Public health departments face limited budgets and personnel resources, challenging their ability to protect the health of the communities they serve. Resource-sharing is beneficial for health departments that believe by working with partners – pooling resources, sharing staff, expertise, funds and programs – across their organizational boundaries – they can accomplish more than they could do alone. Health departments can partner with other government health departments, health centers, community-based organizations, and others. A description of basic concepts of resource sharing can be found at phsharing.org/what-we-do.
The Center for Sharing Public Health Services has identified several factors that can increase the likelihood that any sharing arrangement will be successful. We have divided these success factors into prerequisites, facilitating factors and project characteristics.
The following 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 engaging in further planning.
Clarify Your Objectives
All participants need to explicitly state what their expectations are for the sharing arrangement and be in agreement about what it is intended to accomplish. Equally important is understanding what is “off the table.” Once objectives are discussed and confirmed, it is important to review them often with all partners in order to verify that they remain valid. Failure to reach an agreement on the objectives of the sharing arrangement and to periodically verify its current validity may lead to misunderstandings and complications during the implementation of the agreement.
Improved effectiveness (i.e., enhanced quality of existing services or increased capacity) and increased efficiency (i.e., maximizing the value of each dollar invested) do not have to be mutually exclusive. The most successful sharing arrangements strive to achieve the best results with the amount of money available. An excessive, unbalanced focus on only effectiveness or efficiency is likely to compromise the other element. In this context it is also important to look at effectiveness and efficiency through an equity lens, to make sure that the sharing arrangement takes into consideration the impact on all subgroups of the population and promotes equity in the access to and delivery of public health services.
Trust at all levels of the organizations involved (including the top executives) is essential in all sharing arrangements. Partners in a sharing arrangement must be confident that all involved will make honest, good-faith efforts to achieve the agreed-upon goals. A successful outcome is dependent, in part, on the behavior and reliability of everyone involved. Trust is built slowly but can be lost swiftly. It is important, therefore, to consider the existing trust level between the organizations and stakeholders involved when determining the feasibility of a sharing arrangement. The Center has developed the Collaborative Trust Scale, a tool to measure the existing trust level among partner organizations. It can be found here.
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.
Success in Prior Collaborations
Partners that have successfully worked together in the past may find it easier to work together on new sharing arrangements. 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 partners about the initiative, pointing out success in prior collaborations can help to diffuse it. The Center has developed resources that can help do that: Assessment Tool for Public Health Existing CJS Arrangements: Detailed Survey and Abbreviated Survey.
Sense of Shared Identity
A sense of shared identity, when present, can be a powerful foundation for sharing arrangements. That shared identity can take the form of a regional identity (if partners in different jurisdictions like counties or municipalities have a history of previous sharing arrangements) or similar population or community characteristics (such as being rural communities or having a similar racial or ethnic mix). Partners with a sense of shared 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 the terms of the sharing agreement, can help to facilitate a sharing arrangement. People who like each other and have a positive working history together are more likely to work well together in a new initiative. They also may be more willing to compromise in order to craft an arrangement that is mutually beneficial to all. It is important to involve staff who are known for having good “people skills” and are likely to get along with their counterparts from other organizations in all phases of the sharing arrangement.
The following project characteristics can help a sharing arrangement succeed. Partners should ensure that these elements are addressed in the project plan and implementation.
Sharing arrangements have important implications for the partner organizations in terms of staff, programmatic activities, and overall operations. Therefore, it is imperative that all partners’ executives and governing boards demonstrate strong support for these initiatives. They should clearly express that the sharing arrangement is a priority for them and that they expect everyone in the organization to work toward its success.
Strong Project Management Skills
Sharing arrangements are often complex projects with lots of moving parts. The people on the planning team often have full-time duties in addition to their work to develop a shared service or function. Staying organized and on track can present challenges, especially when several organizations are working together. A strong project management plan is essential to assure that all the planned activities are implemented successfully and smoothly.
Strong Change Management Plans
Sharing arrangements always involve change, which can come in many forms and affect both the organizations as a whole as well as the individuals directly involved in planning and implementation. For example, policies and procedures can change as can reporting structures and staff responsibilities. As a result, staff will have concerns, and sometimes anxiety, when anticipating what lies ahead. Deliberately tending to change and its effect on staff and stakeholders is the essence of change management, and it requires good communication and meaningful engagement of all employees, partners, and stakeholders.
Communication plays a vital role in any undertaking when multiple partners are involved, especially those involving change. Good communication is necessary both among the partners directly involved in the sharing arrangement and with other stakeholders affected by it. Instituting a well-developed communications plan regarding the sharing arrangement (addressing both internal and external communication) is highly recommended. This plan should specify who the target audiences are, what messages should be delivered to them, and which organization(s) or individual(s) are responsible for communicating about the initiative.
Partners planning or implementing a sharing arrangement should keep in mind these success factors, leveraging those that are present, while being aware of the potential impact of those that are lacking, and work to incorporate them into the process. They should take into account important facilitating factors such as highlighting successes in prior collaborations, working with partners who may share a regional identity, and including people (especially those who are negotiating) who have positive interpersonal relationships. Finally, a successful sharing arrangement is marked by a number of characteristics, including senior-level support, strong project management skills, strong change management plans and effective communication.
Select this link for a printable PDF: Factors that Contribute to a Successful Sharing Arrangement