News  |  December 19, 2017

As noted in Discussing Change Management in Public Health, with the right change management tools and skills public health practitioners can be leaders to accelerate change initiatives, innovation, and organizational success within their health departments.

Dawn Emerick, EdD, the Public Health Director of Clackamas County Public Health Division (CCPHD) in Oregon, used change management principles to align an organizational restructure with modernization, accreditation, and other strategic planning efforts in her public health division.

Before Emerick began working at CCPHD in June 2016, Oregon passed Public Health Modernization in 2015, which is legislation aimed to modernize the governmental public health system through core foundational capabilities and programs that increases efficiency and effectiveness and ensures a base level of public health services to every person in the state.

Emerick recognized that significant changes were taking place in public health administration, financing, and service delivery, and used Public Health Modernization as a catalyst for change when she arrived at CCPHD.

“Change is not a bad thing. It can be very aspirational depending on how it is introduced, the type of culture that exists, how it is communicated, and how the catalysts of change are leveraged in an organization.”

Armed with key organizational theories to manage change and advance modernization work, Emerick not only had “quick wins” within CCPHD, but also experienced major improvement outcomes because of her leadership strategies. 

Theories Used

Processes Followed

Outcomes Gained

The First 90 Days: Proven Strategies for Getting Up to Speed Faster and Smarter (Michael Watkins)

8-Step Process for Leading Change (John Kotter)

Find Your Why: A Practical Guide for Discovering Purpose for You and Your Team (Simon Sinek)

Value Mapping™ (Al Emerick)

Diffusion of Innovations (Everett Rogers)


  • Seek understanding to meet staff and learn about expectations.
  • Assess and understand organizational values to determine priorities.
  • Implement plans in phases to create a sense of urgency, generate quick wins, and build trust.
  • Completed SWOT exercise to drive strategic plan development, a PHAB accreditation requirement.
  • Developed e-mail template to communicate change by providing an overview of the change, outlining the “why, where, who, and when” of the change, if and how roles will change, and who to speak to for more information.
  • Improved supervision and employee development.


Emerick’s first ninety days revealed the need to restructure CCPHD to meet identified organizational and Public Health Modernization priorities. Between November 2016 and September 2017, she continued to meet with all program areas to share the strategic vision and answer questions; shifted staff positions and updated job descriptions to reflect foundational capabilities and programs language; communicated change priorities and restructuring activities; and recruited additional public health workers to fill critical vacancies and new positions.

CCPHD experienced many major outcomes because of its change management activities, one of which was the establishment of The Center for Public Health Advancement, where foundational capabilities related to innovation, assessment, assurance, policy, emergency planning and response, emergency medical services, and public health outreach, education, and evaluation are now housed.

Another outcome includes the fiscal recovery of CCPHD from a $130,000 deficit in one of their program areas. Through the restructuring process, program areas that traditionally operated as independent cost-centers were merged into new and larger cost-centers within the organization to better align with Public Health Modernization recommendations – for example, the maternal and child health program moved under a newly established Access to Care program area.

Additionally, the Access to Care program area acquired WIC, immunizations, school-based health centers, and reproductive health. The integration of these critical services under one program area created deeper economies of scale, eliminated duplication of administrative support services, and produced process efficiencies.

Even though CCPHD’s restructuring process was successful and yielded beneficial results, Emerick notes that more change is inevitable and more work needs to be done. With new legislation passed in 2017, which further clarifies and funds how the foundational capabilities and programs are to be implemented across the public health system, CCPHD looks forward to continuing its journey to modernize.

"Change is not an event – it is a process that is started repeatedly."

Health departments and leaders that employ change management techniques can create an organizational culture where public health practitioners implement innovations to improve services. Contact us to share your story of innovation in public health, which could be featured in our upcoming publications.


Learn more about CCPHD’s use of change management from a webinar hosted on October 24, 2017. Please note that a free account is needed to view the webinar.