Policy change: Everything is allowed, (except what is prohibited).

Submitted By

Kellie Teter
Denver Public Health, Colorado
December 19, 2013

We wanted to initiate a policy change at the local level to address infrastructure gaps for Denver Public Health (DPH). But we were stalled because we did not know what level of policy and systems change we were “allowed” to initiate. Federal funding restrictions, contacting the Mayor or the City Council, coordination with government relations staff in other agencies... we didn’t know where to start.

As the focus of community-based public health promotion efforts shifts toward population-level interventions through policy change, public health organizations and staff are entering into new areas of work at the local, state and federal level. In our case, our organizational procedures and structures did not provide staff with clear parameters within which they can conduct education and advocacy work.

Through a needs assessment completed with help from NACCHO, DPH identified the need to develop our organizational infrastructure to support policy work. We contracted with a local consultant to assess our organizational need regarding policy infrastructure and to propose recommendations. The consultant completed interviews with staff, managers and executive leadership within the department, at the Government Relations staff of our parent agency, Denver Health and Hospital Authority, and staff from Denver Environmental Health (the city's health agency) to assess the current state and perceived need related to infrastructure gaps.

The core team that worked with the consultant was happy and relieved to learn the basic findings of the consultant’s work:

  • Our structure (alongside but not part of the city; part of but not fully integrated with a hospital) makes our situation different and challenging;
  • Our structure also offers many leverage points (like a Government Relations department) that we can use in forwarding change.

Recommendations from the consultant included:

  • Implementing a policy “huddle” when opportunities or ideas surfaced, as one way to formalize decision making involving policy and advocacy work,
  • Developing a policy committee to implement the infrastructure building recommendations
  • Provide staff training including general policy training and skill-development training
  • Evolve current public communication newsletter into a policy position paper/fact sheet
  • Add “policy opportunity?” to current grant planning checklist
  • Create an urgent/emergency decision making protocol
  • Add or designate an internal policy analyst/coordinator staff position.

The tools necessary to complete the recommendations are currently being developed. DPH intends on forming the policy committee which will lead the implementation process in 2014.

“No one was more surprised than me when we chose the essential service 'Policy Development' at the end of the NACCHO needs assessment” said Kellie Teter, MCH Manager for DPH. “But all the stake holders were there, the process was very solid, and it just emerged as the logical place to go” she said. In the subsequent 12 months, the various forces that drive organizational development aligned over and over again for DPH. “Somehow, creating that space – starting the conversation – was the momentum we needed. Funds to pay the consultant were identified, a consultant was chosen and the process developed momentum and ownership much beyond MCH” according to Teter.

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