All posts by phsharing

North Dakota Department of Health

This grantee was part of the Center’s Implementation and Impact Measurement Program

North Dakota has four regional networks that share environmental health activities related to on-site septic systems (OSS). The networks planned to develop uniform ordinances and share inspection and enforcement activities among public health units within each network.

The impact measurement project was aimed at estimating the number of new residential units that should have been inspected (based on the local ordinances in effect) and the number of inspections actually conducted, as well as the number of permits approved for newly installed systems after each network became functional. The project also tried to determine the cost and the number of existing OSS inspections in each of the participating local public health units before and after the implementation of the network ordinance/fee schedule. The project team also planned to assess the level of satisfaction of the OSS installers after a new, standardized licensure process was introduced. Due to difficulty in data availability, these plans had to be revised and some measures could not be calculated.

The project team estimated that the cost per inspection of septic systems using a network was $70 less than the cost each local public health unit would have faced independently, due to economies of scale. The new, standardized licensure process introduced as a result of the creation of the networks was favored by most inspectors, despite possible increases in inspector and customer costs.

Horizon Public Health

This grantee was part of the Center’s Implementation and Impact Measurement Program.

In 2015, three previously independent health departments in West Central Minnesota consolidated into one new health department called Horizon Public Health. This five-county regional public health organization serves approximately 67,000 people.

The impact measurement plan included comparing before- and after-consolidation administrative costs, program reach, and staff capacity, as well as outcomes in two programs targeting high-risk populations before and after integration.

Horizon Public Health demonstrated both cost efficiency and quality effectiveness as a result of their full integration. Total administrative costs were reduced by about $300,000 ($200,000 from administrative overhead for the health department’s programs and $100,000 from a reduction of administrative FTEs in the newly created agency). Marked increases in breastfeeding initiation (from 79 to 84 percent) and proportion breastfeeding at three months (from 42 to 50 percent) were observed post-implementation among Women, Infants, and Children (WIC) clients, with only a slight decrease at six months.

For more information about this site, read about its activities as part of the Center’s Shared Services Learning Community.

Northern Michigan Public Health Alliance

This grantee was part of the Center’s Implementation and Impact Measurement Program.

This project focused on measuring gains in effectiveness and efficiency of conducting a common community health assessment (CHA) across jurisdictions. The project team compared cost and quality measures from a region of counties conducting a CHA versus those same jurisdictions conducting individual CHAs within single jurisdictions or smaller collaborations.

The project team collected data for three measures:

Measure 1 – Saved Cost
This measure was aimed at calculating the difference in cost between regional CHAs and individual CHAs performed independently by each public health agency. The project team concluded that they saved both personnel time and other expenses by conducting the CHAs regionally. For one of the regional CHAs (Tip of the Mitt), the saving was estimated at 690 staff hours (equal to $17,277). For another regional CHA (Grand Traverse Region), the savings was estimated at 2045 hours (or $56,085). Further savings (269 hours, or $13,927) were achieved through economies of scale from organizational meetings with common regional hospital partners; training, including time, registration fees, and travel expenses; centralized secondary data collection; and design and development of surveys.

Measures 2 and 3 – Enhanced Quality
These measures were aimed at assessing the quality of the joint CHA using a pre-defined set of quality indicators. The project team used surveys and focus groups with health officers and other community partners and key informants.

The majority of respondents strongly favored the regional CHA, with the overwhelming majority agreeing that the regional CHA was of higher quality than an individual one. The overall quality of regional CHA was rated highly, and most respondents agreed that it addressed the issues expected in a quality CHA. Only one respondent suggested they could definitely produce their own local CHA of equal quality and another said they possibly could. Partners in general felt that the regional CHA facilitated completion and dissemination of the assessment. Resources for technical assistance appeared to be more available regionally than locally. Only a little more than a third of the partners said that they definitely or probably could complete the same CHA for their local community.

Another noticeable finding of this project was that although difficult to measure, the joint work of multiple public health jurisdictions increased their visibility, relevance and weight, and allowed them to become more engaged in joint activities with health care organizations and other partners.

For more information about this site, read about its activities as part of the Center’s Shared Services Learning Community.

Washington-Ozaukee Health Department

This grantee was part of the Center’s Implementation and Impact Measurement Program

The health departments in Washington and Ozaukee Counties in Wisconsin merged in 2016 into one health department that serves 220,000 residents. Their impact measurement plan included measuring changes in productive clinic time and in quality for areas such as access to data, staff support, and customer and staff satisfaction.

Sharing services allowed for staff to specialize in one program area. Staff also found that a higher degree of specialization resulted in a reduction of the time spent on the investigation of each communicable disease case. Sharing services also provided easier access to information from multiple jurisdictions and reduced the time to investigate cases shared between the two counties; in the case of hepatitis C, the reduction was about 50 percent. Waiting time for appointments for immunizations were reduced in Washington County from seven to four days due to shared electronic health records / electronic scheduling that facilitated scheduling appointments. Overall staff satisfaction improved post-merger from 3.6 to 4.0 (out of a possible maximum of 5).

Through the merger, staff were able to examine, optimize and standardize policies and procedures from the two counties. As a result, staff were able to increase referrals of Women, Infants, and Children (WIC) clients for other medical and social services. In Ozaukee County about 77 percent of women received a referral, versus less than 37 percent before the merger. Referral were almost never done in Washington County before the merger; after the merger, almost 15 percent of WIC clients in Washington County received a referral.

Implementation and Impact Measurement Program

READ THE REPORT:

 

In 2015 the Center for Sharing Public Health Services developed a model to measure the impact of cross-jurisdictional sharing (CJS) arrangements on service and program effectiveness and efficiency. The Center selected four projects that had recently implemented a CJS arrangement–located in Michigan, Minnesota, North Dakota and Wisconsin–with the goal of testing the model it had developed. Over a period of 18 months, these four sites conducted activities aimed at measuring changes in the effectiveness and efficiency of a program or service for which they had recently implemented a sharing agreement. All projects completed their work as planned and were successful (to various degrees) in demonstrating that the impact of CJS initiatives can be measured using the systematic approach developed by the Center.

A description of each project follows.

MI – Northern Michigan Public Health Alliance

This project focused on measuring gains in effectiveness and efficiency of conducting a common community health assessment (CHA) across jurisdictions. The project team compared cost and quality measures from a region of counties conducting a CHA versus those same jurisdictions conducting individual CHAs within single jurisdictions or smaller collaborations. Select this link to read about their impact measurement activities.

MN – Horizon Public Health

In 2015, three previously independent health departments in West Central Minnesota consolidated into one new health department called Horizon Public Health. This five-county regional public health organization serves approximately 67,000 people. Select this link to read about their impact measurement activities.

ND – North Dakota Department of Health

North Dakota has four regional networks that share environmental health activities related to on-site septic systems (OSS). The networks planned to develop uniform ordinances and share inspection and enforcement activities among public health units within each network. Select this link to read about their impact measurement activities.

WI – Washington-Ozaukee Health Department

The health departments in Washington and Ozaukee Counties in Wisconsin merged in 2016 into one health department that serves 220,000 residents. Their impact measurement plan included measuring changes in productive clinic time and in quality for areas such as access to data, staff support, and customer and staff satisfaction. Select this link to read about their impact measurement activities.

Public Health Service Delivery in Pawnee County: A Report for the Pawnee County Board of Health

Pawnee County is a rural county in south-central Kansas with a population of about 6,700. The Board of County Commissioners, which also serves as the Board of Health, asked the Kansas Health Institute and the Center for Sharing Public Health Services to examine the current scope of public health department services and evaluate them against the needs of the community and best practices in public health. This report provides findings from the study and proposes for the board a pathway to move forward.

Available online: www.khi.org/assets/uploads/news/14829/public-health-service-delivery-pawnee-county.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: Special consideration is given to opportunities for collaboration and resource-sharing with partners within and outside of Pawnee County.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Service Implications / Phase Two: Special consideration is given to opportunities for collaboration and resource-sharing with partners within and outside of Pawnee County.

 

Cross-Jurisdictional Sharing Map

This page is under construction.

Because cross-jurisdictional sharing (CJS) models vary based on state and local characteristics, the Center for Sharing Public Health Services has developed this map, which represents a state-by-state data repository describing CJS initiatives across the nation.

This is not a complete list of all CJS arrangements in all states. If you have examples to submit, please contact us at phsharing@khi.org.

Legend:
Blue: States with examples of CJS arrangements or other resources.
Gray: States where resources are lacking. Please help us fill out these pages by sharing examples with us at phsharing@khi.org.

Wyoming: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Wyoming is served by a largely shared public health system. There are five independent local health agencies in the state that are led by local government staff and 18 state-run local health agencies that are led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Wyoming?




 
 

South Dakota: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

South Dakota is served by a largely centralized public health system. There is one independent local health agency in the state that is led by local government staff. There also are seven state-run regional or district offices led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in South Dakota?




 
 

South Carolina: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

South Carolina is served by a centralized public health system. There are 63 state-run local health agencies in the state that are led by state employees. There also are four state-run regional or district offices led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in South Carolina?




 
 

Rhode Island: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Rhode Island is served by a centralized public health system. There are no local health agencies or regional/district offices in the state.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Rhode Island?




 
 

Pennsylvania: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Pennsylvania is served by a mixed public health system. There are 10 independent local health agencies in the state that are led by local government staff. There also are six state-run regional or district offices led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Pennsylvania?




 
 

New Mexico: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information


New Mexico is served by a centralized public health system. There are four state-run regional or district offices led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in New Mexico?




 
 

New Jersey: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

New Jersey is served by a decentralized public health system. There are 90 independent local health agencies in the state that are led by local government staff. There also is one independent regional or district office led by non-state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in New Jersey?




 
 

Mississippi: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Mississippi is served by a centralized public health system. There are 80 state-run local health agencies in the state that are led by state employees. There also are nine state-run regional or district offices led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Mississippi?




 
 

Maryland: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Maryland is served by a largely shared public health system. There is one independent local health agency in the state that is led by local government staff. There also are 23 state-run local health agencies that are led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Maryland?




 
 

Indiana: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Indiana is served by a decentralized public health system. There are 93 independent local health agencies in the state that are led by local government staff.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Indiana?




 
 

Idaho: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Idaho is served by a mixed public health system. There are seven independent regional or district offices led by non-state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Idaho?




 
 

Hawaii: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Hawaii is served by a centralized public health system. There are three state-run regional or district offices in the state.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Hawaii?




 
 

Delaware: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Delaware is served by a centralized public health system. There are no local health departments or regional/district offices in the state.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Delaware?




 
 

Alabama: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Alabama is served by a largely centralized public health system. There are two independent local health agencies in the state that are led by local government staff and 65 state-run local health agencies that are led by state staff.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Alabama?




 

West Virginia: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

West Virginia is served by a decentralized public health system. There are 49 independent local health agencies in the state that are led by local government staff. There also are two independent regional or district offices led by non-state employees.
 
The Center’s Resource Library contains resources on cross-jurisdictional sharing (CJS) in West Virginia . Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in West Virginia?




 
 

Virginia: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Virginia is served by a largely centralized public health system. There are two independent local health agencies in the state that are led by local government staff and 128 state-run local health agencies that are led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Virginia?




 
 

Utah: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Utah is served by a decentralized public health system. There are 13 independent local health agencies in the state that are led by local government staff.
 
The Center’s Resource Library contains resources on cross-jurisdictional sharing (CJS) in Utah . Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Utah?




 
 

Texas: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Texas is served by a largely decentralized public health system. There are 59 independent local health agencies in the state that are led by local government staff. There also are eight state-run regional or district offices led by state employees.
 
The Center’s Resource Library contains resources on cross-jurisdictional sharing (CJS) in Texas . Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Texas?




 
 

New Hampshire: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

New Hampshire is served by a largely centralized public health system. There are two independent local health agencies in the state that are led by local government staff.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in New Hampshire?




 
 

Louisiana: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Louisiana is served by a largely centralized public health system. There are two independent local health agencies in the state that are led by local government staff, and 63 state-run local health agencies that are led by state employees. There also are five independent regional or district offices led by non-state employees and nine state-run regional or district offices led by state employees.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Louisiana?




 
 

Tennessee: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Tennessee is served by a mixed public health system. There are 89 state-run local health agencies in the state that are led by state employees. There also are six independent regional or district offices led by non-state employees, and seven state-run regional or district offices led by state employees.
 
The Center’s Resource Library contains resources on cross-jurisdictional sharing (CJS) in Tennessee. Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Tennessee?




 
 

Missouri: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Missouri is served by a decentralized public health system. There are 115 independent local health agencies in the state that are led by local government staff. There also are 9 state-run regional or district offices led by state employees.
 
The Center’s Resource Library contains resources on cross-jurisdictional sharing (CJS) in Missouri . Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Missouri?




 
 

Illinois: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Illinois is served by a decentralized public health system. There are 96 independent local health agencies in the state that are led by local government staff. There also are seven state-run regional or district offices led by state employees.
 
The Center’s Resource Library contains resources on cross-jurisdictional sharing (CJS) in Illinois. Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Illinois?




 
 

Georgia: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Georgia is served by a shared public health system. There are 159 independent local health agencies in the state that are led by local government staff. There also are 18 state-run regional or district offices led by state employees.
 
The Center’s Resource Library contains resources on cross-jurisdictional sharing (CJS) in Georgia. Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Georgia?




 
 

Arizona: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Arizona is served by a decentralized public health system. There are 15 independent local health agencies in the state that are led by local government staff.
 
Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Arizona?




 

Oklahoma: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Oklahoma is served by a mixed public health system. There are two independent local health agencies in the state that are led by local government staff, and one state-run local health agency led by state employees. There also are 68 state-run regional or district offices led by state employees.
 
The Center’s Resource Library contains resources on cross-jurisdictional sharing (CJS) in Oklahoma . Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Oklahoma?




 
 

Arkansas: Cross-Jurisdictional Sharing

Note: This page is under construction.

Background Information

Arkansas is served by a centralized public health system. There are 94 state-run local health agencies in the state. There also are five state-run regional or district offices.

Click here for information about the legal basis for CJS in the state from the Network for Public Health Law.


Can you help us learn more about CJS in Arkansas?




 
 

Public Health Emergency Preparedness for Central Oregon

This grantee was part of the Center’s Shared Services Learning Community.

This page is under construction.

Public Health Emergency Preparedness for Central Oregon
Deschutes, Jefferson and Crook Counties pursued a shared approach to public health preparedness activities. They named their initiative Public Health Emergency Preparedness for Central Oregon (PHEPCO), and ultimately focused on developing shared risk communications and a joint medical surge plan.

The following links provide more information about this site:

  • Summary Report: This report was published in 2015 and provides a summary of the site’s activities during the time it was a demonstration site for the Center.
  • Site Visit Report: The Center visited the site in July 2013. This report documents the activities from the site visit as well as some of the Center’s observations.
  • Project Description: The site produced this report to describe its work.

 


Learn more about CJS in Oregon

To learn more about the public health system and cross-jurisdictional sharing in Oregon, and to find examples of other CJS arrangements there, visit the Center’s state page about Oregon.


Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium

The Alaska Native Epidemiology Center is a part of the Alaska Native Tribal Health Consortium (ANTHC), which operates a large grouping of the Indian Health Service Alaska Area office’s programs. The Alaska Native Epidemiology Center provides public health and epidemiologic services to tribal health organizations and the tribal communities.

Available online: http://anthctoday.org/epicenter/index.html

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Tribal Issues: The Alaska Native Epidemiology Center provides public health and epidemiologic services to tribal health organizations and the tribal communities.

 

Let Our New COMPASS Guide Your CJS Journey


The Center for Sharing Public Health Services has big news! We have launched an interactive online tool called COMPASS: Comprehensive Assistance for Shared Services. We invite you to check it out!

 

We know that public health departments and local governments work hard to serve their communities, often with limited resources and competing priorities. Cross-jurisdictional sharing (CJS) is one model to consider as you look for new ways to maximize your public health efforts. However, CJS may seem like a complex concept, and it may feel overwhelming to know where to start. This is what COMPASS was designed for.

 

COMPASS includes self-guided tours through each of the three main phases of CJS. No matter where you are in the process—whether you are just beginning to explore a CJS route, are in the middle of planning a CJS journey, or are nearing your destination by implementing or improving your CJS arrangement—COMPASS will guide you through each step. The tool includes probing questions to help identify where you are in each phase of CJS, and at each step it will suggest key considerations for your journey. Packed with online resources and interactive multimedia elements, COMPASS provides a wealth of material from sample legal agreements to communications techniques, all of which can be adapted to your unique situation.

 

We want to hear what you think about COMPASS! Please email us at phsharing@khi.org.


– Pat Libbey and Gianfranco Pezzino, Center Co-Directors


Small Grants Now Available

The Center is offering small grants to organizations that wish to explore, plan, implement or improve some specific aspects of cross-jurisdictional sharing in public health. Visit our website for more information and to apply. 

Health Districts as Quality Improvement Collaboratives and Multijurisdictional Entities

This study assessed the capacity of multi-county health districts to serve as “Quality Improvement Collaboratives” and support local health departments to meet accreditation standards.

Available online: https://www.ncbi.nlm.nih.gov/pubmed/23023281

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Accreditation / Essential Services: This study assessed the capacity of multi-county health districts to serve as “Quality Improvement Collaboratives” and support local health departments to meet accreditation standards.
  • Quality Improvement: Key opinion leaders from both the rural and non-rural counties agreed that the Districts were important for providing essential services and supporting quality improvement collaboration. Psychometric testing of the Quality Improvement Collaborative assessment public health instrument yielded high scores for validity and reliability.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Center Launches Two New State Pages: Minnesota and New York

The Center is pleased to announce the launch of two new state pages on cross-jurisdictional sharing (CJS): Minnesota and New York.
 
Given that CJS implementation models vary based on state and local characteristics, we have developed these pages as part a state-by-state data repository describing CJS initiatives across the nation. The pages about Colorado, Kansas and Ohio that we previously published have received positive feedback–you should check them out. Watch for pages about other states to be launched soon. 
 
If you know of any local health departments or community health centers that collaborate in any way, you can help us by taking this short survey. The collaboration can be formal or informal, such as simply sharing services. 

 

To further highlight CJS arrangements in New York and Minnesota, we have published two new Case Reports.  

 

Minnesota’s PartnerSHIP 4 Health
PartnerSHIP 4 Health is a community health board that governs the four local health departments serving Becker, Clay, Otter Tail and Wilkin Counties in Minnesota. Since its establishment, PartnerSHIP 4 Health has undertaken a four-county community health improvement planning process, developed sequential strategic plans, implemented a branding strategy and now shares four programs among all departments. Read the Center’s new CJS Case Report to learn more.
 

New York’s Genesee and Orleans Counties
Two health departments in rural New York implemented a plan to share a director and deputy director. Additional sharing has developed between the health departments in Genesee and Orleans Counties over time, resulting in enhanced quality of services and reduced costs. Read the Center’s CJS Case Report to learn more.

 

We want to hear from you. Email us at phsharing@khi.org.

 

– Pat Libbey and Gianfranco Pezzino, Center Co-Directors

What Were You Reading?

The Center’s experts were busy in 2017 providing technical assistance about cross-jurisdictional sharing. Here are the top three, most-read publications in 2017 on phsharing.org.

 

CJS Case Report: Genesee and Orleans Counties in New York

Genesee County and Orleans County health departments in rural New York implemented a plan to share a director and deputy director. Additional sharing has developed over time, resulting in enhanced quality of services and reduced costs.

Available online: http://phsharing.org/wp-content/uploads/2018/01/NewYorkCaseReport122217.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: Two county health departments implemented a plan to share a director and deputy director. Additional sharing has developed over time, resulting in enhanced quality of services and reduced costs.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Fiscal / Phase Two: Butler and Greenwood County Health Departments conducted a feasibility study to explore a potential shared family planning program.
  • Service Implications / Phase Two: Butler and Greenwood County Health Departments conducted a feasibility study to explore a potential shared family planning program.
  • Implementation and Management / Phase Three: Two county health departments implemented a plan to share a director and deputy director. Additional sharing has developed over time, resulting in enhanced quality of services and reduced costs.

 

Staff Sharing Arrangements for Local Public Health

This report offers a series of case studies on shared staffing arrangements in local public health organizations. These cases, which are located in Massachusetts, Iowa and Oregon, were selected for study based on a national environmental scan of arrangements in place and with attention to variation in location, size of jurisdictions, and type of local government. The shared positions covered in these case studies run the gamut from health directors to physicians, nurses, inspectors, social workers, and administrative staff.

Available online: http://slge.org/wp-content/uploads/2017/11/November-2017-Public-Health-Shared-Staffing-Approaches.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: Shared staffing approaches may be helpful in filling gaps, or in some cases, enabling the provision of services that would not have been feasible in the absence of the partnered approach.
  • Rural / Small Jurisdictions: Shared staffing approaches may facilitate qualification for grant funding that may not be available to an individual health department on its own, whether due to the smaller population served or a lack of in-house capacity and resources.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Fiscal / Phase Two: Provides case studies to demonstrate how shared staffing approaches may be helpful in filling gaps, or in some cases, enabling the provision of services that would not have been feasible in the absence of the partnered approach.
  • Service Implications / Phase Two: Provides case studies to demonstrate how shared staffing approaches may be helpful in filling gaps, or in some cases, enabling the provision of services that would not have been feasible in the absence of the partnered approach.

 

Learning Along the Way

A Message from the Co-Directors

January 10, 2018

People often ask us how we develop the cross-jurisdictional sharing (CJS) tools and resources we provide. We do it through continuous improvement efforts. While Center staff are providing technical assistance to public health groups in the field, we get to observe real-world experiences with CJS–which functions like a learning laboratory. This allows us to collect best practices and share them with the public health community.

The Roadmap to Develop Cross-Jurisdictional Sharing Initiatives is one of the most important tools for the Center, developed nearly five years ago. After learning from groups using the Roadmap during their CJS initiatives, we gathered feedback, analyzed it, and have released a new version for you here. Let us know what you think!

Along with field observation, the Center has brought together our grantees, key partners and other public experts for annual in-person meetings, which have provided a forum for participants to share their experiences with the Center and with other practitioners working on CJS initiatives.

We also review recent trends in public health systems and public administration to identify best practices to shared-service efforts–and look for ways that CJS might be applied.

We do this because public health organizations must be effective and efficient. The Center is no exception. We continuously improve our tools, resources and methods to ensure that they remain relevant and have real-world applicability. How do you improve your programs and services? We want to hear from you. Email us at phsharing@khi.org.

– Pat Libbey and Gianfranco Pezzino, Center Co-Directors

Help Us Find CJS Examples!


Please take this short survey (2-3 minutes)

The National Association of County and City Health Officials (NACCHO) and the Center for Sharing Public Health Services are developing new tools and resources aimed at helping local health departments (LHDs) and community health centers (CHCs) collaborate better. Do you know of any LHDs or CHCs who collaborate in any way? If so, please take the survey. This collaboration can be formal or informal (such as simply sharing services). We appreciate your time.

If you have any questions, please email us at phsharing@khi.org.

Posted December 11, 2017

Updated: Spectrum of Cross-Jurisdictional Sharing (CJS) Arrangements

March 13, 2017

The Center for Sharing Public Health Services has updated its Spectrum of Cross-Jurisdictional Sharing (CJS) Arrangements.

The spectrum identifies four main types of CJS arrangements:

  • As-Needed Assistance
  • Service-Related Arrangements
  • Shared Programs or Functions
  • Regionalization/Consolidation

 
Generally, moving from left to right along the Spectrum, the level of service integration increases, the level of jurisdictional autonomy decreases and implementation becomes more complex, as can governance.

Each type of arrangement has the potential to achieve gains in effectiveness and efficiency, particularly if designed and implemented correctly following the steps outlined in the Center’s Roadmap to Develop Cross-Jurisdictional Sharing Initiatives.

Conceptually, the spectrum has not changed. The updates, which were made to increase clarity, include:

  • Renaming the first column “As-Needed Assistance” to better reflect the episodic nature of the arrangements in that category;
  • Revising the names of the third and fourth columns to provide greater clarity of meaning; and
  • Changing some details in the examples in all four columns, in order to enhance precision.

 
The Center also has published a brief with more information about the Spectrum.

If you have questions about the Spectrum or if you need guidance with new or existing CJS initiatives, please email phsharing@khi.org.

– Pat Libbey and Gianfranco Pezzino, Center Co-Directors

Staff Sharing Arrangements for Local Public Health

Public health challenges, such as disease outbreaks and substance abuse problems, do not recognize jurisdictional boundaries.

Staff Sharing Arrangements for Local Public Health,” a new report from the Center for State and Local Government Excellence (SLGE) in collaboration with the Center for Sharing Public Health Services, examines three cross-jurisdictional sharing (CJS) arrangements in which local public health organizations share staff as a means to expand organizational capacity, better manage expenditures, and/or contain or address existing or emerging issues.

In the three case studies, staff sharing enhanced the health departments’ abilities to:

  • More effectively plan and respond to common infections as well as rare diseases;
  • Qualify for grant funding that may not have been available to an individual jurisdiction on its own;
  • Offer additional services, such as call-in assistance lines, that otherwise would not have been economically feasible; and
  • Provide dependable backup coverage and coordinate scheduling for skilled clinical positions.

 
“Many of this report’s findings and conclusions on staff sharing arrangements are not just applicable to public health departments, but are generalizable to a range of public organizations,” said Joshua Franzel, President/CEO of SLGE. “The shared staffing approach is one key way for local health departments to continue to provide essential services against the backdrop of constrained public resources.”

“Public health cooperation makes sense in terms of both clinical and environmental health expertise and operating efficiency,” added Gerald Young, Senior Research Associate with SLGE. “These jurisdictions have leveraged their respective resources to provide their local residents a wider array of services than they would have been able to deliver on their own.”

“It is heartening to see the value-add potential of cross-jurisdictional staff sharing arrangements described in this report. The ability to improve the efficiency and effectiveness of public health services is very clearly shown,” said Patrick Libbey, Co-Director for the Center for Sharing Public Health Services.

Read the full report HERE.

If you have questions or comments about this publication, please contact us at phsharing@khi.org.

Measuring the Impact of Cross-Jurisdictional Sharing in Public Health

To better understand the impact of cross-jurisdictional sharing (CJS) among public health agencies, CJS teams need to identify suitable measures and measurement processes. This document provides instructions to develop and implement an impact measurement plan. The document contains only efficiency and effectiveness impact measures and measurement processes that have been developed and are supported by the Center for Sharing Public Health Services and are applicable to select public health program, service and function areas.

Available online: http://phsharing.org/wp-content/uploads/2017/09/Measuring-Impact-CJS.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Monitoring and Improving: The document provides guidance on measuring and demonstrating the impact of a CJS arrangement, by identifying and recording “baseline” and “follow-up” measures.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Center for Sharing Public Health Services Announces Newest Grantees

Eleven teams will focus on cross-jurisdictional sharing in public health

July 18, 2017

The Center for Sharing Public Health Services (the Center) has selected eleven public health teams to participate in a new funding initiative focused on cross-jurisdictional sharing (CJS) in public health. CJS occurs when jurisdictions, such as counties or cities, collaborate to deliver public health services across boundaries. By working together, public health agencies can build economies of scale that improve effectiveness and efficiency.

As part of the program, the eleven teams will receive grant funding and one-on-one technical assistance from the Center. The Center will get the opportunity to observe progress and to capture learning that it will use to develop and disseminate new tools and resources and to provide technical assistance to other jurisdictions that are considering or adopting CJS approaches.

“The teams were selected because their work focuses on areas the Center has prioritized for further study,” explained Gianfranco Pezzino, co-director of the Center. “For example, several of the teams are composed of smaller jurisdictions interested in using CJS strategies to provide a broader range of public health services.”

“In another example, some of the teams are working toward system-wide public health improvement at the state level, using a CJS approach,” added Patrick Libbey, who is also a co-director of the Center.

The following public health teams have been selected to participate in the new program:

  • Colorado: West Central Public Health Partnership—This partnership, which comprises six frontier and rural counties, is seeking to improve communications among member counties and to assess the effectiveness of and capacity for shared services and activities. The following counties participate in the partnership: Delta, Gunnison, Hinsdale, Montrose, Ouray and San Miguel.
  • Colorado: San Luis Valley Public Health Partnership—This partnership, which comprises three frontier and three rural counties, will develop and implement a cross-jurisdictional data collection and management system. The following counties participate in the partnership: Alamosa, Conejos, Costilla, Mineral, Saguache and Rio Grande.
  • Florida: Capital Consortium—Ten health departments will evaluate how well their shared information technology (IT) support model is performing and identify needed improvements. The initiative covers Leon, Calhoun, Liberty, Gadsden, Jefferson, Madison, Taylor, Wakulla, Franklin and Gulf Counties. It also involves the Florida Department of Health and the Florida Capital Consortium IT Regional Office.
  • Kansas: American Heart Association—The American Heart Association in Kansas is working on behalf of the four federally recognized Native American Tribes in the state—Iowa Tribe of Kansas and Nebraska, Kickapoo Tribe in Kansas, Prairie Band Potawatomi Nation, and the Sac and Fox Nation of Missouri in Kansas and Nebraska. The tribes are developing a data-sharing arrangement, and they are using a research project on tribal youths’ perception of health as the basis for the arrangement.
  • Kentucky: Tri-County Fitness Challenge—Three local health departments will develop an agreement to support future CJS efforts, starting with a tri-county fitness challenge. The initiative covers Bourbon, Clark and Montgomery Counties, with assistance from the University of Kentucky.
  • Nebraska: Nebraska Association of Local Health Departments (NALHD)—NALHD is leading a project to develop a model website for local health departments. It will be pilot tested by Central District Health Department, North Central District Health Department, Northeast Nebraska Public Health Department, Panhandle Public Health District and South Heartland District Health Department. Additional health departments may choose to launch similar websites in the future.
  • Ohio: Ohio Public Health Partnership (OPHP)—OPHP is a coalition comprising the Association of Ohio Health Commissioners (AOHC), Ohio Association of Boards of Health (OABH), Ohio Environmental Health Association (OEHA), Ohio Public Health Association (OPHA) and Ohio Society for Public Health Education (SOPHE). OPHP will analyze the extent to which local health departments seek to share foundational public health services that meet the Public Health Accreditation Board’s standards and measures. It will then develop a template MOU that can be scaled to facilitate CJS arrangements for these services.
  • Oregon: Clatsop and Columbia Counties—Health departments and behavioral health agencies in Clatsop and Columbia Counties will develop a regional model of a case referral and management program for kids with special health needs.
  • Oregon: Polk and Marion Counties—Polk County and contiguous Marion County will explore the feasibility of cross-jurisdictional sharing and anticipate identifying a specific shared service in the process.
  • Washington: Washington State Department of Health—Washington State Department of Health is collaborating with Public Health Centers for Excellence and Washington State Association of Local Public Health Officials to improve the statewide immunization program. The project partners will develop a pilot program to test a regional approach to administering the Vaccines for Children (VFC) program and the Assessment, Feedback, Incentives eXchange (AFIX) program’s quality improvement activities.
  • Washington, D.C.: Center for State and Local Government Excellence (SLGE)—SLGE, a nonprofit, nonpartisan organization that helps state and local governments become excellent employers so they can attract and retain talented public servants, will develop three case studies focused on sharing local public health department personnel.

 
The Center, which serves as a national resource on CJS, is managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation. The National Network of Public Health Institutes is the Center’s administrative partner for this effort and awards and administers all grants.

Download a full copy of the press release.

Toolkit: Cross-Jurisdictional Sharing Between Tribes and Counties for Emergency Management

This toolkit from the California Tribal Epidemiology Center at the California Rural Indian Health Board has been developed to aid Tribes and counties in cross-jurisdictional sharing (CJS) for emergency management (i.e., preparedness, mitigation, response and recovery). Documents in the toolkit have been developed or adapted at the request of tribal and county representatives in California, although most content is national in scope. Both tribal and county representatives are encouraged to review Tribe-focused toolkit materials to learn more about emergency management issues facing sovereign nations. Mutual acknowledgment of tribal sovereignty and cultural resources by both tribes and counties will provide the foundation for successful Tribe-county CJS relationships.

Available online: https://crihb.org/wp-content/uploads/2017/02/CJSToolkit_Final.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Preparedness / Emergency Response: This toolkit has been developed to aid Tribes and counties in cross-jurisdictional sharing (CJS) for emergency management (i.e., preparedness, mitigation, response and recovery).
  • Tribal Issues: This toolkit has been developed to aid Tribes and counties in cross-jurisdictional sharing (CJS) for emergency management (i.e., preparedness, mitigation, response and recovery).

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Communications / Phase Two: For tribal and county jurisdictions, the ultimate goal of communicating is to develop CJS arrangements that help both jurisdictions work together to deliver services and solve problems more effectively than one jurisdiction on its own.
  •  

Genesee & Orleans County Cross-Jurisdictional Sharing Project Return on Investment

This report consists of both the quantitative and qualitative impacts of the Cross-Jurisdictional Sharing (CJS) initiative between Genesee and Orleans County Department of Health in New York. It includes an analysis of the fiscal impact of the CJS initiative.

Available online: http://phsharing.org/wp-content/uploads/2017/07/ROI-thru-12-31-15.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Fiscal / Phase Two: It reports on the project’s return on investment, that is, the benefits and savings.

 

Case Study: Public Health Shared Services: South Central Kansas Coalition for Public Health

Seven rural counties–Barber, Comanche, Edwards, Harper, Kingman, Kiowa and Pratt–collaborate through the South Central Kansas Coalition for Public Health (SKCPH). While each county has its own health department, they work together through the SKCPH to offer three shared public health programs in the region: family planning, emergency preparedness and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Each program is offered in all seven counties, but only one county must provide the administrative oversight for each program. This reduces the administrative burden on the other health departments while allowing the staff coordinating the program to become specialists in each program area. The counties and health departments receive many benefits through the sharing arrangement, such as more efficient administration of the shared programs and increased collaboration and knowledge transfer between the counties.

Available online: http://www.khi.org/assets/uploads/news/13840/sckphs_casestudy.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Background / History: The counties have a long history of public health sharing, dating back to the formation of their health departments over 40 years ago.
  • Governance: It is governed by an executive board appointed by county commissioners. The board currently consists of four people from each county: one health care provider, one county commissioner, one health care consumer and one member-at-large. The board has the authority to add and discontinue coalition programs as needed.
  • Regionalization: Seven rural counties have individual public health departments that are agencies within each county’s government. They collaborate to share services through a quasi-governmental entity called the South Central Kansas Coalition for Public Health.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Why? / Phase One: Individual counties did not have enough residents to meet the state requirements for offering programs such as the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
  • Governance / Phase Two: It is governed by an executive board appointed by county commissioners. The board currently consists of four people from each county: one health care provider, one county commissioner, one health care consumer and one member-at-large. The board has the authority to add and discontinue coalition programs as needed.
  • Change Management / Phase Two: Whenever there is a change in leadership, personality differences can cause friction. The coalition provides an enduring structure that withstands difficulties brought by change.
  • Communications and Change Management / Phase Three: Because of the partnership, commissioners are more likely to collaborate with those from other counties to build solutions to shared challenges.

 

Case Study: Public Health Shared Services: Northeast Kansas (NEK) Multi-County Health Department

The Northeast Kansas (NEK) Multi-County Health Department is a collaboration between three rural counties: Atchison, Brown and Jackson. It operates as a single agency, but provides public health services in each county. It also operates a home health agency, which is located in the city of Hiawatha and serves all three counties. The arrangement allows the counties to share one administrator and one accountant between all four locations. The counties receive many benefits by offering public health services through this sharing arrangement, such as staffing efficiencies, a revenue stream from the home health agency (which contributes to the financial stability of the entire health department), and moral support among peers from different counties.

Available online: http://www.khi.org/assets/uploads/news/13841/final_nek_case_study.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Background / History: In the late 1960s, the three counties participated in regional health council meetings.
  • Governance: A board of directors provides governance for the NEK Multi-County Health Department.
  • Tribal Issues: The NEK Multi-County Health Department covers an area that is home to all four sovereign nation Tribes in Kansas.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Why? / Phase One: There were two main goals for the combined health department. First, the health council wanted to provide the public health services the community needed. Second, they wanted to pool populations and resources in order to compete with larger counties for grants.
  • Governance / Phase Two: A board of directors provides governance for the NEK Multi-County Health Department.
  • Implementation and Management / Phase Three: A federal grant provided funds to plan and develop a multi-county health department through an interlocal agreement in accordance with Kansas statute (K.S.A. 12-2901). As part of the planning process, a national consultant was brought in to help setup the department’s structure.
  • Monitoring and Improving / Phase Three: Over the years, the NEK Multi-County Health Department has responded to a variety of changes.

 

Case Study: Public Health Shared Services: Southeast Kansas (SEK) Multi-County Health Department

The Southeast Kansas (SEK) Multi-County Health Department is a collaboration between four rural counties: Allen, Anderson, Bourbon and Woodson. It operates as a single agency, but provides public health services in each county. The arrangement allows the four counties to share one administrator, one accountant and one medical director between the four public health locations. The counties receive many benefits by offering public health services through this sharing arrangement, including efficiencies in administration, increased flexibility for staff members, and cooperation and moral support between counties.

Available online: http://www.khi.org/assets/uploads/news/13842/sek_casestudy.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Background / History: The Southeast Kansas (SEK) Multi-County Health Department is the oldest multi-county health department in the state. It originated in the early 1970s when Anderson and Linn counties banded together to increase local immunization rates as part of a statewide initiative.
  • Fiscal and Service Issues: The original funding formula for the SEK Multi-County Health Department required each of the five counties to contribute a set amount of money. However, opposition soon arose to that funding formula because the fixed amount represented different proportions of each county’s budget. In order to account for variations in county population sizes, they decided that some counties would contribute more than others.
  • Governance: The health department is governed by a board of health, which consists of three individuals from each county appointed by county commissioners, including one health care professional, one county commissioner and one health care consumer.
  • Rural / Small Jurisdictions: Four rural counties share a public health agency called the Southeast Kansas (SEK) Multi-County Health Department, with locations in each county.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Why? / Phase One: Benefits of operating as a multi-county health department include increased effectiveness and efficiency of public health services, increased flexibility for staff members, and cooperation and moral support between counties
  • Fiscal / Phase Two: The original funding formula for the SEK Multi-County Health Department required each of the five counties to contribute a set amount of money. However, opposition soon arose to that funding formula because the fixed amount represented different proportions of each county’s budget. In order to account for variations in county population sizes, they decided that some counties would contribute more than others.
  • Service Implications / Phase Two: The original funding formula for the SEK Multi-County Health Department required each of the five counties to contribute a set amount of money. However, opposition soon arose to that funding formula because the fixed amount represented different proportions of each county’s budget. In order to account for variations in county population sizes, they decided that some counties would contribute more than others.
  • Governance / Phase Two: The health department is governed by a board of health, which consists of three individuals from each county appointed by county commissioners, including one health care professional, one county commissioner and one health care consumer.
  • Logistical Issues / Phase Two: Challenges of operating as a multi-county health department include travel time between locations.
  • Communications / Phase Two: Challenges of operating as a multi-county health department include communication and building relationships in multiple communities.
  • Change Management / Phase Two:Opposition arose to the original funding formula because the fixed amount represented different proportions of each county’s budget.
  • Communications and Change Management / Phase Three: Opposition arose to the original funding formula because the fixed amount represented different proportions of each county’s budget.

 

Toolkit: Cross-Jurisdictional Sharing Between Tribes and Counties for Emergency Management

This toolkit has been developed to aid Tribes and counties in cross-jurisdictional sharing (CJS) for emergency management (i.e., preparedness, mitigation, response, and recovery). Documents in the toolkit have been developed or adapted at the request of Tribal and county representatives in California, although most content is national in scope. Both Tribal and county representatives are encouraged to review Tribe-focused toolkit materials to learn more about emergency management issues facing sovereign nations. Mutual acknowledgment of Tribal sovereignty and cultural resources by both Tribes and counties will provide the foundation for successful Tribe-county CJS relationships.

Available online: https://crihb.org/wp-content/uploads/2017/02/CJSToolkit_Final.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Preparedness / Emergency Response: This toolkit has been developed to aid Tribes and counties in cross-jurisdictional sharing (CJS) for emergency management (i.e., preparedness, mitigation, response, and recovery).
  • Tribal Issues: This toolkit has been developed to aid Tribes and counties in cross-jurisdictional sharing (CJS) for emergency management (i.e., preparedness, mitigation, response, and recovery).

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Communications / Phase Two: For Tribal and county jurisdictions, the ultimate goal of communicating is to develop CJS arrangements that help both jurisdictions work together to deliver services and solve problems more effectively than one jurisdiction on its own.

 

Prevalence and Scope of California Tribe-County Cross-Jurisdictional Sharing of Emergency Management Services

This poster presentation from the Academy Health Public Health Systems Research Interest Group Meeting (June 2016) examined the prevalence and scope of cross-jurisdictional sharing (CJS) between California tribal and county governments in emergency management (i.e., preparedness, mitigation, response, and recovery) and whether number of people in a jurisdiction, geographic size, or geographic location of a jurisdiction were associated with having a higher number of CJS functions, including formal CJS arrangements for emergency management.

Available online: http://www.publichealthsystems.org/sites/default/files/PHS4/72458GPmeeting_01.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Tribal Issues: Examines the prevalence and scope of cross-jurisdictional sharing (CJS) between California tribal and county governments in emergency management

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Concordance and Discordance of California Tribe-County Cross-Jurisdictional Sharing of Emergency Management Services

This poster presentation from the Academy Health Public Health Systems Research Interest Group Meeting (June 2016) examined whether California tribal and county governments reported concordant or discordant experiences in cross-jurisdictional sharing (CJS) of emergency management services and whether research participant profession, number of people in jurisdiction, geographic size of jurisdiction, or geographic location of jurisdiction were associated with concordant or discordant tribe-county CJS experiences.

Available online: http://www.publichealthsystems.org/sites/default/files/PHS4/72458GPmeeting_02.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Tribal Issues: Examines whether California tribal and county governments reported concordant or discordant experiences in cross-jurisdictional sharing (CJS) of emergency management services.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Monitoring and Improving / Phase Three: Examines whether California tribal and county governments reported concordant or discordant experiences in cross-jurisdictional sharing (CJS) of emergency management services.

 

CJS Case Report: San Luis Valley Public Health Partnership

This is a case report about one of the Center for Sharing Public Health Services grantees, the San Luis Valley Public Health Partnership.

Available online: http://phsharing.org/wp-content/uploads/2017/05/ColoradoCaseReportMay2017.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Governance: The partnership was formed through an intergovernmental agreement.
  • Quality Improvement: Residents have access to a greater range of public health services and functional capacities.
  • Regionalization: It includes a description about the formation of a new health district in the region.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • What? / Phase One: Health departments in the partnership explored new ways to work together and formalized an existing partnership

 

CJS Case Report: Ohio’s Portage County

Portage County Health District expanded to include the city of Ravenna, resulting in enhanced services for Ravenna. Simultaneously, the health district and the city of Kent engaged in a joint community health improvement planning process that has successfully engaged numerous partners in countywide efforts to further protect and promote the health of all residents.

Available online: http://phsharing.org/wp-content/uploads/2018/02/OhioCaseReportFebruary2018.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Why? / Phase One: Strengthen the public health system without increasing costs.
  •  

Letterhead and Logo and E-Mail Signature Policy Guidelines for Shared Employees (San Luis Valley Public Health Partnership in Colorado)

This document is an example of policy guidelines for letterhead, logo and email signatures in a partnership.

Available online: http://phsharing.org/wp-content/uploads/2017/05/LOGOLetterheadPolicy.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Governance: This document is an example of policy guidelines for letterhead, logo and email signatures in a partnership.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Letter of Support Policy (San Luis Valley Public Health Partnership in Colorado)

Example of policy guidelines for creating letters of support from a CJS partnership.

Available online: http://phsharing.org/wp-content/uploads/2017/05/LetterSupport.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Governance: Example of policy guidelines for creating letters of support from a CJS partnership.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Human Resources Issue Escalation Guidance (San Luis Valley Public Health Partnership in Colorado)

This is an example of a human resources flow chart for resolving issues in a CJS partnership.

Available online:
http://phsharing.org/wp-content/uploads/2017/05/Issue-Escalation-Guidance.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Governance: This is an example of a human resources flow chart for resolving issues in a CJS partnership.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Governance / Phase Two: This is an example of a human resources flow chart for resolving issues in a CJS partnership.

 

Cross-Jurisdictional Public Health Sharing (San Luis Valley Public Health Partnership in Colorado)

This table details public health sharing arrangements in the San Luis Valley.

Available online: http://phsharing.org/wp-content/uploads/2017/05/ServicesSharingNowSUMMARY.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Evaluation Form for Shared Employees (San Luis Valley Public Health Partnership in Colorado)

This Excel spreadsheet for employee evaluation is used by the San Luis Valley Public Health Partnership in Colorado.

Available online: http://phsharing.org/wp-content/uploads/2017/05/EvaluationFormSharedEmployees.xls

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Governance: Excel spreadsheet used by SLV Public Health Partnership for employee evaluation.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Cross-Jurisdictional Sharing Between Tribes and Counties for Emergency Management (Video)

This project from the California Tribal Epidemiology Center at the California Rural Indian Health Board aims to study and promote cross-jurisdictional sharing (CJS) of emergency management (i.e., preparedness, mitigation, response, and recovery) services between tribes and counties in California. It is explained in this recording of the PHSSR Research in Progress Webinar dated April 2016.

Available online: https://www.youtube.com/watch?v=bGxFhB1aH48&feature=youtu.be

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Preparedness / Emergency Response: This project aims to study and promote cross-jurisdictional sharing (CJS) of emergency management (i.e., preparedness, mitigation, response, and recovery) services between tribes and counties in California.
  • Tribal Issues: This project aims to study and promote cross-jurisdictional sharing (CJS) of emergency management services between tribes and counties in California.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Governance / Phase Two: This project provides tribal and county representatives an opportunity to share views about CJS and make recommendations for successful government-to-government CJS arrangements.

 

Barriers to Collaboration Between Tribal and County Governments: Planning for Major Disasters and Other Emergencies

This policy brief from the California Tribal Epidemiology Center at the California Rural Indian Health Board is intended for policymakers, tribal advisors and elected officials, multi-level offices of emergency services or homeland security, state departments of public health, and for the various emergency management and government associations, administrators, and related Native American agencies and their forums. The impetus for writing the brief is the undeniable reality that natural disasters do not recognize political boundaries; hence, in order to be prepared to recover from a disaster, it is extremely important to coordinate emergency response efforts and to work well across jurisdictions.

Available online: http://www.publichealthsystems.org/sites/default/files/PHS4/72458GPreport_06.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Tribal Issues: This report addresses the barriers to partnerships between Tribes and non-tribal government entities.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Cross-Jurisdictional Sharing Between Tribes and Counties for Emergency Management Services (Presentation)

This presentation from the California Tribal Epidemiology Center at the California Rural Indian Health Board describes a project that aims to study and promote cross-jurisdictional sharing (CJS) of emergency management (i.e., preparedness, mitigation, response, and recovery) services between tribes and counties in California.

Available online: http://www.publichealthsystems.org/sites/default/files/PHS4/72458WimsattSummitPres%20July%202016.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Preparedness / Emergency Response: Project aims to study and promote cross-jurisdictional sharing (CJS) of emergency management (i.e., preparedness, mitigation, response, and recovery) services between tribes and counties in California.
  • Tribal Issues: Project aims to study and promote cross-jurisdictional sharing (CJS) of emergency management (i.e., preparedness, mitigation, response, and recovery) services between tribes and counties in California.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Governance / Phase Two: Provides tribal and county representatives an opportunity to share views about CJS and make recommendations for successful government-to-government CJS arrangements.

 

Center News: Small Grant Application Deadline is Friday, March 31

A Message from the Co-Directors

March 27, 2017

Since our founding in 2012, we have been offering grant funding to assist public health departments as they consider or adopt cross-jurisdictional sharing (CJS) arrangements. These have included larger, multi-year demonstration grants as well as smaller grants of a much shorter duration, approximately six months.

The larger, multi-year demonstration grants (which are not open to new applications) are intended to help answer larger issue questions like what it takes to successfully implement a CJS arrangement and if outcomes of CJS arrangements can be systematically measured.

The smaller grants help to answer a number of other questions, like those that follow.

  • What role does a state health department play in CJS arrangements?
  • What issues need to be considered for CJS arrangements to be successful at small, rural or frontier health departments?
  • How can tribal public health organizations engage in CJS?

 
So why does the Center offer this grant funding? Well, the reasons are two-fold.

First, we are always interested in encouraging and assisting public health jurisdictions as they use CJS strategies to improve effectiveness and efficiency in public health service delivery. At its core, it really is just good public stewardship to provide this assistance. In fact, we do this on a regular basis by offering technical assistance, usually free-of-charge, to any public health official or stakeholder who contacts us with CJS-related questions.

Second–and this is our overarching goal–by observing and assisting health departments as they work on CJS arrangements in the field, we’ve been able to learn from their first-hand experiences and then compile a large body of knowledge about CJS efforts. You see, each funded site becomes a part of the larger learning process by providing an opportunity to add to our knowledge and further refine it. By putting pieces together in this individualized way, we can connect dots, create analogies and extrapolate results that are generalizable. Then, we can use that learning to develop and disseminate tools and resources to other jurisdictions that are considering or adopting CJS approaches.

While the funding helps offset the costs of our health department partners who work with us, their connection with the Center also gives them the opportunity for technical assistance as they work on their specific CJS issues. In the course of their work, they have the opportunity to forge and develop tools and knowledge that they can use in other, future CJS endeavors and that the Center can collect and then share with others. So as health departments benefit by receiving direct assistance for their specific projects, their work also contributes to helping other jurisdictions that are working on or considering CJS.

In this way, the Center’s grants not only provide a great opportunity for health departments to expand their capacity for CJS, they also advance our larger mission to be a national resource on cross-jurisdictional sharing.

To illustrate these concepts, we’re writing a number of case reports about our many grantees. As we finalize them over the next few months, we’ll email them to you.

If your organization is working on a public health CJS project and would like our assistance, or if you are interested in helping us expand the body of knowledge about CJS, we encourage you to visit our website to get more information about our small grant offering. But hurry, the deadline to apply is approaching fast.

We would love to hear from you. If you have questions about this small grant opportunity or CJS in general, please email us at phsharing@khi.org.

– Pat Libbey and Gianfranco Pezzino, Center Co-Directors

Organizational Change: Motivation, Communication, and Leadership Effectiveness

Research indicates that numerous variables have an impact on a leader’s effectiveness. This study explores the behaviors associated with leadership effectiveness in driving change. The findings confirm previous research that identifies change effectiveness skills, while isolating the specific leader behaviors deemed most valuable to implementing change: motivation and communication.

Available online:

 

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Change Management: This publications contributes to the literature and research on leadership and organizational change by exploring the following questions: (1) How effective are leaders in implementing change within their organizations? and (2) What specific leader behaviors are most necessary to execute change initiatives successfully?

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Change Management / Phase Two: This publications contributes to the literature and research on leadership and organizational change by exploring the following questions: (1) How effective are leaders in implementing change within their organizations? and (2) What specific leader behaviors are most necessary to execute change initiatives successfully?
  • Communications and Change Management / Phase Three: This publications contributes to the literature and research on leadership and organizational change by exploring the following questions: (1) How effective are leaders in implementing change within their organizations? and (2) What specific leader behaviors are most necessary to execute change initiatives successfully

 
Posted with permission: 3/10/2017.

Spectrum of Cross-Jurisdictional Sharing Arrangements

The Center for Sharing Public Health Services has identified four main types of CJS arrangements, as depicted on the Spectrum of Cross-Jurisdictional Sharing Arrangements. Moving from left to right along the Spectrum, the level of service integration increases, the level of jurisdictional autonomy decreases, and implementation becomes more complex, as can governance. The Spectrum was updated by the Center in 2017.

For more information, read the Center’s Issue Brief about the Spectrum.

This document is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Background / History: The Spectrum of Cross-Jurisdictional Sharing Arrangements describes the types of CJS arrangements.

What’s Your ROI? A Web-based Tool to Estimate Economic Returns on Investments for Public Health Agency Projects

The Association of State and Territorial Health Officers (ASTHO), through a cooperative agreement with CDC’s Office for State, Tribal, Local, and Territorial Support, developed a web-based tool to calculate the return on investment (ROI) associated with public health agency programs or business improvements.

Available online: http://www.astho.org/Programs/Evaluation/

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: The tool can be used prospectively as a decision-making tool for new projects or initiatives.
  • Monitoring and Improving: The tool can be used retrospectively to show economic returns of investments already made.
  • Quality Improvement: The tool can be used during quality improvement (QI) implementation to track ROI.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

The Secret Benefits of Sharing Government Services

Online article in Governing magazine that discusses the benefits of sharing, and suggests that costs savings may not result from shared services.

Available online: http://www.governing.com/columns/public-money/gov-shared-government-services.html

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: Sharing services may not save money in the traditional sense. But it does create flexibility and a bit more certainty in the increasingly uncertain world of local government finance.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Fiscal / Phase Two: Sharing services may not save money in the traditional sense. But it does create flexibility and a bit more certainty in the increasingly uncertain world of local government finance.
  • Service Implications / Phase Two: Sharing services may not save money in the traditional sense. But it does create flexibility and a bit more certainty in the increasingly uncertain world of local government finance.

 

Cross-Jurisdictional Data Sharing and Immunization Information Systems

Cross-jurisdictional data sharing requires the application of varying, and sometimes conflicting local, state and federal laws. These laws often present barriers and prevent the efficient and effective use of data to tackle important public health challenges. A national IIS cross-jurisdictional data-sharing memorandum of understanding (MOU) has been developed to help address these challenges and will be piloted in six states.

Available online from the Network for Public Health Law: goo.gl/8DvC7h

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Legal Issues: A national IIS cross-jurisdictional data-sharing memorandum of understanding (MOU) has been developed to help address laws that often present barriers and prevent the efficient and effective use of data to tackle important public health challenges.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Legal Issues/ Phase Two: A national IIS cross-jurisdictional data-sharing memorandum of understanding (MOU) has been developed to help address laws that often present barriers and prevent the efficient and effective use of data to tackle important public health challenges

 

Emergencies Relevant to California Tribes and the Prevalence of Cross-Jurisdictional Sharing Between Tribes and Counties for Emergency Management

This poster presentation from the from the California Tribal Epidemiology Center at the California Rural Indian Health Board examined the types of emergencies relevant to tribal communities in California and the prevalence of cross-jurisdictional sharing (CJS) for emergency management (i.e., preparedness, mitigation, response, recovery) between California tribal and county governments. This study also explored whether tribes and county jurisdictions are in agreement about whether they have CJS functions.

Available online: http://www.publichealthsystems.org/sites/default/files/PHS4/72458GPmeeting_03_0.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Tribal Issues: Examines cross-jurisdictional sharing (CJS) between tribal and county governments in emergency preparedness capacity building and response.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

National Policy Matrix: Cross-Jurisdictional Sharing Arrangements Between Tribes and Counties

Staff from the California Rural Indian Health Board (CRIHB) interviewed representatives from the National Congress of American Indians (NCAI), the National Indian Health Board (NIHB), and each of the 12 Indian Health Service (IHS) Areas in order to gather information about knowledge of CJS arrangements between tribes and counties throughout the nation.

Available online: https://crihb.org/wp-content/uploads/2015/04/CJSNationalPolicyMatrix.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Tribal Issues: Analysis of knowledge of CJS arrangements between tribes and counties throughout the nation.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Cross-Jurisdictional Resource Sharing in Changing Public Health Landscape: Contributory Factors and Theoretical Explanations ABSTRACT

Cross-jurisdictional resource sharing is a viable and commonly used process to overcome the challenges of new and emerging public health problems within the constraints of restricted budgets. LHDs, particularly smaller LHDs with limited resources, should consider increased resource sharing to address emerging challenges.

Available online: http://journals.lww.com/jphmp/pages/articleviewer.aspx?year=2016&issue=03000&article=00003&type=abstract

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Consolidation of Services: Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environments. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency.
  • Fiscal and Service Issues: Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environments. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Why? / Phase One: Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environments. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency.
  • Fiscal / Phase Two: Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environments. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency.
  • Service Implications / Phase Two: Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environments. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency.

 

Accreditation Considerations for Shared Services and Mergers

The Public Health Accreditation Board (PHAB) is providing this tip sheet for local health departments who are considering or planning major organizational changes. Changes in the organization during or after accreditation may or may not impact the accreditation status of the health department(s). This tip sheet provides clarification of PHAB policies and procedures related to organizational changes in an effort to inform health departments early in their planning process.

Available online: http://www.phaboard.org/wp-content/uploads/Accreditation-Considerations-for-Shared-Services-and-Mergers-July-2016.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Cross ROADS Initiative: Cross-jurisdictional Resources and Opportunities to Advance the Delivery of Services

PowerPoint presentation on the Cross ROADS Initiative to advance the delivery of services in West Virginia. Presents a study design for evaluating the initiative.

Available online: http://phsharing.org/wp-content/uploads/2016/10/CrossROADSInitiative.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Research and Evaluation: 1. Understand the applicability of various models for local boards of health considering resource sharing, up to and including combining; 2. Learn from other service-sharing initiatives both in West Virginia and in other states; 3. Identify quantifiable benefits and costs that occur as a result of resource sharing; and 4. Determine the factors that should inform the geographic design under which local boards of health may share services and/or combine.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Monitoring and Improving / Phase Three: 1. Understand the applicability of various models for local boards of health considering resource sharing, up to and including combining; 2. Learn from other service-sharing initiatives both in West Virginia and in other states; 3. Identify quantifiable benefits and costs that occur as a result of resource sharing; and 4. Determine the factors that should inform the geographic design under which local boards of health may share services and/or combine.

 

Cross-Jurisdictional Sharing in Local Public Health Systems: Implications for Costs, Impact, and Management Capacity

This research brief examined cross-jurisdictional sharing (CJS) among local health departments (LHDs) to assess CJS impacts on the volume, intensity, and unit costs of public health services. Analysis revealed that LHDs with CJS do not appear to spend any more or less per capita on services than those without CJS. However, some LHDs appear to be more efficient.

Available online: http://www.publichealthsystems.org/sites/default/files/PBRN_DIRECTIVE/72055%20PHAST_Brief_Directive_20160929_ms.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: This research brief examined cross-jurisdictional sharing (CJS) among local health departments (LHDs) to assess CJS impacts on the volume, intensity, and unit costs of public health services.
  • Research and Evaluation: Analysis revealed that LHDs with CJS do not appear to spend any more or less per capita on services than those without CJS. However, some LHDs appear to be more efficient.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Fiscal / Phase Two: This research brief examined cross-jurisdictional sharing (CJS) among local health departments (LHDs) to assess CJS impacts on the volume, intensity, and unit costs of public health services.
  • Service Implications / Phase Two: This research brief examined cross-jurisdictional sharing (CJS) among local health departments (LHDs) to assess CJS impacts on the volume, intensity, and unit costs of public health services.
  • Monitoring and Improving / Phase Three: Analysis revealed that LHDs with CJS do not appear to spend any more or less per capita on services than those without CJS. However, some LHDs appear to be more efficient.

 

Legal Completeness and Effectiveness in Cross-Jurisdictional Shared Service Agreements in Wisconsin

Shared service agreements are in widespread use in Wisconsin, especially in highly rural areas. Many people involved in shared service agreements view them as a way to enhance and expand capacity. While most key terms and provisions were found in most agreements reviewed, some important terms, such as regular review, update, and renewal procedures for the agreement and dispute resolution process, only appeared in a minority of contracts reviewed. While this report did not reveal an association between the presence of these terms and effective implementation of the agreements, it seems likely that a more complete agreement may minimize uncertainty and conflict.

Available online: https://www.networkforphl.org/_asset/bp8z56/Legal-Completeness-and-Effectiveness-in-CJSSA-in-Wisconsin_Additional-Information.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Legal Issues: Reviews the legal completeness of shared service agreements.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

A Unified Voice: Policymakers and public health officials working together for the community’s health

Learning Community Quarterly Webinar, May 14, 2013

This webinar examines ways to enhance communications and partnerships between policymakers and public health officials and managers.

It features:
• Randall Allen, Executive Director, Kansas Association of Counties
• Tim Norton, Commissioner, Sedgwick County, Kansas
• Marena Works, Deputy City Manager, Carson City, Nevada
• Tami Bradley, Managing Partner, Bothner and Bradley, Inc., Wichita, Kansas
• Gianfranco Pezzino, Center Co-director (moderator)

Download these items from the webinar:
PowerPoint slides (pdf)
Governance Roles of County Commissioners (pdf)
Questions and Answers (pdf)

Watch a video of the webinar below.

For more videos from the Center for Sharing Public Health Services, visit our Vimeo page.

Managing Change: A Learning Community Webinar

Whether exploring, planning, implementing or improving upon a cross-jurisdictional sharing arrangement, all Learning Community teams are experiencing change. Keeping the work on track involves the successful application of project management strategies, while keeping individuals, teams and organizations on track involves the successful application of change management principles. This webinar provides a framework for effectively managing changes that are emerging as a result of cross-jurisdictional sharing efforts.

Webinar speakers:

  • Michelle Poché Flaherty, a change management expert and president of City on a Hill Consulting. She has worked in managerial and policymaker offices in local government and has extensive experience as a professionally trained coach for elected officials and chief executives.
  • Sandy Tubbs, director of performance improvement and planning at Douglas County Health Department, and co-team lead of the Horizon Minnesota project.
  • Sharon Braaten, director of administration and finance at Pope County Health Department, and co-team lead of the Horizon Minnesota project.

Download these items from the August 6, 2013, webinar:
PowerPoint slides (pdf)
Additional Questions and Answers

Watch a video of the webinar below.

For more videos from the Center for Sharing Public Health Services, visit our Vimeo page.

Cross-Jurisdictional Sharing Arrangements Between Tribes and Counties for Emergency Preparedness Readiness

This ongoing study will examine cross-jurisdictional sharing (CJS) between tribal and county governments in emergency preparedness capacity building and response. Investigators from the California Rural Indian Health Board, Inc., and partners from California Conference of Local Health Officers, Inter-Tribal Long Term Recovery Foundation, California Department of Health Care Services, and Indian Health Program of the California Department of Public Health, seek to gain a better understanding of: 1) the current prevalence and scope of CJS between tribal and county governments focused on strengthening emergency preparedness capacity; 2) the perceived spectrum of “value” in CJS arrangements between tribes and their potential county governmental partners; 3) how CJS value is associated with factors such as perception of the nature of tribal to non-tribal government relationships and formality of CJS agreements, as well as by organizational structure and capacity, quality of collaboration, politico-legal, and historical factors; and 4) the tribal and county government CJS characteristics most associated with achieving benchmark public health emergency preparedness measures. This study aims to identify effective practices for CJS implementation that will protect health and shed light on the nature of tribal and county government relationships from historical, cultural, and legal perspectives. Dissemination tools include a CJS toolkit for tribal and non-tribal governments.

Available online: http://www.publichealthsystems.org/cross-jurisdictional-sharing-arrangements-between-tribes-and-counties-emergency-preparedness

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Preparedness / Emergency Response: The study examines cross-jurisdictional sharing between tribal and county governments in emergency preparedness capacity building and response.
  • Tribal Issues: The study examines cross-jurisdictional sharing between tribal and county governments.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

Visit the Center’s Resource Library

If you are looking for resources about cross-jurisdictional sharing, make sure you check out the Resource Library on the Center’s website.

The Center for Sharing Public Health Services’ resource library contains hundreds of items that are relevant to cross-jurisdictional sharing efforts. New items are added frequently. The library includes items like interactive tools, real-life examples, reports and webinars. The library is catalogued into topical areas to help you find what you need. The library is also cross-referenced to areas along the Center’s Roadmap to Develop Cross-Jurisdictional Sharing Initiatives, which helps guide jurisdictions through the process of considering or establishing cross-jurisdictional sharing (CJS) arrangements.

If you need assistance finding resources related to cross-jurisdictional sharing or if you have items to suggest for inclusion in the library, please email us at phsharing@khi.org.

CJS Implementation and Impact Measurement Program

The Center for Sharing Public Health Services has selected four sites to participate in its new CJS Implementation and Impact Measurement Program, which focuses on calculating the impact that CJS initiatives can have on public health functions and programs.

The sites, which were selected through a competitive process, will conduct baseline and follow-up measurements to show if a CJS approach allows them to improve effectiveness and efficiency in the delivery of selected public health services. The sites may measure efficiency by calculating how the CJS initiative changes revenues or costs, or how it modifies the time or steps needed to carry out a program or function. They may measure effectiveness by calculating how the CJS initiative impacts reach to target populations, dissemination of information, provision of services not available before the CJS agreement, quality of services, customer satisfaction, or preventive behaviors. Detailed measurement plans will be developed by each site in collaboration with the Center as part of the program.

A description of each site’s CJS initiative is below, along with preliminary measurement plans.

Northern Michigan Public Health Alliance

The Northern Michigan Public Health Alliance, in collaboration with two hospital systems, is conducting a community health assessment and improvement initiative in a contiguous 16-county region of approximately 400,000 people in rural Northern Michigan.

The alliance, which consists of six health departments, was formed through a memorandum of understanding (MOU) signed by the chairs of the six boards of health. It is guided by a steering committee that consists of the six health officers.

Preliminary measurement plans are to assess efficiency by comparing the time and cost of conducting the regional community health assessment against the time and cost each agency would have expended conducting its own assessment. Preliminary plans to measure effectiveness are to describe quality enhancements that result from conducting one regional health assessment instead of separate assessments.

Horizon Public Health (Minnesota)

Last year, three previously independent health departments in West Central Minnesota consolidated into one health department called Horizon Public Health. This new, five-county regional public health organization serves approximately 67,000 people.

Preliminary plans are to assess efficiency by comparing administrative costs as a percentage of the entire budget before integration against those same costs after integration. Preliminary plans to assess effectiveness include comparing the reach to a high-risk population before and after integration.

Public Health Regional Networks (North Dakota)

North Dakota has four regional networks that are each governed by joint powers agreements. North Dakota public health units will work together through the public health regional networks to share environmental health activities related to on-site septic systems. They plan to develop uniform ordinances within the networks and share inspection and enforcement activities among public health units.

Impact measures being considered include measuring changes in revenue to assess the efficiency of the sharing arrangement. To measure effectiveness, the project team may measure program reach or the quality of its septic tank inspection activities.

Washington and Ozaukee County Health Departments (Wisconsin)

The health departments in Washington and Ozaukee Counties in Wisconsin have merged into one health department that serves 220,000 residents. As part of that merger, they will implement a shared information technology system that includes electronic health records and billing.

Preliminary conversations on impact measures have focused on measuring changes in revenue to assess the efficiency of the sharing arrangement, and changes in quality in areas such as access to data, staff support, and customer satisfaction to assess its effectiveness.

New Performance Effectiveness and Efficiency Measurement Initiative

Since the start of our work, the Center has frequently been asked, “Does cross-jurisdictional sharing (CJS) really work? Does it make a difference?” These questions come from health officials, who want to know if improvements in public health service delivery resulting from CJS efforts can be demonstrated, and from policymakers, who want to know if cost or other efficiency improvements resulting from CJS efforts can be quantified. Based on our work to date and our review of others’ experiences, our answer is yes — but it is a qualified yes.

Since 2012, the Center for Sharing Public Health Services has provided technical assistance, resources and best practices to communities interested in CJS approaches. During that time, we have learned that CJS — if carefully implemented — can help policymakers and public health officials increase effectiveness and efficiency of public health services. CJS does this by generating economies of scale that allow public health departments to enhance services and provide programs that otherwise would not be economically feasible.

So our answer is, “Yes, it does appear that CJS can make a positive difference in performance and efficiency.” But it’s a qualified yes, because the answer is most often based on case-specific, self-reported and qualitative evidence. As of yet, there hasn’t been a systematic way of measuring differences in performance and efficiency resulting from CJS arrangements. Not being able to provide a more comprehensive and evidence-based answer to these questions has been frustrating.

Given this, we now are extremely pleased to announce the launch of our new CJS Implementation and Impact Measurement Program. We will be working with four sites located in Michigan, Minnesota, North Dakota and Wisconsin. Teams at these sites will work with us to quantify changes in effectiveness and efficiency that result from using cross-jurisdictional sharing approaches.

We will be testing a systematic, common and shareable methodology for measuring changes in effectiveness and efficiency resulting from CJS implementation and, at the same time, we’ll learn more about the specific CJS-related outcomes in each of these four sites. More information on the individual projects can be found below.

With this new measurement initiative, the Center is transitioning from learning how CJS approaches work to measuring their impact. Along the way, we will share what we learn through this newsletter and other venues. This new learning objective should prove to be very interesting, and we hope you will come along with us on this journey. Measuring impact, after all, is applicable in many areas of public health and government.

We also are launching a new mini-grant opportunity that will support the efforts of public health jurisdictions in moving their CJS efforts forward and at the same time will help us improve understanding and knowledge of some select issues related to cross-jurisdictional sharing. For more information on this ongoing funding opportunity, please read the call for proposals.

While we are now turning our attention and efforts more toward measuring the impact of CJS models, we are still available to provide information, guidance and technical support to any jurisdictions or organizations interested in knowing more about CJS or implementing a CJS project.

If you have questions about our new focus, or questions about CJS in general, please feel free to email us at phsharing@khi.org.

– Pat Libbey and Gianfranco Pezzino, Center Co-Directors

Center Offers New Mini-Grant Program

The application period has ended. Please check back for future opportunities!

The Center for Sharing Public Health Services has up to five mini-grants available for public health agencies or their designated agents that wish to explore, plan, implement or improve a CJS arrangement. Eligible arrangements must include a minimum of three jurisdictions of any size, or two jurisdictions if the combined population is 50,000 or greater.

Only proposals that fall into the categories of service-related arrangements, shared functions with joint oversight, or regionalization will be funded under this program (for more information, see the Cross-Jurisdictional Sharing Spectrum). For those in the exploration phase (see the Center’s Roadmap), preliminary conversations among CJS partners must already have occurred and the partners must have agreed in principle to explore some sharing arrangement.

Through this process, the Center wants to both help jurisdictions already underway with some aspect of a CJS initiative and also improve its own understanding and knowledge on some select issues related to CJS. Therefore, priority for funding will be given to proposals that address the specific areas of learning described below:

  • The appropriate role of state health departments in supporting CJS activities at the local level and in improving overall public health system performance.
  • Possible successful models for CJS involving tribes.
  • The applicability of the Roadmap to sharing arrangements among two or more public health jurisdictions also involving entities beyond traditional public health partners, such as hospitals and private nonprofit organizations within an inter-jurisdictional context.
  • The role of a third party (an organization other than the participating jurisdictions) providing a service on behalf of the participating jurisdictions. This could include a state association of local health officials or other organizations.
  • The role of a CJS approach in addressing the special challenges that frontier counties face.
  • The role of CJS as a tool to promote the implementation of foundational public health capabilities and services.

 

Applications will be considered on a rolling basis starting on February 15 until June 10, 2016, or until all five grants are awarded, whichever comes first. The amount of each award will be up to $10,000 for a project period of up to six months. Selected teams will be expected to work with Center staff, who will provide technical assistance during the implementation of the projects, and to be available to share the results and lessons learned from their projects with appropriate audiences.

Funding for this initiative is provided by the Robert Wood Johnson Foundation. The Center will provide technical assistance to the funded project’s teams. The National Network of Public Health Institutes (NNPHI) will be the Center’s administrative partner for this effort, and will award and administer the grants.

For more information, download the Call for Proposals.

To apply, download the application.

Center Offers New Mini-Grant Program

The application period has ended. Please check back for future opportunities!

The Center for Sharing Public Health Services (“Center”) has up to five mini-grants available for public health agencies or their designated agents that wish to explore, plan, implement or improve some aspects of a cross-jurisdictional sharing (CJS) arrangement. Eligible CJS arrangements must include a minimum of three jurisdictions of any size, or two jurisdictions if the combined population is 50,000 or greater.

Applications will be considered on a rolling basis starting on February 15 until June 10, 2016, or until all five grants are awarded, whichever comes first. The amount of each award will be up to $10,000 for a project period of up to six months. Selected teams are expected to work with Center staff, who will provide technical assistance during the implementation of the projects, and to be available to share the results and lessons learned from their projects with appropriate audiences. Priority for funding will be given to proposals that address specific areas of learning described in the Call for Proposals.

Funding for this initiative is provided by the Robert Wood Johnson Foundation. The Center will provide technical assistance to the funded projects’ teams. The National Network of Public Health Institutes (NNPHI) will be the Center’s administrative partner for this effort, and will award and administer the grants.

For more information, download the Call for Proposals.

To apply, download the application.

Accounting for Indirect Costs in Public Health Cost Analyses

There is a gap in research regarding the resources needed to deliver public health activities, which inhibits informed decision making around investments in public health and the allocation of funds among activities. When conducting cost analyses in public health, it is important to include costs from all cost components, including personnel, non-personnel, and indirect costs. However, defining, identifying, and measuring indirect costs is challenging and can impede studies of this type. The purpose of this pilot study is to create a catalog of the methodologies public health researchers have used to account for indirect costs. The final products submitted by the eleven practice-based research networks who received funding from the Robert Wood Johnson Foundation were surveyed to explore the delivery and cost of public health activities for their indirect cost inclusion method. The primary investigators were contacted to verify their methodology. Ten of the 11 networks (91 percent) could be reached. Four of the networks used a prenegotiated rate the health department had with the state agency. Three of the networks used a data collection instrument that had public health administrative staff estimate these costs. Three of the networks did not include indirect costs in their analyses. Although challenging, it is important to include indirect costs in public health cost analyses as they are a real cost to public health departments and research findings without these costs have limited applicability. This review can assist researchers by reviewing approaches previously used by public health researchers.

Available online: http://uknowledge.uky.edu/frontiersinphssr/vol4/iss6/5/

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Change Management: This paper offers examples of ways to determine indirect costs of public health services and may be useful to jurisdictions considering shared arrangements when attempting to determine how to divide costs.
  • Fiscal and Service Issues: This paper offers examples of ways to determine indirect costs of public health services and may be useful to jurisdictions considering shared arrangements when attempting to determine how to divide costs.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Fiscal / Phase Two: This paper offers examples of ways to determine indirect costs of public health services and may be useful to jurisdictions considering shared arrangements when attempting to determine how to divide cost.s
  • Change Management / Phase Two: This paper offers examples of ways to determine indirect costs of public health services and may be useful to jurisdictions considering shared arrangements when attempting to determine how to divide costs.

 

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A Three-Way Approach to Evaluating Partnerships: Partnership survey, integration measure and social network analysis

Resource_Library: This paper explores three ways to evaluate cooperative relationships, including partnership surveys, an integration measure (to assess cooperation between partners) and social network analysis. This paper may assist those in cross-jurisdictional relationships identify ways to evaluate how well they are working.

Available online: http://vocational-rehab.com/wp-content/uploads/SuRGE-6_Evaluating-Partnerships.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Current and Planned Shared Service Arrangements in Wisconsin Local and Tribal Health Departments

This paper reports results of a cross-sectional survey examining current and future cross-jurisdictional sharing efforts across Wisconsin. Authors found wide-spread use of shared services across the state. Participant comments suggested they were satisfied with arrangements.

Available online: http://www.ncbi.nlm.nih.gov/pubmed/24399279

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Change Management: This article explores current sharing arrangements in WI and suggests reasons they are successful. It might be particularly useful for those exploring sharing as an example to present to potential partners or policy makers.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • What? / Phase One: This article explores current sharing arrangements in WI and suggests reasons they are successful. It might be particularly useful for those exploring sharing as an example to present to potential partners or policy makers.

 

Local Health Departments’ Costs of Providing Environmental Health Services

The purpose of this report was to provide empirical estimates of Local Health Departments’ (LHDs’) cost structure. Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per service provided. In a second step, total costs are decomposed into key components, including direct and indirect costs.

Available online: http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1166&context=frontiersinphssr

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • What? / Phase One: This report may assist Local Health Departments explore the cost of services and how costs might be affected through cross-jurisdictional sharing.
  • Fiscal / Phase Two: The purpose of this report was to provide empirical estimates of LHD’s cost structure.

 

The Impacts of Local Health Department Consolidation on Public Health Expenditures: Evidence from Ohio

This paper examines the effects of local health department consolidations on the total and administrative expenditures of local health departments in Ohio from 2001 to 2011. Authors found consolidations resulted in reduced expenditures and improvements in services.

Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355717/pdf/AJPH.2014.302450.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: This article documents savings experienced by public health departments in Ohio when they consolidated between 2001 to 2011. It also documents service improvements.
  • Regionalization: This article explores consolidation of health departments in Ohio and the cost savings and service improvements that occurred following these efforts.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • What? / Phase One: This report may assist Local Health Departments explore the cost of services and how costs might be affected through cross-jurisdictional sharing.
  • Fiscal / Phase Two: This article documents savings experienced by public health departments in Ohio when they consolidated between 2001 to 2011. It also documents service improvements.
  • Service Implications / Phase Two: This article documents savings experienced by public health departments in Ohio when they consolidated between 2001 to 2011. It also documents service improvements.

 

Transitioning to Alternative Models of Police Service

This articles discusses results of a study that explored cross-jurisdictional sharing among police services. It addresses issues that may be faced by organizations when they merge into a single unit or when they share services across multiple units. It also presents information from four case studies of forces that engaged in cross-jurisdictional sharing. While not addressing public health, other government agencies share similar struggles when sharing services cross-jurisdictionally. This study may provide a different perspective on those issues.

Available online: http://icma.org/en/press/pm_magazine/article/106144

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Background / History: This article may provide insight into the challenges faced by different police forces when they attempt to share services, which are similar to some challenges faced by public health departments.
  • Change Management: This article offers information and a new perspective on ways to successfully navigate sharing of services across jurisdictions.

 

Utilizing PHUND$ and Cost-Benefit Analysis to Evaluate Financial Efficiency at the Local Public Health Unit

Local public health units around the country are under significant financial constraints. Seven counties in the Southeast Central Region of North Dakota established a cross-jurisdictional collaborative to increase financial efficiency through shared delivery of public health services. This paper reports on the cost-benefit analysis instrument designed by the collaborative and the ways it was used to analyze current financial efficiency with regard to service delivery. The instrument allowed for the cost-per-beneficiary to be calculated, as well as the portion of the cost of delivering the service that was dependent on public subsidization. Emergency preparedness and tobacco prevention were determined to be the lowest cost per beneficiary, while the Ryan White program and chronic disease management were determined to be the highest cost per beneficiary. These results were used by the collaborative to do strategic planning with regard to service delivery and opportunities for collaboration.

Available online: http://phsharing.org/wp-content/uploads/2015/11/PHUNDS_C_B_Analysis_C.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Change Management: Information provided in this paper may be useful to identify the best services for CJS arrangements and help CJS champions demonstrate the benefits of sharing those services to others.
  • Communications: The analysis done in this paper is useful for starting conversations about what services are best to share.
  • Fiscal and Service Issues: This paper provides an example of a way to explore fiscal issues related to providing services.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Why? / Phase One: This paper might assist jurisdictions interested in sharing to explore how sharing could benefit them.
  • What? / Phase One:This paper could help jurisdictions identify what services to share.
  • Fiscal / Phase Two: This paper provides an example of a way to explore fiscal issues related to providing services.