There have always been politicians who believed that government could be more efficient and impactful if operated more like a business. While often debated throughout the history of civilized government, the same conclusion is always reached – government really can’t run like a business. One has a profit mindset; the other has a people mindset. But that doesn’t mean there aren’t things government can learn from business.
Whether you’re assembling cars, designing clothes, or preventing diabetes, you have to manage a budget; set and work towards goals; thinks strategically; and write, execute, and monitor contracts. This is what businesses are great at and precisely what’s missing in government.
Running a $500M “Business” without Business Skills?
When I worked in governmental public health agencies, I managed budgets of up to $500M and staffs that exceeded 100 employees. I did this without any formal training in business or budgeting. Sure, I had the public health skills needed to understand what communities needed to be healthy, but I had limited qualifications to lead a large team, manage multi-million dollar budgets, or craft city- and state-wide RFPs that awarded millions in government contracts. Looking back, it’s alarming that my responsibilities included so many tasks for which I had no training or expertise.
My experience is far from unique. In a 2014 survey of the state governmental public health agency workforce, financial skills were identified as important by roughly three-quarters of the workforce, but many reported having no better than beginner level skills in this area. I look back on my time in public service with gratitude for the leaders and mentors who guided me through my many management quandaries. When those quandaries got the best of me, I had the opportunity to learn from my failures. Others weren’t nearly lucky. The cost of the skill-gap is the loss of hardworking, dedicated people, who were put in the position of doing something for which they were not trained.
Business Skills Are Essential, Even When Profit Isn’t
Governmental public health workers want to make a difference; they’ve opted for a career of “mission over margin.” But, we can’t continue to ignore this major workforce development need. Business skills need to be recognized as a core competency in effectively managing public health programs. We must have the specialized skills necessary to improve the public’s health, like epidemiology, maternal and child health, and preparedness, but we also need to develop critical strategic skills – like budgeting, contracting, and management – that amplify our reach, effectiveness, and impact. This reality is being recognized by some of the nation’s top public health educators. Through a partnership between the Department of Public Health Sciences in the Miller School of Medicine and the School of Business Administration, the University of Miami (UM) will launch an online, asynchronous certificate program called Building Expertise in Administration and Management (BEAM) in May 2018. BEAM will be offered through UM’s Schools of Business and Medicine and will be tailored to the unique needs of program managers working in governmental public health agencies at the state and local levels. This certificate joins the Northwest Center for Public Health Practice’s Public Health Management Certificate, a distance and in-person hybrid focused on planning, organizing, budgeting, and analyzing performance.
These programs alone cannot meet the overwhelming need to develop business skills in the governmental public health workforce. Schools and programs of public health must find a way to develop this skill set in the workforce of the future, while federal funders – primarily the Centers for Disease Control and Prevention and Health Resources and Services Administration – need to identify and align funds to support this as a major training objective for the nation’s public health workforce.
Implications of Failure
When a business fails, the products and services they produced are no longer available. But, if a demand exists for that product or service, the gap will be filled. We hardly miss Blockbuster, Eastern Airlines, or Compaq, and we can be sure that even as Mattel faces financial uncertainty, there is no fear of a world without Barbies. But when governmental public health fails, there’s no one there to fill the void. Critical services aren’t delivered; communities are less prepared for health emergencies; and the risk of disease outbreaks increases. Accuse me of being overly dramatic, but our lives are literally on the line.
If that’s not a reason to start prioritizing business skills in the governmental public health workforce, I don’t know what is.
Brian Castrucci is the Chief Program and Strategy Officer at the de Beaumont Foundation. Prior to joining the Foundation, Brian spent a decade working in state and local health departments. Brian is currently pursuing his doctorate in public health leadership at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. You can follow Brian on Twitter at @BrianCCastrucci and the de Beaumont Foundation at @deBeaumontFndtn.