NACCHO Q&A: John Wiesman
On July 1, John Wiesman, Director of Clark County Public Health Department in Washington State became president of the National Association of County and City Health Officials (NACCHO), which is having its annual meeting in Los Angeles this week. NewPublicHealth spoke to Wiesman about his work in Clark County and his goals as president of NACCHO.
>>Follow NewPublicHealth coverage of the NACCHO conference throughout the week.
NewPublicHealth: What are some health-related accomplishments in Clark County that might serve as models for other communities?
John Wiesman: I think we’ve done a number of important things in our county. We strategically transitioned out of clinical services and partnered with community organizations that could provide those services.
NPH: What were some of the advantages of that change?
John Wiesman: I think one of the biggest advantages was it has freed up supervisory and management time, and actual staff time, to do more of that leadership role of system building and thinking. For example, how do we implement the Affordable Care Act and opportunities for bridging the divide between medical care and public health? So it really has, I think, freed us up from the day to day crises that have to be dealt with to being able to think more systematically and provide leadership to the system.
We made sure that the services were retained in our community, but this new approach allows us to look forward to where we think public health needed to go—in particular, how we addressed policy system and environmental changes to create conditions in which all people could be healthy. And in doing that, that has freed us up to work on a number of important projects, one being a “Growing Healthier” report, which looked at eight different components that could be impacted by a comprehensive growth management plan that the county has, and linked with the built environment.
We have also been working really hard on shared services in our region. The emergency preparedness area is probably where we have had the most experience so far in success. That success led to us actually delegating four counties and a tribe to a single incident command team. The goal was better use of the sort of overhead and management so that we could best deploy the public health workforce on the ground doing the work that was needed.
NPH: Do you think your new strategy could work for every health department?
John Wiesman: The solution we had does not work for everyone. If you’re in a community, for example, where there is no federally qualified health center, where there are no other resources to provide comprehensive care to the un- and under-insured, then the health department in that area might become the provider of last resort. So, it has to depend on community and resources. It has to be in the context of what resources are there, and the geopolitical issues of your area. That said, I do think that constantly we have to push ourselves to think how can we help lead systems and how can we continue to develop resources and assets in the community.
NPH: What do you hope to focus on as NACCHO president?
John Wiesman: Really I think there are two key foci. First is to help position local health departments for the future, and then secondly to continue to strengthen NACCHO.
When I look at positioning health departments for the future, I’m looking at, as I’ve said, closing the divide between public health and medical care. I’ve been one of those who has, for a long time, said “oh, that’s not my job, that’s the medical care system’s job, let’s get that over there and not get involved.” But I think that’s really short-sighted and I don’t think it’s working for anyone. When you look at the amount of money we’re spending on health care in this country, the kind of outcomes we’re getting and how public health is struggling, I honestly don’t think that divide is working for medical care, for public health, nor for our citizens. But I think we have to close that divide and the Affordable Care Act gives us many opportunities to do that.
Secondly, I think we need to fully embrace defining and costing out the minimum package of public health services that all health departments should provide and that all citizens should expect. I think we can no longer say “when you see one health department; you’ve seen one health department.” That thinking is not serving anyone well. So, by getting a minimum package of public health services, I think we’ll be able to define a set of core services that people need, and then we’ll actually have a public health brand that people can understand.
Thirdly, I also think we have to sustain our past successes, like communicable disease control, say food, water, air and soil and healthy starts for kids, while we also address the new public health challenges of obesity, healthy eating, active living and certainly climate change, which is one of those things that I fear is dropping off many people’s radars–although maybe not this last week with all the severe weather that’s been occurring across the U.S.
Then I think underlying those things, if we’re going to position health departments for the future, we have to address workforce issues. We’ve got to look at succession planning for the baby boomers who are going to be retiring—and looking at this from top leadership positions all the way to the staff level of the people who are going to go into those first supervisory jobs. We’ve got to prepare people for the challenges of the management of today and into the future, which I think is getting increasingly complex.
Another underlying issue is looking at technology and how we modernize our information systems, how we actually think about public health informatics bridging the delivery of medical care with epidemiology, with planning, with quality improvement, and actually pull together information in a way that’s useful for us as a system, and how we use technology to conduct outreach and educate folks to change behavior. We need to take a look at what’s been tried and what evidence do we have for what works.
NPH: What strengths do you bring to the job as a health director?
John Wiesman: I think I bring the ability to listen and to understand the multiple perspectives that people are facing in their work and in their communities. And I really do like to think and envision about what is a practical but bold path forward, get that path going and then let others lead it.
NPH: Clark County has an interesting collaboration model. Tell us about that.
John Wiesman: Located here in southwest Washington, we’re part of a four county region in the Portland metropolitan area. My office is just a 15 minute drive from Lillian Shirley’s office–Lillian Shirley, the director of Multnomah County Health Department and the immediate past president of NACCHO.
One example of our partnership was during the H1N1 response. We knew that the counties had to really be on the same page as much as possible about vaccine distribution, because our systems overlap. We have health provider systems that cross all of these counties, and so for them it was certainly critical that we have some consistent approach. We also share the same media market, and so it was really important to the public to get the same prevention messages.
So we were coordinating daily, literally, during that project. And that then broadened to us having the four health department directors and our health officers getting together monthly to talk about issues are we all addressing. What are we working on with our boards of health, that we might maybe duplicate in another community, given that geographic boundaries really are kind of invisible? We have people who work in each other’s communities, who shop, live, play in other’s communities, and so to the extent that we can have some consistent approach, that makes sense.
We also serve as sort of a learning collaborative among ourselves to understand why somebody’s taking on an issue, what have been the barriers to addressing it, what have been the facilitators to that. The collaboration has been really helpful in our own practice. It keeps all of us doing our best work, it gives us a chance to dialogue with each other, think critically about our future and learn from each other.
NPH: Is collaboration right for every health department in some form?
John Wiesman: I think it is, and collaboration can range from simply having an occasional meeting and just sharing information to literally thinking about well, gosh, what services might we be able to more efficiently provide across boundaries. For example, in southwest Washington, the four counties that we have range from one county, which has a population of about 3,500, to the county that I’m the department director of which has about 430,000 people. So are there opportunities for us to collaborate, for example, around health assessments? Can we share epidemiologists who do that? Again, we’ve got some systems that cross boundaries. Sometimes they are hospital systems, and so how might we share those kinds of resources? We collaborate when one department might be short, for example, environmental health specialists. How can we share resources across boundaries to help out during a time of recruitment? Then, of course, it goes to the whole gamut of maybe there are those collaborations that end up resulting in a merged health jurisdiction.
NPH: What about collaborations beyond public health?
John Wiesman: Absolutely. I really don’t think we can do our work today without those multiple collaborations. If one were to look at the favorite organization chart I have of my department, it has the governmental public health pieces in the middle, but it’s surrounded by an outer circle, which has business, tribal health, non-profits, schools–all the entities that truly make up the public health system. For example, we’re partnering with local corner stores in neighborhoods to sell healthy foods and we’re working with neighborhood associations and businesses in developing community gardens. We’ve got community gardens that are actually on business property. The owners are providing the water for the gardening, the master gardeners from the local university extension are working with people in helping to grow and produce their products. So, I think in our department we have as one of our central themes that we must build partnerships in order to build these healthier environments, and I think truly that’s where we need to head as a field if we aren’t already.
NPH: How do you think local health departments will benefit from the implementation of the Affordable Care Act?
John Wiesman: I do think that as leaders we need to certainly make sure that we are looking at how we’re going to implement the Affordable Care Act with the medical care community. I think there are four really key opportunities that some of us should be taking advantage of, if not all of us. The first is if we’ve got those non-profit hospitals in our community, they’re required to do community health assessments, and we should be right there at the table with them offering to help and maybe even lead those community assessments given that many of us have the resources in our departments to do that. And that leads into the non-profit hospitals community benefit requirement as uncompensated care decreases that opens up a whole opportunity to think about how hospitals also support a system that gives better care for everyone; patient navigators, for example, or funding asthma coordinators who might look at what makes a healthy home.
The second piece is in developing the health information exchanges. We should look at how we’re prepared to share electronic information with the medical providers. Certainly, the most obvious and easiest for the public health needs are reporting of communicable disease information, doing that electronically. But beyond that, looking at quality and outcomes data with the medical care systems to really see how we’re doing, where we need to target perhaps some focused quality improvement.
And the third place is in developing Accountable Care Organizations [read an FAQ about Accountable Care Organizations from Kaiser Health News]. Prevention has to have a prominent role in those, and public health and other non-profit providers, mental health providers, substance abuse providers need to be at the table talking about how accountable care organizations are going to provide services to the most vulnerable folks in our community. We have that expertise and we should be at those tables bringing that knowledge there and looking at how community supports are going to be put in place.
And the last one that comes to my mind is how do we engage health plans in reimbursement for services that we know will improve the patient experience and produce better population health outcomes—for example, reimbursement for systems that provide patient navigators so that a patient’s experience of the system can work for them and provide cheaper care.
I think these are some of the ways that public health can be an active player—by seeking out partners and finding the tables where we need to be sitting.
NPH: Finally, any advice for first time attendees of NACCHO Annual?
John Wiesman: Pace yourself. Pick a few areas that you might want to focus on and find out those sessions or those opportunities to learn more about and that you know will make a difference back in your community. Then, secondly, be willing to do that networking to reach out to people who are at the conference. I’m going to do my best to let everybody at the conference know that we’ve got first time attendees and new members and that those of us who have been there a few times ought to reach out to those folks, make them feel welcome, see how it is we can be helpful.