Audit criticizes Utah health department for lack of innovation

The Utah Department of Health has garnered a reputation as an “agency of no,” according to a new legislative audit that suggested health leaders can do better at fostering innovation and collaborating with other state and local officials.

Utah Department of Health (UDOH) employees told auditors “that new ideas and processes may be accepted but are not encouraged, and there is a lack of will to implement innovation.”

In fact, the report noted, the health agency in 2013 landed $3 million in federal grant funding to develop a state health care innovation plan but never fully implemented it — highlighting the need for growth in this area.

And while the department does have an office dedicated to performance improvement, it hasn’t lived up to its potential, auditors say.

The review of the health department’s internal culture also found that local health agencies don’t feel that they’re getting enough pass-through grant money from the UDOH. One health officer told the auditors that the local health departments will never receive enough funding to support the communicable disease programs they’re supposed to have.

“Epidemiology capacity at the local level was not where it should have been at the start of COVID,” the local health officer said. “We’ve been asking DOH for help in that regard for years with almost no response.”

In one example, the state agency received $184 million in federal coronavirus funding and initially only proposed allotting $9 million of that to local health departments throughout the state. A local health officer said it felt like “we’re dying out here fighting COVID and the state is keeping all that money.”

After a state health governance committee reviewed the grant, the local portion increased to roughly $52 million — demonstrating that greater transparency could yield more equitable and cost-effective funding decisions, auditors said.

According to the report, UDOH also seems “beholden to the federal government,” in part because so much of the agency’s money comes from federal grants. On the other hand, there’s room for improvement in the relationship between the Legislature and the UDOH, the audit found.

The health agency has clashed with state lawmakers during the coronavirus pandemic, as legislators have accused public health leaders of being overly restrictive.

The auditors discovered that most of the state bills pertaining to the health department were “conceived outside of DOH” and said the agency has an opportunity to play a larger role in developing forward-thinking policies.

The emphasis on grants can also create problems within UDOH, the report states.

“[I]f grants aren’t strategically driven, they can create inefficiencies due to the amount of work needed to apply for and manage grants, limited flexibility and difficulties in sustaining programs beyond the expiration of grant funding,” auditors wrote.

UDOH should be strategic about which grants it pursues and ensure these programs have the greatest potential to deliver long-term health benefits to state residents, the audit advises.

In a response to the audit, UDOH leaders noted that the agency only receives 11.65% of its budget from the state general fund and said it depends on federal dollars to “meet Utah’s basic public health responsibilities.”

Increased state funding for the agency could free it up to be more selective about which federal grants it seeks, according to the audit reply.

And House Speaker Brad Wilson said, in terms of the agency’s focus and direction, state lawmakers should help provide clarity.

“A lot of this is the department of health’s responsibility,” the Kaysville Republican said during a Monday afternoon legislative hearing on the audit. “But a lot of this is actually our responsibility.”

The agency’s executive director, Nate Checketts, also wrote in a response that UDOH can be proud of the audit’s findings that it has a committed workforce and dedication to public heath but agreed that there is room for improvement.

“We will begin addressing these recommendations immediately within the Department,” Checketts wrote, adding that the agency would also keep the suggestions in mind during its forthcoming merger with the state’s department of human services.

Among other things, the report recommends that UDOH:

• establish an innovation center that reports to the governor’s chief innovation officer.

• remove roadblocks to innovation.

• achieve an “appropriate balance” in its relationships with the Legislature and executive branch.

• better focus its strategic plan and seek grants that advance this mission.

• provide greater transparency by sharing detailed budget and expenditure data in the agency’s governance committee meetings.

• make more of an effort to come to a “satisfactory agreement” with local health departments about grant proposals.