FOC: Miller County, GA Vignette
Forces of Change
Miller County is a small, rural county (population: approximately 6,000) in the southwestern corner of Georgia. When faced with the possible closure of the local hospital in 1997, a coalition of community organizations and representatives initiated a community strategic planning process.
The potential hospital closure was a clearly identified catalyst for initiating the strategic planning activities, providing the impetus for convening partners, obtaining external technical assistance, and designing the process. Closure of the hospital would leave residents without a nearby hospital or emergent care system and represented a possible loss in jobs and economic and population growth for the county. In addition, several other forces were identified that contributed to healthcare delivery problems in the county. The onset of Medicaid managed care in the state had affected the rural healthcare system. It also became apparent that a broader "healthcare crisis" was occurring, in the guise of the rapidly decreasing number of local physicians.
The Miller County Coalition recognized that there were important forces aggravating those that prompted the process. At a strategic planning retreat, a broad range of forces were identified. Some were beneficial to the community, including (1) a history of success with community-driven projects such as "Swamp Gravy" (a local theater production) and the Tarrer Inn (a restored historic inn); (2) the recent successful collaboration among community leaders, physicians, the hospital authority, and the public health director; (3) the enthusiastic community spirit; (4) the willingness of community leaders to learn; (5) the agreed-upon plan based on solid information and the support of the "Safety Net Project"; and (6) a desire within the state public health system (supported by the district health director) for increased strategic planning.
The coalition also identified forces that threatened to derail the quest for a successful healthcare system. The most serious potential threat was the failure of the community to work together toward a common vision. Community leaders identified competition for scarce resources, fear of the unknown, lack of communication, hidden personal agendas, turf guarding, negative attitudes, and resistance to change as specific problems that might hinder success. The coalition also feared that leaders responsible for managing the healthcare system might not have the knowledge and preparation needed to make the new vision a reality, and that this lack of leadership might result in a loss of momentum.
These and other forces affected the process—either by posing obstacles or providing opportunities upon which to build. Many of these forces were recognized by the Miller County Executive Committee (which oversaw the process) or were illuminated by a survey that gathered community perceptions. These forces, and the fact that they were recognized as having an impact on the public health system, helped the Miller County Executive Committee move forward with their eyes open to the challenges and opportunities that lay ahead. The identification of Forces of Change was instrumental in shaping the process and its resulting action plans.