work can be found in the Tobacco Winnable Battle. CDC began providing technical support to the FDA in the area of tobacco control, where CDC’s science and analyses inform the FDA in accomplishing its regulatory work, implementing the Family Smoking Prevention and Tobacco Control Act.
Another example comes from Motor Vehicle Injuries. CDC signed a memorandum of understanding (MOU) with the National Highway Traffic Safety Administration (NHTSA), following which the Injury Center’s Transportation Safety Team was able to work with NHTSA staff on ignition interlock research and other motor vehicle injury prevention efforts.
The CDC senior leadership’s ability to build bridges with the Centers for Medicare and Medicaid Services (CMS) has dramatically increased the number of hospitals reporting healthcare-associated infections. CDC’s Division of Healthcare Quality Promotion, lead of the Healthcare- Associated Infections Winnable Battle team, collaborated with CMS to promote the nascent surveillance system, the National Healthcare Safety Network, to become the standard surveillance system for tracking and targeting healthcare-associated infection prevention efforts to meet HHS and Winnable Battle goals.
“As a Winnable Battle, we were challenged to be strategic and prioritize our activities based on how much we can impact the health of Americans,” noted Ann Dellinger, PhD, MPH, who previously served CDC as epidemiologist and team leader for the Motor Vehicle Injury Prevention Team at NCIPC.“ How do we save as many lives as possible? We focused on some of the policy changes to facilitate more widespread adoption of critical behaviors, like wearing your seat belt.”
For other programs, the opportunity to access the expertise and vision of other senior leaders, including the Associate Directors of Communications, Science, and Policy could be invaluable. One example of the synergy created by Winnable Battles within the agency is found in Teen Pregnancy. The Division of Reproductive Health (DRH) and the Division of News and Electronic Media in the Office of the Associate Director of Communication (OADC) collaborated to develop a Teen Pregnancy Social Media Toolkit to better reach teens where they are, online.
Another example comes from Food Safety. The Division of Foodborne, Waterborne, and Enteric Diseases (DFWED), which was designated the lead program for the Food Safety Winnable Battle, is a science-focused office that has great expertise in outbreak response and surveillance. The Winnable Battle designation gave the program the opportunity (and impetus from leadership) to think differently – to focus on preventing, rather than on merely reducing foodborne illness. Working closely with the Associate Director for Communication, DFWED staff embraced a broader connotation of Food Safety to prevent and respond to health threats in the nation’s food supply and consequently expanded its identity and role in public health.
Sharing the Message
In addition to making progress on the Winnable Battle focus areas, the agency wanted to share ongoing successes and challenges across CDC. CDC Director, Dr. Frieden updated staff on Winnable Battles at All-Hands meetings. An intranet site, email listserv and information sharing events provided virtual and face-to-face forums to update staff on strategy, approaches and tools.
Early in 2012, CDC held an Expo, at which each Winnable Battle program created a display which they staffed and provided short talks. The Expo was an opportunity for Winnable Battle programs to highlight strategies, approaches and products each has used to promote the public health goals in their focus areas. Designed as a showcase of the strategies and products used to achieve those accomplishments, the Winnable Battles Expo featured presentations on how strategies and products were developed, their impact, and lessons learned. The Expo provided an informal setting to give attendees a better understanding of Winnable Battles “best practices,” as well as inspire programs throughout the agency with new ideas that could be applied to their work.
CDC organized several “Lunch and Learns” around specific themes such as strategies for accelerating progress through partnerships and new tools and resources to demonstrate the effectiveness of interventions. Programs also connected informally on common issues on which one may have progressed and could advise the other.
While the designation of “Winnable Battle” did not bring with it automatic additional funding, Winnable Battles did have access to certain agency resources to enhance their work, including support from the highest levels of the Director’s office. For example, some of CDC’s best communications offerings were made available. Winnable Battles generally had an annual Vital Signs issue devoted to an aspect of their focus area. Each Vital Signs is followed by a set of communications activities, including a virtual Town Hall, giving programs a unique opportunity to focus external attention on a particular issue, including burden data and recommended evidence-based interventions.
When opportunities came to the agency or were offered by the Office of the Director, Winnable Battle programs often were prioritized to take advantage of them. For example, applications to an Office of the Associate Director of Policy (OADP) Policy Competition were required to address HHS or CDC health priorities and used Winnable Battles to describe the agency’s priorities.