Local policymakers and public health officials are increasingly turning to cross-jurisdictional sharing (CJS) as a way to improve the efficiency and effectiveness of public health services. By collaborating with other jurisdictions and sharing capacity and services, public health departments can create economies of scale that make the most of existing resources.
There are many kinds of CJS arrangements, from simple handshake agreements to full-scale consolidation or mergers of health departments. Throughout this wide spectrum of arrangements, there are several factors that can increase the likelihood that a CJS arrangement will be successful. We have divided these success factors into prerequisites, facilitating factors and project characteristics.
Three important success factors should be in place before partners start to work on a sharing arrangement. If any are missing, we recommend that partners spend some time addressing them before a CJS initiative actually starts.
Clarity of Objectives
Public health officials, policymakers and other stakeholders from all jurisdictions need to state explicitly what their expectations are for the CJS initiative and to be in agreement about what the CJS arrangement will accomplish. Equally important is understanding what is “off the table” in the sharing arrangement. Once objectives are determined and confirmed, it is important to review them often with all stakeholders in order to verify that they are still valid and to avoid misunderstandings, hurt feelings and damaged relationships.
Improved effectiveness (i.e., enhancing existing services or adding new ones) and increased efficiency (i.e., maximizing the results of each dollar invested) do not have to be mutually exclusive. While cost savings are often a result of the initiative, they should not be the only goal of a CJS arrangement. An excessive, unbalanced focus on one of these two elements is likely to compromise the other. The most successful CJS arrangements strive to maximize investment by achieving the best results with the amount of money available.
Trust is essential in all CJS arrangements. Partners in a CJS agreement must be confident that the other parties involved will make honest, good-faith efforts to achieve the common goals that were agreed upon. A successful outcome is dependent, in part, on the behavior and reliability of every jurisdiction involved. Trust is built slowly but can be lost swiftly. It also can be a sensitive and emotional topic. It is important, therefore, to consider the existing trust level between the jurisdictions, organizations and stakeholders involved when determining the feasibility of a sharing arrangement. A tool to measure the existing trust level among partner organizations can be found on the Center’s website.
There are three factors that facilitate a CJS arrangement. While the presence of these qualities is positive, their absence does not mean a CJS arrangement will fail. Partners in the arrangement can leverage the facilitating factors, if present.
Success in Prior Collaborations
Jurisdictions that have successfully worked together in the past may find it easier to work together on new CJS initiatives. It often takes time for group members to trust each other and to learn how to be productive when working together. If there is anxiety among stakeholders about the initiative, pointing out success in prior collaborations and understanding what may be different in the new effort can help to diffuse it.
Sense of Regional Identity
A sense of regional identity can be a powerful foundation for CJS arrangements. Stakeholders from an area with a regional identity are more likely to express sentiments like “We’re all in this together” and “We need to help each other out.”
Positive Interpersonal Relationships
Positive interpersonal relationships, especially among those negotiating, can help to facilitate a CJS initiative. People who like each other and have a positive working history together are more likely to work well together in a new CJS initiative. They also may be more willing to compromise in order to craft an arrangement that is mutually beneficial to all communities involved. Positive relationships are most often built among jurisdictions before a specific CJS arrangement begins.
Four important project characteristics can help a CJS arrangement succeed. Partners in a CJS initiative should ensure that these elements are addressed in the project plan and implementation.
CJS initiatives have important implications on functions, services and capacity. Therefore, it is imperative that all CJS initiatives have the support of senior-level administrators and policymakers from all jurisdictions. Administrators may not be involved in the detail work of a CJS arrangement, but they should be kept informed of big-picture progress in order to maintain their support of the initiative. They also should clearly express that the CJS initiative is a priority for them and that they expect everyone in their agency to work toward its success.
Strong Project Management Skills
CJS initiatives are often complex projects with lots of moving parts. The people on the CJS team often have full-time duties in addition to their CJS work. Staying organized and on track can present challenges, especially when several organizations are working together on the initiative. A strong project management plan is essential to assure that all the planned activities are implemented successfully and smoothly.
Strong Change Management Plans
CJS initiatives always involve change, which can come in many forms and can affect both the organizations and the individuals involved. For example, policies and procedures can change as can governance and staff responsibilities. People may have concerns while they try to anticipate what is ahead of them. Deliberately tending to change and its effect on stakeholders is important. An essential element of change management is the presence of good communication and meaningful engagement of all employees and stakeholders.
Communication plays a vital role in any undertaking, especially those involving change. Communications activities should be targeted both to internal stakeholders directly involved in the CJS effort and to external partners who can be affected by the initiative. Good communication is also an essential component of the change management process. A well-developed communications plan is recommended in CJS efforts. This plan should specify who the target audiences are, what messages should be delivered to them, and which organization or individual is responsible for communicating about the initiative.
Health officials and policymakers planning or implementing a CJS arrangement should carefully consider which success factors they can identify in their initiative. They should leverage those that are present, while being aware of the potential impact of those that are lacking.