For the last three decades, public health has experienced declining financial and political support. Like other local health departments, the Cabarrus County Health Department was operating within a survival mentality, making the best of inadequate resources. There was the imminent possibility that some public health services might not be available in the community, that those least able to provide for themselves would not have access to healthcare services, and that within the dynamic environment of healthcare and an ever increasing population in need, public health services would not survive. As a result, the Cabarrus County Health Department, a unit of county government, changed its governance structure to become a public health authority, an autonomous, independent governmental entity (the Cabarrus Health Alliance).
Cabarrus Health Alliance seeks to: 1) Increase grant funded revenues 2) Increase capacity to provide public health services and targeted initiatives, and 3) Ensure customers are satisfied with services received. Through the process of increasing revenues, increasing staff capacity, and providing excellent customer service, Cabarrus Health Alliance can prosper and continue to provide services that the community needs and cannot often access. To improve the health and well-being of Cabarrus County residents in the long-term, the Health Alliance intends to remain viable and able to meet public health needs of the 21st century.
Challenged with providing health services for increasing numbers of uninsured and low-income residents, the Cabarrus County Health Department was facing unprecedented budgetary, programmatic, and staffing needs. Formerly, as a department of county government, public health programs were inadequately funded due to competition among county programs for limited funding. Grant applications had to be approved through county government who limited and sometimes prohibited these alternative funding sources. Further, response to community health problems was hampered by slow, restrictive personnel processes that affected the department’s ability to hire staff and create needed positions.
Cabarrus County Health Department’s transition from an entity of County government to an independent authority of its own was established under the Hospital Authorities Act as a public health authority. Prior to this, a public health authority had never been created in North Carolina. In 1998, the North Carolina General Assembly created the Public Health Authority Act which has provided the vehicle for other health departments to change their governance structure as Cabarrus has done. Currently, the only program that resembles the Cabarrus Health Alliance is the Hertford Public Health Authority, located in northeastern North Carolina and modeled after the Cabarrus Health Alliance.
Agency Community RolesPrimary stakeholders/partners in this process included the community, staff, clients, and County government. The initial process began with a public health study committee, composed of ten health department employees. From there, Board of County Commissioners created a task force made up of fifteen Cabarrus County citizens with expert knowledge of health care systems. These teams contributed to the organizational design of the organization. The Cabarrus Health Alliance board played a strategic role in guiding the organization through the beginning of the operation. This seven member board included: a designee from the local hospital board of trustees, a hospital medical staff appointee, and representatives from the medical society, County Commissioners, and three public members.
In adopting the mission statement, “achieving the highest level of individual and community health through collaborative action,” the Health Alliance Board developed a series of collaborative efforts. The Board created Healthy Cabarrus (a Healthy Carolinians partnership since 1999), a community coalition to help carry out this mission. More than thirty organizations, health and human service agencies, private medical and dental providers, government officials, educators, business and faith community representatives, and residents work together to identify issues and develop strategies and interventions.
ImplementationThrough a change in governance structure, Cabarrus Health Alliance seeks to provide public health services that improve the health and well-being of Cabarrus County residents. To do this, three overriding objectives were developed to reach this goal.
1) Ensure that customers are satisfied with services received.
To measure the degree to which customers are satisfied, a survey is conducted each quarter. For over six years, 96% of our customers have rated Cabarrus Health Alliance services as good, very good, or excellent and for the last two years the good to excellent ratings have exceeded 99%. Cabarrus Health Alliance Leadership members are expected to identify and utilize best practices in accordance with established industry bench marks.
2) Increase the capacity to provide public health programs in the community.
The first official action of the Cabarrus Health Alliance Board was the creation of Healthy Cabarrus, a community coalition to help carry out the newly adopted mission statement: “Achieving the highest level of individual and community health through collaborative action.” As a result, more than thirty organizations, health and human service agencies, private medical and dental providers, government officials, educators, business and faith community representatives, and residents work together to identify issues and develop strategies and interventions that directly meet the needs of our community.
3) Increase grant funding to expand program services.
A grant writing team was formed in the Cabarrus Health Alliance to research and direct what types of grants would be pursued. This team consulted the Health Alliance’s goals and objectives as well as the Community Health Assessment. The Community Health Assessment is an ongoing process that engages multiple agencies, providers, and individuals in identifying community assets and strengths as well as unmet needs. Every four years, a Community Health Assessment Final Report is issued to the Health Alliance and the community to utilize as a resource. A full-time Grant Writer position was developed in the Health Alliance to further organize and develop opportunities for the team to pursue.
Goal: Through a change in government structure, Cabarrus Health Alliance seeks to progressively provide public health services that improve the health and well-being of Cabarrus County residents.
Objective: To ensure that customers are satisfied with services received:
Performance measures: Customer satisfaction surveys (printed in English and Spanish) were conducted between 1999 and 2005.
Data collection: Customer satisfaction surveys provided in the clinical waiting area and distributed directly to clients.
Outcomes (short-term): Between 1999 and 2005, customers rated CHA servicse as "very good" to "excellent" on average more than 96% of the time.
Objective: To increase the capacity to provide public health programs in the community:
Performance measures: School nurses assigned full-time in each of 35 public schools by 2005; By 2005, dental services would be provided to at least 1,000 patients.
Data collection: (School nurse) full-time employment records, human resources, determine the number of nurses wokring with the school system; (Dental) number of dental visits, dental department, annual reports showing dental visits per person.
Outcomes (intermediate): In 1996, six nurses served 24 public schools and no dental services were provided. In 2005, each of 35 schools had a nurse and dental care was provided to 2,125 parients and 4,082 children were screened for dental problems.
Objective: To increase grant funded revenue for program services:
Performance measures: Grant funded revenuse would be increased to $600,000 by 2005.
Data collection: Contract and competitive grant receipts, finance department, utilized grants database to determine grants awarded from 1998-2005.
Outcomes (long-term): In 1998, grant revenuse were $63,000 and in 2005 grant revenues were $1,775,000.
There is more than sufficient stakeholder commitment to perpetuate the success of the Health Alliance. The Cabarrus Health Alliance has prospered for nine years since it transitioned to a public health authority. The Health Alliance has worked diligently along with its Board and the Healthy Cabarrus Partnership to ensure successful community programs, excellent customer satisfaction, and financial stability. Northeast Medical Center and local physicians have supported the Health Alliance by serving on its board and financially supporting its programs.
The Cabarrus Health Alliance will continue to apply for competitive grant opportunities to expand its community programs, while continuing to charge clients for clinical services on a sliding fee scale and bill insurance and Medicaid when applicable. In addition, Cabarrus Health Alliance receives an annual per capita stipend from the County to provide mandated public health services such as environmental health, communicable disease control, and vital records services.