In 1988 and again in 2002, the Institute of Medicine described the public health system as being “in disarray” in their landmark reports, The Future of Public Health and The Future of Public Health in the 21st Century.​^1,2​ The statement resonates today as the public health system — confronted by chronic underfunding,​³​ pandemic-driven burnout and turnover,​⁴​ and sweeping real and proposed budget cuts —faces a cascade of challenges that threaten to weaken its capacity and erode workforce morale.​⁵​ 

How can public health leaders improve workforce culture in the face of such challenges? Most writing on this topic focuses on strategic issues, such as innovation, evidence-based practice and community engagement. However, as Peter Drucker warns, “Culture eats strategy for breakfast.” Here, organizational culture refers to the shared values, norms and behaviors that shape how work gets done and can determine whether teams adapt, endure or fall apart.​⁶​  

In this post, Candice Sauers, Deputy Director of the Saline County Health Department, shares how her team intentionally strengthened their culture, offering a practical model for public health innovation and leadership. 

Recognizing the Need for Change  

The Saline County Health Department is a mid-sized health department in central Kansas. The department provides a wide range of services — from home health and maternal-child health to emergency preparedness and Women, Infants, and Children (WIC) nutrition support — all under the shared mission of promoting a healthier, more connected community. In recent years, that mission has come with added pressure — navigating COVID-19, staff turnover and shifting community expectations.  

Coming out of the pandemic, Sauers recognized that the signs for culture change were there. Morale was low, turnover was high, and something deeper was off. “It wasn’t a fun place to be professionally,” Sauers recalled. “We knew we wanted change.” Four issues stood out as the clearest signs culture change couldn’t wait.   

Drama and Gossip 

The tone of workplace interactions had soured. “Our culture was siloed, gossipy and bitter,” Sauers said. “There was cattiness. There was drama. There was gossip.” Instead of fostering collaboration, the environment bred tension and distrust, making it harder for staff to engage with their work, or each other, in a healthy way. 

Leadership Team Dysfunction 

At the top of the organization, the leadership team was facing significant challenges in how they worked together. “They had been operating in the same way for more than ten years,” Sauers said. Meetings often became lengthy and unfocused, sometimes marked by competing priorities and unspoken tensions. “You could sense the existing alliances — who worked closely, who had informal conversations outside of meetings.” Eventually, the strain became noticeable enough that leadership meetings were moved offsite to allow for more constructive dialogue. “There were moments of intense disagreement,” she recalled. “It was clear the current approach wasn’t serving the team well.” Instead of providing a space for strategy and alignment, the leadership team was navigating the same unresolved tensions felt throughout the department. 

Silos 

“I could probably go three months without seeing someone from home health,” Sauers noted. This reflects the deep silos that had emerged in the department. Sauers said that the silos were reinforced by the building’s floorplans that sectioned program staff away from one another. But deeper than that, there was a siloing effect driven by the county merger as well as the COVID-19 pandemic. For veteran staff, losing tenure recognition and autonomy when the department merged with the county created lasting resentment. “It led to survival mentality,” Sauers explained. “Everyone was looking out for their own department. The conflict between the ‘we were here’ and the ‘now we are here’ dynamics contributed to that trauma.”  On top of that, new fractures emerged during and after the COVID-19 pandemic. “There was trauma response in our health department for employees who were here during COVID,” Sauers said, “and then confusion for those who came after.” New staff wanted to act innovatively, but veterans of the pandemic were burnt out and disillusioned. Trust and collaboration were difficult to foster in this environment.  

Lack of Knowledge About Public Health and Systems 

Another challenge was a lack of shared understanding about public health itself. “We had a lot of staff that didn’t really understand what public health was,” Sauers said. “Public health was something they fell into — they were just doing their job, and that’s all they knew.” Many staff were not trained in public health broadly before working at the health department, and they didn’t know how or why decisions were being made. “Why does one department get $80,000 in grants and my program only gets $10,000? Why are they doing a big spend-down and I’m struggling to make ends meet?” Without a grasp of the bigger picture, frustration was inevitable. 

“Culture Doesn’t Fix Itself” – Creating Change at the Saline County Health Department  

Culture change doesn’t happen by accident — it takes daily work, honest reflection and leadership that’s willing to go first. At the Saline County Health Department, that meant letting go of outdated plans, listening to real frustrations and putting people at the center of every decision. “We weren’t going to do another strategic plan in that way and ignore the culture piece,” Sauers said. “All of our efforts were dedicated to culture.” Over time, that commitment reshaped not just how the team worked, but how they felt about coming to work in the first place. 

Culture Became the Strategy 

For years, strategic planning at the Saline County Health Department was broken. Even though they adopted innovative practices, such as including department data and project management platforms, the approach still fell short.  “[The leadership team] had all these ideas,” she said, “but no one had the capacity to follow through. The plans were built by a small group, with no input from the rest of the staff.” 

“We knew something had to change,” Sauers said. “So we decided we weren’t going to do another strategic plan in that way.” Instead, they made a bold shift: to treat culture as the strategy itself. That meant re-centering the planning process around people — not just policies or goals. This is well aligned with leadership models that state leaders must have a vision for their co-workers, not just for the organization itself.​⁷​ It was a simple shift on paper, but a profound one in practice: by changing how they planned, they began to change who they were as an organization. 

Leaning Into Values  

Recentering their values also became a core part of their culture change. Their values provided the purpose, or the reason why, they chose the public health mission. “We realized that we needed to lean into our values,” Sauers said. “That’s what started all of this — we had these values and nobody could list them to know they were living them.” The team recognized that values weren’t just statements for a document, they had to become a way of life. 

This shift echoes leadership author Simon Sinek’s belief that great leaders inspire action by starting with why. By grounding their work in purpose, why they exist and what they stand for, the Saline County Health Department created a foundation strong enough to support both strategy and change. It wasn’t just about setting goals; it was about building a culture people could believe in. 

Today, values and culture are part of onboarding and reflection. During every 30-day check-in, Director Jason Tiller asks new staff a direct question: “Are we holding up to our mission, vision and values?” Staff with fresh eyes are encouraged to speak up — what they see, what’s missing, and how the department can do better. “You’re a brand-new employee,” Sauers said. “Does it feel like we are doing the things we said we were going to do? Then the team follows through with what we learn.” 

They also created a practice to keep values front and center. “We assign each division a value,” she explained. “For example, Administration was assigned equity last month. So we had to come together and show one way we’re demonstrating equity.” At each all-staff meeting, each division shares how they had supported their assigned value, then passes their value along to another team. “We do it so we’re continuously living up to these values — because we should be every day.” 

Centering on Our People  

Culture change isn’t just about values or strategy, it’s about people. That meant taking an honest look at how staff were doing, what they needed, and what they hoped the organization could become. 

One question made it painfully clear how much work there was to do: How do you feel on Sunday night knowing you have to be at work Monday morning? Responses poured in. Some were lighthearted; “I’m not a fan of Mondays, but I look forward to the week.” But others hit harder. “I get Sunday scaries,” or “My blood pressure goes up on Monday and resolves by Friday.” Sauers said that they didn’t brush these comments aside. “As an organization, that’s really hard to hear,” she said, “but we had to do something about this.”  

To address these issues, they focused on building an open and honest environment.  

• A Space for Honest Input: They created space for honest input by posting weekly anonymous questions on a large sticky note in the break room. The prompts ranged from workspace improvements and dream collaborations to off-the-wall funding ideas and how staff felt about coming to work. “We wanted to hear what was going well and what wasn’t,” Sauers said. “Because we can’t fix what we don’t know.” 
• Inviting Real Conversations: They created space for meaningful dialogue, hosting lunch and learns to build a shared understanding of public health which was accessible to everyone. All-staff meetings became a venue to talk openly about culture, values and improvement. Communication shifted from top-down directives to intentional, two-way conversations that invited everyone’s voice. 
• Building an Open-Door Culture: Leaders made a deliberate effort to be approachable and responsive and follow the examples set by the Director and Deputy Director. “I could open my door right now and our administrative assistant would have six ideas,” Sauers said. Staff were encouraged to speak up, no matter how off-the-wall or unexpected their ideas might be. The message was clear: your voice matters here — and we are willing to try and experiment. 

Pancakes and Priorities 

A program called “Pancakes and Priorities” was one of the most impactful steps in shifting the culture at the Saline County Health Department. Once a month, Director Tiller and Deputy Director Sauers made pancakes for one division at a time and invited them to a casual conversation — no agenda, just connection. 

The goal was to get to know staff as people. “We didn’t talk about work things unless they came up organically,” Sauers said. Questions like “What superpower would you want?” opened the door to deeper conversations about what mattered to staff, what stressed them out, and what they needed to do their jobs better. 

Some insights had real consequences. One staff member shared that clients avoided home visits because they thought it meant involvement from child services, a misunderstanding that led to changes in how services were communicated. 

“It wasn’t a work meeting,” Sauers said. “It was a meeting about you.” Pancakes and Priorities became a deliberate act of trust-building — and one of the most powerful things they did to shift the culture. The team plans to expand the effort by mixing new hires, supervisors and different divisions to keep the conversations going. “We made it clear,” Sauers said. “You are the priority. And we’re here to prove it.” 

A Culture to Be Proud Of 

Changing culture isn’t a checkbox. It doesn’t happen all at once. As Sauers put it, “Our culture didn’t break down overnight, it didn’t rebuild overnight, and it must be continuously nurtured.” But at the Saline County Health Department, the investment paid off. Staff are no longer just clocking in and out — they’re showing up with ideas, energy and pride. 

You can see it in their survey results: 78 percent of staff said they are satisfied in their current roles, 73 percent aren’t looking elsewhere, and 100 percent said they feel what they do is important. As one employee put it, “My job is like a hiking adventure — rough, with unknown territories and unexpected obstacles, but at the end…you’ve achieved your goals and went the distance.” Another described it simply as “the best place to spend 40 hours of my week.” 

You can see it in the work. After a Pancakes and Priorities session, one staff member pitched a new event focused on fatherhood. The leadership team gave her the green light, and she pulled together a panel with speakers from across the state, drawing in 20 dads for a powerful community conversation. The event was a success, but even more telling was what she wrote afterward — a heartfelt public post about how proud she was to work at the Saline County Health Department, and how deeply she felt the support of her team. 

That kind of culture can’t be faked. It’s built with intention, patience and a deep belief that people come first. “We are a place where every single employee feels valued,” Sauers said. “We are proud of that over anything else, and we aren’t done yet.” 

References 

1. Institute of Medicine. The Future of Public Health. National Academy Press; 1988. 
2. Institute of Medicine. The Future of the Public’s Health in the 21st Century. National Academies Press; 2002. 
3. Mayfield Gibson SK, Fleming D, Harris RT, et al. The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations 2024. 2024. Accessed February 25, 2025. https://www.tfah.org/wp-content/uploads/2024/08/2024-PublicHealthFunding-FINAL.pdf 
4. Leider JP, Castrucci BC, Robins M, et al. The exodus of state and local public health employees: separations started before and continued throughout COVID-19. Health Aff (Millwood). 2023;42(3):338-348. doi:10.1377/hlthaff.2022.01251 
5. Infectious Disease Special Edition. Federal funding cuts are already affecting local health departments. Accessed May 27, 2025. https://www.idse.net/Policy-Public-Health/Article/04-25/Federal-Public-Health-Funding-Cuts/77013 
6. Gershon RRM, Stone PW, Bakken S, Larson E. Measurement of organizational culture and climate in healthcare. J Nurs Adm. 2004;34(1):33-40. doi:10.1097/00005110-200401000-00008 
7. Kotter JP. A Sense of Urgency. Harvard Business Review Press; 2008. 

Thig blog post was originally published by the Kansas Health Institute (KHI) in its Transforming Public Health for the 21st Century: Bridging Theory to Practice blog. A link to the original post can be found here: Building a Culture Worth Being Proud of at the Saline County Health Department – Kansas Health Institute

Candice Sauers is the Deputy Director at the Saline County Health Department. She serves as the subcommittee vice chair for the Public Health and Healthy Communities Health Steering Committee and is an active member of the Rural Action Caucus with the National Association of Counties (NACo). Candice is also the 2026 Treasurer for the Kansas Public Health Association (KPHA). Deeply engaged in her community, she serves with the mounted patrol and rescue squad and is active in several civic clubs. Her work is driven by a commitment to authentic communication, access, community engagement, and conservation.

Kevin Kovach, DrPH, MSc, Senior Analyst & Portfolio Strategist, leads planning and activities for Kansas Health Institute’s (KHI) public health services and systems portfolio. In his current role, Kevin leads the Transforming Public Health for the 21st Century blog, co-directs the Region 7 Public Health Innovation Hub, and leads research and programing for public health services and systems and other population health issues. See his full bio at http://www.khi.org/team/kevin-kovach.