Arizona Department of Health Prevention Services' Work to Advance Health Equity Starts With an Assessment of Its Own Organizational Culture

Abstract

Objective: To identify skills, organizational practices, and infrastructure needed to address health equity.

Design, setting, and participants: We developed an anonymous online staff survey to assess how to address health equity and policy implications and develop a baseline for future initiatives. We distributed invitations to all Arizona Department of Health Services (ADHS) Division of Prevention Services (DPS) state- and non-state-designated employees in February 2021.

Main outcome measures: Employee self-reported perceptions of how agency, division, and programs address health inequities; information about (1) organizational and individual traits needed to support our ability to implement effective health equity-focused work and (2) processes to enable improved organizational and workforce capacities; and implications for strategic planning.

Results: Seventy-eight percent (N = 123) of eligible staff participated. Overall, we identified 21 of 28 organizational and 17 of 31 workforce capacities needing significant improvement. Organizational capacities were "Institutional commitment to address health inequities" (described using 6 elements), "Hiring to address health inequities" (2 elements), "Structure that supports true community partnerships" (3 elements), "Support staff to address health inequities" (4 elements), "Transparent and inclusive communication" (4 elements), "Community accessible data and planning" (1 element), and "Streamlined administrative process" (1 element). Workforce capacities were "Knowledge of public health framework" (4 elements), "Understand the social, environmental, and structural determinants of health" (1 element), "Community knowledge" (1 element), "Leadership" (4 elements), "Collaboration skills" (3 elements), "Community organizing" (3 elements), and "Problem-solving ability" (1 element). Using survey results, groups of staff identified change needed, specific actions, and training and communication to increase employee understanding. Proposed activities focused on data/evaluation, program planning/contracts, communications, personnel development, and community engagement.

Conclusions: This survey allowed ADHS to establish a baseline of staff knowledge of the ADHS and DPS organizational commitment to address health inequities; results show us what areas to focus on to strengthen our capacity to achieve better outcomes; and improve health and wellness for all Arizonans.