Sharing Public Health Resources and Services

1. Sharing Public Health Resources and Services Gianfranco Pezzino Patrick Libbey Co-Directors, Center for Sharing Public Health Services

2. Outline • Frame the issue of cross-jurisdictional sharing (CJS) • Introduce the Center for Sharing Public Health Services

3. Cross-Jurisdictional Sharing Spectrum Shared Functions with Joint Oversight Service Related Arrangement Informal and Customary Arrangements Regionalization • “Handshake” • MOU • Information sharing • Equipment sharing • Coordination • Service provision agreements • Mutual aid agreements • Purchase of staff time • Joint projects addressing all jurisdictions involved • Shared capacity • Inter-local agreements • New entity formed by merging existing LHDs • Consolidation of 1 or more LHD into existing LHD

4. Two Critical Questions • Who makes the decision to enter a CJS arrangement? • What are the drivers behind deciding to engage in CJS?

5. Drivers National Public Health Standards Emergency Preparedness CJS Agreements Increasing burden of chronic disease Health care reform Lean fiscal environments

6. Survey FindingsInsights from Implementers of Shared Services • Most common goal - cost savings • Most participants - achieved goals • Most common measurement of progress - cost savings • Most positive result - improved service • Most negative result - “people issues” • CJS most often initiated - by agency leaders • Most common driver - cost or service variables • Most significant lesson learned from implementing CJS - “Change Management Is Key” • Biggest mistake - insufficient change management • Thing most organizations did well - project management • Greatest challenges - “people issues”; overcome with - improved communication Source: Success Factors for Implementing Shared Services in Government. IBM Center for the Business of Government, 2008

7. Survey FindingsInsights from Implementers of Shared Services • Most common goal - cost savings • Most participants - achieved goals • Most common measurement of progress - cost savings • Most positive result - improved service • Most negative result - “people issues” • CJS most often initiated - by agency leaders • Most common driver - cost or service variables • Most significant lesson learned from implementing CJS - “Change Management Is Key” • Biggest mistake - insufficient change management • Thing most organizations did well - project management • Greatest challenges - “people issues”; overcome with - improved communication Source: Success Factors for Implementing Shared Services in Government. IBM Center for the Business of Government, 2008

8. Survey FindingsInsights from Implementers of Shared Services • Most common goal - cost savings • Most participants - achieved goals • Most common measurement of progress - cost savings • Most positive result - improved service • Most negative result - “people issues” • CJS most often initiated - by agency leaders • Most common driver - cost or service variables • Most significant lesson learned from implementing CJS - “Change Management Is Key” • Biggest mistake - insufficient change management • Thing most organizations did well - project management • Greatest challenges - “people issues”; overcome with - improved communication Source: Success Factors for Implementing Shared Services in Government. IBM Center for the Business of Government, 2008

9. Greater efficiency Enhanced capacity

10. Who Are We? • The Center for Sharing Public Health Services (DOB: May 2012) is a national initiative managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation.

11. Center’s Goal • Increase the ability of public health agencies to improve the health of communities by helping explore, inform, track and share learning about regional and shared approaches to delivering public health services.

12. Target Audiences • Policymakers • Public health practitioners • Professional organizations representing these groups

13. Center’s Role • Support exploration approaches to share public health functions and services • Technical Assistance (TA) • Decision-making tools • Share knowledge • Document examples • Translate evidence • Support a learning community

14. The Learning Community • Public Health Officials • ASTHO • NACCHO • NALBOH • CDC • Policymakers • ICMA • NACo • USCM • NGA • NCSL • Learning community • 16 local projects • Both groups will • Learn • Share • Explore

15. The Learning Community • Public Health Officials • ASTHO • NACCHO • NALBOH • CDC • Policymakers • ICMA • NACo • USCM • NGA • NCSL • Learning community • 16 local projects • Both groups will • Learn • Share • Explore

16. Shared Services Learning Community 16 sites 14 states 2-year grants

17. Teams at Learning Sites • Teams funded are: • Working with two or more PH agencies • Made up of PH officials and policymakers • Exploring, implementing or improving CJS • Committed to • achieving greater efficiency • enhancing public health capacity • collaborating

18. Range of Site Activities • Begin exploration • Identify specific goals • Develop a feasibility study • Learn about various sharing models • Review implications of shared capacity

19. Range of Site Activities • Select sharing model • Develop strategic plan • Prepare for implementation • Begin implementation

20. Key Points: CJS, QI, Accreditation • QI and PM tools can support successful CJS efforts • CJS can provide QI and PM documentation for accreditation • CJS may increase accreditation readiness • Some jurisdictions can achieve standards jointly, but not independently

21. Change Management

22. The Uncomfortable Questions • We have about 2,700 LHDs in the U.S. • Do we need 2,700? • Can we afford 2,700? • Can we imagine a day when all of them would meet accreditation standards? • Is it politically feasible to change the current LHD structure? Adapted from: Gene W. Matthews, JD

23. Moving Forward Let’s look at things differentlyLet’s brainstorm possibilitiesLet’s explore options and alternativesThen, let’s SHARE

24. www.PHSharing.orgPHSharing@KHI.org(855) 476-3671 The Center for Sharing Public Health Services is a national initiative managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation.

25. Steven J. Ward, MA, MPH Assistant Director of Public Health City of Worcester Division of Public Health CMRPHA Quality Improvement Plan

26. 351 MUNICIPAL BOARDS OF HEALTH Central Massachusetts

27. Background of Central Massachusetts Regional Public Health Alliance (CMRPHA) • City Manager Task Force and State Department of Public Health (PHDIG) encourage regional shared service model • Develop and sustain a high quality cost effective and labor-efficient regional public health district • Using Constant Quality Improvement methods • Share lessons learned with National Partners and Massachusetts PHDIG communities as to Cross Jurisdictional Best Practices

28. Quality Improvement Plan AIM: Standardize the practice of Environmental Health throughout the 5 CMRPHA communities Why It Is Important: Standardization leads to a uniform approach to regulatory programs and enforcement strategies and efficient use of staff time. Field staff will have more time for Community Health and Emergency Preparedness programs

29. Establish a baseline • Time-motion study to support Environmental Health Standardization • Workforce development • Filed staff and BOH Credentials

30. Planned Improvement Activities • Assure consistent training of all staff • Assess current academic credentials of field staff and develop plan to address acquisition of needed academic credentials • Creation of Center for Public Health Practice for producing field ready Environmental Health interns and to deliver IDP academic content to staff

31. Planned Improvement Activities • Institutionalize standardized practices • Improve efficiency of staff time • Utilize time-motion and direct observation analysis to ensure appropriate allocation of personnel and staff

32. Review program in December of 2013 for ongoing QI

33. Northwoods Shared Services Project

34. Starting Out • 2003 influx of funding created public health preparedness consortia • 2003-2010 Northwoods Consortium • 21 jurisdictions • Epidemiology/outcomes-based approach • Accreditation • July 2011 elimination of consortia funding • August 2011Northwoods Collaborative • 9 jurisdictions (now 10)

35. Why not 21 of 21? Possible barriers to joining collaborative: • Budget cuts/retain staff • Agency size allows for dedicated staff • Extra funding helps shore up other efforts (accreditation) • Distance/relate more to other regions

36. Northwoods Collaborative Memorandum of understanding • Preparedness • “Other services” Mutual aid agreement Public Health Infrastructure Improvement Project (accreditation)

37. Shared Services Learning Community Grant Application to Robert Wood Johnson Foundation • Natural fit for collaborative and region • Accreditation • Shrinking resources • Examine and improve on what we are doing • Increase policymaker involvement • Local team approach/identity

38. Sharing Arrangements Fall 2012

39. Key Questions • What criteria should health departments use to evaluate the effectiveness of sharing arrangements? • When is cross-jurisdictional sharing cost-effective? • How can sharing arrangements contribute to an increase in quality and capacity in public health department services, functions, and accreditation efforts?

40. Northwoods Shared Services Project

41. Resources & Expectations • Pressure to provide effective and efficient services • Wisconsin at bottom in funding public health • Affordable Care Act • Accreditation • Performance management

42. Current Course • Public Health Accreditation Board (PHAB) self-assessment • Performance management • Strategic planning • Performance monitoring and measurement • Quality improvement • Community Health Assessment (CHA)/Community Health Improvement Plan & Process (CHIPP)

43. Infrastructure Road Blocks • Lots of will! • Capacity deficit

44. Policymakers – aligning paths • Support for reallocating resources • Essential Services as framework for internal capacity • What are we getting from tax levy support? • Customer satisfaction • Focus on efficiency, effectiveness, and spending

45. Lessons Learned • Money isn’t everything • Build capacity from within • Need access to people resources you can draw on quickly • Conserving policymaker time while keeping them involved

46. Evaluate to Improve Sharing Arrangements • What types of services and functions are being shared? • What are inputs, benefits, costs? • What criteria should be used for entering into a shared services arrangement?

47. What we hope to accomplish • Increased understanding among policymakers • 10 Essential Services/national accreditation • Infrastructure necessary to support public health • Cross-jurisdictional sharing criteria • How sharing can increase capacity and infrastructure