DPH 840 Module 8 Immersion and DPH Project Progress Example

From the Budget Office to the Blood Pressure Clinic: Immersion Reflection and DPH Project Progress

Student Name

Doctor of Public Health Program, Aspen University

DPH 840: Strategic Planning and Financial Management in Public Health

Instructor Name

Month Day, Year

From the Budget Office to the Blood Pressure Clinic: Immersion Reflection and DPH Project Progress

Doctoral public health education joins theory with practice. This course includes practical immersion and progress on the Doctor of Public Health project. This paper reflects on 50 hours spent in a composite county health department's chronic disease program and finance office and reports progress on a DPH project evaluating the department's community health worker hypertension program.

The Immersion Site

The site was a county health department serving 420,000 residents, in the first year of a new five-year strategic plan focused on narrowing the nine-year difference in life expectancy separating east-side neighborhoods from the rest of the county. The site mentor was the deputy director, who oversees both strategy and finance.

Immersion Log

The table summarizes immersion activities and hours.

Learning About Strategy in Practice

The quarterly review showed how strategy lives or dies in routine meetings. Leaders spent more time on indicators that were off track than on those meeting targets, and decisions were recorded with owners. The review also showed tension between the plan's priorities and grant requirements, which sometimes pulled staff toward funded activities outside the plan.

Learning About Budgets

Budget meetings revealed how little of the department's money is flexible and how much time staff spend reconciling grants. The finance director explained that categorical rules shape daily decisions more than the strategic plan does. This experience made clear why the plan's goal to increase flexible funding is essential rather than administrative. Reconciling one federal grant alone required three staff days each quarter.

Learning From the Program

Site visits with community health workers showed the program's strengths: trusted relationships, home blood pressure monitoring and help navigating clinics and pharmacies. They also showed challenges: high caseloads, gaps in data entry and difficulty reaching residents who work night shifts. Workers suggested text message reminders and weekend visits, which the program has begun to test.

Evidence-Based Practice

The department's approach reflects evidence-based public health, which combines research evidence, community preferences and practical judgment (Brownson et al., 2009). Watching staff adapt a program with strong research support to local conditions showed how the three elements interact in practice.

The DPH Project

The DPH project asks: among east-side adults with uncontrolled hypertension, does enrollment in the community health worker program improve blood pressure control at 12 months compared with similar adults not enrolled, and at what cost per participant controlled? The project links directly to the strategic plan's first priority.

Design and Data

The project uses a matched comparison design with clinical data shared by the hospital system and health centers under a data use agreement. Participants will be matched to nonparticipants on age, sex, baseline blood pressure, insurance and neighborhood. Costs will come from program budget records. The primary outcome is a 12-month reading under 140/90; secondary outcomes include medication adherence and emergency visits.

Progress to Date

The project proposal has been approved by the committee. The data use agreement has been signed by the hospital system and is under review by the health centers. The analysis plan is complete, and the institutional review board has determined the project to be program evaluation with minimal risk.

Challenges

Data sharing has taken longer than planned, and blood pressure readings are recorded differently across clinics. The project will standardize readings using a common protocol and has built a two-month buffer into the timeline. A second challenge is defining the comparison group fairly, since motivated residents may be more likely to enroll.

Mentor Feedback

The site mentor advised narrowing the cost analysis to the department's perspective for the project and suggested presenting early results at a quarterly review, so the evaluation informs decisions during the plan rather than after it.

Links to Course Competencies

The immersion and project apply several course competencies: developing and monitoring strategy, analyzing public budgets and applying economic evaluation to a public health decision. They also build leadership skills in working across organizations, a core expectation of public health practice today (DeSalvo et al., 2017).

Population Health Perspective

The project measures outcomes not only for participants but for the east-side population, reflecting a population health perspective that attends to the distribution of outcomes across groups (Kindig & Stoddart, 2003). This helps the department judge whether the program narrows the gap.

Next Steps

Next steps are to finalize the health center data agreement within two months, complete data extraction and matching by the end of the next term, conduct the analysis and present preliminary findings at the department's quarterly review. The final report will be delivered to the board of health.

Personal Reflection

The immersion changed how I think about leadership. I had pictured strategy as a matter of vision and plans; in practice it is a matter of negotiated budgets, grant rules and patient follow-through in meetings. The deputy director's habit of ending every meeting by naming owners and dates is one I intend to adopt.

Ethical Considerations

Evaluating a program in the community where one works raises ethical questions about confidentiality and power. The project uses de-identified data, and findings will be shared with community health workers and residents before publication. Staff were assured that the evaluation examines the program, not individual performance.

Dissemination Plan

Results will be shared through a brief for the board of health, a presentation to the hypertension partnership, a summary for east-side residents and a manuscript for a peer-reviewed journal. Sharing early with the department ensures findings inform the strategic plan's next review.

Time Management

Balancing immersion hours, coursework and employment required careful planning. Scheduling immersion activities in blocks around the department's meeting calendar made the hours productive and allowed attendance at key decision points such as budget hearings.

Questions for Further Study

The immersion raised questions beyond the project: how categorical funding shapes strategy, how community health workers can be sustainably financed and how health departments can measure their convening role. These may inform future research or practice.

Conclusion

Fifty hours of immersion showed how strategy and budgets shape daily public health work and how evidence-based programs are adapted in practice. The DPH project, now approved with data agreements under way, will evaluate the hypertension program's effect and cost and inform the county's efforts to close its life expectancy gap.

References

Brownson, R. C., Fielding, J. E., & Maylahn, C. M. (2009). Evidence-based public health: A fundamental concept for public health practice. Annual Review of Public Health, 30, 175-201. https://doi.org/10.1146/annurev.publhealth.031308.100134

DeSalvo, K. B., Wang, Y. C., Harris, A., Auerbach, J., Koo, D., & O'Carroll, P. (2017). Public Health 3.0: A call to action for public health to meet the challenges of the 21st century. Preventing Chronic Disease, 14, Article E78. https://doi.org/10.5888/pcd14.170017

Kindig, D., & Stoddart, G. (2003). What is population health? American Journal of Public Health, 93(3), 380-383. https://doi.org/10.2105/AJPH.93.3.380