Paul K. Halverson, Dr.P.H., M.H.S.A., FACHE
Director and State Health Officer
Arkansas Department of Health
Halverson: Hello, and welcome to RE-ACT, the podcast supporting evidence-based practice for public health agencies. I am your host, Dr. Paul Halverson. Given constraints in time, financing, and other key resources, health departments are increasingly seeking innovative ways to address organizational capacity concerns, particularly in service delivery. One approach that has been taken by some to fill gaps is that of cross-jurisdictional sharing. CJS provides opportunities for multiple health departments to collaborate and to build collective capacity to ensure that their communities receive the services that they need. With a variety of approaches being implemented across the country, sharing also presents an important opportunity for public health services and systems researchers to examine processes and contribute to evidence-based recommendations for successful sharing. With me today is a researcher examining exactly such issues. Dr. Justeen Hyde is Co- Director of the Massachusetts Public Health Practice-Based Research Network, or PBRN, and a senior scientist at the Institute for Community Health. She has been looking at what sparks and maintains interest in cross-jurisdictional sharing for public health service delivery. Welcome, Justeen.
Hyde: Thank you for having me, Paul.
Halverson: As we talk about CJS, I think it’s important for our listeners to understand the context that is driving sharing approaches. As your study discovered, what are the key factors that influence these kinds of collaborations?
Hyde: Well, as you know, there are vast disparities around the nation in terms of public health service delivery. These disparities are sometimes driven by limited funding, sometimes by variation in leadership and organizational structure. We found in other public health services and systems research that small health departments, in particular, really struggle sometimes to provide basic public health services that they are asked to provide and this can lead to a lot of challenges in many states. In Massachusetts, for example, where each municipality is responsible for providing public health services, more than half of our municipalities have populations of less than 10,000 people, which means that more than half of our communities fall into that “very small health departments” category. In these kinds of environments, it’s really challenging to provide state-mandated services, and cross-jurisdictional service sharing becomes a strategy for increasing the capacity of these health departments to deliver essential services and meet growing expectations around performance standards.
Halverson: So the idea then is that by working together, these health department collaborations can become greater than the sum of their parts. In other words, by working together, services can be delivered and perhaps at a lower cost.
Hyde: Yes, that’s the hope and the goal I think for most of our municipalities. And so what our study has done is to focus on planning activities to identify the motivations, approaches, successes, and the challenges that health departments faced as the move from independent to shared service delivery model.
Halverson: Well that’s really interesting and certainly really very topical for today. And what have you discovered so far?
Hyde: Among other things, we found that the CJS planning process works best where relationships are already in place among the participating communities, which means there is a history and a certain level of trust between the collaborators. We also have found that strong, transparent, action-focused facilitation in planning meetings has been a real plus for these efforts. In particular, finding a facilitator that has both strategic planning and local public health knowledge has been key. And I think most important when the people around the planning table have common goals from the beginning the process goes much more smoothly.
Halverson: That certainly makes sense. As you looked at the groups that were doing planning for CJS, did you find particular challenges among the groups and is there a way to characterize those challenges?
Hyde: Sure. I think one of the biggest challenges that some groups faced was if they were planning with communities that were heterogeneous in terms of size, demographic, governance structures, that they tended to have more challenges in coming up with a common shared services model. And I think, importantly, municipalities that invested differently in public health services -- since it is a local responsibility in Massachusetts, you have vast disparities in how municipalities invest in these services -- and those that had very different levels of investment had a harder time coming to agreement for end things like what would be a viable financial model for shared services.
Halverson: So generally the more similar you were in terms of those characteristics, the more likely you were to have a successful collaboration, is that right?
Hyde: Yeah, certainly. Our recommendations coming out of this study would be you want to invest some time up front and clarify you jurisdiction goals and then find like-minded partners that want to embark on this journey with you, so to speak. That can help minimize competing needs and competing values. And then also to recognize that the planning process requires a real investment in building relationships and mutual trust. And at the participating health departments you need strong leaders that are going to do this work, and it’s tough work. It’s a lot of planning and people are very busy; a lot of times they add this on to their already busy schedules, so finding leaders that can move a process forward has been critical for a number of our municipalities. And finally, I think -- as with all partnerships -- it is essential for participants to be flexible and have open minds about the process. There is nothing magical that happens when you bring multiple low-resourced jurisdictions together, but we found with clear and shared goals, a plan in place, and available resources, CJS can help improve capacity for providing essential public health services in many communities.
Halverson: This is very helpful and encouraging Justeen. I am sure that many of our listeners would agree that this helps move us forward in terms of better understanding what makes for a great or better collaboration as we think through shared services. If our listeners are interested in learning more about your research, how could they contact you?
Hyde: So they can reach me directly, my email is email@example.com. I would also send them to the Boston University School of Public Health Practice Office webpage. There is a tab on that webpage -- it’s called recentralization -- and all of our state’s tools that we have developed over the years are on that site and available for anyone to use. And then finally I would send them to the Center for Sharing Public Health Services, which is at the Kansas Health Institute: www.phsharing.org, and there will be a growing number of tools available on that website.
Halverson: Thank you Justeen, and thanks to all for listening to RE-ACT, the podcast that brings you the most recent evidence from Public Health PBRNs and the field of public health services and systems research. I’d like to thank again today’s guest, Dr. Justeen Hyde of the Massachusetts Public Health PBRN, for joining us. Until next time, I am Dr. Paul Halverson and this has been RE-ACT.