DHSS Director's Message

Dear Partners,

Over the years I have had the opportunity to work in a variety of places when employers were implementing institutional culture, customer service or staff retention programs. These programs were structured in various ways with the goal of improving targets such as culture, experience and organizational performance. Improved organizational performance may mean improved customer service scores or perception of work, financial strength, market share, turnover or quality outcomes among many others. While an employer may implement a program because of a particular issue, ultimately, the desire is overall improvement for the investment; and the investment is huge.

The financial investment is often considered the biggest and most immediately measurable investment. I have worked in organizations that spent hundreds of thousands of dollars securing international companies to share their expertise and drive the work. Then, there are costs of training leaders and staff, process changes, and securing and deploying equipment and supplies. Additionally, there are other investments such as time, human resources, and strategically embedding change for sustained results. At the heart of any investment aimed at improving things like culture, customer service, and quality is the employee who will continue the cultural transformation, improve customer service, and drive organizational performance. So, why do so many of these initiatives fail to achieve or sustain the desired impact?

At first, the structure, training and excitement around new tools and possibilities may enhance performance, help leaders improve, reduce turnover, improve outcomes or whatever the desired result was. However, true transformation can only occur if the environment is healthy. Why? In service-based industry or government sectors there is an immense amount of constant change. Being able to adapt to this level of change requires an environment that can withstand the impact of constant change, otherwise called a healthy work environment. A healthy environment is one focused on skilled communication, respect, leadership, meaningful recognition and collaboration. 

According to the American Association of Critical-Care Nurses, research shows that a healthy work environment can contribute to nurses who are more engaged, lower turnover, decreased burnout, and improved patient care. As a nurse leader, I have spent considerable time learning about the AACN’s Healthy Work Environment model and encouraging its principles. However, a healthy work environment isn’t a “nursing thing.” The concept and principles of a healthy work environment have been broadly applied across many disciplines and different work environments.

I realized what skilled communication in a healthy work environment meant when nurses would tell me about the things that they wanted the most like having the CEO come to their breakroom and have lunch with them. They desired thoughtful and respectful information sharing and listening. They didn’t expect the lunch to be provided, an agenda, or that every suggestion would be implemented. They wanted unexpected time and presence with real conversation. They also described the importance of having their unique contributions specifically recognized instead of a general pizza party when meeting a milestone. There’s a difference when we say, “great job” versus “Jim, I learned that you recommended a change to our protocol and that it is resulting in better communication with Environmental Services.” It’s important to make the recognition meaningful.

A healthy work environment is a level far beyond implementation of a program to achieve a certain outcome. It’s transformational. Programs should occur in the context of a work environment that is healthy to achieve success. At DHSS, we have work to do in defining our healthy and creating that environment. The department is not unique in this way. If we are to truly address the healthcare workforce crisis, regardless of the setting, we must fix the environment in which our employees work so we can more effectively address the external threats like reduced enrollment in healthcare careers, funding cuts, social violence and behavioral health.

The department continues to track and monitor communication on federal funding changes. It appears most federal funds for community and public health and laboratory services continue to be awarded to the department. The current exception to this is the Hospital Preparedness Program (HPP). While we were awarded the funds with a thirty percent reduction, we were notified that we must reapply and submit a new budget, which was completed. All HPP funds have been on hold for several weeks pending approval and award availability. There is uncertainty as to the future status of the program. Likewise, the department received the notice of award for the Public Health Emergency Preparedness grant less thirty percent. We have notified partners of award decreases stemming from the thirty percent reduction. The department has been holding on refilling certain positions and reducing expenses. We are prepared to make budgetary requests and reductions in services understanding the state fiscal outlook.

Departments are working with the Governor’s Office to assess the impact of the OBBBA. DHSS does not appear to be heavily impacted directly but could be if there were to be shifts in Medicaid and Supplemental Nutrition Assistance Program enrollment changes. Section 71401 of H.R.1 authorizes the creation of a Rural Health Transformation Program. The Centers for Medicare & Medicaid Services recently released a memo further explaining the intent of the program.

The department is assisting other state departments and the Governor’s Office on a plan to help ensure sustainable access to health care in rural Missouri. States are awaiting further guidance to estimate the dollars they may receive. There are several factors being considered in the award amount including how rural the state is. Missouri is the 21^st most rural state in terms of rural population; however, there are no actual definitions of “rural” to guide states on how to propose to use the funds currently. The language directs the Administrator to approve or deny applications by December 31, 2025.

It seems clear that the aim of our federal partners is a systemic, and long-term change in funding for rural health care. I believe there is opportunity to build strategic collaborations and focus on health promotion to improve the health and safety of Missourians.

The last two weeks have been busy! I have had the opportunity to meet with:

• a licensed cannabis facility
• Missouri Hospital Association
• a residential care provider
• AAA-Aging Best
• Mid-America Transplant Center
• Gateway Business Health Coalition
• STL Integrated Health Network
• a hospital in southwest Missouri
• a local public health department in southwest Missouri
• Next to Rise
• Missouri Associated Grocers

I enjoy the time spent getting to know our partners, stakeholders, regulated entities, and groups with similar interests in safety, quality, and health outcomes. It is my goal to make it to as many places and meet with as many related groups as possible. I also hope more groups will let my office know of special events or opportunities to connect (contact Debbie Mebruer). The networking will help the department be responsive to changing needs and make meaningful connections between entities to facilitate collaboration. It seems there is a growing opportunity, or even necessity, to develop meaningful collaborations among and amid public health, healthcare, behavioral health, special interests, and related providers. In the future, the department plans to place an increasing value on local collaborations to improve health and safety of Missourians.

In April 2024, the Department of Justice published a new rule on digital accessibility under Title II of the Americans with Disabilities Act. This new regulation requires that public entities provide fully accessible digital content by April 24, 2026. The Department of Health and Senior Services is leading the state in understanding and efforts to ensure digital accessibility standards are met. Staff and partners will notice changes to existing information and new requirements this coming spring. We are also planning to train team members basic accessibility guidance to ensure digital materials created and shared electronically are compliant. As the home to Missouri’s Division of Senior and Disability Services, we should be meeting, if not exceeding, federal accessibility requirements regardless of rule enforcement. All Missourians should be able to access important health information.

Recently, department staff had a peer-to-peer discussion with the Association of State and Territorial Health Officials (ASTHO) regarding our BOLD Alzheimer's Program strategies that focus on dementia risk reduction and care. As a result of that discussion, ASTHO and the Alzheimer’s Association have shared “Bridging Silos: Aligning State Health Improvement, Aging, and Dementia Plans," an article highlighting the analysis of our state’s dementia plan. The information was published in the Journal of Public Health Management and Practice. The insights from our plan will support other states/partners as they refine their own strategies, and we hope this resource is valuable to you as well. Please feel free to share this resource within your networks.

Thank you for your continued partnership!