The Center for Sharing Public Health Services is a $4 million national initiative managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation. The project involves 16 teams in 14 states comprised of public health agencies, policymakers, their partners and key stakeholders that are collaborating to strengthen their ability to provide public health essential services, improve efficiency and control costs.
The 16 teams make up a national Shared Services Learning Community working to identify, test and define methods of cross-jurisdictional sharing. The Center communicates these sharing activities and provides technical assistance to the Shared Services Learning Community and others in the broader public health arena.
Gianfranco Pezzino, KHI senior fellow and strategy team leader, serves as co-director of the Center with Patrick Libbey, a former local public health official and former executive director of the National Association of County and City Health Officials.
Pezzino says that new performance measures — including national accreditation standards — are prompting public health officials to think about how they could cooperate to improve efficiency and performance.
“All communities, rural and urban, face greater challenges with fewer resources,” he says. “Today, many public health providers are looking for ways to deliver services more efficiently and effectively. Small or large, public health systems face similar struggles as they search for answers.”
Financial pressures play a key role in the movement toward sharing resources. As Libbey notes, “In public administration circles of all kinds, regionalization and shared services is one method being looked at and increasingly being used as a means of becoming more effective and efficient.”
In addition to public health, Libbey says, public sectors that have considered or implemented shared services include schools, traditional government service areas such as fire and police, library services and parks and recreation.
Approaches vary to these arrangements, known as cross-jurisdictional sharing. The graphic below illustrates the broad spectrum of shared arrangements, from informal agreements to the creation of new public health entities.
The Center will provide each of the 16 Shared Services Learning Community sites with a customized package of technical assistance. A pool of national and regional experts will provide assistance on topics such as financial analysis, legal analysis, operations and management, facilitation, stakeholder engagement, health improvement planning, quality improvement, communications and evaluation.
Additional training and technical assistance opportunities will be offered during annual meetings, quarterly webinars and convenings of subgroups of the Shared Services Learning Community sites that are facing similar issues and challenges.
In many jurisdictions, public health officials and policymakers have different reasons for pursuing cross-jurisdictional sharing arrangements. The authority to enter into cross-jurisdictional relationships typically resides with the policymakers — often elected bodies — rather than with public health agencies.
The policymakers’ role is crucial, according to Libbey. “Policymakers need to know that their obligation to their constituency is met and potentially improved as a result of the service sharing, and they need to have a say and an oversight in that,” he says. “And health officials need to be in a position of assuring that the public health needs of their jurisdictions are being met or improved.”
While there is no one-size-fits-all approach to cross-jurisdictional sharing, the main goal of the project is to develop a collective knowledge of what works and under what circumstances. During its work with the 16 sites, the Center will record and share the lessons learned and gather or develop tools for use in future cross-jurisdictional sharing efforts.