The U.S. governmental public health system is confronting an urgent and complex imperative: to transform itself in order to meaningfully address persistent and worsening health inequities rooted in racism and other structural determinants of health. Although there is increasing recognition that system‑level, upstream interventions are essential, public health agencies remain hindered by fragmented infrastructures, inconsistent and categorical funding, and uncertainty about what true transformation requires in practice. Despite numerous frameworks and substantial national investment, progress has been slowed by the absence of a shared vision, operational clarity, and a practice‑grounded understanding of what success in systems transformation looks like.
To address this gap, this study examined the real‑world experience of one statewide governmental public health system as it pursued transformational change. Through a qualitative single‑case, multi‑phase design, the research explored how leaders across this statewide system conceptualized transformation, pursued equity‑centered systems change, and defined meaningful indicators of progress. Using brown’s Emergent Strategy as the primary analytic anchor, the study interrogated the dominant paradigms that have historically constrained governmental public health. This lens, complemented by Kotter’s framework on vision and Mintzberg’s distinctions between deliberate and emergent strategy, provided the scaffolding for understanding direction and strategy formation. The Water of Systems Change framework further supports examination of outcomes across structural, relational, and transformative levels, enabling an assessment of the depth and sustainability of the changes perceived by system leaders.
Data sources included extensive documents generated through the statewide system’s transformation efforts and semi‑structured interviews with leaders from both the state health department and local health departments. Deductive and inductive coding strategies, guided by an integrated conceptual framework, supported analysis of themes within and across phases. Preliminary findings were later presented to the system’s transformation leadership group during a working meeting, generating Phase 3 validation data and enhancing the credibility and applicability of the results. Synthesized across all phases, the findings illuminate how this statewide system operationalized its transformational intent, the conditions that supported or limited progress, and how success was defined in practice by leaders embedded within the system.
Taken together, this research offers a practice‑based, theory‑informed perspective into one statewide governmental public health system navigating the complexity, creativity, and possibility of equity‑centered systems transformation, offering insights that can inform future action for other states, national partners, and the field at large.
","abstract_html":"<p dir="ltr">The U.S. governmental public health system is confronting an urgent and complex imperative: to transform itself in order to meaningfully address persistent and worsening health inequities rooted in racism and other structural determinants of health. Although there is increasing recognition that system‑level, upstream interventions are essential, public health agencies remain hindered by fragmented infrastructures, inconsistent and categorical funding, and uncertainty about what true transformation requires in practice. Despite numerous frameworks and substantial national investment, progress has been slowed by the absence of a shared vision, operational clarity, and a practice‑grounded understanding of what success in systems transformation looks like.</p><p dir="ltr">To address this gap, this study examined the real‑world experience of one statewide governmental public health system as it pursued transformational change. Through a qualitative single‑case, multi‑phase design, the research explored how leaders across this statewide system conceptualized transformation, pursued equity‑centered systems change, and defined meaningful indicators of progress. Using brown’s Emergent Strategy as the primary analytic anchor, the study interrogated the dominant paradigms that have historically constrained governmental public health. This lens, complemented by Kotter’s framework on vision and Mintzberg’s distinctions between deliberate and emergent strategy, provided the scaffolding for understanding direction and strategy formation. The Water of Systems Change framework further supports examination of outcomes across structural, relational, and transformative levels, enabling an assessment of the depth and sustainability of the changes perceived by system leaders.</p><p dir="ltr">Data sources included extensive documents generated through the statewide system’s transformation efforts and semi‑structured interviews with leaders from both the state health department and local health departments. Deductive and inductive coding strategies, guided by an integrated conceptual framework, supported analysis of themes within and across phases. Preliminary findings were later presented to the system’s transformation leadership group during a working meeting, generating Phase 3 validation data and enhancing the credibility and applicability of the results. Synthesized across all phases, the findings illuminate how this statewide system operationalized its transformational intent, the conditions that supported or limited progress, and how success was defined in practice by leaders embedded within the system.</p><p dir="ltr">Taken together, this research offers a practice‑based, theory‑informed perspective into one statewide governmental public health system navigating the complexity, creativity, and possibility of equity‑centered systems transformation, offering insights that can inform future action for other states, national partners, and the field at large.</p>","abstract_has_math":false,"creators":["Sarah Kerch (23796868)"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026-05-19T00:00:00Z","date_published":"2026-05-19T00:00:00Z","updated_at":"2026-07-27T21:33:35Z","subjects":["transformational change","Transformational leadership and shared leadership","public health"],"languages":[],"rights":["In Copyright"],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://doi.org/10.25417/uic.32245323.v1","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Sarah Kerch (23796868)"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2026-05-19T00:00:00Z"]},{"key":"dc:relation","label":"Dc Relation","values":["https://figshare.com/articles/thesis/The_Pursuit_of_Transformation_How_a_Governmental_Public_Health_System_Characterizes_and_Operationalizes_Transformational_Change/32245323"]},{"key":"dc:type","label":"Dc Type","values":["Text","Thesis"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["transformational change","Transformational leadership and shared leadership","public health"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:rights","label":"Dc Rights","values":["In Copyright"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["10.25417/uic.32245323.v1"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["The U.S. governmental public health system is confronting an urgent and complex imperative: to transform itself in order to meaningfully address persistent and worsening health inequities rooted in racism and other structural determinants of health. Although there is increasing recognition that system‑level, upstream interventions are essential, public health agencies remain hindered by fragmented infrastructures, inconsistent and categorical funding, and uncertainty about what true transformation requires in practice. Despite numerous frameworks and substantial national investment, progress has been slowed by the absence of a shared vision, operational clarity, and a practice‑grounded understanding of what success in systems transformation looks like.
To address this gap, this study examined the real‑world experience of one statewide governmental public health system as it pursued transformational change. Through a qualitative single‑case, multi‑phase design, the research explored how leaders across this statewide system conceptualized transformation, pursued equity‑centered systems change, and defined meaningful indicators of progress. Using brown’s Emergent Strategy as the primary analytic anchor, the study interrogated the dominant paradigms that have historically constrained governmental public health. This lens, complemented by Kotter’s framework on vision and Mintzberg’s distinctions between deliberate and emergent strategy, provided the scaffolding for understanding direction and strategy formation. The Water of Systems Change framework further supports examination of outcomes across structural, relational, and transformative levels, enabling an assessment of the depth and sustainability of the changes perceived by system leaders.
Data sources included extensive documents generated through the statewide system’s transformation efforts and semi‑structured interviews with leaders from both the state health department and local health departments. Deductive and inductive coding strategies, guided by an integrated conceptual framework, supported analysis of themes within and across phases. Preliminary findings were later presented to the system’s transformation leadership group during a working meeting, generating Phase 3 validation data and enhancing the credibility and applicability of the results. Synthesized across all phases, the findings illuminate how this statewide system operationalized its transformational intent, the conditions that supported or limited progress, and how success was defined in practice by leaders embedded within the system.
Taken together, this research offers a practice‑based, theory‑informed perspective into one statewide governmental public health system navigating the complexity, creativity, and possibility of equity‑centered systems transformation, offering insights that can inform future action for other states, national partners, and the field at large.
"]},{"key":"dc:title","label":"Title","values":["The Pursuit of Transformation: How a Governmental Public Health System Characterizes and Operationalizes Transformational Change"]}]}],"canonical_facts":{"dc:creator":["Sarah Kerch (23796868)"],"dc:date":["2026-05-19T00:00:00Z"],"dc:description":["The U.S. governmental public health system is confronting an urgent and complex imperative: to transform itself in order to meaningfully address persistent and worsening health inequities rooted in racism and other structural determinants of health. Although there is increasing recognition that system‑level, upstream interventions are essential, public health agencies remain hindered by fragmented infrastructures, inconsistent and categorical funding, and uncertainty about what true transformation requires in practice. Despite numerous frameworks and substantial national investment, progress has been slowed by the absence of a shared vision, operational clarity, and a practice‑grounded understanding of what success in systems transformation looks like.
To address this gap, this study examined the real‑world experience of one statewide governmental public health system as it pursued transformational change. Through a qualitative single‑case, multi‑phase design, the research explored how leaders across this statewide system conceptualized transformation, pursued equity‑centered systems change, and defined meaningful indicators of progress. Using brown’s Emergent Strategy as the primary analytic anchor, the study interrogated the dominant paradigms that have historically constrained governmental public health. This lens, complemented by Kotter’s framework on vision and Mintzberg’s distinctions between deliberate and emergent strategy, provided the scaffolding for understanding direction and strategy formation. The Water of Systems Change framework further supports examination of outcomes across structural, relational, and transformative levels, enabling an assessment of the depth and sustainability of the changes perceived by system leaders.
Data sources included extensive documents generated through the statewide system’s transformation efforts and semi‑structured interviews with leaders from both the state health department and local health departments. Deductive and inductive coding strategies, guided by an integrated conceptual framework, supported analysis of themes within and across phases. Preliminary findings were later presented to the system’s transformation leadership group during a working meeting, generating Phase 3 validation data and enhancing the credibility and applicability of the results. Synthesized across all phases, the findings illuminate how this statewide system operationalized its transformational intent, the conditions that supported or limited progress, and how success was defined in practice by leaders embedded within the system.
Taken together, this research offers a practice‑based, theory‑informed perspective into one statewide governmental public health system navigating the complexity, creativity, and possibility of equity‑centered systems transformation, offering insights that can inform future action for other states, national partners, and the field at large.
"],"dc:identifier":["10.25417/uic.32245323.v1"],"dc:relation":["https://figshare.com/articles/thesis/The_Pursuit_of_Transformation_How_a_Governmental_Public_Health_System_Characterizes_and_Operationalizes_Transformational_Change/32245323"],"dc:rights":["In Copyright"],"dc:subject":["transformational change","Transformational leadership and shared leadership","public health"],"dc:title":["The Pursuit of Transformation: How a Governmental Public Health System Characterizes and Operationalizes Transformational Change"],"dc:type":["Text","Thesis"]},"updated_at":"2026-07-27T21:33:35Z"}