A New Role for Public Health?

Today’s post comes to us from Workforce Institute board member Nanne Finis, RN MS and chief nurse executive for Kronos Incorporated.

As I ponder the current state of our healthcare system in the U.S., I have mixed emotions. Without a doubt, this pandemic has exposed various processes that are in dire need of repair and improvement. At the same time, I’ve never been prouder of my colleagues in the healthcare profession for the bravery and dedication they have shown in meeting this pandemic head-on. After giving 40+ years to the healthcare profession as a clinician and leader in an academic medical center, a consultant, and a business leader serving on many advisory boards, I’m sure I’m not alone in finding myself questioning whether I have had any impact at all on a system that has so many opportunities for repair and improvement.

Healthcare Complexities

As nurses who care for those who enter our doors and the populations we commit to serving, it is more clear than ever that healthcare is a local phenomenon. Inside the organization, the focus is on teamwork, research and applying evidence-based principles, process improvements, innovation, and a laser-like focus on safe/quality care for our patients and their families.

But outside of those hospital walls, so much happens. A population of patients are living their lives and using the hospital for both dire needs and convenience stops in the Emergency Departments. Funding of hospitals supports community work and focus on the population, but that work has often resulted in discrete community screening or celebratory events and perhaps done little to change the health dynamic of the total community.

The health of our community has been relegated to our local public health departments. But, public health has often been under the radar and underfunded and it has never been given its full due.

The Emergence of the Need for Public Health

Over the past several months, multiple forums to discuss the importance of public health have been publicly available. Michelle A. Williams, an internationally renowned epidemiologist and public health scientist and Dean of the Harvard University T. H. Chan School of Public Health, has hosted a series of online symposiums called “When Public Health Means Business” and she plans to launch a curriculum later this year aimed at helping business leaders more fully understand public health and its application to business. Williams has stated that perhaps it is time to have a new role, a Chief Public Health Officer, at the senior leadership table of organizations in diverse business sectors.

Public Health (PH) as a science promotes the study and application of theory for populations of people vs. individuals. PH professionals have been involved with epidemics and pandemics before and know that the potential for crises like our current one has always existed. COVID 19 is a novel virus that we are learning about, in real-time, as the pandemic evolves. We need to combine knowledge from our scientists focusing on public health with that of medical professionals studying infectious disease and epidemiology and with other professionals dealing with matters of incidence, distribution, and possible control and outcome of disease. None of our population has natural immunity to this new virus and all are susceptible to the virus, so now is the time to make change.

We Know How to Do This

For those of us who have “grown up” in hospitals, we know that most of our Infection Preventionists and Infection Control Physicians are trained in epidemiology and are skilled at collecting and using data to design prevention and mitigation interventions.

These specialists have training in the principles of public health and have expertise in “viewing an infectious event” from the perspective of a population and directly managing an outbreak. They have experience managing the isolation process for infectious persons – from what  equipment is needed to what isolation precautions must be taken – all while educating and mentoring the multiple care teams on the mitigation of risks to their personal safety and to the safety of others.

There are published staffing models that scientifically lay out the ideal numbers of such experts based on the population of patients served, intensity of surveillance and regulations. For example, The Joint Commission requires that hospitals identify the individual responsible for leading the infection prevention control program and allocate needed resources for the program.

These infection prevention programs have always been the conduit to local public health experts, primarily focused on mandatory reporting requirements. But, though our worlds of public health and provider healthcare organizations have worked together in the past, we can and must advance this relationship further.

What to Do

The COVID-19 pandemic has rapidly brought discussions of worker physical safety to the forefront of all leadership. As organizations across all business sectors contemplate returning to work, the focus on safety for all employees, visitors, and most importantly vulnerable patients in a healthcare setting has become a mandate for organizations. The World Health Organization (WHO) has even selected ‘Health Worker Safety: A Priority for Patient Safety’ as the theme for World Patient Safety Day 2020.

Here are some specific steps I would recommend to start making Public Health a priority in your organization:

  • Think about whether or not your organization needs a public health officer to be responsible for linkages to the community; stay on-top of real time knowledge of the national issues, disease and health promotion expertise; and engage with local organizations and community structures.
  • If you are in a healthcare environment, leverage the skills and expertise of your infection preventionists, infection prevention and control committees, and Infection Control Physician Leader, and use the available professional associations and CDC content to support that focus.
  • Study your population; population health is a science. Use your trained Public Health experts to guide you on this journey.
  • This is the time for healthcare organizations and leaders to serve as the example for the larger community in terms of infection prevention – now during this pandemic and in the future.

If you are a healthcare leader, SPEAK OUT and SHARE YOUR KNOWLEDGE. Take control of this situation – we are experts and know what needs to be done. The safety of our communities and the populations that we service are at stake, and our own families and friends are looking for us to lead. Let’s not let them down.

It takes a time of significant crisis – like the one we find ourselves in now – to appreciate how the whole system should work with the critical inclusion of public health professionals. I would suggest it is time to understand and formally integrate public health into our daily work in healthcare and across all industries.

A special thanks to my friend and colleague Barbara Soule for her wisdom and guidance over many years and for her deep commitment to the science of Public Health and Infection Prevention and Control.

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