Utah Department of Health “heavily influenced” by federal government, state audit finds

After more than a year of tensions between state lawmakers and public health officials over pandemic-related health orders, a new audit urges the Utah Department of Health to prioritize requests from the Utah Legislature.

The Salt Lake City-based Utah Department of Health audit found the agency appears to be “heavily influenced” by the federal government over the Utah Legislature and has been slow to implement recommendations made by state legislators.

“We have heard that (the Department of Health) is a ‘no agency’,” auditors wrote in a pair of reports released Monday at a meeting of the legislative audit subcommittee on Capitol Hill. ‘State.

“Our review of bills affecting the ministry, as well as our observations on efforts to implement audit recommendations, support the view that (the ministry) did not proactively seek opportunities to innovate. within federal oversight and to respond more fully to legislative guidance, ”the report said.

The Office of the Legislative Auditor General, which works under the legislative direction, conducted the audits at the request of the Utah Legislature.

Relationship with the legislature

Auditors believe the agency’s stronger relationship with the federal government is due to financial incentives from federal funding, which comes with federally mandated rules. The report argues that the Utah Department of Health “may have allowed this process to hinder the department’s pursuit of new ideas and innovations.”

This is despite the fact that the Utah legislature allocated more than $ 600 million to the health department in this year’s general fund, according to auditors. State lawmakers also allocate federal funds to the department.

The health ministry has implemented two-thirds of recommendations made in previous legislative audits, the report says – warning of a “potential risk” of inadequate funding if all recommendations are not followed.

The report calls for the health department‘s leadership to “balance the needs of stakeholders and appropriately focus on legislative priorities,” with auditors saying they believe employees will follow suit.

The auditors also noted that the Department of Health had not proposed much legislation in recent years and that the Legislature was responsible for two-thirds of the bills passed that affect the public health agency.

According to the report, the Utah Department of Health should “develop and take the lead in bringing new innovations in public health policy to the attention of the legislature because (the department) has the expertise and the experience to be a leader in healthcare innovation ”.

Auditors said they believe the merger between the Utah Department of Health and the Department of Human Services – which was implemented in the 2020 legislature – will provide a “framework” for creating a department. that the legislature, the governor’s office, local governments and the federal government “can rely on the state’s public health authority. “

The audit did not delve into the pandemic and ensuing health orders, prompting the Utah legislature in 2021 to pass a “final” bill that placed emergency health orders in the hands of locally elected bodies and state legislators.

Collaboration with local health services encouraged

Auditors said the department also sometimes seeks grants to address issues already addressed by other agencies or for “relatively less significant” issues in Utah, which can lead to diminishing returns. The auditors called on the Department of Health to be more “strategic” in applying for federal grants.

The report urged the state health department to work more closely with local health services to “identify the state’s most urgent needs.” The state health department and local health departments should increase transparency with each other to better use the funds, auditors said.

For example, coronavirus funding for local health services has increased by $ 43 million from what the Utah Department of Health initially proposed after discussions among state health officials and local.

“While we recognize that in the end, the committee’s reviews and negotiations were successful in changing the fund allocation strategy to align with needs, it is of concern that the original proposal was designed without input. substantial local nor significant local funding, ”the auditors wrote.

Need more innovation?

The auditors also expressed concern over what they described as a culture that does not encourage innovation, and noted that “employees said that new ideas and new processes can be accepted but are not. not encouraged, and that there is a lack of will to implement the innovation ”.

Several years ago, the ministry created an office of organizational development and performance improvement, but it encountered “significant obstacles” to inspiring innovation, the auditors wrote. The department also received nearly $ 3 million to create and implement Utah’s Health Innovation Plan, which was “never fully implemented,” according to the report.

“Our employee survey (of the department) also identified that new ideas or new processes can be adopted but are not encouraged, and that there is a lack of will to implement the innovation”, have declared the listeners.

Fearing that the new merged agency “will not be enough” to solve all the problems, the auditors also recommend the creation of an “innovation center” to “foster a culture of innovation” and help the state improve its public health efforts.

Listeners highlighted centers established in Idaho, Oregon and Washington that aim to promote initiatives to improve health in their states.

Listeners believe that such a center in Utah should:

• Identify information opportunities that will “help shape the future of health care in the state”.
• Use precise data to find strategies for health care transformation and health information infrastructure.
• Build a “coherent political agenda”; recommend strategies to reduce health care costs.
• Promote better healthcare practices.
• “Support efforts to provide a workforce in sufficient numbers and training” to meet the demands of the health system.

Auditors said they found “several encouraging aspects” of the health department’s culture, including a dedicated workforce, a willingness to follow the direction of the department and overall job satisfaction.

Performance of social service agencies

A second audit report found that the state’s departments of human services – which include the offices of the Utah Department of Health and the Utah Department of Workforce Services – no ‘have “no legislative performance measures required” in core budget bills, giving the legislature limited control over them.

Many social service performance metrics reported in 2020 were “consistently below target and indicate deteriorating performance,” auditors said.

The report’s recommendations include that agencies, as well as the tax analyst and the governor’s office, fill “oversight gaps” in major programs, and ensure that the information system used can be held accountable. multi-year trends for the basic budget bill measures.

In a letter responding to the Utah Department of Health audit, its executive director, Nate Checketts, noted that over the years, the department has “simultaneously implemented several advancements in its services to the Utahns in very difficult circumstances ”.

“The department, state, and its residents can rightly be proud of many aspects of the overall health of our state and the actions we collectively take to improve it,” Checketts wrote.

But he recognized that the department can improve in some areas, including culture, innovation and process. He said the agency “will start dealing with these recommendations immediately.”

In a joint response to the social services audit, Checketts and Tracy Gruber, executive director of the Social Services Department, called the development of “comprehensive strategic plans and meaningful performance measures” essential to the new joint department.

They said the department will include a strategic performance management center with divisions focused on quality, improvement and data.