Sharing Public Health Resources and Services

Gianfranco Pezzino

Patrick Libbey

Co-Directors, Center for Sharing Public Health Services

Outline

Frame the issue of cross-jurisdictional sharing (CJS)

Introduce the Center for Sharing Public Health Services

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• “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

Informal and Customary

Arrangements

Service Related Arrangement

Shared Functions with Joint Oversight

Regionalization

Cross-Jurisdictional Sharing Spectrum

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Two Critical Questions

Who makes the decision to enter a CJS arrangement?

What are the drivers behind deciding to engage in CJS?

DriversNational Public

Health Standards

Increasing burden

of chronic disease

Emergency

Preparedness

Lean fiscal

environmentsHealth

care

reform

CJS Agreements

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

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

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

Greater efficiency Enhanced capacity

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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.

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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.

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Target Audiences

PolicymakersPublic health

practitioners Professional

organizations representing these groups

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Center’s Role

Support exploration approaches to share public health functions and servicesTechnical Assistance (TA)Decision-making tools

Share knowledgeDocument examplesTranslate evidence

Support a learning community

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The Learning CommunityPolicymakers

ICMA NACo USCM NGA NCSL

Learning community 16 local projects

Both groups will Learn Share Explore

Public Health OfficialsASTHONACCHONALBOHCDC

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The Learning CommunityPolicymakers

ICMA NACo USCM NGA NCSL

Learning community 16 local projects

Both groups will Learn Share Explore

Public Health OfficialsASTHONACCHONALBOHCDC

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Shared Services Learning Community

16 sites

14 states

2-year grants

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Teams at Learning Sites

Teams funded are: Working with two or more PH agenciesMade up of PH officials and policymakersExploring, implementing or improving CJSCommitted to

achieving greater efficiencyenhancing public health capacitycollaborating

Range of Site Activities

Begin explorationIdentify specific goalsDevelop a feasibility

study Learn about various

sharing modelsReview implications of

shared capacity

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Range of Site Activities

Select sharing modelDevelop strategic planPrepare for implementation Begin implementation

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Key Points: CJS, QI, Accreditation

1. QI and PM tools can support successful CJS efforts

2. CJS can provide QI and PM documentation for accreditation

3. CJS may increase accreditation readiness Some jurisdictions can achieve standards

jointly, but not independently

Change Management

Change Management QI and PH Practice

Assess willingness to change QI approach: • Identify issues• Brain storming• Affinity diagram

Develop strategy for change PDSA = PLANUse of QI tools (workflow analysis, affinity diagrams, etc.)

Implement change PDSA = Do

Evaluate experience PDSA = Study

Phased approach PDSA = ActQI approach: start on small scale, assess and expand

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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

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Moving Forward

Let’s look at things differentlyLet’s brainstorm possibilities

Let’s explore options and alternativesThen, let’s SHARE

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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.

CMRPHA Quality Improvement Plan

Steven J. Ward, MA, MPH Assistant Director of Public Health City of Worcester Division of Public Health

351 MUNICIPAL BOARDS OF HEALTH

Central Massachusetts

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

Quality Improvement PlanAIM: 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

Establish a baseline

Time-motion study to support Environmental Health Standardization

Workforce development

Filed staff and BOH Credentials

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

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

Review program in December of 2013 for ongoing QI

Northwoods Shared

Services Project

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)

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

Northwoods Collaborative

Memorandum of understanding – Preparedness– “Other services”

Mutual aid agreementPublic Health Infrastructure Improvement Project (accreditation)

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

Sharing Arrangements Fall 2012Type of Sharing Arrangement Number of

AgenciesMemorandum of Understanding (MOU) 16Joint Projects 13Informal agreement or coordination 10Mutual Aid Agreement 8Services 5Capacity 5Staff time 3Equipment 1Merger 1

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?

Northwoods Shared Services Project

Resources & Expectations

• Pressure to provide effective and efficient services

• Wisconsin at bottom in funding public health• Affordable Care Act• Accreditation• Performance management

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)

Infrastructure Road Blocks

• Lots of will!

• Capacity deficit

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

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

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?

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