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Receive a presentation on the proposed redesign of the Health and Social Services and recommendations for an organizational structure and staffing that will support the County’s needs; Consider establishing a Health and Social Services Executive Compliance Committee and charter; and Consider adopting a resolution amending the List of Numbers and Classifications of Positions to add a net 7.0 FTE, reclass 2.0 FTE and revise 2 classifications
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Published Notice Required? Yes ___ No _ _
Public Hearing Required? Yes ___ No _ _
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board:
1. Receive a presentation on the proposed redesign of the Health & Social Services and recommendations for an organizational structure and staffing that will support the County’s needs;
2. Consider establishing and approving an H&SS Executive Compliance Committee and charter; and
3. Consider adopting a resolution amending the List of Numbers and Classifications of Positions to add a net 7.0 FTE (TBD), reclass 2.0 FTE (TBD) and revise 2 classifications.
SUMMARY:
For the past year, the Department of Health and Social Services (H&SS) has been actively working with three external consultants examining state and national trends in health and human services delivery and reviewing the H&SS compliance unit. Increasingly, counties and states have been involved in moving toward a more integrated way of providing services in their communities which are more consumer focused and lead to better outcomes. A central aspect of these trends includes providing more preventative and care coordination services in the community which are more cost effective and improve community health. The proposed reorganization will assist H&SS with delivering more integrated services to the community and result in increased effectiveness and efficiencies. This structural recommendation is based on best practices gathered from other counties with integrated services, as well as with input from staff, service recipients and community stakeholders.
FINANCIAL IMPACT:
The cost of the proposed reorganization is approximately $1,872,885. If approved, H&SS will include the cost and associated funding in the FY2019/20 Requested Budget. H&SS anticipates using a combination of Public Health Intergovernmental Fund Transfer (IGT) revenues, 1991 Realignment, and 2011 Realignment to fund the reorganization. The positions will also be able to draw down some federal and State dollars for various H&SS programs. The costs associated with preparing this agenda item are nominal and absorbed by the department’s FY2018/19 Adopted Budget. There is no additional financial impact to the County General Fund.
DISCUSSION:
On June 26, 2018, the Board received a presentation from H&SS and approved its new mission, vision, and value to “Promote Healthy, Safe, and Stable Lives” and the Department specific vision of “A Healthy, Safe, and Stable Community.” During the presentation, the Board encouraged the Department to continue this work and keep the Board apprised of continuing efforts in this venue. H&SS identified its next steps as continuing ongoing work in culture improvement, effectiveness and efficiencies, as well as an external scan and engagement with community partners and stakeholders. H&SS partnered with two consultant organizations, Performance Works and the American Public Human Services Association (APSHA), to assist with these efforts. Additionally, H&SS has been actively involved in Harvard Health and Human Services Summit.
Performance Works assisted with building a foundation to accelerate performance, develop leadership capacity, shape an adaptive culture and provide tools to keep employees engaged and informed. In addition, Performance Works completed an organizational assessment and provided recommendations to ensure the department is “future ready.” APHSA introduced the Human Services Value Curve (HSVC) which aims to drive the department toward an internal cultural shift and increasing collaboration with community partners to enhance practice and services within the community. The focus of the HSVC model and research is to design a system of delivery of services based on the true needs of customers which are more wholistic and preventative. HSVC also includes a public health approach to service delivery by working upstream with many stakeholders in the community who play a part in meeting the health and human services needs of the population.
As part of H&SS’s partnership with Performance Works and APHSA, multiple surveys and listening sessions were conducted with program participants, staff, and various other community stakeholders. Some of the feedback received is that although administratively the Department is managed as integrated, much more could be done in serving and coordinating care for the whole person or whole family. Responses from program participants demonstrated that the majority would prefer a coordinated, multi-program application process with information shared between programs in order to optimize care. Meeting this preference requires better data sharing between divisions and other departments in the county, better integrated IT systems; less “siloed” funding sources, and more multi-disciplinary team involvement.
On November 6, 2018, the Board adopted a resolution as authorized by Assembly Bill (AB) 2821 and effective January 1, 2019, which allows H&SS to operate as an integrated and comprehensive County Health and Human Services agency including maintaining and evaluating an administration system that integrates and coordinates the management and support of client services and maintains a system of reporting and accountability that provides for the combined provision of services without the loss of State or Federal funds. The integration initiates the process of allowing funding to follow clients based on need.
In January 2019, H&SS, Human Resources and the County Administrator’s office discussed the consultants’ recommendations. The recommendations include:
• Structure: designing the organization to address specific objectives; build structured collaboration in key areas
• Resources: Assess data systems and leverage existing best practices from peers; address employee workloads
• Culture: Build an employee centric culture; drive accountability
• Job Design: Assess relevance and impact of job classifications; build shared understanding that the job isn’t just the classification
• Work Process: Design/redesign work processes; build a business case for technology improvement
Separately, the July 2018 Grand Jury report on In Home Supportive Services recommended the department consider restructuring and reassigning its Compliance Unit. These recommendations were reviewed by an outside consultant engaged by the County Administrator’s Office and Human Resources. In response to the recommendations, H&SS is proposing staffing changes in the Compliance Unit, the creation of an H&SS Executive Compliance Committee, and an interdepartmental Memorandum of Understanding between H&SS, the Auditor Controller’s Office, Human Resources/Risk Management and County Counsel. The proposed charter outlines the scope and responsibilities of the proposed Compliance Committee.
In summary, H&SS is proposing a redesigned organizational structure that will provide the capacity and ability to engage and act on the recommendations above. If approved, implementation of the new structure will in March 2019 with new classifications developed and recruitments starting in July 2019.
The proposed additional positions include:
• 4.0 FTE Chief Deputy positions (Health/Health Officer, Human Services, Administration, Behavioral Health) (TBD)
• 3.0 FTE Administrative Secretary (TBD)
• 2.0 FTE Navigation Team (TBD)
• 1.0 FTE Administrative Services Deputy Director (TBD)
• 1.0 FTE Grant Writer position (TBD)
New/revised classifications proposed include:
• 1.0 Public Health Deputy Director (non-MD required) (TBD)
• 1.0 Maternal and Child/Adolescent Health Medical Officer (TBD)
• 1.0 Deputy Compliance and QA Manager to H&SS Training Officer (TBD)
• 1.0 Compliance and QA Analyst to Credentialing Specialist (TBD)
Positions to be deleted:
• 4.0 vacant positions (TBD by Requested Budget FY2019/20)
H&SS is committed to eliminating barriers and moving towards person-centered and outcomes-based approach and focused on greater sector impact and systems change. This timing and capacity building will allow the department to focus the next three to five years in building integration from the customer perspective, enhancing service delivery outcomes and efficiencies.
ALTERNATIVES:
The Board may choose not to approve H&SS proposed reorganization, including changes to the Compliance Unit and associated position classification changes, the establishment of an executive compliance committee, or an interdepartmental Compliance MOU. This is not recommended because the proposed staffing model is a necessary component of implementing the H&SS’s strategy to be future ready while providing increasingly integrated and high-quality services, and a component in establishing a Compliance Unit aligned with best practices.
OTHER AGENCY INVOLVEMENT:
In creating the recommendations and organizational structure, H&SS and Performance Works worked with the County Administrator’s Office, Human Resources and solicited input from stakeholders such as local community-based organizations and customers/recipients of services.
In creating the H&SS Executive Compliance Committee charter, H&SS worked with County Counsel, Human Resources, Auditor-Controller and County Administrator and were all consulted and part of the development of the charter as written.
The County Administrator’s Office has been consulted on the presentation.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION