practice

Public Health Policy in Practice

Martin Charns and David Rosenbloom have bridged decades of research into practice to provide health resources to many vulnerable populations, including veterans.

Translating public health scholarship into practice has been a core component of the work of Martin Charns and David Rosenbloom, professors of health law, policy & management. Charns, an expert in healthcare organization, and Rosenbloom, a scholar in public administration, have worked to improve health systems and develop health interventions that aim to make health equity a reality for vulnerable populations.

Trained in organizational behavior, Charns was one of the earliest people to apply organization theory to healthcare. His research has focused on three major issues: the organization of care, coordination among individuals and among organizations providing care, and implementation of change to improve quality of care.

Charns has also spent much of his career in the Veterans Health Administration (VHA), beginning in 1993 as the founding director of the Management Decision and Research Center (MDRC). He led the center’s efforts to analyze the VA’s national organization and recommend a restructuring into regional healthcare networks, which improved the VA’s quality of care and patient satisfaction.

“The VA was mission-driven truly to care for Veterans, and I’m happy to have contributed to that mission,” says Charns. “The Center made numerous contributions to the VA and healthcare delivery in general, and our work in bridging research and practice spread through VA Health Services Research and spawned new centers and major programs.”

At the VA, Charns also led the Center for Organization, Leadership and Management Research, the successor to the MDRC, in which he partnered with four VA Veterans Integrated Service Networks and two national program offices. He co-led the development of VA’s annual national employee survey, which provides feedback to managers and staff on organizational climate, burnout and satisfaction, and makes these data available for longitudinal research.

“In the early 2000’s, the VA had excellent reporting systems for clinical and financial performance, but not a system for monitoring employee satisfaction, employee perceptions of their supervisors and senior leadership, teamwork, or organizational culture,” says Charns. “I co-led the development of the annual national employee survey, and in the most recent administration of the survey, it had over a 60 percent response rate and 200,000 respondents.”

Charns emphasizes the importance of researchers partnering with leaders of healthcare organizations.

“I have been a pioneer in conducting and advocating for partnered research in which researchers partner with healthcare organizations for discovery and improvement,” he says. “This is in sharp contrast to research that is done ‘on’ organizations and implementation of findings done ‘to’ them. In VA, research is embedded in the organization and partnering means working with operations leaders.”

Rosenbloom says he joined SPH 30 years ago to do two things: work with communities throughout the country to prevent and reduce alcohol, drug, and tobacco social and health harms, and teach MPH students to be effective leaders.

In 1991, he founded and directed Join Together, an SPH program funded by the Robert Wood Johnson Foundation for more than 20 years, which assisted communities throughout the country in developing leadership and effective strategies to address substance use disorders and gun violence. 

“The premise for our work was simple,” says Rosenbloom. “Harms from these substances are major national public health problems, but they are expressed differently in every community. Policy and funding matter, but local strategy, leadership and accountability are essential for success.”

The work itself, however, was not so simple, he says.

At the time the program launched, “local leaders were motivated, but often isolated,” Rosenbloom says. “They worked in small, unfunded groups and had little access to data and evidence of effective approaches. They had no training in strategy, coalition building or communications. Burnout was frequent and fast, insurance coverage for individual treatment was virtually non-existent, and the internet did not exist.”

A team of SPH faculty and staff created and implemented a strategy to enable community leaders to be effective, leading national surveys and conferences to understand their needs, and providing training and tools on policy, coalition, and strategy development so that they could create their own state and national organizations.

“We trained them to do coalition and strategy development and gave them tools that use locally available data to measure effectiveness and accountability,” says Rosenbloom. “Within weeks of the release of the first internet browser, we launched the Join Together website to make the tools available and dispatched staff around the country to help them get and stay connected. We were among the first to create a daily email news service, Join Together Online, reaching more than 50,000 local, state and national leaders every day by the late 90’s. Almost all these initiatives continue.”

Rosenbloom has also led the development of several web-based tools to help individuals reduce hazardous drinking and quit smoking, including AlcoholScreening.org (now hosted by the Center on Addiction), QuitNet.com, and Vetchange.org. He also co-created the Police Assisted Addiction Recovery Initiative, which provides training, strategic guidance, support, and resources to help law enforcement agencies create non-arrest pathways to treatment and recovery.

“I do these things because it matters to the public’s health,” Rosenbloom says. “Alcohol, tobacco and drug misuse are major sources of social mayhem, disease and death. Much of the harm they cause can be prevented. We must try.”