FOC: East Tennessee Region Vignette
Forces of Change
The East Tennessee Regional Health Office (ETRO) serves a predominantly rural 15-county region. The regional office has oversight responsibilities for the 15 local health departments, which serve a total population of 600,000. Each county conducts a community assessment and planning process that is overseen by local health councils. ETRO—which assists in these efforts—undertook its own internal organization planning process in 1997 in an effort to supplement local efforts and devise a plan for the future. As part of this organizational assessment, ETRO assessed the forces of change affecting its community.
ETRO undertook a 12-step process for conducting the assessment—one of which focused on external trends, forces, and contingencies. As part of this process, the agency director developed a survey instrument to gather input from ETRO staff and others. Two items related to forces of change were included on the survey:
The director and a core group of staff compiled and analyzed responses. The forces identified as most important were technology, changing demographics, and healthcare reform. ETRO recognized that these and other trends had prompted the regional organizational assessment and had brought the need for more planning into focus. (For example, a shift in primary care services was caused by the rise in federally funded and private primary care centers. The 1994 implementation of TennCare, the state's Medicaid managed care program, also caused changes in primary care services as well as within the Tennessee public health infrastructure.) Last, a significant amount of funding was shifted from Tennessee's Department of Health to support TennCare. Since then, many local public health departments have refocused efforts on outreach and assurance of care (reimbursable services), as opposed to providing direct services.ETRO is continuing with its organizational and community planning at both the county and regional levels, relying on the identification of these factors and forces to help both processes.