RHODODENDRON CouNTY HEALTH DEPARTmentRecent History –Prior to January 1995AdministrationPersonal Health ServicesEnvironmental Health ServicesSnapshot - October, 1995Personal Health Services Situation ErodesEnvironmental Health ServicesSnapshot - October, 1996Environmental Health ServicesTHE ELECTRONIC HALLWAYTM NETWORK A PRODUCT OF THE PUBLIC SERVICE CURRICULUM EXCHANGERHODODENDRON COUNTY HEALTH DEPARTMENTLike local health departments/districts throughout the state of Washington, theRhododendron County Health Department is in the midst of a challenging time. It istrying to balance the need for change and a focus on population-based services with thefinancial and political realities of public health on the local level. At the same time thehealth department is dealing with a great deal of change and uncertainty, the identity andstructure of the county is changing.The several small towns in the county do not communicate frequently and have their ownidentities (not to mention strong high school football rivalries). Their own values are veryimportant. Over one-third of the population lives in rural areas. The population isrelatively poor. The reasons for this include the downturns in the logging industry and therecent low-income arrivals.Recent History –Prior to January 1995AdministrationMs. Simmons has been the director of the health department since 1985. The healthdepartment has a history of providing clinical services. The community respects both herand her staff for these services, even though their interaction with most segments of thecommunity is minimal. Personal Health ServicesOne major department under Ms. Simmons is Personal Health Services (PHS). MariaEspinoza, RN, is the Director of Personal Health Services. She started at the healthdepartment as a public health nurse in 1977. Ms. Espinoza is respected statewide and is astrong opinion leader. Internally, she is also very supportive of her staff as they seek toeither directly provide services or make sure that people in need have access from anotherhigh quality source. Reflecting her philosophy, clinical services is a strong component ofDistribution of this case study is made possible through the generous contributions of The Pew Charitable Trusts as part oftheir support for the Electronic Hallway. Development of this case was funded by the Washington State Department of PublicHealth. This case was prepared by Brenda Suiter under the supervision of William Dowling, Professor of Health Services atthe University of Washington.The Electronic Hallway is operated by a multi-university consortium and is administered by the Cascade Center for PublicService at the University of Washington’s Graduate School of Public Affairs.This case study is intended as a basis for class discussion and is not intended to suggest correct or incorrect handling of thesituation depicted. While based on field research, names may have been disguised and certain facts simplified in the interestof confidentiality and effective classroom use. Use of this case study is subject to the terms of the Subscriber Agreement (http://www.hallway.org/agree.htm). If the terms ofthis agreement are not acceptable to the user, user should terminate access and refrain from any storage, printout, distributionor other use of this material. This material may not be altered or copied without written permission from the Cascade Center forPublic Service. For more information, contact the Cascade Center at [email protected] or (206) 616-8777.Copyright 1998 Cascade Center for Public ServiceF96Rhododendron County Health Departmentthe health department. Services offered include well-child, STD, TB, HIV/AIDS, familyplanning/reproductive health, immunizations, Women Infants and Children (WIC), andMaternity Support.Environmental Health ServicesAnother area Ms. Simmons oversees is Environmental Health Services (EHS). Mr.Johnson, the Director of EHS, is a superb field sanitarian, but has limited managementskills. He has worked for the department for 20 years. He makes all decisions andfocuses on program operation and maintenance. He has allowed few programmaticchanges to take place in the past ten years. EHS staff and supervisors are impatient with Mr. Johnson’s "traditional" approach. Twoof the environmental health specialists are becoming increasingly frustrated. They are bothrecent graduates of a progressive environmental health program at the local university.They want to expand programs and rearrange resources to put more emphasis onemerging problems like hazardous wastes and toxic substances in the home. Mr. Johnsonresists discussing their efforts and ideas. Everyone acknowledges staff members receiveassignments or lead responsibilities based more on their common conservative philosophythan their skills, education, or abilities. Mr. Johnson ignores the impact this has on themorale of other staff members and the department as a whole. Ms. Simmons has madesome efforts over the years to work with him on his management skills, however, due tohigher priorities she has largely ignored this issue.Snapshot - October, 1995Personal Health Services Situation ErodesMs. Espinoza is becoming increasingly concerned about the quality of clinical servicesreaching high-risk populations. In June, well-child services were terminated because ofdeclining revenues. Of children receiving the services, the 80% that were eligible forMedicaid were no longer coming because they were receiving care from their HealthyOptions providers. The other 20% of clients still wanted the service but did not bring anyfunds. She and her staff are working to sign up these clients with the Basic Health Plan. Maternity Support Services now has to partially subsidize other activities of the publichealth nurses including communicable disease services, since the County contribution doesnot cover all population-based services. Ms. Espinoza is concerned about the healthdepartment's ability to deal with a communicable disease outbreak, such as TB, measles orHepatitis A, if the department lets the public health nurses go for lack of funding.Despite all of these concerns, Ms. Espinoza nurtures a good positive relationship withstaff. The threat of layoffs and the voluntary time reductions sparks anxiety, but