Leveraging PHIG to Advance Policy Infrastructure at Austin Public Health

May 04, 2026 | Colton Anderson, Kristin Sullivan

Public health agencies rely on clear, accessible policies to guide day-to-day work, but over time those systems can become difficult to navigate or keep up to date. Austin Public Health (APH) recently took a closer look at its policy review and development process after recognizing that certain policies and procedures were outdated and the existing system was not working as efficiently as possible. With support from the Public Health Infrastructure Grant (PHIG) and technical assistance from ASTHO, the department improved how the agency reviews, maintains, and accesses its policies.

In this interview, APH’s Public Health Infrastructure Unit Manager, Lauren Marsh, discusses how updates to the health department’s policy development and review process improved collaboration across the agency, increased efficiency, and created momentum for continued progress.

Why was it important that APH update its policy review and development process?

The need to update APH’s policy review and development process first came up during a continuous quality improvement effort in 2019, and then again during our reaccreditation in 2023. In both cases, it was clear that many policies were outdated and the overall system was not working as well as it should. We stored policies in SharePoint, but staff often had to know exactly what they were looking for to find them, which slowed down their work. There were also concerns about knowledge retention, especially when just one person knew certain processes or context and that person left the agency. On top of staff departures, the disruptions during COVID led to starts and stops in maintaining policies. Altogether, it highlighted the need for a more user-friendly system with clear access and shared understanding so staff could easily find and apply the policies they rely on to do their jobs.

As a PHIG recipient, what role did PHIG play in supporting this work?

PHIG played a major role in getting this work off the ground. Before that, it was hard to gain momentum because no one person was responsible for moving it forward. With PHIG funding, the department was able to dedicate resources, including hiring a temporary policy administrator to focus on managing and improving the process. That person has been reviewing the full policy inventory, identifying what needs updating, and will be conducting a policy gap analysis to better understand what is missing.

The technical assistance from ASTHO was instrumental. Monthly coaching calls helped the team stay on track, and ASTHO conducted a workshop that created space to bring the right people together to review APH’s current-state process map, identify areas of waste and opportunities for improvement through root cause analysis, and develop a future-state map outlining the redesigned process. What might have taken months to accomplish was completed in just two days. Having that structure and dedicated time made it possible to move from general discussion to clear next steps and tangible action.

What challenges or gaps became most evident when you took a closer look at the existing process?

When the team took a closer look at the existing process, it became clear that it was overly complicated. There were too many steps and checkpoints, which created bottlenecks and slowed the process. In some cases, it could take months for a policy to move through drafting and review, largely because there were no clear timelines or expectations for each stage.

Because the process felt cumbersome and unclear, staff were not consistently following it. People were unsure where a policy should go at each step or who was responsible for moving it along. That lack of clarity, combined with several approvals, made the process feel slow and frustrating and reinforced the need to simplify.

What changes or improvements have you already seen as a result of this work?

One of the biggest changes has been taking a full inventory of the policy and procedure library and identifying what is out of date, with particular attention to administrative and operational policies that affect the entire department. Following the workshop, we developed an implementation plan and updated the overall process. ASTHO worked with us to update the gap analysis tool to incorporate criteria for retiring policies and procedures and for determining whether something should be classified as a policy or a procedure. Through this work, we now have a clearer picture of which policies and procedures need to be updated and prioritized, along with a realistic understanding that addressing them will take time and sustained commitment. This clear picture has helped us start to embed the Public Health Accreditation Board’s requirements into our process so that required documents are consistently being reviewed and updated, not just during a reaccreditation cycle.

We also strengthened our governance structure. We created a policy advisory committee that includes two executive sponsors. Having leadership champions at the table, along with broader staff representation, has helped build buy-in and shared ownership of the work. The team also started working more closely with policy owners and updating templates to create greater consistency moving forward.

How did ASTHO’s technical assistance support or accelerate this work in ways you may not have been able to do internally?

ASTHO’s technical assistance brought an outside perspective that was hard to replicate internally. Having a third party to reach out to through the coaching calls provided steady guidance and accountability. ASTHO shared best practices from other health departments, reviewed current documents, and offered practical feedback that helped sharpen our approach. That external expertise helped the team see gaps and opportunities more clearly than we might have on our own.

The workshop was especially impactful. It created dedicated time to convene the right people, get everyone aligned, and leave with a shared understanding of the path forward. We developed a new, improved process map, are using ASTHO’s gap analysis tool to identify policy gaps, and developed criteria to retire a policy and to decide if a policy or procedure is needed.

What advice would you give to other health departments looking to improve similar processes?

Just start! The work may feel overwhelming at first, but it will develop and take shape as you dig in and learn more. Building momentum matters, and that starts with putting a committed team in place that is ready to move the work forward.

It is also important to be intentional about who is at the table. A diverse, cross-agency team makes a difference. That can include roles such as a nursing coordinator, government liaison, accreditation staff, an auditor, IT support for templates and systems, and executive leaders who can help make timely decisions. Executive sponsorship is key, as is bringing policy writers and reviewers into the conversation so they have a voice and understand the changes. Coordinating that level of engagement takes time, but that investment pays off in stronger buy-in and a smoother path forward.

What about this work are you most proud of?

While there is still more work ahead, we are most proud of the clarity and energy the team now has around the effort. What once felt like a large, looming issue without a clear path forward has turned into a defined plan with concrete next steps. There is a shared understanding of where we are headed and how we will get there, which has created a sense of enthusiasm across the team.

We are also proud that the work has continued despite staff changes and competing priorities. Maintaining momentum through those shifts has not been easy, but it has reinforced our commitment to sustaining the improvements made to this process. Being able to see the end goal and feel confident in the direction we are moving has been a meaningful shift for our team.

Requesting Additional Information

Jurisdictions interested in learning more about how to improve administrative policy processes can visit ASTHO’s STAR Center or contact ASTHO at performanceimprovement@astho.org.

Reviewed by Lindsey Myers, MPH, Vice President, Public Health Workforce & Infrastructure.