Perspectives of Local Health Department Executives for Successfully Navigating Economically Challenging Times

introduction: Public health organizations are consistently facing funding constraints; thus it is imperative we develop a better understanding of the organizational capacity, human resources and determinants of performance to maximize public health services operations with the decreasing resources. This is achievable by identifying high functioning leaders and their strategies towards efficient delivery of public health services.

methods:A national sample of Local Health Department (LHD) executives were surveyed on leadership style. These results were linked with the NACCHO Budget Cuts and Job Losses survey to identify executives who did not experience budget, personnel and/or program cuts, stratified by size of population served. Semi structured telephone interviews were conducted with a representative sample.

results: Emerging themes include: 1) the expectation that collaborative partnerships both within their jurisdiction and with neighboring communities will improve efficiency, however it is too soon to tell; 2) anxiety about implications of unfunded mandates from state health departments and portions of the Affordable Care Act; and 3) openness to new ideas, outside public health.  Executives advise flexibility, creativity, and continued learning to maximize efficiency in public health delivery services during these periods of uncertainty.

discussion: Effective LHD executives demonstrate creativity, critical thinking and adaptability. The management style varies by composition of the LHD and population size served. Current and future LHD executives will benefit by strengthening the identified leadership skills including resourceful strategies to maintain programs during these economically challenging times. Results may impact those who are struggling to maintain the resources that serve their communities.