The effort of the Health Agency Steering Committee is commendable however, the proposed Operational Framework falls short of representing its mission and precludes implementation of the Board priorities. With respect to attempting such a challenging task, the Board of Supervisors now possess the consolidated thoughts and opinions of county employees, contract agencies, community activists and Directors that govern the county systems of care.

What’s missing is a live strategic plan that facilitates a fair and impartial organizational design, planning and coordinated implementation processes that link core functions of the county’s three systems. Such framework guided by social marketing communications will prepare and inform citizens of Los Angeles County to voice their opinion and concerns as to how best the health agency will advance individual and community well-being.

From a systems thinking approach it would be advantageous for the Board of Supervisors to immediately contract an external consultant suggested under Access to Clinical Services – Major organizational next steps as the appropriate course of action hence forth. Accordingly, such contractor should perform a details analysis of the Boards requested reports to create an objective assessment indicating how best to share information and operationalize identified Board priorities defined by community input while initiating cross-sectional discussions among the three Departments. The Directors strategic priorities and operational framework suggest development of an integrated system of care however, contradicting statements suggest otherwise preventing ecological changes that sustain comprehensive transformation.

Case in point, the mission of the LA County Health Agency is “To improve the health and well-being of LA County residents through provision of comprehensive, culturally appropriate services, programs and policies that promote healthy people living in health communities.” The strategic planning workgroup should have included the thoughts and opinion of diverse medical and mental health professionals given cultural competence is a board priority. Certainly, few understand the magnitude of each Director’s responsibilities, however taking into consideration increasing health and mental health disparity in LA County, closed door processes reinforce institutional bias and discrimination. Focus of Health Agency should be to appropriately serve Angelinos to reduce health disparities or we have missed the mark in favor of bureaucratic repositioning.

Another example, statement #7: “Departments shall maintain spectrum and level of current activities. Services, budget, and staffing for Department activities shall not be cut and financing streams shall not be redirected because of a transition to the Agency model.” This statement reinforces “medical model” thinking and will prevent county residents from developing sustainable, comprehensive and fully integrated health and human services system of care.
Question: Which Department or Agency will oversee the implementation of countywide prevention early intervention programs critical to bettering population health outcomes?

Example: Statement #8 suggest conflicting agreement; “Agency shall avoid unnecessary bureaucratic processes. The Agency shall operate in such a way as to ensure strategic alignment of operational and administrative activities with and between Departments in pursuit of Board-supported priorities.” While this statement supports the mission of the Health Agency in comparison statement #7 suggest “activities shall not be cut and financing streams shall not be redirected because of a transition to the Agency model”

Withstanding the significance of providing culturally proficient integrated care; equally significant is ensuring the county’s structure supports an integrated billing mechanism and information technology system. The risk associated with failing to redirect financing streams circumvents true integration and eliminates the opportunity of closing service gaps.

Example: Statement #14 “Departments shall maintain individual mechanisms to engage internal and external stakeholders.” Allowing each Department to maintain separate internal operating committees and external community stakeholder groups reinforce a biased and myopic approach to health integration. The sharing of cross cultural information is crucial to developing a culturally proficient system of care particularly acknowledging an emergent multi-cultural millennial generation. Provided each system has individual stakeholder processes attempting to communication within an integrated system, please describe a vision of what a complimentary mechanisms stakeholder committee structure and process will resemble?

The Board of Supervisors action lends credibility toward operationalizing mental health parity per the Patient Protection Affordable Care Act. The County current system of care requires transformation into the knowledge age paradigm to satisfy emergent culture and eliminate Departments working independently.

It is recommended, the Board of Supervisors include executive administration and front line staff from the Departments of Children and Family Services, Probation Department, Los Angeles County Office of Education and Department of Public Social Services in coordinated working group discussions to guide transforming the county’s health and human services infrastructure. Working groups shall also include contract providers and community stakeholders in the designing and planning process to legitimize the Health Agency operational structure and services delivered. Otherwise as presumed in the strategic priorities and operational framework, the Boards initiatives will fall exclusively on the Health Agency Director to manage, while business as usual continues with the remaining departments to the detriment of advancing individual and community well-being throughout Los Angeles County.

The attached executive summary frames whole system transformation dynamics and processes related to large scale systems change. I am hopeful the Board of Supervisors will continue to advance this important initiative under the guidance of an external consultant to bridge system mandates with community need. The end result will produce a culturally proficient system of care legitimized by residents intended to serve.