Abstract:
Beginning in the late 1990s and lasting through much of the next decade, the Arkansas Department of Health underwent multiple changes to its organizational structure. Part A of "A State of Flux" recounts how, after a brief period in which the director of health replaced traditional hierarchical leadership with team-based management, several findings of administrative shortcomings helped prompt Governor Mike Huckabee and the state legislature to merge the department with the Arkansas Department of Human Services. Supporters of the merger argued that not only would it force the health division to adopt the highly regarded administrative practices of human services, it would also result in substantial cost savings for the state budget. However, the public health community quickly grew frustrated with the new arrangement, arguing that instead of being the marriage of two equals, the merger had resulted in the subordination of health to human services. Soon a movement to end the merger emerged, and Part B of the case explores how public health officials and their political allies rallied both publicly and behind the scenes to reverse course and reestablish a fully autonomous health department. An epilogue to the case portrays the main tasks and challenges public health leaders encountered as they worked to rebuild a reconstituted Arkansas Department of Health after this tumultuous period of organizational change.
Learning Objective:
This case prompts readers to reflect on public health as a distinct field in state and local government and to consider whether it is best administered by a fully-autonomous health department -- or whether it can successfully be folded into a larger agency also responsible, for instance, for human service programs. In addition, it raises questions about whether corporate management structures are suited to the public sector and highlights the political dimension of public administration.
