Q&A: Tracy Gruber on the high-level conversations around the DHS-DOH merger
Tracy Gruber is the executive director of the Utah Department of Human Services (DHS) and will serve as the executive director of the newly merged Utah Department of Health and Human Services (DHHS) when it operationalizes in July of 2022.
In this Q&A, Gruber discusses the challenges of the merger, the status of the conversations happening in the steering committee, and their future plans to ensure access to behavioral and physical health care, centered around the whole person.
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Patrick Jones: What are you spending your mental energy on in these recent months? What has been occupying your time nowadays?
Tracy Gruber: “The merger of the Department of Health (DOH) and DHS is taking up a big part of our mental energy. We also, given the merger of our two departments, are focused on having Utah safely emerge from the pandemic. Just the day to day operations of running a department with 4,000 staff and multiple state institutions is taking up our mental capacity as well.
PJ: So from inside the steering committee of this merger, how do you feel those conversations are going?
TG: “Well, the steering committee framework has worked very well for us, both in terms of being able to lead the merger and also engage over 300 staff members across our two departments. [This engagement allows us to leverage their] expertise to guide us in bringing these two departments together. That work has been going exceptionally well.
We meet weekly on the steering committee and the work group leads for two hours. The executive group of the steering committee plans our upcoming week’s activities for two hours at the end of the week. The workgroups have been meeting regularly since mid-May, after the legislation has passed. They’re making great progress.”
PJ: Can you give me a little bit of insight as to what that progress is?
TG: “Well, they really have been laser-focused on the requirements of the legislation [HB 365]. That bill laid out requirements for a report that we’re in the process of finalizing right now, and they’ve been focused on those issues. Those issues included things like, ‘Where are people going to work? Which buildings are they going to work in?,’ … [and figuring out] what legislative statutory changes need to take place in order to have this realized.
I would say [we are] bonding as a team [and are] starting to work together to realize the vision of the consolidated department. That’s a tremendous amount of work in a pretty short period of time.”
PJ: What would you say have been your biggest successes and biggest struggles or challenges so far in this planning stage?
TG: “I think our biggest successes have been [our ability] to clearly articulate a vision for the new department, to set up the proper advisory structures through the steering committee and workgroups, and to have them — across both departments — work collaboratively for several months. [We are] starting a conversation around performance metrics, and making some important recommendations to the steering committee as we merge our two departments together, including things like bringing together licensing divisions and what that structure might look like in bringing together complex data systems and IT systems.
A piece that’s often overlooked is establishing the culture … when you’re putting together two departments that have different cultures. To achieve a vision and having a conversation about culture is really important in gelling the team. Those conversations have also been very beneficial to what we’re trying to accomplish.
In terms of challenges, I think there’s a lot of uncertainty when you’re engaging in an effort of this scale. Managing that anxiety and uncertainty with your personnel is a challenge. We meet with our staff every two weeks on all-staff Zoom calls to keep them up to date on what’s happening, provide transparency to the extent that we can, and inform them of decisions that we’ve made. With questions that we still can’t answer, [we] try to manage those expectations and that anxiety, and that’s a significant challenge for people personally.”
PJ: How are you feeling heading into December’s presentation of your implementation plan with the governor and legislature?
TG: “Very good. We will meet the deadline to produce a transition plan. We’re in the process of editing it currently, and it’s in very good shape. That’s a testament to all of the great work that has been taking place by the steering committee in the work group for the past nine months. … the report is definitely an important deliverable.”
PJ: What will be your priorities as a new leader of DHHS and how do you think the transition will go once the department becomes official in July of 2022?
TG: “We are shaped up to have the transition go very well for that July 1, 2022 deadline, and we will have the legal structure in place. We will do it without having any gaps in service delivery for the people in Utah who rely on both of our departments to access important resources and support. In July, our staff will be in the right places and in the right buildings. We will be one entity [on that date], but there will still be work remaining.
We’ve got very large data systems and IT structures that will evolve as they’re merging over the next couple of years. We have some issues of personnel in terms of job classifications and pay parity that are going to take a couple of years. There still will be work to be done after July 1, but in terms of the public, they will see us as one one entity while we’re continuing to build out these other very important pieces to realize the vision of the new department for all Utahns. [We aim for Utahns] to have an equitable opportunity to be healthy and safe and receive services from our department that will provide that in a seamless system delivery structure.”
PJ: Do you have any notable health policy or legislative priorities for the upcoming session?
TG: “Our focus is going to be on drafting the statutory framework to establish the new department. Our two codes are very, very large and very complex. Just rewriting those codes is going to be important and be a pretty heavy lift. But there are always issues that emerge. And as I mentioned, we still are operating two very large departments that will have statutory priorities in the upcoming legislative session that fall outside of the merger itself.”
PJ: Why do you think merging these two departments will benefit the health of Utahns? Why?
TG: “One thing is that we are designing this new department so it is centered around the individuals and communities that we serve throughout the state of Utah. That might not seem like rocket science, but in most systems, including our existing systems, it’s very complicated and difficult to navigate from the public’s perspective. We [will center] our new organizational structure and division around the customer experience, and have our organization be designed around those individuals and communities. That’s going to make a big impact for people who need to have access to resources from our two departments …
We also are going to have an opportunity to eliminate duplication of services. [The] departments, in some instances, both have programs addressing certain issues. For example, suicide prevention — the DHS has [partnership with] DOH by bringing the departments together and having one clear outcome for efforts around suicide prevention and pooling our resources. We think we’re going to have a greater impact and have a greater influence on positive outcomes on some of those initiatives.
Thirdly, I would point out that we are creating a system that’s going to be responsive to the whole person. We are integrating behavioral and physical health in two of our divisions, both in direct health in our health care administration area, and then in our community health and wellbeing area, in the area of prevention. In making sure that when we’re talking about prevention of disease or substance use, we’re incorporating both behavioral health prevention and physical health prevention in this new structure, rather than having people be going to one place for their physical health and another department for their behavioral health. We think that’s going to make a big impact on the citizens of Utah.
I think it’s also really important to know the level of engagement that we’ve had with community stakeholders. In the same way that we’re meeting with our staff bi-weekly, we’re engaging with our community stakeholders bi-weekly. We’ve done 18 listening sessions in communities throughout the state of Utah, representing all 29 of Utah’s counties.”
This interview was edited for clarity and length.