The Extent of Interorganizational Resource Sharing Among Local Health Departments

BackgroundForty one percent of local health departments in the U.S. serve jurisdictions with populations of 25,000 or less. Researchers, policymakers, and advocates have long questioned how to strengthen public health systems in smaller municipalities. Cross-jurisdictional sharing may increase quality of service, access to resources, and efficiency of resource use.ObjectiveTo characterize perceived strengths and challenges of independent and comprehensive sharing approaches, and to assess cost, quality, and breadth of services provided by independent and sharing health departments in Connecticut (CT) and Massachusetts (MA).MethodsWe interviewed local health directors or their designees from 15 comprehensive resource-sharing jurisdictions and 54 single-municipality jurisdictions in CT and MA using a semi-structured interview. Quantitative data were drawn from closed-ended questions in the semi-structured interviews; municipal demographic data were drawn from the American Community Survey and other public sources. Qualitative data were drawn from open-ended questions in the semi-structured interviews.ResultsThe findings from this multistate study highlight advantages and disadvantages of two common public health service delivery models – independent and shared. Shared service jurisdictions provided more community health programs and services, and invested significantly more ($120 per thousand (1K) population vs. $69.5/1K population) on healthy food access activities. Sharing departments had more indicators of higher quality food safety inspections (FSIs), and there was a non-linear relationship between cost per FSI and number of FSI. Minimum cost per FSI was reached above the total number of FSI conducted by all but four of the jurisdictions sampled. Independent jurisdictions perceived their governing bodies to have greater understanding of the roles and responsibilities of local public health, while shared service jurisdictions had fewer staff per 1,000 population.ImplicationsThere are trade-offs with sharing and remaining independent. Independent health departments serving small jurisdictions have limited resources but strong local knowledge. Multi-municipality departments have more resources but require more time and investment in governance and decision-making. When making decisions about the right service delivery model for a given municipality, careful consideration should be given to local culture and values. Some economies of scale may be achieved through resource sharing for municipalities <25,000 population.

Section: Introductionmentioning

confidence: 99%

Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost

Humphries¹,

Hyde

Hahn

et al. 2018

“…Researchers have studied the extent of cross-jurisdictional sharing among LHDs; (17–20) however, despite the need for efficient use of LHD resources (13–15), little is known about cross-jurisdictional sharing in community health improvement efforts.…”

Section: Background and Rationalementioning

confidence: 99%

Cross Jurisdictional Boundaries to Build a Health Coalition: A Kentucky Case Study

Carman

McGladrey

2018

Cross-jurisdictional sharing is accomplished through collaboration across jurisdictional boundaries to deliver essential public health services and solve problems that cannot be easily addressed by single organizations or jurisdictions. Partners across 10 counties and three public health jurisdictions of the Barren River Area Development District (BRADD) convened as Barren River Initiative to Get Healthy Together (BRIGHT), a community health improvement coalition. Focus groups and interviews with BRIGHT members indicate that the use of effective strategies to focus collaborative health improvement efforts fosters a cohesive coalition even when the group is populated by individuals from across public health jurisdictional boundaries. Focusing strategies identified included: the importance of organizing workgroups so members can draw upon expertise, adoption of a community engagement model for health assessment and improvement; and use of a facilitator, who offers guidance and administrative support to groups and focuses members on accomplishing goals.

“…Today's public health departments operate in environments of chronic fiscal stress from severe cuts to state and local health jurisdiction (LHJ) budgets (1,2). This stress exists as they are responsible for responding to urgent public health issues (2)(3)(4) and emergencies and addressing "upstream" prevention activities with consistently inadequate resources. At the same time, state departments of health are also faced with new challenges as federal program requirements change or increase expectations without additional funding (5).…”

Section: Introductionmentioning

confidence: 99%

“…Literature suggests that adopting shared-services models, or Cross Jurisdictional Sharing (CJS), can facilitate pooling of resources and talent/capabilities, and can lead to more effective use of funding and service delivery (2,4). CJS has been used successfully for emergency preparedness services in areas with low financial resources and across multiple jurisdictions (1,3). In addition, CJS has been used to share programs, services, and staff among smaller LHJs (3).…”

Section: Introductionmentioning

confidence: 99%

The Diamond Project: A Quality Improvement Model for Adopting Shared Service Delivery in the Washington Vaccines for Children Program

Bekemeier

Delaney

Wenzl

et al. 2020

Context: Increasing federal requirements with no change in the Centers for Disease Control and Prevention budget creates an unsustainable delivery model between states and their local counterparts for programs like Vaccines for Children (VFC). Project: The Washington State Department of Health collaborated with the Washington Association of Local Public Health Officials to identify how best to improve the quality of the VFC program. Approach: Utilizing Quality improvement and Lean Six Sigma methods, the project team was able to adopt a new shared-service delivery model to improve the quality of the VFC program in Washington State. Discussion: Through utilization of quality improvement methods and Lean methodology Washington State Department of Health identified recommendations to adopt a shared-service delivery and implemented those changes.