Public Health Institutes are free-standing multisector entities able to function as conveners to improve health status and foster innovations in health systems. Turning Point is a program funded by The Robert Wood Johnson Foundation, involving 21 statewide initiatives and 2 "linked" states that formed multisector collaborative partnerships for public health systems change. In 18 of the Turning Point states, there are also Public Health Institutes, some formed by Turning Point partnerships and some established independently. Both Turning Point and Public Health Institutes represent efforts to reform and enhance public health systems. What has been the relationship between these two organizational forms? This descriptive, qualitative study examined the relationships between state-level Turning Point partnerships and Public Health Institutes in states that have both. Key participants in both institutions were interviewed, and models were developed to represent those relationships. Principal findings suggest that the relationships of Turning Point state partnerships with Public Health Institutes have taken many shapes. Factors that influence the choices and sequencing of these options are largely related to the political and economic resources of each state. Turning Point participants perceived Public Health Institutes to be a useful organizational form for sustaining public health systems change. Public Health Institutes have more administrative and fiscal flexibility than state government and greater opportunities for policy development and advocacy. However, free-standing institutes also have greater financial uncertainty.
This discussion reports the status of a 12-year program administered by a statewide health agency to strategically assess, redevelop, and monitor the architectural and facility management performance of its network of community-based public health care facilities. A protocol, the Strategic Facility Improvement initiative, has directly resulted in significant improvements to the major share of a network of over 100 community clinic and clinical support facilities in the State of Louisiana. The SFI initiative provides oversight with respect to the allocation of public health capital improvement infrastructural resources and has guided completion of 55 facility replacement or renovation projects to date. Its administrative mission, organizational structure, and field methodology is presented as a vehicle to significantly improve the architectural condition of clinical and clinical support environments for underrepresented patient populations. The SFI process is discussed as an evidence-based means to foster greater systemic success in capital improvement efforts within public sector health agencies in the United States and in international contexts.
This article is a retrospective that traces the development of an evolutionary process for a state health agency in addressing the challenge of implementing core public health functions and the provision of essential services. Coalition, partnership, and constituency building were critical elements in the process. Various initiatives are described and their importance as building blocks to a larger process of organizational change is explained. Key lessons from the process are outlined.
The Louisiana Public Health Institute (LPHI) is a new governance structure that embodies cross-sector approaches to improving the public's health. Formed in 1996, LPHI's first grant was from the Robert Wood Johnson Foundation for the Turning Point initiative. The lessons learned from Turning Point have been instrumental in developing the strategic direction of LPHI and Turning Point will be sustained through ongoing projects at LPHI. LPHI is part of a growing trend in America, and a new national network has been created to support the development of public health institutes in many states.
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