Q&A: Mimi Hall looks back as her time as health services director in Santa Cruz comes to a close

The COVID-19 pandemic led many to reevaluate their overall work-life balance and trajectories, and the same can be said for Mimi Hall. Santa Cruz County’s health services director announced last month that she would be stepping down from her position on Oct. 30, moving to help run a nonprofit health exchange.

While the change brings an end to Hall’s tenure with the agency, she hopes the community understands she is leaving with a great amount of joy and gratitude for Santa Cruz County: “I am so glad I closed out my years of public service here — I’ve had the best time.”

Here are some insights from Hall’s conversation with Lookout ahead of this week, her final one with the county. Responses have been edited for length and clarity.

You have worked in public service for health departments across California over the past 20 years. What made Santa Cruz different?

I have typically worked in very small, rural counties that also tend to have a conservative bent, both in the elected officials and in the people that I served. In those rural communities, it’s really, really hard to get things done.

I love my work — I really am grateful for those years. They taught me how to bring people together at the table, and how to inform and educate people who make really important decisions about the community. Santa Cruz is a totally different animal, and I’m so glad I closed out my years of public service here. Here in Santa Cruz, even before COVID-19, what a wonderful environment of partnerships ... this community believes in working together to serve everybody, and that’s really important when it comes to publicly funded health services.

I’ve had the best time the last four years. As difficult as it’s been and as hard as the work is, I really have had the best time because I’ve enjoyed people believing in my work.

When you began your current role in October 2018, you had already worked with the Santa Cruz community for a few years [both as assistant director and interim director for the county’s Health Services Agency]. What were some of your original focus points in entering this position, and what were some of the highlights?

One of the things that I know government and public health departments can and should be doing is elevating the overall health of the community. When I started as the interim director in May 2018, our organization didn’t have a strategic plan, and we are a health department responsible for 273,000 people with no road map. One of the early things we did was begin the strategic planning process and align it with the county strategic plan.

I have a vision still now, that will continue after I go, to do more shared community-wide planning. For the first time ever, in the next few years, all of our health system partners — Dominican, Sutter, United Way — will work together in a joint community health assessment, so together we can have shared community health improvement plans. We can share resources and optimize funding and do that collectively, which is really exciting.

We also really needed a culture change at HSA, and to value our employees for their individual and collective contributions. Our job as government is to serve the public — the best way we can do that is to value our employees and ensure they have the motivation to stay. The way that I have led these past few years is to bring out the strength of every single staff person, and encourage this culture of innovation and speaking up. It’s been a really productive way to work, and it gave people the feeling of safety: We’re all in this together, bring your ideas to the table.

“I have three kids, and I’ve missed so much of them growing up,” Hall says. “I have given a lot to the communities I’ve served, and I need to prioritize myself and my family first.”

(Kevin Painchaud / Lookout Santa Cruz)

What was the most challenging aspect of working as the HSA director during your tenure?

This is a very tight-knit community that values people who have history here. I knew in coming here, that I was coming in from the outside and I had to build trust. I spent my first six to 12 months telling every partner that I know this job, but I don’t know this community. I needed to get to know this community to serve it well; you can’t fast-track trust and relationship-building. Without that, you can’t make big social change — you can’t just talk the talk.

I knew the way our community was going to thrive was to let the people who really have great ideas on how to expand our reach and put more capacity where it was needed, and leave it up to them. I just help make it happen.

How prepared were you for the COVID-19 pandemic, and how do you feel the county’s health systems managed the uncertainty?

The first time we discussed a potential pandemic was the first week of January 2020, when we knew of a new virus potentially circulating.

Back in 2005-06, California made public health emergency preparedness funds. In my role as panflu coordinator for Plumas County in 2006, I happened to be the first county coordinator when those funds were released. I worked with the state and the [Centers for Disease Control and Prevention] to develop key planning and response benchmarks across the federal, state, and local jurisdiction levels; this coordination was further accelerated and improved when H1N1 hit. As soon as January 2020 came, I had never forgotten that training.

With the vaccines, our health system partners were on top of it — people stepped up. After the first surge of mass vaccinations, the health department convened all of our partners and there was a commitment to get the vaccine out to the priority populations as quickly as possible. We had incredible voice and partnership from all of our South County partners, who helped us gain trust in the community through Pajaro Valley Prevention and Student Assistance. We can have the ideas and the epidemiologists, but without those partnerships, we couldn’t have done it.

There has been a lot of burnout for health care workers throughout the pandemic. What do you hope Santa Cruzans will take away from those trends?

We had to keep it all going — we can’t stop our other responsibilities. It was difficult. We doubled the size of our public health staff to meet the demands of controlling the COVID-19 surges, and also focused on the medical and health components for all the shelters following the CZU Lightning Complex fire.

There’s really no recourse for burnout, and we were all furloughed in 2020. What’s helped me personally is all the appreciation, the gratitude and the recognition, but our everyday managers and rank-and-file staff don’t get that. If you know someone who works in public health, know that there is an army out there to keep this community safe, not just from COVID-19, but from everything.

We can’t do everything but we feel like we need to because lives are at stake. We can only do what we have the capacity for, so let’s prioritize. That kind of permission and direction from the top up is needed to sustain people in an emergency, but it sure wouldn’t hurt if the public found all different ways to rally behind public servants in public health.

How did the pandemic make you reflect on your own needs?

For me personally, I wouldn’t say COVID-19 is why I’m leaving county service. For more than 20 years, I’ve worked — getting people health insurance coverage, making sure there is adequate access to substance abuse services. COVID-19 was just the icing on the cake, and it made me reprioritize.

I have three kids, and I’ve missed so much of them growing up. I have given a lot to the communities I’ve served, and I need to prioritize myself and my family first. It’s a reassessment that a lot of people are doing. I love my job, but I want to be a different type of wife and mom.

Can you expand upon what you’ll focus on in your new role?

Manifest Medex is the largest nonprofit health information exchange in California. Manifest Medex was formed in 2017 when Cal INDEX and Inland Empire Health Plan merged, creating a statewide nonprofit health information exchange; I will be their first director of public health innovation.

What we know in California right now is that public health infrastructure is so far behind where we need to be. There are a lot of efforts at the federal and state levels to bring publicly funded health services to the forefront. What we hope to accomplish is to move forward a transformative time for Medicaid with CalAIM, and bring together those entities responsible for the social determinants of health. All of these things have to tie together so we have a handle on individuals and populations.

My role is to think about Californians statewide — how do we partner with health departments to improve community health? Everyone needs to be able to talk to each other.

Looking to the future, what do you hope to remind Santa Cruzans in relation to public health guidance for the long run?

I hope people come out of the pandemic with a better understanding of what public health is and what we provide. We rely on certain types of infrastructure in our daily lives — clean water, electricity — public health is that for the health and vitality of the community.

We can’t do the work we do without the public doing some things for themselves and for others. I hope community members take away from COVID-19 that there are some things in life that are going to take everyone to pitch in. Have enough kindness, compassion and humanity toward your neighbors; the more connected we are to each other, the better off we’ll be.