Sharing Public Health Resources and Services
Gianfranco Pezzino
Patrick Libbey
Co-Directors, Center for Sharing Public Health Services
Outline
Frame the issue of cross-jurisdictional sharing (CJS)
Introduce the Center for Sharing Public Health Services
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• “Handshake”• MOU• Information
sharing• Equipment
sharing• Coordination
• Service provision agreements
• Mutual aid agreements
• Purchase of staff time
• Joint projects addressing all jurisdictions involved
• Shared capacity
• Inter-local agreements
• New entity formed by merging existing LHDs
• Consolidation of 1 or more LHD into existing LHD
Informal and Customary
Arrangements
Service Related Arrangement
Shared Functions with Joint Oversight
Regionalization
Cross-Jurisdictional Sharing Spectrum
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Two Critical Questions
Who makes the decision to enter a CJS arrangement?
What are the drivers behind deciding to engage in CJS?
DriversNational Public
Health Standards
Increasing burden
of chronic disease
Emergency
Preparedness
Lean fiscal
environmentsHealth
care
reform
CJS Agreements
Survey FindingsInsights from Implementers of Shared Services
Most common goal - cost savings
Most participants - achieved goals
Most common measurement of progress - cost savings
Most positive result - improved service
Most negative result - “people issues”
CJS most often initiated - by agency leaders
Most common driver - cost or service variables
Most significant lesson learned from implementing CJS - “Change Management Is Key”
Biggest mistake - insufficient change management
Thing most organizations did well - project management
Greatest challenges - “people issues”; overcome with - improved communication
Source: Success Factors for Implementing Shared Services in Government. IBM Center for the Business of Government, 2008
Survey FindingsInsights from Implementers of Shared Services
Most common goal - cost savings
Most participants - achieved goals
Most common measurement of progress - cost savings
Most positive result - improved service
Most negative result - “people issues”
CJS most often initiated - by agency leaders
Most common driver - cost or service variables
Most significant lesson learned from implementing CJS - “Change Management Is Key”
Biggest mistake - insufficient change management
Thing most organizations did well - project management
Greatest challenges - “people issues”; overcome with - improved communication
Source: Success Factors for Implementing Shared Services in Government. IBM Center for the Business of Government, 2008
Survey FindingsInsights from Implementers of Shared Services
Most common goal - cost savings
Most participants - achieved goals
Most common measurement of progress - cost savings
Most positive result - improved service
Most negative result - “people issues”
CJS most often initiated - by agency leaders
Most common driver - cost or service variables
Most significant lesson learned from implementing CJS - “Change Management Is Key”
Biggest mistake - insufficient change management
Thing most organizations did well - project management
Greatest challenges - “people issues”; overcome with - improved communication
Source: Success Factors for Implementing Shared Services in Government. IBM Center for the Business of Government, 2008
Greater efficiency Enhanced capacity
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Who Are We?
The Center for Sharing Public Health Services (DOB: May 2012) is a national initiative managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation.
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Center’s Goal
Increase the ability of public health agencies to improve the health of communities by helping explore, inform, track and share learning about regional and shared approaches to delivering public health services.
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Target Audiences
PolicymakersPublic health
practitioners Professional
organizations representing these groups
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Center’s Role
Support exploration approaches to share public health functions and servicesTechnical Assistance (TA)Decision-making tools
Share knowledgeDocument examplesTranslate evidence
Support a learning community
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The Learning CommunityPolicymakers
ICMA NACo USCM NGA NCSL
Learning community 16 local projects
Both groups will Learn Share Explore
Public Health OfficialsASTHONACCHONALBOHCDC
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The Learning CommunityPolicymakers
ICMA NACo USCM NGA NCSL
Learning community 16 local projects
Both groups will Learn Share Explore
Public Health OfficialsASTHONACCHONALBOHCDC
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Shared Services Learning Community
16 sites
14 states
2-year grants
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Teams at Learning Sites
Teams funded are: Working with two or more PH agenciesMade up of PH officials and policymakersExploring, implementing or improving CJSCommitted to
achieving greater efficiencyenhancing public health capacitycollaborating
Range of Site Activities
Begin explorationIdentify specific goalsDevelop a feasibility
study Learn about various
sharing modelsReview implications of
shared capacity
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Range of Site Activities
Select sharing modelDevelop strategic planPrepare for implementation Begin implementation
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Key Points: CJS, QI, Accreditation
1. QI and PM tools can support successful CJS efforts
2. CJS can provide QI and PM documentation for accreditation
3. CJS may increase accreditation readiness Some jurisdictions can achieve standards
jointly, but not independently
Change Management
Change Management QI and PH Practice
Assess willingness to change QI approach: • Identify issues• Brain storming• Affinity diagram
Develop strategy for change PDSA = PLANUse of QI tools (workflow analysis, affinity diagrams, etc.)
Implement change PDSA = Do
Evaluate experience PDSA = Study
Phased approach PDSA = ActQI approach: start on small scale, assess and expand
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The Uncomfortable Questions
We have about 2,700 LHDs in the U.S.Do we need 2,700?Can we afford 2,700?Can we imagine a day when all of them
would meet accreditation standards?Is it politically feasible to change
the current LHD structure?
Adapted from: Gene W. Matthews, JD
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Moving Forward
Let’s look at things differentlyLet’s brainstorm possibilities
Let’s explore options and alternativesThen, let’s SHARE
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(855) 476-3671
The Center for Sharing Public Health Services is a national initiative managed by the Kansas Health Institute with support
from the Robert Wood Johnson Foundation.
CMRPHA Quality Improvement Plan
Steven J. Ward, MA, MPH Assistant Director of Public Health City of Worcester Division of Public Health
351 MUNICIPAL BOARDS OF HEALTH
Central Massachusetts
Background of Central Massachusetts Regional Public Health Alliance (CMRPHA)
City Manager Task Force and State Department of Public Health (PHDIG) encourage regional shared service model
Develop and sustain a high quality cost effective and labor-efficient regional public health district
Using Constant Quality Improvement methods Share lessons learned with National Partners and
Massachusetts PHDIG communities as to Cross Jurisdictional Best Practices
Quality Improvement PlanAIM: Standardize the practice of Environmental
Health throughout the 5 CMRPHA communities
Why It Is Important: Standardization leads to a uniform approach to
regulatory programs and enforcement strategies and efficient use of staff time.
Field staff will have more time for Community Health and Emergency Preparedness programs
Establish a baseline
Time-motion study to support Environmental Health Standardization
Workforce development
Filed staff and BOH Credentials
Planned Improvement Activities
Assure consistent training of all staff
Assess current academic credentials of field staff and develop plan to address acquisition of needed academic credentials
Creation of Center for Public Health Practice for producing field ready Environmental Health interns and to deliver IDP academic content to staff
Planned Improvement Activities
Institutionalize standardized practices
Improve efficiency of staff time
Utilize time-motion and direct observation analysis to ensure appropriate allocation of personnel and staff
Review program in December of 2013 for ongoing QI
Northwoods Shared
Services Project
Starting Out
• 2003 influx of funding created public health preparedness consortia
• 2003-2010 Northwoods Consortium– 21 jurisdictions– Epidemiology/outcomes-based approach– Accreditation
• July 2011 elimination of consortia funding• August 2011Northwoods Collaborative
– 9 jurisdictions (now 10)
Why not 21 of 21?
Possible barriers to joining collaborative:• Budget cuts/retain staff• Agency size allows for dedicated staff• Extra funding helps shore up other efforts
(accreditation)• Distance/relate more to other regions
Northwoods Collaborative
Memorandum of understanding – Preparedness– “Other services”
Mutual aid agreementPublic Health Infrastructure Improvement Project (accreditation)
Shared Services Learning Community Grant Application to Robert Wood Johnson
Foundation
• Natural fit for collaborative and region• Accreditation• Shrinking resources• Examine and improve on what we are doing• Increase policymaker involvement• Local team approach/identity
Sharing Arrangements Fall 2012Type of Sharing Arrangement Number of
AgenciesMemorandum of Understanding (MOU) 16Joint Projects 13Informal agreement or coordination 10Mutual Aid Agreement 8Services 5Capacity 5Staff time 3Equipment 1Merger 1
Key Questions
• What criteria should health departments use to evaluate the effectiveness of sharing arrangements?
• When is cross-jurisdictional sharing cost-effective?
• How can sharing arrangements contribute to an increase in quality and capacity in public health department services, functions, and accreditation efforts?
Northwoods Shared Services Project
Resources & Expectations
• Pressure to provide effective and efficient services
• Wisconsin at bottom in funding public health• Affordable Care Act• Accreditation• Performance management
Current Course
• Public Health Accreditation Board (PHAB) self-assessment
• Performance management– Strategic planning– Performance monitoring and measurement– Quality improvement– Community Health Assessment (CHA)/Community
Health Improvement Plan & Process (CHIPP)
Infrastructure Road Blocks
• Lots of will!
• Capacity deficit
Policymakers – aligning paths
• Support for reallocating resources• Essential Services as framework for internal
capacity • What are we getting from tax levy support?• Customer satisfaction• Focus on efficiency, effectiveness, and
spending
Lessons Learned
• Money isn’t everything• Build capacity from within• Need access to people resources you can draw
on quickly• Conserving policymaker time while keeping
them involved
Evaluate to Improve Sharing Arrangements
• What types of services and functions are being shared?
• What are inputs, benefits, costs?• What criteria should be used for entering into
a shared services arrangement?
What we hope to accomplish
• Increased understanding among policymakers– 10 Essential Services/national accreditation– Infrastructure necessary to support public health
• Cross-jurisdictional sharing criteria• How sharing can increase capacity and
infrastructure
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