Paul Kuehnert: NewPublicHealth Q&A
This summer, Paul Kuehnert, MS, RN, joined the Robert Wood Johnson Foundation (RWJF) as senior program officer and director of the Foundation’s Public Health Team. For nearly 20 years, Kuehnert has provided executive leadership to private and governmental organizations to build and improve systems to address complex health and human services needs. As the county health officer and executive director for health for Kane County, Ill, he led public-private partnerships, integrated planning with transportation, land use, parks and recreation and other diverse sectors, and a comprehensive wellness program for government workers that resulted in demonstrable improvements to the health of employees – as well as marked cost savings [watch an RWJF Public Health in Action video profile of Kuehnert].
NewPublicHealth caught up with Paul Kuehnert during the National Association of County and City Health Officials Annual Meeting this week to talk about the future of public health, and what his decades of leadership in government and private organizations to improve health has taught him.
NewPublicHealth: You were a health director at a time of great change in public health, and that includes massive budget cuts and incredibly rising rates of chronic disease, all creating a very challenging environment. How did that shape your approach to leadership at Kane County and how do you think it will inform what you’ll now be doing in your position?
Paul Kuehnert: I think we’re living through a time that there’s this incredible convergence of the recession, the epidemic of chronic diseases and other situations that all present challenges for public health. As a local public health leader, the key thing was to really develop a strategic focus and to find ways to engage policymakers and other community leaders and partners. That was and is so critical because I think what we have to do in these times is really sort out what it is that public health, and in particular, governmental public health really has to do in order to meet these challenges. And, what is it that other partners can do or, in fact, may do better than governmental public health, which has to be an excellent steward of the public resources. Governmental public health has to be really well versed in what the evidence is for the kinds of things that we’re doing, and be mindful of being very accountable and very transparent in the community as relatively scarce dollars are used to provide services to the community.
Those are the issues that were key for me when I was a local health director, and I think what that does for me in my new position at the Robert Wood Johnson Foundation is that it has really grounded me in the reality that these are very different and very difficult times for public health. So, I would say the same things that were true for me as a local health director really have to be true for Robert Wood Johnson Foundation as well. We need to be strategic, we need to be focused, we need to engage policymakers and stakeholders in our work and we need to be very transparent about what we’re doing. So, I feel like my recent experience, in the trenches really provides a grounding for me in this new position.
NPH: Partnerships are critical to the future of public health and health departments. What partnerships did you develop or advance that were most critical to the success of public health endeavors in Kane County?
Paul Kuehnert: One of the things that we identified early was that we had to develop a very robust set of partnerships, some that I would consider externally focused, such as community businesses, schools and hospitals and health centers. And then also, we needed to be focused on developing partnerships internally within government and also look at non-traditional partners for public health. One of the areas that I really focused on was developing partnerships with our development department, our transportation department, certainly law enforcement and emergency management. It’s really a challenge to develop all those at the same time, but it’s really necessary for a couple of reasons: One is certainly the resource constraints, but the other is that we really know that the health of people in our communities and the health of the community as a whole is really shaped by so much more than clinical health care. So while I think oftentimes we’re comfortable with developing those kind of health-based partnerships, I think doing more to reach out to the business community, to the education community, to folks that are doing municipal planning and doing the development of the transportation network, those are all things that are really incredibly important as we face the complex public health issues in the 21stcentury.
NPH: What are some specific examples of those partnerships?
Paul Kuehnert: When I came on board at the health department I found that we were one of the larger employers in the county. Like so many other businesses, our health insurance costs were going through the roof every year, and so one of the things that the county executives challenged me with was to convene a task force to really look developing some ways to promote wellness and reduce health insurance costs. So we convened a task force from within county government, to look at evidence-based workplace wellness programs and then got our county board to agree to support workplace wellness and began implementing that. What we saw over the course of about four years is that by using these evidence-based practices we were able to reduce health insurance costs and see results in terms of employees’ health.
So that had benefits for both the county as an employer and then for all the employees that participated as well. And it gave us hands-on experience and credibility to go into the business community and say, ‘we’re betting that you’re struggling with some of these similar issues.’ Being able to bring our experience as an employer dealing with health insurance costs and containing them was something that helped us gain entrée into the business community, and then that has in turn led to ways that we can find other areas for collaboration in terms of working with the business community.
It also really enhanced support for public health, so suddenly public health is not viewed as simply health care for poor people. It’s now something that businesses in the community recognize as ‘oh, this is really an area of government that has some relevance to what I do as a business and has benefit to me,’ because we provided that consultation around evidence-based workplace wellness programs as part of our services as a health department.
We also developed a county-wide initiative around reversing childhood obesity, and our business relationships were part of developing that comprehensive plan, so we really were able to bring businesses to the table and really help them see and also help them articulate to us what role they could play in rolling back childhood obesity.
NPH: And what about partnerships with hospitals?
Paul Kuehnert: I think people in public health are very much aware that the health care environment oftentimes is extremely competitive. So, in our county, we had five hospitals and three federally-qualified health centers and they were all competing with each other. However, what the county health department or municipal health department can do in that situation is really be seen as the convener to bring folks around the table to really look at common interests and areas for collaboration and to try to identify mutual benefit.
One of the ways that we did that very concretely was to see if we could do a collaborative around building a comprehensive community health assessment, and everybody was interested in that. We started with how we were going to make decisions and how we were going to share funding. We were able to articulate what the common benefits would be, and then really being able to staff against that. At the same time we had a need as a health department for a community assessment as a prerequisite for accreditation and the hospitals had not done community assessments for periods of three to five years and they needed one under the new regulations of the Affordable Care Act in order to maintain their non-profit status.
>>Watch a video in which public health directors from around the U.S. talk about their pursuit of public health department accreditation.
We were also able to interest our two largest United Way divisions and so we were able to do an assessment that was much more comprehensive than any of the organizations could have done by themselves, and by sharing the activity, we were able to reduce costs for everybody. That resulted in a very robust health assessment and improvement plan, and then also built a platform for tackling the issues that were identified or prioritized in the improvement planning process.
NPH: What other types of changes do you feel are most needed to position public health departments for the future? What kinds of changes in emphasis or approach might this suggest for our nation’s local public health leaders?
Paul Kuehnert: Well, I think that one of the things that we absolutely have to do is contribute to the evidence base for what works in public health and a key way to do that is to build relationships with public research institutions.
I think the other real challenge that we need to face, and we did this more with our governmental partners within county government, is that we really need to find ways to better communicate what the value of public health and other public services are in these times when people in the community are really questioning the role of government in almost everything. And so I think finding ways to engage policymakers in a real honest dialogue around how government and governmental services, including public health, contribute to quality of life in our communities, and how do we make those connections, how do we really articulate what the value is of health to a community of people and how does that get turned into support?
NPH: You mention your work as a health director pursuing public health department accreditation. What do you see as the value and promise of accreditation?
Paul Kuehnert: I have found that accreditation really helps us in that last piece that I was talking about, really communicating the value of public health and saying to our policymakers and to the residents that support us in communities that we want to be held accountable and here are a set of standards that have been established nationwide, and your local health department is going to meet those standards and this is what we’re all about. It also enhances our credibility. Even though we don’t often think about it this way, public health is in a very competitive environment for funding and I think accreditation helps us there as well.
NPH: Shared services have also emerged as a valuable strategy help health departments leverage resources in support of their mission and goals. What role do you see this approach playing in helping position health departments for the future?
Paul Kuehnert: I think it’s critical for every health department leader and every local health board to really ask themselves the hard questions about how are we doing business and why are we doing business this way? Are there opportunities for efficiencies? Are there things that perhaps others could do better than we do or that we could do better if we did it together? So I think the opportunity there is to ask those questions and then really explore them with others in the public health community, in the region or the area that we’re working in. Again, I think the external environment is really, really shifting and we don’t have the luxury to think that everything can be done on a very local level, and so we really have to look at what are the things that must be done by and for every community, and what are things that we could actually gain some efficiencies and maybe even get improved quality of services if we did look at sharing the organization of those services.