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Operationalizing Goals to Maximize Public Health Planning Operationalizing Goals for Public Health Planning Sara Bell, Marta McMillion Unlock four simple, adaptable tools that will help with operationalizing goals and detailing concrete steps for effective public health planning. Public health plans often include bold goals but can stop short of outlining how those goals will be achieved. Without defined actions, timelines, and responsibilities, plans risk becoming “shelfware,” leaving teams inspired by strategy but unclear on how to move it forward. This resource provides practical, adaptable tools to help public health agencies move from planning to action with clarity and momentum. Organized into the following sections, it is designed to support teams in translating high-level goals into concrete steps, prioritizing activities, and navigating real-world implementation challenges: Translating Strategy into Action: Introduces tools like the Strategic Priority Planning Worksheet and Implementation Plan Template to help teams define goals, identify key players, outline activities, and establish timelines, resources, and measures of success. Prioritizing What Matters Most: Uses the Impact and Effort Matrix to help teams assess which actions will generate the greatest impact relative to effort, enabling them to focus on quick wins and high-value projects to build momentum. Navigating Barriers and Enablers: Applies Force Field Analysis to identify and assess the driving and restraining forces that influence implementation, helping teams focus their energy on what will move work forward. Sustaining Implementation in Practice: Offers facilitation strategies such as 90-day sprint cycles, action ladders, co-creation with implementers, and the use of action libraries to support iterative progress, adaptability, and team engagement over time. By combining structured tools with practical facilitation strategies, this resource helps teams operationalize their goals, maintain momentum, and build more responsive and effective implementation processes. Get the Resource (PDF) Reviewed by - DeNubila, Myers, Rakotoniaina, Westermann OE22-2203 PHIG article yes

Defining Clear Roles and Responsibilities for Effective Public Health Plans Defining Clear Roles and Responsibilities in Public Health Sara Bell, Marta McMillion Executive Summary Public health plans often stall not because of weak strategy but because roles, decision-making authority, and accountability are unclear. Without clear ownership, teams may hesitate, duplicate efforts, or lose momentum. This resource provides practical tools to help teams move from planning to action with clarity and consistency. It is designed to help public health agencies define roles, clarify decision-making authority, and strengthen accountability to support effective implementation of organizational plans: Ownership and Role Clarity: Introduces the RACI model to define who is responsible for tasks, accountable for outcomes, and engaged in the work. This helps reduce confusion and improve coordination across teams. Decision-Making Authority: Focuses on identifying who has authority to make decisions and how decisions are communicated. Tools like decision-making charts and the DACI model help clarity ownership and prevent delays. Accountability Mechanisms: Outlines formal approaches (e.g., project tracking, performance management) and informal approaches (e.g., peer accountability, leadership modeling, team norms) to reinforce follow-through and transparency. Putting It Into Practice: Provides actionable strategies such as assigning implementation champions, using short-cycle check-ins, embedding progress reporting, and strengthening team culture. It also emphasizes adapting over time and celebrating progress to sustain momentum. By clarifying ownership, decision-making, and accountability, teams can create more coordinated and effective implementation processes that turn plans into action. Introduction It’s not uncommon for public health plans to stall during implementation due to unclear roles and responsibilities. Without defined ownership, decision-making authority, and mechanisms for accountability, teams may hesitate, duplicate effort, or disengage. This resource provides tools and strategies to support health departments and their partners in clarifying ownership, navigating decision-making, and reinforcing follow-through. Ownership and Role Clarity Use the RACI model to define who is responsible for each aspect of your implementation plan, as illustrated in Table 1: R = Responsible — Who is doing the work? A = Accountable — Who owns the outcome? C = Consulted — Who should be asked for input? I = Informed — Who needs to be kept in the loop? Table 1 - Resource - Defining Clear Roles and Responsibilities for Effective Public Health Plans Decision-Making Authority Understanding who has formal and informal decision-making power is essential in cross-functional and collaborative environments. To support this process, consider reviewing ASTHO’s Charter Template and Guide, which includes a structured approach to documenting governance, decision-making norms, and communication practices across implementation teams. Additionally, when collaborating with internal teams, across departments, or even external organizations, a Memorandum of Understanding (MOU) can be a helpful tool to formalize shared expectations. MOUs clarify roles and responsibilities, outline how communication and decision-making will occur, and document commitments in a way that supports transparency and accountability. A well-structured MOU typically includes the purpose of the partnership, the scope of work, responsibilities of each party, communication channels, and points of contact, helping key partners stay aligned as work progresses. Decision-making authority is often overlooked during implementation planning, yet unclear or misaligned authority can create barriers that impede progress. Teams can create a Decision-Making Agreement Chart (illustrated in Table 2) to help proactively identify key decisions, clarify ownership, and support smoother implementation. Table 2 - Resource - Defining Clear Roles and Responsibilities for Effective Public Health Plans(2) Finally, the DACI Model (Driver, Approver, Contributor, Informed) offers another helpful framework for clarifying decision-making roles. Similar to RACI, DACI emphasizes who is driving the decision process, who is the final approver, who contributes input, and who should be informed. Accountability Mechanisms Reinforce follow-through on implementation work with a mix of formal and informal approaches. Formal Approaches Project tracking systems: Use project management platforms to assign tasks and deadlines. You don’t need a fancy paid option; often, tools made available through your organization or free options are just what you need. Regular status reports: Include updates in recurring meeting agendas or distribute monthly progress reports. Performance management: Use your organization’s performance management system to monitor progress. Review data regularly to inform course corrections. Routine working meetings: Come together as a team to work on the item at hand in a shared environment to help with focus. Visual management: Use dashboards, charts, or simple visual trackers to display progress and milestones. These tools make dense information easy to interpret at a glance, promote transparency, and help communicate progress to a broad range of audiences, including those less involved in day-to-day implementation. Informal Approaches Peer accountability: Set up buddy systems or peer-review structures to create shared ownership. Leadership modeling: Encourage leaders to publicly share their own progress or reflect on implementation challenges to foster openness. Norms and expectations: Co-develop shared group norms (e.g., communicating back to teams as a liaison, circling back with homework done/reaching out to the lead in advance with delays, sharing responsibility for facilitating or notetaking), and revisit them during team check-ins. Putting It Into Practice Clarifying ownership and ensuring accountability aren't one-time activities — they require ongoing practices that reinforce role clarity, build mutual trust, and promote follow-through over time. The following strategies can help implementation teams embed accountability into their daily work and cross-functional collaboration Assign Implementation Champions Designate a person or small team to lead implementation for each major goal or strategic area. Assign champions thoughtfully, with attention to role clarity, capacity, and opportunities to rotate responsibilities over time. This champion doesn’t do all the work but ensures tracking of progress, elevation of barriers, celebration/acknowledgement of milestones, and adjustments when needed. Rotating champions can help distribute ownership, reduce fatigue among highly engaged team members, and infuse fresh energy and perspective into the work. Use Short-Cycle Check-Ins Break down implementation into manageable intervals. Check in every 30, 60, or 90 days to revisit responsibilities, track progress, and realign if roles or context shift. Consider identifying a secondary point of contact or back-up lead during these check-ins to support continuity if the primary lead is unavailable. This builds agility and accountability without being overwhelming. <!-- ASTHO’s “Operationalizing Goals to Maximize Public Health Planning” offers additional guidance and strategies for keeping plans actionable. --> Embed Progress Reports Into Team Culture Make accountability visible. Use shared reporting templates, dashboards, or standing agenda items to make progress transparent. Consider spotlighting wins or learning moments during regular meetings to reinforce shared responsibility. You might also establish time for site visits or rounding practices, creating opportunities for teams to share their successes visually and in person. These face-to-face exchanges help celebrate progress, surface challenges, and strengthen connections across teams. Strengthen Team Culture Through Shared Roles Team norms around shared facilitation, rotating notetaking, and collective problem-solving can reinforce a culture of inclusion, empathy, and ownership. Rotating responsibilities builds appreciation for the complexity of project management, ensures everyone has a voice, and reduces reliance on a single point person to carry the process forward. Visualize Roles in Real-Time Use visual tools like RACI charts or decision maps during meetings to remind everyone who owns what. When teams use these actively, there is a shift from documentation to facilitation. Normalize Course Correction Implementation rarely goes as planned. Normalize the practice of revisiting roles, responsibilities, and accountability practices. Discuss openly: Is this still working? Do we need to redistribute roles? Are our accountability methods inclusive and effective? Celebrate Successes and Small Wins Build in time to recognize progress along the way. Celebrating achievements — whether completing a key deliverable, reaching a milestone, or modeling collaborative problem-solving — helps sustain momentum and morale. These moments reinforce accountability by reminding teams that their efforts matter and that consistent progress, even in small steps, leads to long-term success. Reviewed by - DeNubila, Myers, Rakotoniaina, Westermann <!-- OE22-2203 PHIG --> article yes

PHIG: A Transformative Infrastructure Grant for Health Equity and Inclusive Workforces ASTHO, Association of State and Territorial Health Officials, phig grant, infrastructure grant, public health, health equity, public health grant, inclusive workforce, public health infrastructure grant, health departments, public health funding, public health institutes, data systems, public health workforce, community engagement, federal grants, restrict spending, health disparities, community partnership, underserved populations, diversity equity inclusion, educational institutions, high risk and underserved, ethnic minority, rural communities, overall capacity, minority institutions Amber Williams, Lindsey Myers The Public Health Infrastructure Grant (PHIG) program provides flexible, non-categorical funding to help public health departments across the United States build their infrastructure and capacity to meet their unique needs and address barriers in health equity and workforce development. Following the COVID-19 pandemic, Congress made a historic investment in public health workforce and infrastructure, presenting a game-changing opportunity for public health transformation. In the fall of 2022, CDC rolled out a first of its kind, five-year grant program called the Public Health Infrastructure Grant (PHIG) to address critical governmental public health workforce and system improvement needs. This program is all about supporting health departments across our states, territories, and freely associated states to ensure every community has the people, services, and systems needed to promote and protect optimal health for all. Along with funding 107 health departments, CDC also partnered with three organizations: the Association of State and Territorial Health Officials, the National Network of Public Health Institutes, and the Public Health Accreditation Board to help agencies modernize data systems, recruit and retain a skilled public health workforce, and address longstanding public health infrastructure needs. Challenges in Public Health Funding and the Pivotal Introduction of PHIG The majority of public health department funding comes from topic-specific federal grants, which usually restrict spending to prescribed programmatic activities and do not allow agencies to build foundational capabilities—like improving hiring or procurement processes, communication, and community engagement. For example, while advancing health equity and addressing health disparities is often emphasized as a central goal of public health practice, many jurisdictions face barriers to fully incorporating health equity into their strategies. Additionally, the public health workforce often does not reflect the communities they serve, which can impact their ability to build community partnerships and fully respond to the needs of underserved populations. PHIG is different in that it provides flexible, non-categorical funding that health departments can use to build their infrastructure and capacity to meet their unique needs and address barriers. PHIG Impact: Advancing Health Equity and Promoting Inclusion in Public Health Agencies Many agencies are using their PHIG funding to boost efforts to tackle health disparities in their jurisdictions and promote diversity, equity, and inclusion within their agencies. Internally they are focusing on examining compensation, assessing equitable pay, developing leadership programs for staff of color, streamlining hiring processes, and assuring unbiased hiring practices. Some agencies are creating paid internships, hiring people with lived experience, and building new workforce pipelines through engagements with minority-serving educational institutions. Plus, they are training managers and staff to create more inclusive workplace environments and partner with and serve diverse communities better. Other approaches include: Taking lessons learned from other funded programs, such as the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant, to focus and build on successes. Strengthening the overall capacity of the agency to address health equity, such as by incorporating health equity into agency-wide performance improvement offices and ensuring equity principles are embedded in health assessments and strategic plans. Improving partnerships with community organizations—looking at opportunities to simplify processes; support minority-owned institutions in competing for and managing federal funding; and hiring new staff dedicated to health equity, liaisons with special populations including tribes, and community health workers. This is a remarkable time for public health. Improving public health infrastructure and strengthening the workforce will lead to better health outcomes for all. These grants are critical, providing much-needed funding and flexibility to make real progress in promoting diversity, equity, and inclusion in the workforce and ensuring health equity in public health strategies. 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Every year on Nov. 22, ASTHO—and countless other agencies and organizations worldwide—take a moment to acknowledge the public health workforce on Public Health Thank You Day. Like so many other days of recognition, it has become a blip on our yearly calendar. And, simply put, that’s just not enough. This year, ASTHO leadership took pen to paper to share some of our feelings, fears, and—yes, our thanks—for everything the public health workforce has always done to protect us.

Researchers estimate more than 140,000 children in the United States experienced the death of a parent or grandparent caregiver between April 1, 2020 and June 30, 2021. The study highlights disturbing disparities in caregiver deaths by race and ethnicity. Hispanic, Black, and American Indian/Alaska Native children were at 1.1 to 4.5 times higher risk of losing a caregiver than non-Hispanic White children. These inequities result from structural and social conditions such as discrimination, living in under-resourced neighborhoods, barriers to accessing healthcare, experiencing food insecurity, and economic instability.

The recent mass shootings in Buffalo, Uvalde, and elsewhere across the country, have drawn renewed attention to firearm violence as a major public health issue in our nation. It’s a particularly important issue to consider during Men’s Health Month because men are disproportionately victims and perpetrators of firearm violence.

Creating Successful Collaboration Structures in Public Health Initiatives Creating Successful Collaboration Structures in Public Health Sara Bell, Marta McMillion Public health initiatives rely on strong partnerships to sustain momentum and achieve impact, but collaboration can stall when roles, structures, and relationships are unclear. Without intentional design, collaborative efforts risk misalignment, fragmented communication, and missed opportunities to fully engage partners. This resource provides practical tools and guidance to help public health teams design, strengthen, and sustain effective collaboration structures. Highlighting the following, it is designed to support agencies in organizing partnerships, building trust, and aligning communication to advance shared goals: Clarifying Collaboration Structures: Outlines common structures — such as backbone entities, advisory bodies, and community-based implementation teams — and how they function together to support coordinated, inclusive, and effective action. Understanding Group Dynamics: Applies Tuckman’s stages of group development to help teams recognize where they are in the collaboration lifecycle and use stage-appropriate strategies to build trust, navigate tension, and strengthen performance. Organizing and Strengthening Partnerships: Introduces tools like the Partner Inventory, Engagement Pathways, Ecosystem Mapping, and “Who’s Missing?” tool to help teams understand partner roles, identify gaps, and intentionally expand and deepen engagement. Aligning Communication and Influence: Uses tools such as the Power-Interest Matrix, CLIP framework, and communication planning templates to help teams tailor engagement strategies, clarify influence and leadership dynamics, and maintain consistent, meaningful communication across partners. Putting Collaboration Into Practice: Offers actionable strategies — such as co-creating charters, using inclusive facilitation, building from local context, and reflecting on shared power — to help teams operationalize collaboration and sustain engagement over time. By combining structured tools with relationship-centered practices, this resource helps public health teams build stronger, more coordinated partnerships that support effective and sustainable implementation. Get the Resource (PDF) Reviewed by - DeNubila, Myers, Rakotoniaina, Westermann OE22-2203 PHIG article yes

Public Health Leadership Starts in the Classroom Public Health Leadership Starts in the Classroom Ashley Nanthavongsa-Mosley Learn how states are integrating public health education into K-12 schools and building pathways for future public health professionals. Governmental public health agencies across the country are showing interest in integrating public health concepts into K-12 education. This interest has been driven by a growing realization that students should understand the importance of public health work early and see it as a viable and meaningful career option. In early 2025, ASTHO members asked how public health agencies were integrating public health into K-12 schools. This interest prompted ASTHO to convene a workshop series, through which it became clear that states are not only interested in the topic — they are already doing innovative and impactful work within their jurisdictions. Below are key examples and lessons learned from states that participated in these discussions and takeaways that may help other organizations exploring similar efforts. Classroom Partnerships in Action Montana: Classroom-Ready Public Health Curriculum Montana is leveraging funding from the Public Health Infrastructure Grant (PHIG) to collaborate with the Montana Public Health Training Center to bring public health concepts directly into classrooms through a comprehensive curriculum for teachers. The curriculum is ready to use with worksheets and answer keys. The materials fit into teachers’ busy schedules and make it easier to introduce public health topics in the classroom. The curriculum has already been accessed by more than 130 people across 37 states, one U.S. territory, and eight countries. Also, with support from the Montana Healthcare Foundation, the training center is developing a toolkit to help local health departments collaborate with schools and host community health fairs that connect students directly with public health professionals. Kentucky: Career Exposure Through the Health Occupations Students of America (HOSA) With support from PHIG, Kentucky is leveraging existing student career organizations, such as HOSA, to introduce students to public health concepts and careers. At past HOSA conferences, students participated in a simulated outbreak activity that exposed them to epidemiology, public health nursing, environmental health, the public health laboratory, and public health career pathways in an engaging, hands-on way. New Jersey: Youth-Led Immunization Campaigns New Jersey hosts the Protect Me With 3+ annual poster and video contest, a joint initiative between the Partnership for Maternal and Child Health of Northern New Jersey and the New Jersey Department of Health. The statewide initiative aims to raise awareness on the importance of adolescent immunizations among preteens, teens, and parents, increase vaccination rates for several important vaccines, and, most importantly, empower students to use their creativity and voice to spread the important message of getting vaccinated. The contest invites New Jersey students in grades 5-12 to display their creativity by designing a poster or a 30-second video highlighting the importance of vaccines for themselves, their families, and their communities. Over the years, the contest has proven to be a successful and impactful model for peer-to-peer education around immunization. Connecticut: Multiple Entry Points into Public Health Through PHIG funding, Connecticut builds sustainable, credit-bearing pathways that introduce students to public health and connects them to college and career opportunities. Through the CT Science Olympiad, the Connecticut Department of Public Health sponsors the “Disease Detectives” event, giving middle and high school students hands-on experience with outbreak investigation and direct exposure to public health professionals. Over the past three years, 188 students from 35 schools have participated. Connecticut also expands access to college-level coursework. In partnership with the University of Connecticut, high school teachers are trained to deliver Public Health 101 through Early College Experience, allowing students to earn transferable college credit while still in high school. Beginning in Fall 2026, students from participating schools can further their studies through Dual Enrollment with Connecticut State Community College, where they will have access to undergraduate public health courses. Washington: Teacher Licensure and Data-Driven Curriculum Washington state focuses on supporting educators while grounding public health education in real-world data. K-8 teachers are required to complete STEM hours for licensure renewal, and teams are exploring ways to integrate youth engagement into this process. With support from the Educational Service District, Washington created an asynchronous professional development model teacher training program on using Washington Tracking Network data in classrooms. This program provides licensure clock hours while helping educators incorporate local public health concepts and data into instruction. Cross-Cutting Lessons from States Across jurisdictions, several common strategies consistently supported successful efforts to introduce students to public health and build early career awareness. Build on Existing School Programs and Structures Many successful initiatives did not require creating entirely new programs. Public health agencies integrated public health concepts into existing school activities, competitions, and career organizations that already have student participation and administrative support. Agencies interested in this work can start with established programs to make it easier to introduce public health concepts while minimizing additional demands on teachers and school administrators. Co-Create Curriculum with Educators Programs are more likely to succeed when teachers are involved in the early design process. Educators understand their classroom needs, curriculum standards, time constraints, and their input ensures that materials are practical and usable. Several agencies emphasized the value of developing curriculum collaboratively with teachers and testing materials in classrooms before broader rollout. This pilot, revise, scale approach helps refine lessons, ensures alignment with educations standards, and increases the likeliness that teachers will adopt the materials. Elevate Youth Voice and Peer Engagement Agencies can get students more engaged in public health work when they can create and share their own public health messages. Youth-led campaigns, contests, and peer education initiatives allow students to translate what they learned into messages for their peers and community members. Agencies noted peer-to-peer approaches such as student-created posters, videos, or presentations can be effective for topics like prevention, immunization, and community health awareness. These activities not only reinforce public health knowledge but also help students develop communication and leadership skills. Support Teachers Through Professional Development and Data Tools Teachers are more likely to incorporate public health topics into their classrooms when they receive training, resources, and incentives that align with their professional requirements. Some states support educators by offering professional development that provides continuing education or licensure renewal hours while also teaching educators how to use public health data, case studies, or state/local health examples in the classroom. Providing ready-to-use activities, datasets, and lesson plans reduces the burden on teachers while strengthening the integration of public health into classroom education. Build Sustainable Communication Channels with Schools Successful programs often relied on consistent communication channels between health agencies and education partners rather than relying on one-time outreach. Agencies built systems that allowed educators to regularly receive information about public health learning opportunities. Examples include educator newsletters, resource portals, partnerships with school districts or health districts, and coordination with state and local education networks. These systems help ensure that teachers and schools can easily learn about new curriculum resources, competitions, professional development opportunities, and student engagement activities related to public health. Keep Evaluation Simple and Actionable Agencies also emphasized the importance of evaluating K-12 public health programs in ways that are practical for schools and partners rather than complex evaluation requirements. Many use simple feedback mechanisms such as teacher surveys, student reflections, participation counts, or brief post activity questionnaires. These short feedback loops help agencies understand what worked, what needs improvement, and how programs can be refined before expanding to additional schools. Barriers and Challenges While agencies shared many promising approaches, they also identified several common challenges when working within K-12 education systems. Limited classroom time and competing priorities. Teachers often face strict curriculum requirements and limited instructional time, which can make it difficult to introduce new topics. Programs that align with existing standards or integrate into science health or career exploration courses are more likely to be adopted. Navigating school approval processes. Introducing new curriculum or programs may require approval from school district administrators or curriculum committees. Building relationships with education partners and piloting programs with a small number of schools can help build trust and demonstrate value. Resource and staffing limitations. State and local health agencies may have limited staff capacity to support ongoing school engagement. Developing reusable curriculum materials partnering with

Sustaining Accreditation: How Montana and Southern Nevada Are Building Resilient Public Health Infrastructure for the Long Term How Montana and Southern Nevada Are Building Resilient Public Health Infrastructure for the Long Term Melissa Touma Learn how public health accreditation helped Montana and Nevada improve their health agencies' work in this blog post. Public health accreditation is a dynamic process that requires ongoing commitment, strategic planning, and organizational alignment for agencies to uphold consistent quality, accountability, and performance over time. Across the country, health departments are reimagining how they approach accreditation, shifting towards sustainable systems that weave accreditation practice into everyday operations and bolster the agency’s ability to face the common challenges of changing resources, limited funding, and leadership or staff turnover. During ASTHO’s webinar Tools and Strategies for Building a Sustainable Accreditation Infrastructure, two health departments — Montana Department of Public Health and Human Services and Southern Nevada Health District — described how they leveraged ASTHO’s Guide for Sustainable Accreditation and strategies gained from participating in ASTHO’s Accreditation Sustainability Learning Community to develop plans that strengthen their accreditation infrastructure, improve internal communication, and help maintain momentum beyond each accreditation cycle. Montana’s Sustainability Plan: From Rodeo to Roadmap Montana’s sustainability journey began with the launch of its Performance Excellence Program, a strategic initiative to embed the Public Health Accreditation Board’s (PHAB) standards, best practices, and data-driven methodologies into everyday agency operations. After Montana earned reaccreditation, the team launched an effort to transform the agency’s approach to sustaining accreditation. Their objective was to build an organizational resilience that would support continuous improvement throughout each cycle by fostering shared ownership across the agency and strategically spreading accreditation activities over the five-year timeline. Their plan of action: developing and implementing an accreditation sustainability plan that turned accreditation from a sporadic, rodeo-like scramble into a structured, data-driven ecosystem. Montana’s Public Health Accreditation Sustainability Plan defines the agency’s accreditation approach and framework by: Structuring team roles and defining responsibilities for accreditation coordinators, subject matter experts, and support staff. Creating a detailed roadmap with quarterly milestones and annual reporting requirements. Integrating with the agency’s performance management system, AchieveIt, for real-time tracking and accountability. Structuring an internal communication plan and campaign to raise awareness and keep staff engaged throughout the five-year cycle. Incorporating onboarding and ongoing training to build institutional knowledge. Establishing a single-source repository for required documents, templates, and examples. Knecht - How Montana and Southern Nevada Are Building Resilient Public Health Infrastructure for the Long Term By having a plan in place, Montana’s Performance Excellence Program improves the agency’s capacity to sustain accreditation by: Securing buy-in and support from agency leadership to prioritize accreditation as part of core operations. Preventing last-minute scrambles and distributing accreditation work evenly across the cycle instead of backloading tasks. Ensuring continuity and preserving institutional memory by providing a clear handoff if staff turnover occurs. Improving accountability through dashboards and automated reminders that keep teams on track. Building a culture of quality by linking quality improvement projects and performance measures directly to accreditation standards. Enhancing transparency by creating a clear, documented process that can be shared internally and externally. Southern Nevada’s Communications-Driven Strategy Southern Nevada Health District (SNHD) serves a densely populated region with over 2.5 million residents and 800 full-time staff. During their initial accreditation phase, SNHD’s accreditation team arrived at the process with limited context and institutional knowledge, and a large Accreditation Committee Action Report response with a tight 90-day turnaround time. The experience underscored the need for earlier preparation, better alignment, and a more predictable, agencywide approach to documentation and communication. Recognizing these lessons, SNHD made a strategic commitment to shift toward building a more organized, proactive, and sustainable accreditation infrastructure. Central to this shift was the development of a robust internal communications strategy designed to increase transparency, strengthen engagement, and create consistent accountability mechanisms that keep accreditation visible, relevant, and understood across the entire organization. This communications-driven model now serves as the backbone of SNHD’s reaccreditation sustainability strategy, ensuring that staff at every level — executive leaders, managers, frontline contributors, and new hires — remain aligned and supported as they collectively move through the reaccreditation timeline. Key elements of SNHD’s internal communications strategy include: Engagement of the Internal Communications Team: SNHD’s communications departments plays a key role in shaping messaging, designing materials, and identifying new channels. Quarterly Executive Updates: SNHD’s accreditation manager meets with the executive leadership team every quarter, using this time to share structured progress updates, highlight outstanding contributors, surface challenges, and reinforce why accreditation matters. All-Hands Meetings: SNHD hosts virtual all-hands meetings that bring together staff and senior leadership across the organization to share big-picture updates, celebrate accomplishments, and reinforce the value of accreditation. Tailored Messaging: Communications are customized for different audiences to ensure relevance and impact. A tailored approach ensures every audience understand the “why” and their role in the “how.” Creative, High-Visibility Channels: SNHD utilizes multiple channels to make accreditation part of daily life and reinforce visibility of accreditation as a shared organizational priority. Reader Boards: Digital displays throughout offices feature rotating content that keep accreditation visible and engaging. Login Bubble Messages: When staff log into their computers, brief, high-impact messages about deadlines, successes, or calls to action reinforce awareness. Onboarding Videos: A three-minute accreditation explainer video introduces new hires to PHAB, expectations, and the department’s quality culture from day one. Hazeltine - How Montana and Southern Nevada Are Building Resilient Public Health Infrastructure for the Long Term By treating accreditation as a shared responsibility and leveraging every opportunity to communicate its importance, SNHD has built a communication-driven infrastructure that aims to strengthen organizational cohesion, maintain momentum across all five years, and prepare the department to weather staffing changes, leadership transitions, and shifting priorities. Their approach demonstrates how intentional, consistent communication can help turn accreditation from an isolated project into a unifying force within the agency. A Shared Vision for Sustainability As health departments continue to navigate evolving public health demands, sustainability planning has become essential for maintaining accreditation momentum, strengthening organizational resilience, and embedding quality improvement into everyday practice. The experiences of Montana and Southern Nevada demonstrate that with intentional planning, robust internal systems, and clear communication, accreditation can begin to shift from a fragmented documentation collection process to a continuous, agency-wide commitment. This blog post highlighted the work of Public Health Infrastructure Grant recipients as they strive to develop a resilient accreditation infrastructure for their communities and ensure accreditation becomes a continuous journey. Check out ASTHO’s two-part webinar series to hear how their systems are evolving: Tools and Strategies for Building a Sustainable Accreditation Infrastructure (October 30, 2025) Sustaining Accreditation Through Smart Documentation Systems (November 6, 2025) To learn more about ASTHO’s Guide for Sustainable Public Health Accreditation and access tools to support your department’s journey, visit A Guide for Sustainable Public Health Accreditation. Reviewed by - Lindsey Myers OE22-2203 PHIG article yes

How Public Health Can Support Modern Administrative Readiness in a Dynamic World How Public Health Can Support Modern Administrative Readiness in a Dynamic World Kristin Sullivan, Heidi Westermann Learn how creating resilient administrative infrastructure is critical to public health work. Public health agencies must be administratively ready to fulfill core functions, respond capably to public health emergencies, and utilize funds efficiently and effectively to improve health outcomes. Administrative readiness also depends on an organization’s ability to navigate challenges and ensure operational continuity in a complex and uncertain environment. Key strategies used in health departments emphasize proactive planning, risk assessment, leveraging information technology, building resilience, and continuous improvement. When in place, these foundations support readiness to respond to any public health issue. What is Administrative Readiness and Why Does It Matter? Administrative readiness is the capacity of an organization to rapidly adapt administrative and operational systems to support daily operations and emergency response. It ensures that administrative barriers do not delay critical actions during a public health emergency. Readiness is marked by: Flexibility in processes. Having the tools, data, and trained workforce for fiscal management, procurement, contracting, human resources, or staffing. Legal authorities. Public health agencies must be able to perform daily operations and respond to unexpected events or crises while maintaining compliance with laws and regulations. Administrative readiness matters because it provides the infrastructure for public health agencies to continue normal operations efficiently and effectively. At a 2025 convening of executive leaders from state and territorial health agencies, ASTHO asked how administrative readiness helps public health work. Responses included: Facilitates rapid assessment. Helps to ask the right questions. Promotes intentional data requests. Improves employee satisfaction. Standardized approach to data sharing. Builds better relationships and trust. Reduces grey areas. Promotes anticipatory decision making. Increases compliance. Creates projections. Creates strong processes. Matches expectations with reality. Critical Strategies in a Dynamic World Understanding Context and Environment Our current environment is fast-paced, rapidly changing, and unpredictable. The challenge for leaders is to shift away from reacting to change and move toward a proactive stance built through available frameworks and tools that help understand context and environment, make better decisions, and manage change more effectively. For example, Volatility, Uncertainty, Complexity, or Ambiguity (VUCA) is a framework that describes the environment or how people view the conditions under which they make decisions, mitigate risks, solve problems, and manage change. VUCA compares how much you know about a situation and how well you can predict the results of your actions. In this way, the framework helps leaders respond more effectively. Other frameworks include Kotter’s Change Management Theory, Kriegel and Brandt’s Seven Traits of Change Readiness, and Rogers’ Law of Diffusion of Innovations. Applying these together can help organizations understand how to adopt new ideas and manage the process of change: Adopting new ideas in an organization follows a bell curve from quick (innovators) to slow (laggards) with the majority in the middle needing proof and commitment to advance. Find innovators and early adopters that look for a challenge and the “why” to adopt. Traits of change readiness include resourcefulness, adaptability, optimism, confidence, adventurousness, and tolerance for ambiguity. These contribute to the ability to thrive during significant change. Create true urgency for change with fast moving action, clear purpose, and alignment. Move away from complacency and status quo, and an environment of false urgency where everything is a priority. Replace the sole focus on a traditional organizational hierarchy with a “dual operating system” that includes a broad network of volunteers across the agency for agility, speed, and innovation. Improving Internal Communication and Clarifying Roles and Responsibilities Often challenges to readiness start with communication and clarity of roles and responsibilities. It is critical to build strong working relationships and communication internally and across different teams. When agencies invest in standardized and accessible process documents, they support efficiency and accountability while reducing friction caused by ambiguity. Clearly defined roles eliminate confusion over who should do what, reducing bottlenecks and preventing duplicate work. Challenges stem from constant organizational restructuring or change and poor communication. Use a Responsibility Assignment Matrix, also called a RACI chart, by assigning each task or decision to one of four categories: Responsible (does the work), Accountable (owns the outcome, final sign-off), Consulted (provides input), and Informed (kept updated). Data Sharing and Information Management Data and information are critical to decision-making, timely and effective response, and continuity of operations. Health agencies need modern information systems, tools, and resources to move from data collection to managing and harnessing information for decision-making and action: A thoughtful data sharing strategy that includes current and adaptable data use or data sharing agreements with key partners should consider the risks of disclosing the data by considering current laws (permissible or requirement), the benefits of disclosing data, and the risks of not disclosing data. Informatics workforce capacity that can obtain, effectively use, and securely exchange information electronically to ensure data-driven decision-making to improve health outcomes. Interoperable systems for efficient data sharing that reduce the labor-intensive data manipulation critical for assessment and forecasting. Many agencies are improving interoperability as well as building tools and trackers that support improved response times to data and information requests. Leveraging AI for real time access to and production of information. This can include integrating AI-enabled or automated tools into existing information systems or workflows to support operations. Knowledge Management Knowledge management is an important yet often overlooked aspect of public health operations and helps sustain many of these foundations during disruptions to staffing and organizational changes, for example. It encompasses a broad range of activities, from documenting best practices and lessons learned to facilitating mentorship and peer-to-peer learning or leveraging technology for knowledge sharing to capture both explicit and tacit knowledge. Role-based knowledge management is often captured through standard operating procedures, training, and succession planning. Capturing institutional knowledge is more complex but just as important. It ensures valuable insights and experiences are not lost but instead become part of the agency’s long-term memory and used to inform decision-making, ensure continuity, improve performance, and drive innovation. Continuous Improvement Continuous improvement involves testing, exercising, and streamlining processes and procedures to improve response times. Rather than a one-time achievement, it is an ongoing process of developing the capacity to adapt to changing environments, optimize workflows, and maintain high performance. Incorporating Plan-Do-Check-Act cycles and basic lean principles to eliminate waste helps ensure that processes are simple, user centric and support operations as intended. Build Resilience Resilience is the capacity to withstand or recover quickly from difficulties or challenges. Strength or relationship-based leadership skills such as competent humility (the balance of having expertise to make sound decisions while remaining grounded, self-aware, and open to others’ input), appreciative approaches (strengths-based and positive change approach that focuses on what works well rather than just fixing problems), and well-being (nurturing employees’ physical, emotional, and mental health to foster a thriving environment) foster resilience by building psychological safety, trust, and long-term sustainability. Encourage and provide leadership development opportunities. Shift from knowledge and technical skills to building team cohesion and psychological readiness. Conclusion Employing these critical strategies can support your administrative readiness; however, this work is rarely linear or simple. Your operational systems must address the complex and intersecting nature of people, processes, technology, and governance, performance, and accountability. As public health leaders, it can be helpful to embrace humility to foster resilience. With this, and a value on transparency and continuous improvement, you and your teams can thoughtfully ready your administrative and operational systems and feel empowered in the face of our continuously evolving field. Reviewed by - Lindsey Myers OE22-2203 PHIG article yes

How Palau is Advancing Its Data Modernization Infrastructure and Capacity Through Partnership How Palau is Advancing Its Data Modernization Infrastructure and Capacity Through Partnership Saisha Adhikari Discover how Palau is improving public health data by leveraging private-sector partnership in this blog post. The Republic of Palau is navigating a rapidly shifting public health landscape with an approach rooted in creativity, clarity, and community. Rather than slowing down in the face of limited staffing and competing priorities, the Ministry of Health and Human Services (MoHSS) has chosen to use this moment to build systems that will last. Through Public Health Infrastructure Grant (PHIG) funding, Palau hired HealthEfficient, a health care consulting organization, to support data modernization (DM) initiatives, including a new national electronic health record (EHR). Palau previously collaborated with HealthEfficient through the Pacific Islands Primary Care Association (PIPCA), which introduced HealthEfficient to the region through a multi-year initiative to support regional EHR planning, readiness, and adoption. During that time, HealthEfficient developed a strong understanding of Palau’s priorities, needs, and operating context. Palau subsequently joined HealthEfficient's Health Center Controlled Network. This multi-phased, ongoing partnership has helped Palau bring structure to complex work, expand internal capacity, and make progress on long-standing priorities. Laying the Groundwork for Meaningful Progress As part of its PHIG workplan, MoHSS is committed to adopting modern, flexible technologies and standards, reducing data silos, and strengthening its workforce. Given the need for external support to implement the EHR, Palau also considered how to leverage its partnerships to advance broader DM efforts. MoHSS collaborated with ASTHO to clarify needs and what success should look like. This preparation, combined with HealthEfficient’s familiarity with Palau’s health system and cultural context, created a strong foundation for their partnership. HealthEfficient has been instrumental as Palau transitions from a largely manual system to a modern, comprehensive EHR. The consultant’s ability to understand local realities of how staff work, how communities engage with health services, and what modernization means in Palau’s context has helped decisions remain grounded in what the country truly needs. Project Management as a Capacity-Building Strategy HealthEfficient serves as an extension of the MoHSS team, managing day-to-day coordination and creating structure around the DM work. They lead agendas, capture meeting notes, track progress, and manage overall project flow. This allows Palau MoHSS staff to stay focused on vision, strategy, and local leadership. Palau MoHSS and HealthEfficient meet on a consistent cadence: twice weekly on EHR implementation and twice monthly on broader DM activities. As demand has increased, additional meetings and hours are scheduled as needed throughout the week. This rhythm keeps the work aligned while giving each workstream to move at its own pace. Due to capacity, MoHSS moved the EHR launch from December 2025 to the first half of 2026. Rather than treating this as a setback, they used the new timeline as an opportunity to refine workflows and better support staff. Together, MoHSS and HealthEfficient updated their approach and kept the work moving. Although the workload is still considerable, the partnership has made it manageable. Clear roles, shared communication, and reliable structure have allowed the team to maintain momentum without overwhelming MoHSS staff. This progress is also driven by a strong internal MoHSS team of five staff members, several of whom are featured in this blog, who are working closely with HealthEfficient and the EHR vendor to move implementation forward. Sherilynn Madraisau, Director of the Bureau of Public Health Services at MOHSS, explained: “Even with limited staffing, leadership recognized how critical this project was for Palau and contracted HealthEfficient not only to manage much of the day-to-day work but also to help build our internal capacity, ultimately strengthening overall systems and creating long-term impact.” Navigating Challenges with Cultural Awareness Like many small jurisdictions, Palau MoHSS faces: Limited staffing and competing priorities. Navigating technical jargon. The need to coordinate across multiple external partners. These challenges show up in real ways: teams are stretched across responsibilities, vendors may not understand local context, and cross-agency communication requires ongoing attention. Edolem Ikerdeu, Executive Director of the Palau Community Health Center, noted the importance of cultural mediation in this work: “Our consultants bring valuable expertise and guidance, but it’s equally important that the work reflects our culture and our priorities.” Her role includes working with staff members to help partners understand context, smoothing miscommunication, and ensuring all stakeholders stay aligned around the mission of serving Palau’s people. That spirit of shared learning and adaptation is echoed across the team. Tmong Udui, Acting Chief of Division of Health Informatics and Intelligence at MoHSS, added, “A lot has been new for [staff], but learning together and building skills in this new area has been a good experience.” Partner engagement remains personal and intentional. The MoHSS team keeps partners engaged by having real conversations, naming the shared purpose, and showing exactly how the EHR will help the whole country, not just the health sector. Early Wins and Emerging Strengths Even just a few months into the EHR migration, MoHSS is already seeing measurable progress: Accelerated EHR Implementation: After years of anticipation, MoHSS now has a clear structure, dedicated support, and renewed momentum behind the EHR work. Informed Technology Decisions: With HealthEfficient at the table for external stakeholder discussions, MoHSS has had a trusted advisor to help evaluate system options and advocate for what best fits the country’s needs. Growing Internal Capacity: Through trainings and ongoing collaboration with subject-matter experts, staff are strengthening their skills in cybersecurity, systems upgrades, and process improvement. Stronger Organizational Coordination: Clear oversight and consistent communication have helped reduce the burden on staff and increased alignment across the ministry. These wins reflect progress beyond just technology, but in confidence, communication, and long-term planning. The work is strengthening the system as a whole and not just a single project. A Foundation for the Future With HealthEfficient managing much of the operational load for DM, Palau can focus on guiding strategy and determining long-term direction. HealthEfficient advances the work; MoHSS shapes the vision. Edolem Ikerdeu shared, “If you hire people and the funding goes away, then what is this for? We want a stronger system that includes the people who are already here.” Palau’s approach offers a compelling model for other resource-limited jurisdictions: Start with clarity. Build the right partnerships. Protect space for local leadership. Design systems that will outlast short-term funding. By centering community, embracing thoughtful project management, and working with culturally aligned partners, Palau MoHSS is building public health infrastructure that will serve its people well into the future. Reviewed by - Lindsey Myers OE22-2203 PHIG article yes

Learn how public health agencies can leverage community impact statements to showcase their critical work.