Government work is inherently collaborative.
So when we hosted a Roundtable conversation last week featuring practitioners from state health departments, local agencies, and nonprofits to swap experience, it was no surprise that collaboration was a key theme. What really stood out was how much cross-organizational collaboration it takes to tackle public health problems—and just how much of an obstacle siloes can be for public health initiatives.
The question isn't whether to coordinate, but how to break down barriers that prevent public health agencies from responding nimbly to community needs — from overdose spikes to workforce development to measles preparedness.
Here are three takeaways from our conversation that public health practitioners mentioned again and again.
Public health challenges don't respect organizational boundaries. Overdoses involve mental health services, emergency response, and community organizations. Health improvement plans require alignment between state priorities and local implementation. The more fragmented and siloed a public health landscape, the more patients who need care feel the lack of coordination and stifled service delivery.
Tricia Bishop from Utah's Department of Health and Human Services explained that in some places agencies are doing “the same thing, but in two totally separate lanes,” generating duplicative work because of the institutional siloes that exist naturally between organizations.
But institutional siloes can also arise for reasons outside a department’s control. Bishop recalled a forty-person coalition who worked together pre-COVID, only for complexity from the pandemic — a switch to digital-first interactions and emergent public health groups like opioid task forces — to further muddy the waters.
In Nebraska, 600 public servants working on public health issues are spread across 19 local health departments in 93 counties. The scope of their work is massive, ultimately responsible for the administration of more than 80 programs. Ashley McCracken, Program Manager at Nebraska's Division of Public Health, told us that “obviously working in a state, you always hear the silos,” like email threads missing people, duplicated efforts, and lost institutional knowledge.
In public health, it’s mission-critical that everyone is on the same page — the inherently federated networks of public health practitioners across states make gaps like those identified by McCracken all but inevitable.
Both Utah and Nebraska turned to Roundtable as the infrastructure to power coordination across disparate groups of public health practitioners.
Utah focused on creating a central hub where partners could access standing orders for naloxone, SAMHSA guidance, and spike alerts without searching through emails or tracking down colleagues.
Bishop explained the critical unlock: “I know I can go to this one place and potentially find [answers] or have this group of people available that I know have those answers.” Beyond centralized knowledge, Bishop explained that Roundtable “has been very easy to use. . . It communicates with our other platforms, so if you are sending a message out through Civic Roundtable, it goes directly to your primary email,” eliminating communication and coordination gaps that would otherwise arise without a technology like Roundtable that brings public servants together.
Nebraska took a phased approach, starting with their Preventive Health and Services Block Grant as a pilot group of 30 program managers before expansion. They’re seeing similar benefits in their governor's priority areas of nutrition and physical activity.
McCracken described how meetings and working groups need to be able to continue the work and share information after in-person events and meetings end. “We want to also have that centralized place for them to have all of those resources, meetings, all that information,” she said.
In one example, Roundtable supported a meeting of 80 community representatives working on nutrition in Nebraska. McCracken described the platform as “a great way” for the group “to come in together, get updated on the work, to move the initiative forward.”
For most public health issues, response time has a direct correlation to outcomes.
In practice, breaking down siloes has material impacts on public health service delivery by government agencies. In Utah, better coordination enables more accurate responses to emergent challenges, like when a small town saw a higher than usual number of people overdose. Bishop explained, “We were quickly, in real time, able to understand and disseminate information that these were unrelated issues.” Bishop added “Working across organizations to share that information, is, to me, us doing our job well.”
Working faster together is critical. “We want to facilitate rapid communication and response,” Bishop explained. “When it comes to our overdose response, when new risks emerge, when outbreaks emerge, when we're seeing new drug trends, we can quickly connect partners and mobilize to coordinate any responses.”
Bringing along stakeholders to ensure they’re read-in and engaged is just as important. One attendee from a public health foundation emphasized the importance of building systems that serve “not just my needs as the funder, but the needs of all of our key stakeholders.” This shift from individual to collective infrastructure ensures continuity even as team members change.
These public health practitioners made abundantly clear that coordination isn't optional.
Whether responding to overdoses in Utah, implementing block grants in Nebraska, or preparing for disease outbreaks in other states, public health agencies deserve systems and technology that serve them. That means infrastructure to bridge organizational siloes, unlock interagency collaboration, and help teams work together in real-time, connecting the right people with the right resources at the right time.
Could your agency benefit from working across organizational siloes? Let’s talk.
