Summit County Health District and Akron Health Department - PDF document

Summit County Health District and Akron Health Department Consolidation Feasibility Study Presentation Intr oduc tion Re c e ntly e c o no mic , po litic a l a nd le g isla tive stre sse s ha ve le a d to a mo re o pe n c lima te fo r d isc ussio n a nd e xplo ra to ry initia tive s fo r me rg ing lo c al public he alth a g e nc ie s. Wha te ve r the mo tiva tio n, the pro c e ss o f me rg ing is a n e xc e ptio na l e xpe rie nc e a nd le nd s itse lf to the ra re o p po rtunity to e ng a g e pub lic he alth with the c o mmunity, e va lua te o rg a niza tio na l value s a nd visio n a nd re c a st the ro le o f yo ur a g e nc y. T he q ue stio n o f me rg ing a g e nc ie s is c o nte ntio us, po la rize s o pinio ns a nd is a so urc e o f g re a t a ng st. L o c a l c o mmunitie s a nd g o ve rna nc e e ntitie s must c o nsid e r whe the r to pursue a d ialo g ue to e xplo re fo rmal unio ns with g re a t tho ug htfulne ss a nd re spe c t fo r lo c al value s a nd tra d itio n. T he fo llo wing d o c ume nt is a n a tte mp t to c a p ture the c o nso lida tio n in Summit Co unty, Ohio o f thre e lo c al he alth d istric ts. E a c h c o mmunity is o b vio usly d iffe re nt a nd e ve ryo ne ’ s e xpe rie nc e in this re g a rd is uniq ue . T his is ne ithe r a g uid a nc e d o c ume nt o r ho w-to pa mphle t no r d o e s it c ite re fe re nc e s o r is it e vid e nc e b a se d . It is o ne pe rspe c tive with le sso ns le a rne d . T he info rma tio n is pro vid e d in a g e ne ric na rra tive fa shio n fro m the g e rm o f the me rg e r id e a to the c o ntra c t c o mple te ; e ffe c tive d a te o f unio n. I ha ve inc lud e d te xt b o xe s whic h pro vid e insig ht o f ho w we lo c ally a d d re sse d spe c ific issue s re fe re nc e d in the na rra tive . Also inc lud e d a re se ve ra l a ppe nd ixe s o f d o c ume nts we c re a te d d uring o ur me rg e r pro c e ss tha t so me o ne mig ht find use ful. Be st o f luc k to a nyo ne tra ve lling d o wn this ro a d , Ge ne Nixon

Pre - Preparations for Preparing 2/09 – 6/09 Assess local resolve to support a merger DIRECT or even casual overtures can be dangerous The consolidation of public health agencies, no less other government systems requires thoughtful consideration and early on-the-ground preparation to assure that there is sufficient social, political and institutional support for exploring the idea. Initially the water should be tested with trusted confidants that have sufficient political savvy to gauge and provide advice on community capacity for change. Seeking key community player’s guidance, direction and mentorship for moving forward and assessing the feasibility and political climate for a merger will pay dividends. Timing is crucial and to precipitously proceed before cultivating the appropriate community and governance institutional support may initiate fervent opposition stronger than any budding support. This potential backlash can become entrenched, hard to dislodge or reverse once established. The risk of initiating a swell of opposition in the community can immediately stall any dialogue and potentially lead to intense damage control or even; personal career or credibility damage. The consolidation of community institutions is a change and change requires the community capacity and flexibility to consider innovative alternatives. Local politics which is ineffective and mired in inaction may negatively politicize efforts to consolidate. Any discussions regarding a merger may easily be painted as a pointed failure in a depressed political climate that tends towards fault finding rather than solutions building. The appropriate confidants in the community can help provide an honest assessment of local politics and advice on moving forward. Trod carefully It helps to cultivate broad based origin support for the merger concept. The more principals that can claim early ownership of the idea; the more individuals there are with a stake to assure the success of the initiative. Stakeholders may include mayors and other elected officials, hospital leadership, Board of Health members, academic administrators, and other critical community leaders. The willingness of these local idea leaders to promote the merger concept with others broadens the base of original interest in the idea. This expanded base of early interest decreases the opportunity for personalized political attacks and begins to build broad “community support”. Early discussions with these leaders should not be too detailed or prescriptive. Rather, these early exploratory dialogues should be inquisitive of views towards the logic and expediency of a consolidation effort initiative. If it is determined that there is a core progressive capacity willing to carry the merger concept further, details will follow. Absent critical support, the details become irrelevant.

The principally affected agencies’ standing in the community and their recognized credibility are important predictors of success. The willingness of community leaders to expend political capital on any innovative idea, such as a merger of public agencies which may jeopardize their own public standing depends on their judged risk in the proposition’s success. The perceived risk is directly related to the perceived strength, past performance and credibility of those directly affected agencies. The stronger the organization or health district’s standing in the community, the more likely it will be to gain local support for advancing new ideas. Unfortunately of course, the inverse holds true as well. The merger of public health districts will face many challenges both administratively and directly; even in the form of personal attacks. Before seeking community support, an honest assessment of the internal agency capacity to carry forward the burden of a formal merger should be conducted and measured. Considerations include: Is the agency’s administration robust enough to manage the tasks associated with transition (personnel, fiscal, IT, legal)? Does the agency harbor enough top leadership capacity to bear the internal and external scrutiny of the process? Do the directors and supervisors have the experience, flexibility and innovative ability to transform and expand their units’ capacity? Is there sufficient Board of Health support? Is the agency fiscally strong enough to weather expected and unanticipated costs associated with a merger? Are there other organization issues, internal conflicts or circumstances that may undermine or limit progress towards consolidation? Why? It will significantly help the process of merging agencies if the question why is answered early. Different perspectives drive different assumptions about the need or value of a consolidation. Economic savings, greater efficiencies, better positioning for grant eligibility, stronger public health services are all equally valid priorities depending on the perspective. What should and what should not be expected from a union of health districts must be articulated clearly and often to avoid establishing unrealistic expectations. Significant dollar savings may not be possibly nor is it typical with other merger experiences. Greater public health services may not immediately materialize due to a transition period challenges, declining funds, or administrative limitations. Why then?