A USPHS in the 21st Century

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A USPHS in the 21st Century
Are We Present Where We Need to Be?
RADM Clara H. Cobb CAPT Arlene M. Lester LCDR
(select) Donna L. Phillips

• USPHS Scientific and Training Symposium
• June 3, 2009 - Atlanta, GA

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Todays Objectives

• Overview transformation history and pillars
• Identify current assignment and placement of
  USPHS Officers
• List opportunities to strengthen the presence of
  Officers in Americas health infrastructure
• Describe the application of Systems Dynamics
  Modeling to mitigate alignment of presence with
  the USPHS mission

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911
Everything changed
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Leading a strong public health workforce
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Former HHS Secretary Mike Leavitt on
Transformation of the PHS Commissioned Corps -
2006
I see a Commissioned Corps that expands
dramatically the number of duty station
organizations that we work with. In addition to
HHS, we need to expand our relationship to state
governments, to local governments, to other
federal agencies, with community health centers,
universities and many others.
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WHAT WE DO AND WHERE

• RADM Clara H. Cobb

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11 Categories/Professions
Source CC Mid-Year Force Strength Report - FY2009
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6253 Commissioned Officers
Source CC Mid-Year Force Strength Report - FY2009
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4814 Officers Within HHS
Source CC Mid-Year Force Strength Report - FY2009
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1439 Officers Outside of HHS
Source CC Mid-Year Force Strength Report - FY2009
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Example of Physicians Category - 975 Physicians
Source CC Mid-Year Force Strength Report - FY2009
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Example of Nurses Category - 1467 Nurses
Source CC Mid-Year Force Strength Report -
FY2009
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PHS DUTY STATION MAP
Source www.usphs.gov Commissioned Corps
Answering the Call
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Visibility Potential for the Future

• LCDR (select) Donna L. Phillips

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USPHS Commissioned Corps Mission Statement
The mission of the U.S. Public Health Service
Commissioned Corps is to protect, promote and
advance the health and safety of our nation.
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USPHS Core Values

• Leadership
• Provides vision and purpose in public health
  through inspiration, dedication and loyalty
• Service
• Demonstrates a commitment to public health
  through compassionate actions and stewardship of
  time, resources and talents
• Integrity
• Exemplifies uncompromising ethical conduct and
  maintains the highest standards of responsibility
  and accountability
• Excellence
• Exhibits superior performance and continues
  improvement in knowledge and expertise

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Charting a new course
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State and Local Government Can PHS Officers
fill in skills gaps?

• State and local health department workers often
  lack public health training and adequate science
  backgrounds
• Severely constrained state budgets and rigid
  hiring practices pose additional barriers to
  recruitment

Source Institute of Medicine HHS in the 21st
Century
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Community Health Centers (CHC)?

• Over 16,000 additional primary care physicians
  necessary to fill the need in currently
  underserved areas
• http//www.bhpr.hrsa.gov/shortage/
• CHCs had the following vacancy rates
• Family practice (13)
• Dentists (19)
• Nurses (11)
• Pharmacists (11)
• NACHC, 2007

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The Crisis in Higher Education ---- Can PHS
Officers help close the gap?

• On the frontline
• Decrease Faculty Shortages
• Enhance the Educational Experience
• Expand JR and SR COSTEP Liaisonship

Source American Dental Education Association
Dental Health Workforce Trends 2007
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Non-profit and community-based entities?

• SERVICE
• Environment
• Communities
• Health for the Underserved

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Institute of Medicine Recommendation
The Secretary, in concert with other public and
private partners, should develop a comprehensive
national strategy to assess and address current
and projected gaps in the number, professional
mix, geographic distribution, and diversity of
the U.S. public health and health care
workforces.
Source Institute of Medicine HHS in the 21st
Century
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Each day is challenging.

• CAPT Arlene M. Lester

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Transformation focus on the future
.Memoranda of understanding will be rapidly
developed and signed with non-HHS agencies and
non-Federal entities to enable the Corps to
assign officers to non-traditional duty stations
(e.g., state and local health departments,
universities, community health centers)
Source Transformation Accomplishments and Future
Directions USPHS 2007
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Transformation Challenges - concerns

• Overall benefit to Federal government, HHS and
  the USPHS
• Conflicts of Interest
• Personnel Costs
• Responsibility for Contingency Costs

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Policy resistance the human endeavor
The tendency of dynamic systems to delay,
defeat, or dilute the effects of planned
interventions.
Source Meadows, Richardson, Bruckman, 1982
Background on System Dynamics for Public Health
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Is there a means for mitigation?
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System Dynamics
Dr. Jay W. Forrester
Source www.systemdynamics.org
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Systems thinking

• Systems are dynamically fundamental in time
• The behavior of a system is ultimately controlled
  by its structure
• Systems are controlled by their stocks and flows
• Controls of systems are circular feedback
  relationships, not linear chains of cause and
  effect

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Systems thinking - who, what, why, where..
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Systems thinking - the human body
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System dynamics modeling - chronic disease
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System dynamics - application

• Climate Change
• World Dynamics

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System dynamics and K-12 Education
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System dynamics modeling - urban dynamics
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System dynamics modeling - human services delivery
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Mitigating complexities in todays world
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Transformation take home questions..

• What aspects of a systems behavior are of
  concern?
• Why are these features changing in those ways at
  those times?
• Where is the system headed if no new action is
  taken?
• How else can the system behave, if different
  decisions are made?
• Who has the power to move the system in a
  different direction?

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Sharons Life Lessons From a Spoon

• Only take what you can handle at the moment, and
  leave everything else in the bowl.
• Sometimes the ice cream of life is too hard to
  handle alone. Dont get bent out of shape. Allow
  others to help you.
• If you really werent designed for the job, admit
  it, and leave it to the professionals.
• Just because the other guys at the table dont
  look like you, doesnt mean they wont be key
  players on the team.

Source Sharon L. Ricks, MA Deputy Regional
Health Administrator HHS IV
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New HHS Leadership
SECRETARY KATHLEEN SEBELIUS
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Thank you from HHS Region IV
RADM Clara H. Cobb
CAPT Arlene M. Lester
LCDR (S) Donna L. Phillips