All posts by phsharing

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/2017/04/OhioCaseReportApril2017.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

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.

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

 

Letter of Support Policy

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.

 

Issue Escalation Guidance

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 in the San Luis Valley

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

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

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 and 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 and 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 and 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 and Service Implications / 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.

 

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.

 

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.

 

Local Government Management Guide: Shared Services in Local Government

This manual, provided by the New York state comptroller, provides a step-by-step process for implementing shared services within a local government.

Available online: hthttp://icma.org/en/icma/knowledge_network/documents/kn/Document/301683/Local_Government_Management_Guide_Shared_Services_in_Local_Government

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 book addresses multiple aspects of change management, from identifying stakeholder to communicating clearly.
  • Communications: This handbook has a chapter on communication and explores it across multiple entities.
  • Legal Issues: The handbook has a chapter on legal authority, including who can participate and how to get started with an agreement.

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

  • What? / Phase One: As an overview of the sharing process, this handbook would be very useful for anyone at the beginning of the sharing process.

 

Responding to Public Health Emergencies on Tribal Lands: Jurisdictional Challenges and Practical Solutions

Observers have identified a strong need for states and tribes to coordinate responses to public health emergencies on Indian lands. This paper explores the need for such collaboration and the difficulties such cross-jurisdictional relationships face.

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.

  • Preparedness / Emergency Response: The article focuses on tribal/non-tribal cross-jurisdictional relationships during responses to public health emergencies.
  • Tribal Issues: This paper focuses on issues that must be addressed when sharing with tribes.

 

A Case Study of Cross-Jurisdiction Resource Sharing: The Merger of Two Tuberculosis Clinics in East Tennessee

Cross-jurisdiction resource sharing is considered a possible means to improve efficiency and effectiveness of public health service delivery. A merger of the tuberculosis (TB) clinics of a rural and a metropolitan jurisdiction in East Tennessee provided an opportunity to study service provision changes in real time. A mixed methods approach was used, including quantitative data on latent TB treatment outcomes and qualitative data from staff interviews, as well as documentation of changes in staffing time in TB services. Results showed a mix of efficiency changes, indicating probable increased pressure on key service providers after the merger, in addition to expected improvements of economies of scale such as a reduction in overall staff time. Mechanisms found beneficial in coping with the merger, such as face-to-face meetings between coworkers and management of the different jurisdictions were identified at interview. The clinic merger was associated with a balance of efficiency changes, problems and advantages, and this balance is likely to change as new working arrangements become more routine.

Available online: http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1118&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.

  • Consolidation of Services: The authors evaluate consolidation of rural and metropolitan tuburculosis clinics operated through a public health service delivery system and find benefits from the merger. This may offer an example of benefits of consolidating some public health services.
  • Research and Evaluation: Authors of this article used mixed methods to evaluate a sharing arrangement and found a mix of efficiency changes. This article may serve as an example for others interested in evaluation.

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

  • Monitoring and Improving / Phase Three: Authors of this article used mixed methods to evaluate a sharing arrangement and found a mix of efficiency changes. This article may serve as an example for others interested in evaluation.

 

New Funding Available


Gianfranco Pezzino and Pat Libbey are Co-Directors of the Center.

The Center for Sharing Public Health Services has shown that cross-jurisdictional sharing (CJS) — if implemented using best evidence and promising practices — can help policymakers and public health officials increase effectiveness and efficiency in public health service delivery. CJS approaches can generate economies of scale and can allow expansion of public health services that otherwise might not be economically feasible.

Questions remain, however, as to the extent CJS can provide more value for investments in public health. Therefore, the Center has begun a new initiative focused on measuring the impact of public heath CJS arrangements on effectiveness and efficiency.

In order to measure impact, the Center is looking for up to seven CJS Implementation and Impact Measurement Program sites. These sites will be selected by a competitive process and will be awarded up to $75,000 each to participate. We are now accepting proposals from sites that would like to be considered for the program. A call for proposals (CFP) is available on the Robert Wood Johnson Foundation website.

To determine if your organization may qualify to participate in the program, please read the entire CFP, including the appendices. In a nutshell, we are looking for sites that are working on a CJS initiative that was new in 2015 and involves at least three contiguous jurisdictions of any size, or two contiguous jurisdictions if the combined population is 50,000 or greater. Improving effectiveness and efficiency in one of the public health areas specified in Appendix A of the CFP must be a stated goal of the initiative, and sites must be willing to take baseline and follow-up measurements to show if the initiative met that goal.

Important dates follow:

  • August 25, 2015: The CFP is published.
  • September 8, 2015 (1:30 p.m. ET): Optional applicant webinar is held.
  • September 15, 2015 (3:00 p.m. ET): Optional Q & A webinar is held. Select the link to join the webinar.
  • October 20, 2015 (3:00 p.m. ET): Applications are due.
  • Early January 2016: Funding decision notifications are sent.
  • February 16, 2016: Grants are initiated.

 

We want to thank the Robert Wood Johnson Foundation for providing the funding for this initiative.

Select this link to access Frequently Asked Questions.

If you have questions, please contact us at phsharing@khi.org. We look forward to hearing from you.

– Pat Libbey and Gianfranco Pezzino, Center Co-Directors

Important Publications


The Center’s Roadmap is available online.

The Center for Sharing Public Health Services has developed two important publications to assist communities as they consider and adopt cross-jurisdictional sharing (CJS) approaches. Communities that are considering applying to become part of the CJS Implementation and Impact Measurement Program will be required to include an assessment of the strength of the CJS initiative that is the basis of the impact measurement project. That assessment relies heavily on the information contained in these two publications.

A Roadmap to Develop Cross-Jurisdictional Sharing Initiatives

The Center’s Roadmap to Develop Cross-Jurisdictional Sharing Initiatives is a guide for jurisdictions considering or establishing CJS arrangements. There are three distinct phases on the Roadmap: explore, prepare and plan, and implement and improve. Each phase contains specific areas to consider and issues to address. Resources and tools are linked to areas along the Roadmap and provide additional guidance.

While the progression of phases should take place in the order presented, the areas and issues within each phase do not necessarily have to follow the same order as listed on the Roadmap. If it becomes apparent during the process that some key areas or issues from an earlier phase were overlooked, it is important to go back to that phase and resolve them before moving forward.

Success Factors in Cross-Jurisdictional Sharing Arrangements

The Center’s Success Factors in Cross-Jurisdictional Sharing Arrangements describes several factors that can increase the likelihood that a CJS arrangement will be successful. It categorizes these Success Factors as prerequisites, facilitating factors and project-specific characteristics.

Prerequisites should be in place before partners begin work on a sharing arrangement. They include clarity of objectives, a balanced approach to improving both efficiency and effectiveness, and mutual trust.

Facilitating factors can be leveraged, if present, and include success in prior collaborations, a sense of regional identity, and positive interpersonal relationships.

Project-specific characteristics can help a CJS arrangement succeed. Partners in a CJS initiative should make sure that these elements are addressed in the project plan and implementation. They include senior-level support, strong project management skills, strong change management plans, and effective communication.

Health officials and policymakers considering and adopting CJS initiatives should consider the success factors that are present in order to leverage them. They should also be aware of the potential impact of those that are lacking.

Center’s Resource Library


Select this link on our home page to access the most recently added resources.

The Center for Sharing Public Health Services has a large resource library about cross-jurisdictional sharing on its website. The library includes Center-developed materials and items developed by the demonstration sites. Reports, tools and publications from other experts also can be found there. Staff at the Center are constantly identifying and classifying new products to add to the library.

To help site visitors find the most recently added resources, the Center has provided a link on the home page of its website.
 
Please email phsharing@khi.org if you need assistance finding resources related to cross-jurisdictional sharing.

NACo Podcast About Cross-Jurisdictional Sharing


Commissioner Todd Schneeberger (right) sits with other members of the Horizon team.


County Commissioner Ken Falgren (fifth from left) with members of the Central Oregon team and Center co-directors.

The National Association of Counties (NACo) recently produced a podcast about cross-jurisdictional sharing (CJS) that featured representatives from two of the Center’s original demonstration sites.

Grant County Commissioner Todd Schneeberger from the Horizon Public Health demonstration site discussed their CJS initiative in which three public health departments in west-central Minnesota merged into one health department serving five counties. The new health department, which opened its doors in January, has already realized several benefits. One benefit of the merger is that now staff can specialize in just one or two program areas instead of many program areas. By allowing staff to focus on fewer programs, they have become more effective at their jobs and the organization has become more efficient, in part because fewer staff members must be trained in each program. There have been several challenges to merging, but Commissioner Schneeberger affirms merging the three departments is beneficial because the agreement will help to sustain a robust public health presence in their part of the state.

Crook County Commissioner Ken Falgren from the Central Oregon demonstration site also participated in the podcast. He discussed the three-county emergency preparedness collaboration in his region. While each county maintains its own health department, they decided to work together on emergency preparedness because residents cross county lines on a daily basis for jobs, recreation, shopping, health care and more. Therefore, if there was a disease outbreak or a fire in one county, it would affect the entire region.

Center Co-Director Pat Libbey also contributed to the podcast by reviewing the Spectrum of CJS arrangements available to help counties improve efficiency and effectiveness. He also discussed the resources the Center provides for any community considering or adopting CJS arrangements.

Listen to the complete podcast at www.naco.org/resources/cross-jurisdictional-sharing.

Upcoming Presentations


Pat Libbey, Center Co-Director, will present at upcoming conferences.

Staff from the Center for Sharing Public Health Services will attend the following meetings this fall to talk about cross-jurisdictional sharing and the resources available from the Center.

Open Forum for Quality Improvement in Public Health

The National Network of Public Health Institutes (NNPHI) Open Forum for Quality Improvement in Public Health will take place at the Westin Seattle on October 15-16, 2015. Center Co-Directors Pat Libbey and Gianfranco Pezzino will present a session on cross-jurisdictional sharing. If you are at the Open Forum, please come to the Center’s presentation. Visit NNPHI’s website for more information about the Open Forum.

APHA Annual Meeting

The American Public Health Association (APHA) Annual Meeting will be held October 31-November 4, 2015, in Chicago. The Center co-directors will be offering sessions on cross-jurisdictional sharing at the meeting.

Gianfranco Pezzino will present “Tools to Assist in the Development of Sharing Agreements Across Public Health Jurisdictions” at 8:45 a.m. on Tuesday, November 3. During the presentation, he will discuss the knowledge repository available from the Center and several tools the Center has produced to assist health departments in planning and implementing cross-jurisdictional sharing (CJS) agreements.

Immediately following Gianfranco’s presentation, Pat Libbey will take the stage to present, “Initial Results and Identification of Factors Associated with Successful Cross-Jurisdictional Initiatives.” He will discuss evidence that suggests that CJS initiatives can achieve outcomes such as reduced costs, greater productivity, enhanced grant eligibility, increased range and availability of public health services, and improved quality of services. He also will talk about three groups of success factors identified by the Center that can help maximize success in CJS initiatives.

For more information about the meeting, visit APHA’s website.

Other Presentations

Aug. 26-27: Grace Gorenflo, senior project consultant for the Center, will participate in the California Department of Public Health’s 2015 Public Health Accreditation Readiness Conference in Sacramento, California.

Sept. 2: Center Co-Directors Pat Libbey and Gianfranco Pezzino will participate in a webinar hosted by the National Association of County and City Health Officials (NACCHO) for leaders of state associations.

Sept. 29: Center Co-Director Gianfranco Pezzino and Grace Gorenflo, senior project consultant for the Center, will participate in the wrap-up meeting of the Public Health District Incentive Grant (DIG) Program managed by the Massachusetts Department of Public Health.

A Case Study of Cross-Jurisdiction Resource Sharing: The Merger of Two Tuberculosis Clinics in East Tennessee

Cross-jurisdiction resource sharing is considered a possible means to improve efficiency and effectiveness of public health service delivery. A merger of the tuberculosis (TB) clinics of a rural and a metropolitan jurisdiction in East Tennessee provided an opportunity to study service provision changes in real time. A mixed methods approach was used, including quantitative data on latent TB treatment outcomes and qualitative data from staff interviews, as well as documentation of changes in staffing time in TB services. Results showed a mix of efficiency changes, indicating probable increased pressure on key service providers after the merger, in addition to expected improvements of economies of scale such as a reduction in overall staff time. Mechanisms found beneficial in coping with the merger, such as face-to-face meetings between coworkers and management of the different jurisdictions were identified at interview. The clinic merger was associated with a balance of efficiency changes, problems and advantages, and this balance is likely to change as new working arrangements become more routine.

Available online: http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1118&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.

  • Consolidation of Services: The authors evaluate consolidation of rural and metropolitan tuburculosis clinics operated through a public health service delivery system and find benefits from the merger. This may offer an example of benefits of consolidating some public health services.
  • Research and Evaluation: Authors of this article used mixed methods to evaluate a sharing arrangement and found a mix of efficiency changes. This article may serve as an example for others interested in evaluation.

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

  • Monitoring and Improving / Phase Three: Authors of this article used mixed methods to evaluate a sharing arrangement and found a mix of efficiency changes. This article may serve as an example for others interested in evaluation.

 

SurvCost: Estimating the Cost of Surveillance

SurvCost is a spreadsheet-based tool developed by the Centers for Disease Control and Prevention to aid public health officials in estimating the cost of Integrated Disease Surveillance and Response (IDSR) systems at national, region/province, district, and health facility levels.

Available online: http://www.cdc.gov/globalhealth/healthprotection/ghsb/idsr/tools/survcost.html

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: Disease surveillance and response is part of the core services of public health and this tool can aid in estimating funds needed to perform associated tasks.
  • Fiscal and Service Issues: SurvCost estimates the costs of seven categories of resources: personnel, office operating items, transportation, laboratory materials and supplies, treatment and programmatic response items, media or public awareness campaigns, and capital items.

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

  • Fiscal and Service Implications / Phase Two: SurvCost estimates the costs of seven categories of resources: personnel, office operating items, transportation, laboratory materials and supplies, treatment and programmatic response items, media or public awareness campaigns, and capital items.

 

Selecting an essential package of health services using cost-effectiveness analysis: A manual for professionals in developing countries

This manual provides guidelines to estimate disease burden at the national or regional levels and to calculate cost-effectiveness of alternative packages of health interventions. Results can be used in decision making on how to allocate resources to health care. The methodology will assist public health systems in providing a cost-effective and essential package of health services to the population. The end of the document includes worksheets readers can use for their own planning purposes.

Available online: http://www.hsph.harvard.edu/ihsg/publications/pdf/No-5.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 manual provides guidelines for estimating disease burden at the national and regional levels and for calculating the cost effectiveness of different public health interventions designed to improve the public’s health.
  •  
    This resource is also linked to the Roadmap. Select a link below to read more about each area.

    • What? / Phase One: This manual provides guidelines for estimating disease burden at the national and regional levels and for calculating the cost effectiveness of different public health interventions designed to improve the public’s health.
    • Fiscal and Service Implications / Phase Two: This manual provides guidelines for estimating disease burden at the national and regional levels and for calculating the cost effectiveness of different public health interventions designed to improve the public’s health

     

Programmatic Cost Analysis: Assessing Resources: The Third of a Five-Part Series

This module demonstrates programmatic cost analysis. This type of analysis is used to assess the resources required to implement an intervention or program and the costs associated with the use of those resources.

Available online: https://www.cdc.gov/dhdsp/programs/spha/economic_evaluation/docs/podcast_iii.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-Jurisdictional Sharing and the Law

This blog post, published by The Network for Public Health Law, explores cross-jurisdictional sharing and the law. It discusses specific case studies, including projects in Michigan, New York, and Nevada. Case studies consider how each partnership was formed under the laws of its governing state.

Available online: https://www.networkforphl.org/the_network_blog/2015/03/27/563/cross-jurisdictional_sharing_and_the_law

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: This blog explores some of the laws that have allowed cross-jurisdictional sharing in three different states.

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

  • Legal Issues/ Phase Two: This blog explores some of the laws that have allowed cross-jurisdictional sharing in three different states.

 

Cost-Benefit Analysis: Primer for Community Health Workers

This document provides instructions and tools to conduct cost-benefit analysis of community health programs. Instructions assume no prior knowledge of this kind of analysis and detailed formulas and worksheets are provided.

Available online: https://apps.publichealth.arizona.edu/CHWToolkit/PDFs/Framewor/costbene.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 document provides tools to conduct cost-benefit analysis of existing or proposed programs, which can help practitioners decide which programs are best for their communities.

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

  • Fiscal and Service Implications / Phase Two: This document provides tools to conduct cost-benefit analysis of existing or proposed programs, which can help practitioners decide which programs are best for their communities.

San Luis Valley Public Health Partnership Guidelines for Shared Services

This brief document succinctly outlines the guidelines for a successful shared services arrangement.

Available online: http://phsharing.org/wp-content/uploads/2015/06/SLVPHP_Guidelines_for_Shared_Services_093013.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: This document succinctly outlines what must be in place to have a successful shared services arrangement.

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

 

San Luis Valley Public Health Partnership Feasibility Study

A feasibility study answers the questions, “Should we do this?” and “What do we need to do it?” In this report, the San Luis Valley project examines the feasibility of creating and sustaining the San Luis Valley Public Health Partnership as outlined by their strategic plan. They evaluate their capacity to meet established goals and analyze the applicability of sharing models.

Available online: http://phsharing.org/wp-content/uploads/2015/06/SLVPHP_Feasibility_Study_012715.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: The feasibility study explores the likelihood that the partnership will meet goals with available resources, and considers what needs to be done to make it happen.

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

  • What? / Phase One: This may be of interest to those just beginning to explore cross-jurisdictional sharing, as they consider how to evaluate whether outlined goals are feasible.
  • Change Management / Phase Two: The feasibility study explores the likelihood that the partnership will meet goals with available resources, and considers what needs to be done to make it happen

 

Michigan’s Public Health Code and Sharing Public Health Services

This presentation explores the aspects of Michigan’s public health code that allow for cross-jurisdictional sharing and the types of sharing arrangements that are occurring.

Available online: http://phsharing.org/wp-content/uploads/2015/06/Michigan_Public_Health_Code_and_Sharing_Public_Health_Services.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 presentation explores the aspects of Michigan’s public health code that allow for cross-jurisdictional sharing and the types of sharing arrangements that are occurring.

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

  • What? / Phase One: This presentation explores the aspects of Michigan’s public health code that allow for cross-jurisdictional sharing and the types of sharing arrangements that are occurring and may be useful to those exploring sharing arrangements.

 

Northern Michigan Cross-Jurisdictional Sharing Team

This one-pager describing the Northern Michigan Cross-Jurisdictional Sharing team includes a brief description of the different partners in multiple sharing arrangements, their priorities, and accomplishments to date.

Available online: http://phsharing.org/wp-content/uploads/2015/06/CJS_overview.doc

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 document provides an inventory of shared services arrangements in Northern Michigan, their priorities and goals.

 

Northern Michigan Cross-Jurisdictional Sharing Team

This presentation provides an overview of those involved in the Northern Michigan Cross-Jurisdictional Sharing Team and their reasons for engaging in cross-jurisdictional sharing.

Available online: http://phsharing.org/wp-content/uploads/2015/06/CJS_NALBOH.ppt

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 presentation provides an example of a tool that can be used with local boards of health to persuade them to explore cross-jurisdictional sharing.

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

  • Why? / Phase One: This presentation provides an example of a tool that can be used with local boards of health to persuade them to explore cross-jurisdictional sharing.

 

PNM Family Home Visiting (FHV) Shared Services Feedback Form

The purpose of this form is to obtain your feedback about the past year of Family Home Visiting Shared Services to be provided to staff participating in the arrangement. It could be modified for staff participating in other shared service arrangements.

Available online: http://phsharing.org/wp-content/uploads/2015/01/MSW_PNM_FHV_evaluation.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: This form provides a way to explore staff views of a shared services arrangement.
  • Research and Evaluation: This form provides a way to evaluate staff perceptions of a shared services arrangement.li>

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

 

Minnesota Shared Services Learning Collaborative: Partnership4Health CHB

This is a brief overview of the Partnership4Health CHB, a project involved in the Minnesota Shared Services Collaborative. It explores the idea behind the projects, partners involved, outcomes, and lessons learned.

Available online: http://phsharing.org/wp-content/uploads/2015/01/MSW_P4HStoryboard.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: This set of slides outlines a shared services arrangement and its impetus. It also explores lessons learned and outcomes of the project.

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

  • What? / Phase One: This set of slides may be useful to someone in the exploration phase of a shared services arrangement as they consider what services to share and the potential outcomes of attempting shared services

 

Minnesota Shared Services Learning Collaborative: Evaluation Report February 2013-January 2015

This report outlines the process involved in developing shared services arrangements in Minnesota. It includes information on evaluating the process, including the methods used and results obtained. It concludes with lessons learned and next steps.

Available online: http://phsharing.org/wp-content/uploads/2015/06/MN_Evaluation_Rpt.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: This document includes information regarding the evaluation process used by Minnesota in exploring the success of a project that included planning and implementing shared service arrangements across the state.
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Minnesota Shared Services Learning Collaborative Polk‐Norman‐Mahnomen Community Health Services

This is a brief overview of the Polk‐Norman‐Mahnomen Community Health Services, a project involved in the Minnesota Shared Services Collaborative. It explores the idea behind the projects, partners involved, outcomes, and lessons learned.

Available online: http://phsharing.org/wp-content/uploads/2015/01/MSW_PNM_Storyboard.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: This set of slides outlines a shared services arrangement and its impetus. It also explores lessons learned and outcomes of the project

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

  • What? / Phase One: This set of slides may be useful to someone in the exploration phase of a shared services arrangement as they consider what services to share and the potential outcomes of attempting shared services
  •  

Minnesota Shared Services Learning Collaborative: Bloomington Edina Richfield Public Health Alliance

This is a brief overview of the Bloomington/Edina/Richfield Public Health Alliance, a project involved in the Minnesota Shared Services Collaborative. It explores the idea behind the projects, the partners involved, outcomes, and lessons learned.

Available online: http://phsharing.org/wp-content/uploads/2015/01/MSW_BER_Storyboard.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: This set of slides outlines a shared services arrangement and its impetus. It also explores lessons learned and outcomes of the project.

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

  • What? / Phase One: This set of slides may be useful to someone in the exploration phase of a shared services arrangement as they consider what services to share and the potential outcomes of attempting shared services.

 

Updating Minnesota’s Blueprint for Public Health

The Minnesota State Community Health Services Advisory Committee called for a workgroup to investigate increased changes in organizational and governance structures of local public health departments, to understand the changes at a foundational level and to update an earlier blueprint for a strong and successful system of public health departments. This report documents the workgroups findings, including exploration and discussion of public health sharing.

Available online: http://phsharing.org/wp-content/uploads/2015/06/MinnesotaBlueprint.pdf

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: The document highlights the importance of sharing to provide essential services in the community
  • Change Management: The document addresses procedures for investigating, planning, and implementing system level change within an organization.
  • Consolidation of Services: The document discusses the range of shared services arrangements.
  • Regionalization: The document discusses the range of shared services arrangements.
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Local Project Storyboards: Minnesota Shared Services Learning Collaborative

This is a brief overview of multiple projects involved in the Minnesota Shared Services Collaborative. It explores the idea behind the projects, partners involved, outcomes, and lessons learned.

Available online: http://phsharing.org/wp-content/uploads/2015/01/MSW_Level2_Storyboards.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: This set of slides outlines a number of shared services arrangements and their impetus. This set of slides explores lessons learned by a number of projects engaged in creating shared services arrangements, including a list of positive outcomes that may not have been anticipated in the beginning of the projects.

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

  • What? / Phase One: This set of slides may be useful to someone in the exploration phase of a shared services arrangement as they consider what services to share and the potential outcomes of attempting shared services.

 

Minnesota Shared Services Learning Collaborative: Kandiyohi-Renville Community Health Board

This is a brief overview of the Kandiyohi-Renville Community Health Board, a project involved in the Minnesota Shared Services Collaborative. It explores the idea behind the projects, partners involved, outcomes, and lessons learned.

Available online: http://phsharing.org/wp-content/uploads/2015/01/MSW_KR_Storyboards.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: This set of slides outlines a shared services arrangement and its impetus. It also explores lessons learned and outcomes of the project

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

  • What? / Phase One: This set of slides may be useful to someone in the exploration phase of a shared services arrangement as they consider what services to share and the potential outcomes of attempting shared services

 

Cross-jurisdictional Sharing Developmental Measures

This is a short survey (three questions) developed to obtain information from local entities about whether or not they are sharing services.

Available online: http://phsharing.org/wp-content/uploads/2015/01/MSW_MDH_CJS_Measures.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: This survey might be used when considering who to partner with to develop a shared services arrangement.

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

  • Who? / Phase One: This survey might be used when considering who to partner with to develop a shared services arrangement.

 

Cross-Jurisdictional Sharing Toolkit

This document explores how two public health departments progressed through the Roadmap to Develop Cross-Jurisdictional Sharing Initiatives to form a CJS agreement. It also highlights the lessons they learned along the way.

Available online: http://phsharing.org/wp-content/uploads/2015/06/CJSToolkitR.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: This document provide the background for why these health departments decided to enter into a shared services arrangement.
  • Communications: The document briefly discusses developing a communications plan and highlights the importance of keeping staff informed throughout the process.
  • Environmental Issues: The document discusses two health departments entering into an agreement to share environmental health services.

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

  • Why? / Phase One: This report documents one CJS initiative’s progress along the CJS Roadmap and includes information regarding why they entered into an agreement, what the agreement is, and who is partnering.
  • What? / Phase One: This report documents one CJS initiative’s progress along the CJS Roadmap and includes information regarding why they entered into an agreement, what the agreement is, and who is partnering.
  • Who? / Phase One: This report documents one CJS initiative’s progress along the CJS Roadmap and includes information regarding why they entered into an agreement, what the agreement is, and who is partnering.
  • Communications / Phase Two: Although the document deals with multiple aspects of each phase of the Roadmap, it especially focuses on communication.
  • Communications and Change Management / Phase Three: Although the document deals with multiple aspects of each phase of the Roadmap, it especially focuses on communication.

 

Horizon Public Health Organizational Chart

This organizational chart shows the organization of the different sectors and staff positions of the Horizon Public Health Department. At the top of the organization is the Administrator. Immediately below the administrator are Assistant Administrators, the Budget and Finance Supervisor, and the Human Resource Coordinator. Additional staff positions and programs flow down from there.

Available online: http://phsharing.org/wp-content/uploads/2015/01/HPH_org_chart.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: This chart helps define the organizational structure of a newly regionalized health department.
  • Communications: This chart shows the chain of command at a newly regionalized health department.
  • Regionalization: This chart shows the organizational structure of a newly regionalized health department.

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

  • What? / Phase One: This chart might assist those thinking of merging health departments in exploring what their organizational structure might look like.
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Regionalization Exploration of an Alternate Organizational Model

It examines the concept of a regionalized organizational structure in relation to Oklahoma’s public health system. It presents a broad model of regionalization possibilities.

Available online: http://www.naccho.org/topics/infrastructure/accreditation/upload/Regionalization-Exploration-for-an-Alternate-Organizational-Model.pdf

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

 

Regional Public Health Emergency Preparedness: The Experience of Massachusetts Region 4b

This article describes the formation of Region 4b, an emergency preparedness region in Massachusetts, and how the region came together to work on emergency preparedness issues. It also examines the organizational, financial, and planning challenges associated with organizing these towns as a unified entity.

Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430641/

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 article describes the formation of Region 4b, an emergency preparedness region in Massachusetts, and how the region came together to work on emergency preparedness issues.

 

Resource Sharing Among Ohio’s Local Health Departments: April, 2013

The report explores local health departments in Ohio. It emphasizes the importance of collaboration and resource sharing among LHDs in order to facilitate the provision of the minimum package of local public health services most efficiently.

Available online: http://www.communitysolutions.com/assets/docs/Major_Reports/State_Budget_and_tax/publichealthfinal4.12.13.pdf

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: The report emphasizes the importance of collaboration and resource sharing among LHDs in order to facilitate the provision of the minimum package of local public health services most efficiently.
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Evaluation of Regionalization Planning Efforts in Kansas and Massachusetts

This report presents findings from a qualitative evaluation of the efforts of public health leaders in Kansas and Massachusetts to develop plans for regionalizing local public health. The evaluation was designed to document the planning activities of each state and gather feedback from a variety of participants on the strengths, challenges and lessons learned from the processes undertaken.

Available online: http://www.naccho.org/topics/infrastructure/accreditation/upload/NACCHO-final-regionalization-evaluation-report.pdf

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 report reflects on how public health sharing efforts affect local health department’s capacity to offer essential services.
  • Regionalization: Both states represent a different approach to planning for regionalization. This report provides an overview of each approach and a summary of lessons learned from participating public health leaders.

 

Collaboration Among Local Public Health Departments Preparing for Accreditation

This report explores public health sharing efforts in Kansas and highlights how these efforts may improve initiatives towards accreditation.

Available online: http://www.gih.org/files/usrdoc/Collaboration_Public_Health_Department_Accreditation_May_2009.pdf

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 report explores public health sharing efforts in Kansas and highlights how these efforts may improve initiatives towards accreditation.

 

Massachusetts Public Health Regionalization Project Status Report

This Status Report highlights the work of the Massachusetts Public Health Regionalization Project. The Regionalization Project’s goal is to strengthen the Massachusetts public health system by creating a state-funded regional structure for equitable delivery of local public health services across the Commonwealth.

Available online: http://www.ct.gov/dph/lib/dph/government_relations/local_health_council/ma_regionalization_status_report_9-1-09.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: This paper begins with an analysis of why public health regionalization needs to occur in Massachusetts.
  • Change Management: This status report highlights longstanding examples of successful public health districts in Massachusetts.
  • Regionalization: The report highlights recent regionalization efforts by local municipalities, like Melrose and Wakefield.

 

Case Study: The West Central Public Health Partnership

This case study is part of the Partnerships for Health initiative, an initiative designed to help improve the coordination of health services at the community level. Partnerships were among hospitals, local health departments, community-based organizations, government agencies and community members. Each partnership identified a Healthy People 2010 focus area important to its community. Grants were awarded to assist partnerships in building, strengthening and sustaining the infrastructure of Colorado communities by proactively addressing public health issues.

Available online: http://www.coloradotrust.org/sites/default/files/PFH_CaseStudy_090612-FINAL.rev_.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 case study explores the reasons for shared services among multiple partnerships and the histories of these agreements.

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

  • Why? / Phase One: This case study provides an excellent overview of key elements required for successful shared service agreements and would be helpful for those in the exploration phase of a new arrangement.
  • What? / Phase One: This case study provides an excellent overview of key elements required for successful shared service agreements and would be helpful for those in the exploration phase of a new arrangement.
  • Who? / Phase One: This case study provides an excellent overview of key elements required for successful shared service agreements and would be helpful for those in the exploration phase of a new arrangement.

 

Case Study: Robert Wood Johnson Foundation, Cross‐Jurisdictional Services Project, Southwest Washington: 2014‐2015

This case study examines the Center’s demonstration site in Southwest Washington. The participants were seeking to develop a governance structure that could be used for a wide variety of projects and services. After eight meetings, the team ultimately determined that further pursuit of the original goal would not be productive. This case study is intended to understand how the effort progressed, factors that hindered the desired progress, and lessons that could inform other jurisdictions interested in similar pursuits.

Available online: http://phsharing.org/wp-content/uploads/2015/01/CaseStudy_SW_Washington.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: Through the case study development process, it became clear that participants approached this effort from different philosophical approaches. These differing philosophies, although not clearly stated during the project, appear to be at the heart of some of the difficulties experienced by the group.
  • Communications: Participants agreed that trust among the participants was undermined early in the project due to the lack of agreement and communication about hiring of a new health officer for the region. Trust was damaged when participants did not communicate about expectations and role of a shared, regional health officer.

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

  • What? / Phase One: The consultant observed that participants did not agree on the project goals. While meeting agendas contained stated meeting and project objectives, they were not reflected in any of the meeting notes reviewed.
  • Communications / Phase Two: Participants agreed that trust among the participants was undermined early in the project due to the lack of agreement and communication about hiring of a new health officer for the region. Trust was damaged when participants did not communicate about expectations and role of a shared, regional health officer.
  • Change Management / Phase Two: Through the case study development process, it became clear that participants approached this effort from different philosophical approaches. These differing philosophies, although not clearly stated during the project, appear to be at the heart of some of the difficulties experienced by the group.

 

Sharing Resources Across Jurisdictions: A Roadmap to Success

This webinar provides highlights from three Nebraska health districts that are sharing community outreach workers. It also provides highlights from CJS initiatives in New York and Colorado. Information about the Center’s Roadmap to Develop Cross-Jurisdictional Sharing Initiatives and Success Factors in Cross-Jurisdictional Sharing Arrangements is also included.

Available online: http://phsharing.org/2015/05/28/nebraskawebinar/

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: This webinar provides examples of public health jurisdictions that have shared services (primarily management and staff positions) to increase efficiency and effectiveness of their services.

 

Sharing Resources Across Jurisdictions: A Roadmap to Success

The Center held a webinar with the Nebraska Association of Local Health Directors on May 19, 2015.

Gianfranco Pezzino, Center Co-Director, provided an overview of the Center’s Roadmap to Develop Cross-Jurisdictional Sharing Initiatives and also outlined the Factors for Success in cross-jurisdictional sharing (CJS) arrangements. Grace Gorenflo, Senior Project Consultant, presented CJS case studies.

Teresa Anderson, MSN, APRN-CNS, Health Director at Central District Health Department, and Michele Bever, PhD, MPH, Executive Director of South Heartland District Health Department, discussed sharing community health outreach workers among multiple health districts in Nebraska.

Select this link for a copy of the presentation slides.

Watch a video of the webinar below.

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

Case Study: Pennyrile District Health Department Crittenden County, Kentucky

This case study examines a 30 year old shared service arrangement in rural Kentucky, examining the reasons for the agreement, the history of its formation, and the keys to its success.

Available online: http://phsharing.org/wp-content/uploads/2014/12/Case-StudyCrittendenCountyKentucky.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: Management, staff, and elected officials who understand their roles working for the entire district community are critical in maintaining working relationships to achieve success.
  • Communications: Fostering trust between board members is a key component of creating an agreement. Getting people on board can prove to be a challenge in the beginning.

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

  • Communications / Phase Two: Fostering trust between board members is a key component of creating an agreement. Getting people on board can prove to be a challenge in the beginning.
  • Change Management / Phase Two: Management, staff, and elected officials who understand their roles working for the entire district community are critical in maintaining working relationships to achieve success.

 

Case Study: Prowers County Public Health and Environment and Kiowa County Public Health, Lamar, Colorado

This document describes the development of a shared services arrangement in Colorado for one county to provide qualified staff to another county and keep both counties in compliance with state law.

Available online: http://phsharing.org/wp-content/uploads/2014/12/CaseStudyProwersCountyLamarColorado.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 document provides information about the two counties entering into a shared services arrangement and reasons for their sharing.
  • Change Management: The document describes how individuals in the county made the case for shared staffing, which was needed to stay in compliance with state law.
  • Consolidation of Services: The document describes one county in Colorado providing another county with qualified staff to offer services and stay in compliance with state law.

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

  • Change Management / Phase Two: The document describes one county in Colorado providing another county with qualified staff, in order to offer services and stay in compliance with state law
  • Implementation and Management / Phase Three: The case study describes the implementation of a shared services agreement between two counties in Colorado to share staff and stay in compliance with state law.

 

Case Study: Eastern Highlands Health District, Mansfield, Connecticut

This case study describes the formation of the Eastern Highlands Health District in Mansfield, Connecticut. Ten towns were involved. The case study provides how and why the agreement was formed, making the case for sharing services. It defines a shared services model, and discusses obstacles, benefits and key takeaways.

Available online: http://phsharing.org/wp-content/uploads/2014/12/CaseStudyMansfieldConnecticut.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 document describes the entities involved in forming a health district and the impetus for sharing services.
  • Change Management: The document describes the process in forming the health district and how the case for sharing services was made.
  • Regionalization: The document describes the forming of a health district.

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

 

Practice Enhancement Recommendations for the Oral Health Program at Guilford County Health Department

Guilford County Health Department’s dental program is a valuable asset for people in the Greensboro, NC area and given its current size, the dental program needs to be maximally efficient and effective. The strategies outlined in this plan are designed to help guide dental program stronger and more effective.

Available online: http://phsharing.org/wp-content/uploads/2015/05/PracticeEnhancementGuilford.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: This document outlines steps to make the oral health services provided by Guilford County Health Department more efficient and effective.

 
 

Practice Enhancement Recommendations for the Oral Health Program at Cabarrus Health Alliance

Cabarrus Health Alliance’s dental program is a valuable asset for people in and around Charlotte, North Carolina. Given its current size, the dental program needs to be maximally efficient and effective. The strategies outlined in this plan are designed to help guide the dental program to become stronger and more effective.

Available online: http://phsharing.org/wp-content/uploads/2015/05/PracticeEnhancementCabarrus.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: This document outlines strategies that could make the oral health program at Carbarrus Health Alliance more efficient and effective.

 

Engaging Policymakers in Public Health Partnerships

This resource provides an overview on how to effectively engage policymakers in public health partnerships by providing tips about key take-aways, connections, communications and support, and education.

Available online: http://phsharing.org/wp-content/uploads/2015/05/SLVPHP_Engaging_policymakers_points.pdf

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

  • Communications: This document provides tips for communicating effectively with policymakers when attempting to engage them in public health related issues.