Improving performance at the Local Public Health Unit (LPHU) through gap analysis

North Dakota local public health units (LPHU) have been exploring ways to overcome financial and staff capacity barriers so they can better deliver the Ten Essential Services and be in a position to achieve Public Health Accreditation Board (PHAB) accreditation. The SE Central Regional Network of North Dakota, comprising seven LPHUs, established a goal to improve financial and performance efficiency by reviewing their budget and services delivered, and then established a performance management system to carry out the prescribed changes.

The gap analysis was a two-year process that included financial and qualitative assessment. Financial assessment was done by cost-benefit analysis of public health services delivered and PHUND$ analysis of institutional financial efficiency. Cost-benefit analysis ranked 23 services provided by cost per beneficiary. PHUND$ analysis determined that the LPHU’s administrative expenditures were only 13.78%, and total operating margin 2%. Qualitative assessment was done through the administration of a survey of LPHU employees, county health board members, and community-based partners. Among the many findings was the extent to which public perception of public health as free compromises financial sustainability. This was followed by the development of a performance management system that will be used to guide on-going future development.

This presentation will describe the process by which the gap analysis was performed, with the recommendation that LPHUs in rural counties consider undertaking a systematic review of their work processes in order to redesign the process of delivering the essential public health services.