Operationalizing Health Equity Practice: Approaching the challenges in traditional health administration culture and leadership from a systemic problem-solving perspective

While the Louisville Metro Department of Public Health & Wellness has long embraced a commitment to, and demonstrated leadership in Health Equity -- including launching the ‘Center for Health Equity' -- the first of its kind in a Local Health Department; institutionalizing an organizational cultural shift to a social justice / health equity lens in a traditional hierarchical local health department has been challenging. The “Operationalizing Health Equity Practice” (OHEP) initiative, a comprehensive organizational culture change effort where Learning Organization principles and practices serve as the process driver, utilizes ‘dialogue' as a key methodology and ‘health equity' is nested intentionally within a larger strategic culture change effort. Our ‘Theory of Change', therefore, is based on the premise that operationalization of health equity practice will be most effective within a broader structural ‘Learning Organizational' context; and where learning is purposeful and connected to the work. CHE is testing two key ideas: a) What is the most effective way to operationalize health equity practice? b) Does a learning organization culture, utilizing team learning and the intentional examination of individual and collective mental models through dialogue, promote systemic practice change that ensures the deliberate and effective application of health equity lenses to all areas of work? Finally, while our experience to date is suggestive of a promising effective practice, many of the challenges faced underscore the persistence of barriers to change within a traditional local public health department -- even in the face of strong commitment to health equity and leadership from the top.