MN SSLC Update Newsletter

Minnesota Shared Services Learning Collaborative

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Winter 2014 Update
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Calendar Winter 2014

New Resources Winter 2014


In November 2013, the Center for Sharing Public Health Services released a resource to help support the development and implementation of cross-jurisdictional sharing (CJS) arrangements. A Roadmap to Develop Cross Jurisdictional Sharing Initiatives outlines questions to be considered at different phases of project development, starting with an exploration phase and then moving into a preparation and planning phase which is followed by an implementation and improvement phase.

At each stage there are key questions to consider, such as:

Exploring: What is the issue that needs to be addressed? Can the solutions to the issue be found through internal management activities or reallocation of existing resources? Is CJS likely to help solve the issue being addressed?

Planning/Preparing: What is an organizational structure adequate to assure proper management? Does the plan achieve a balance between increasing efficiency and effectiveness? Who will have the authority to make decisions? What changes will occur as a result of the CJS arrangements? Who will be affected? How will changes be managed?

Implementing/Improving: Are the activities being implemented as planned? Are communications among all parties affected flowing well? Are the results of the activities satisfactory?

Each jurisdiction that is considering cross-jurisdictional sharing will surely have local questions or concerns that will need to be identified as well; the roadmap simply provides a starting point to guide jurisdictions through the process. Note that each phase is meant to build on the previous—they are not intended to be addressed concurrently. To be successful, the authors note, "it is important to start with a clear understanding of what is wanted and why it is wanted in a CJS arrangement before considering the operational details." All CJS arrangements should be built on shared values and goals.

In addition to the roadmap itself, the Center has also developed several supporting tools and resources:
Self-Assessment of Progress Along the CJS Roadmap
A self-assessment tool to determine where you are on the roadmap
Assessment Tool for Public Health – Existing Services
An organizational assessment tool for use in the Exploration Phase
Legal Issues
Resources that may help address legal issues that come up in the Planning/Preparation Phase


The roadmap can be found here: CJS Roadmap, and a list of tools and resources for different steps along the roadmap is located here: Overview of Roadmap (PDF: 90KB / 1 page)

National Meeting Winter 2014


A meeting of the national project partners was held in San Diego, CA in January 2014. In addition to unveiling the Roadmap (see above), there were presentations on involving tribes in cross-jurisdictional sharing (CJS) arrangements, utilizing collaborative leadership strategies to support CJS, and analyzing the financial dimensions of sharing services across jurisdictions. For a summary of the meeting and links to the presentation slides, visit Common Themes: January 2014 and January 2014 SSLC Meeting.

Engaging Policymakers Winter 2014


Resources from the Wisconsin Northwoods Project

Minnesota SSLC partners may recall a presentation by Chris Dobbe, project director of the Northwoods Wisconsin Shared Services Project, at an early mini-collaborative meeting in 2013. The Northwoods project has an excellent website that includes specific information for policymakers. Visit Northwoods Shared Services Project and explore the information available under the Resources tab.

Local Project Spotlight: Fillmore-Houston (Level 2) Winter 2014


The purpose of the Fillmore-Houston shared services project is to self-assess staffing, programming (public health services/functions), and funding streams in order to identify unnecessary duplication, underused assets, or service gaps. In addition, it is hoped that information about where the two counties are already working well together can be identified and strengthened. Results of this project will include 1) a written document outlining the results and conclusions of the self-assessments and 2) a presentation of the results that can be easily communicated to others.

To date, Fillmore-Houston has conducted assessments in both counties, reviewed and analyzed the data, drawn conclusions and identified areas for further exploration. A recent accomplishment was the preparation and presentation of the final results to the Fillmore-Houston CHB Advisory Board. The presentation was well received.

Ongoing work includes redefining project goals now that phase one is complete. Questions that need to be asked and answered include:

  1. What do we want to accomplish over the second year of the grant?
  2. Where do we want to go from here?
  3. How should we continue to use the assessment information?
Promoting Peer Learning Winter 2014


Have tools or resources from your Shared Services project that others might be helpful? Please contact Becky Sechrist at becky.sechrist@state.mn.us. Your peers and colleagues thank you!

Questions? Winter 2014


Please contact Becky Sechrist at 651-201-3883 or becky.sechrist@state.mn.us.


Fall 2013 Update
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Calendar Fall 2013

  • January 8, 2014 (tentative) – Mini Collaborative meeting
  • January 22-24, 2014 – National project meeting, San Diego, CA
Engaging Local Elected Officials Fall 2013


SSLC Level One partners along with one of their elected officials joined the mini collaborative in early October for a panel discussion focused on engaging and sustaining the involvement of policymakers in shared services discussions and implementation. Highlights from the conversation include:

  • Engaging board/council members often takes place through one identified public health champion. Council members described their own journeys to becoming that champion and the critical role of their relationship with public health directors.
  • Being intentional about planning communications was identified as a best practice. For example, ask new commissioners explicitly what level of communication they want, and through what means. Public health staff should also be aware of other commissioners who may not be on the CHB, who may need more time to process information and generate questions.
  • There were few concerns or fears described regarding loss of local control and autonomy through CJS. Most of the panelists had longstanding positive relationships with partnering jurisdictions. Panelists described placing their emphasis on program improvement and service provision. Working to keep council members involved from an early stage is important. These fears can come up with staff when there are program changes being implemented.
  • Trusting relationships between commissioners or council members and public health leadership was a significant theme. Panelists described the importance of having common goals and a common vision. A Commissioner commented, "Trust was critical, and a willingness to take risk and ability to see it through long enough to see if it's working or effective. It boils down to time, patience, and trust."
  • Transition in board membership can be a challenge, as new members may have less understanding of current issues. It is important to get information to these members: "Sit down and have frank conversations: What are this person's concerns? What are they hearing that might not be accurate? What is their understanding the situation?" A Commissioner offered that "most new commissioners will look to someone on the board who they look to as a mentor. Target that person to help bring the other commissioner up to speed." In one jurisdiction, new commissioners have a full day orientation with public health staff. Another project team discussed the importance of intentional succession planning for board or council vacancies.
  • In reflecting on the conversation, a level two partner noted how much relationship building and trust work seems to occur outside of the formal board setting, while a Public Health Nurse Consultant added that county administrators can be critical partners as well. A level one team lead reflected that unexpected changes in direction can have positive outcomes—what may seem like a failure initially might turn out for the best in the end.

A full transcript is available upon request.

SSLC Pre-Assessment Results Fall 2013


MN SSLC partners participated in a pre-assessment survey during the summer of 2013. The assessment was designed to provide baseline information about the status of cross-jurisdictional sharing (CJS) in Minnesota from the perspectives of level one (currently implementing CJS in their jurisdictions) and level two (exploratory phase of CJS) partners. The responses reflect the Center for Sharing Public Health Services readiness factors in several ways.

  • All respondents (100%), regardless of implementation level, indicated that they were motivated for change because they wanted to make better use of resources.
  • On average, 48% of the respondents reported that a policymaker champion has been identified to promote CJS, with level one partners being more likely to have identified a champion than level two (64% and 23% respectively).
  • Both level one (82%) and level two (77%) partners have key decision makers who support a vision for CJS.
  • As expected, and given the different starting points for level one and level two participants, level one participants were more likely to have CJS partner roles and responsibilities identified (82%) compared to level two participants (31%).
Website Resources Fall 2013


The SSLC concurrent session presentation from the Community Health Conference has been posted on the Collaborative's website under Reports, Presentations and Videos. During the session, level one partners discussed the continuum of options for CJS, change management, stakeholder engagement and identified factors for success within the context of their local shared services projects. Resources and tools, such as Polk-Norman-Mahnomen's Force Field Analysis, were also shared.

The Center for Sharing Public Health Services recently posted A Roadmap to Develop Cross-Jurisdictional Sharing Initiatives on their website. This Roadmap describes three phases for developing cross-jurisdictional sharing initiatives: (1) exploration, (2) preparation and planning, and (3) implementation and improvement.

Just for Fun Fall 2013


At a recent mini collaborative meeting, SSLC partners were asked to fill in the blank: Working on Cross Jurisdictional Sharing is ________? This word cloud is the result of the group's round robin responses. The larger the word, the more frequently it was mentioned by SSLC partners.

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Questions? Fall 2013


Please contact Phyllis Brashler at 651-201-3877 or phyllis.brashler@state.mn.us.


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News Summer 2013

  • Thanks to those who have completed the Minnesota pre-assessment. We plan to share results in the next MN SSLC Update.
  • Reminder that the MN SSLC Website is up and will be updated as new resources become available.
Calendar Summer 2013

Upcoming Mini Collaborative meeting dates (format and location TBD):

  • Wednesday, October 2, 2013
  • Wednesday, January 8, 2014
Grantee Updates Summer 2013


Project Charters and Quarterly Status Reports: Thank you for sending in Project Charters and Status Reports! This information is valuable and provides a broad snapshot of all cross jurisdictional sharing endeavors occurring across our state. Here are a few project highlights:

PROJECT GOALS
Year 1 Goal: Using the MAPP process, we will complete phase 1, organization and partnership development, phase 2, visioning, and phase 3, the four MAPP assessments. Year 2 Goal: Using the MAPP process, complete phase 6, action cycle steps 1-3 and prepare Community Health Assessment and Action Plan for submission to MDH. (Brown-Nicollet)

PROJECT SCOPE
Align the Public Health Infrastructure Governance Functions and the Performance Planning and Reporting Functions to address local government redesign, cross jurisdictional sharing, and public health accreditation standards. (Partnership4Health)

CHANGE MANAGEMENT
Trust between partners is increasing through monthly meetings, discussing differences and addressing fears and concerns. (Kandiyohi-Renville)

CHALLENGES
"Challenging the Process" of how things have always been done is invigorating, brings new ideas and efficiencies, but requires much time to dialogue, gain trust and apply the plan-do-study-act process to accomplishing the long term visions. Sadly, Public Health professionals are stretched in many directions so "time" can be a challenge. (Polk-Norman-Mahnomen)

CJS RESOURCES
Our team referred to the Center for Sharing Public Health Services Readiness Factors in our discussions. Internally, we also referred to MDH's MN SSLC website templates and tools. The Project Charter template was especially helpful to us. To guide some of our discussions for the work done with the Charter, we also took from the Communications Plan and Project Scope Statement tools. (Fillmore-Houston)

Resources Summer 2013


Website: At the recent Mini Collaborative meeting, Chris Dobbe from the Northwoods Shared Services Project spoke to the group about this national grantee's work in north central Wisconsin. Chris briefly introduced the Northwoods Shared Services Project website. MN SSLC will likely find the Role of Policymakers (PDF: 296KB / 1 page) and the Literature Review helpful.

The Policymaker Role in the Shared Services Learning Project briefly describes, within the context of Wisconsin, how policymakers can contribute to the Collaborative, what role they play, and what they can do to further the work of the Collaborative within their own jurisdictions.

REGIONALIZATION OF GOVERNMENT SERVICES: LESSONS LEARNED AND APPLICATION FOR PUBLIC HEALTH SERVICE DELIVERY

Formal Citation:
Kaufman, N. (2010). Regionalization of Government Services: Lessons Learned & Application for Public Health Service Delivery. Mequon, WI: The Strategic Vision Group. Retrieved from www.rwjf.org.

Description: Regionalization of government services has occurred in education, public safety (fire, police, preparedness), water and waste management and economic development. This report summarizes best practices and lessons learned. Case studies are presented, including the example of how regionalization at the North Shore Fire Department in southeastern Wisconsin also helped lead the way for regionalization for library services and public health.

Web page: Regionalization of Government Services: Lessons Learned & Application for Public Health Service Delivery (PDF: 1.3MB / 112 pages)

Question For Health Officers:
Key barriers to shared services include issues of mistrust, fear and the politics of place; state and federal laws & regulations; engagement of stakeholders; timing and ignoring critical steps in achieving change. How has your agency been able to overcome barriers in your current shared services?

Question For Board Members:
What barriers are present when two or more jurisdictions engage in shared services?

While a number of the articles and references on the website are specific to Wisconsin's shared services context, there are themes that will likely resonate for Minnesota's SSLC grantees.

Newsletter: The Northwoods Shared Services Project just released their latest newsletter. Included is a short overview of why cross-jurisdictional shared services should be considered and how do describe various levels of shared services.

Local governments face many challenges including the need to provide high quality services and often higher levels of service in the face of declining or unstable revenue. Some reasons that local health departments may consider shared services is to:

  • Increase capacity to provide core functions of a local public health department and improve quality to meet new performance measures (Public Health Accreditation Standards)
  • Improve effectiveness and efficiency in the delivery of services
  • Develop and train staff for evolving public health problems and recruit and retain qualified public health professionals who may be in short supply in more rural, sparsely populated areas
  • Adapt to declining revenues from local, state and federal sources.

Cross-jurisdictional sharing is the process of reaching across boundaries to share resources, tasks and results. The levels of shared services may include: informal "handshake" arrangements, service-related arrangements, shared functions with joint oversight and regionalization.

View the entire newsletter at the Northwoods website. If you would like to sign up to receive their newsletter, select this link.


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News May 2013

  • July mini collaborative meeting available via video conference from MDH district office sites
  • Slides from the May quarterly national call
  • Thanks to those who have completed their initial TA check-in calls--there's lots of exciting CJS related work planned in MN! If you haven't scheduled yet, call Phyllis.
  • Website up--tons of resources, especially around project mgmt
Calendar May 2013


Mini Collaborative meeting dates pre-scheduled through the end of the grant (format and location TBD).

  • Wednesday, July 10, 2013
  • Wednesday, October 2, 2013
  • Wednesday, January 8, 2014
  • Wednesday, April 2, 2014
  • Wednesday, July 9, 2014
  • Wednesday, October 1, 2014
  • Wednesday, January 7, 2015
Resources May 2013


Article: "Shared Services and the Velveteen Rabbit Factor" by Feather O'Conner Houstoun, Governing magazine (September 26, 2012). One of the biggest barriers to consolidating service delivery is a jurisdiction's fear that it will lose its individual identity. There are ways to deal with that.

Article: "Change Management for Effective Quality Improvement: A Primer" by Prathibha Varkey, MBB, MPH, MHPE, American Journal of Medical Quarterly, May 2010. The authors provide an overview of the steps to design and execute QI projects that require change management. [Note: the link is to the online article abstract. If you are interested in reading the full text, please email Allison.]

Video: All project directors were interviewed at the SSLC national kickoff meeting in March. Watch Deb Burns and Sandy Tubbs describe the two MN grant projects, and the benefits, motivations and challenges of taking on this work. You can read and hear more about CJS projects going on around the country on the "funded sites" page.


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News April 2013


MN SSLC is "In the News"
An article about the MN Mini Collaborative Kickoff meeting was posted to the Center for Sharing Public Health Services site earlier this month.

Presentations on CJS at Keeneland Conference
The 2012 Keeneland Public Health Systems and Services Research (PHSSR) conference was held April 8-11 in Lexington, KY. The concurrent sessions highlighted research findings on a wide variety of topics including workforce; consolidation; partnerships; and organization. While consolidation is only one of many possible arrangements along the spectrum of CJS, the research presented in the session on it echoed themes that have been raised in the MN SSLC. One presentation highlighted tasks that jurisdictions had to engage in together during a consolidation process, including creating new strategic directions; building credibility with the community; assessing progress; making changes in work arrangements; making changes to the technology infrastructure; changing the use of different facilities; merging organizational cultures; and facilitating communications.

In addition, national project coordinator, Gianfranco Pezzino, held a roundtable discussion on CJS at the conference. The discussion focused on lessons learned from a recent consolidation of local health departments in Ohio and some of the governance challenges they experienced, including navigating different labor agreements (the case study presented above). The conference was stimulating and informative, and we encourage you to explore the presentations. The conference program and presentations are available online.

ImgNational Learning Community Kickoff is Big Success!
More than 100 people gathered in Kansas City March 12-14 for the first Shared Services Learning Community (SSLC) meeting. The SSLC is made up of 16 sites across the United States that are exploring, expanding or implementing ways to share services to increase the efficiency and effectiveness of delivering public health services. Public health officials and policymakers spent the conference becoming acquainted with the variety of nationwide projects, meeting colleagues and sharing ideas on how best to move their projects forward. To learn about the individual site projects, visit the Funded Sites tab at PHSharing.org and view the video interviews of each team leader. This article was excerpted from the Center for Sharing Public Health Services E-Newsletter (April 2013). Join their mailing list to receive this free email publication.

Calendar April 2013


Mini Collaborative meeting dates pre-scheduled through the end of the grant (format and location TBD).

  • Wednesday, July 10, 2013
  • Wednesday, October 2, 2013
  • Wednesday, January 8, 2014
  • Wednesday, April 2, 2014
  • Wednesday, July 9, 2014
  • Wednesday, October 1, 2014
  • Wednesday, January 7, 2015
Resources April 2013


Article: "Shared Services and the Velveteen Rabbit Factor" by Feather O'Conner Houstoun, Governing magazine (September 26, 2012). One of the biggest barriers to consolidating service delivery is a jurisdiction's fear that it will lose its individual identity. There are ways to deal with that.

Article: "Change Management for Effective Quality Improvement: A Primer" by Prathibha Varkey, MBB, MPH, MHPE, American Journal of Medical Quarterly, May 2010. The authors provide an overview of the steps to design and execute QI projects that require change management. [Note: the link is to the online article abstract. If you are interested in reading the full text, please email Allison.]

Video: All project directors were interviewed at the SSLC national kickoff meeting in March. Watch Deb Burns and Sandy Tubbs describe the two MN grant projects, and the benefits, motivations and challenges of taking on this work. You can read and hear more about CJS projects going on around the country on the "funded sites" page.


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Background March 2013


Minnesota is one of 16 recipients of a two-year grant (January 2013-January 2015), from the Robert Wood Johnson Foundation, designed to help health departments explore how cross jurisdictional sharing might better equip them to fulfill their mission of protecting and promoting the health of communities served. There are two funded projects from Minnesota--Horizon's "Integrating local health departments in west central Minnesota" project, and our project the "Minnesota System-wide Shared Services Learning Collaborative."

Our Project March 2013


The Minnesota Shared Services Learning Collaborative (MN SSLC) will provide a regular venue to bring together public health leaders in our state to learn from each other about CJS; to disseminate information from the national collaborative broadly throughout our state; to provide support and assistance for local CJS activities that are already in process; and to develop tools (like MN guidelines for CJS and a self-assessment or CJS readiness tool) to promote and support future CJS activities in Minnesota. The MN mini-collaborative will meet quarterly.

Our project will pursue three objectives:

  1. To support and assist grant partners in achieving two-year goals for Cross Jurisdictional Sharing (CJS);
  2. Implement a systematic, statewide approach to CJS; and
  3. Foster a two-way exchange of information on CJS between the national community and Minnesota's local public health system.

There are two levels of participation in our project:

Level 1: Four local partner teams who are currently implementing CJS in the jurisdictions, and who have identified an elected official "champion". Level 1 teams have set individual two-year CJS related project goals, and will report on their progress in MN and as a part of the national learning community. They will participate in national meetings and site visits, and will also participate in the MN mini-collaborative.

  1. PartnerSHIP4health: Becker, Clay, Wilkin and Otter Tail counties
  2. BER: the cities of Bloomington, Edina and Richfield
  3. Kandiyohi-Renville CHB
  4. Polk-Norman-Mahnomen CHB

Level 2: Eight local partner teams, who are in an exploratory phase of CJS, will participate in the MN mini-collaborative. They will develop a two year aim statements for advancing their CJS efforts and will report on their progress within MN. Additionally, Horizon has agreed to participate as a partner in the MN SSLC mini collaborative.  

  1. Brown-Nicollet CHB
  2. Carlton-Cook-Lake-St. Louis CHB
  3. Fillmore-Houston CHB
  4. Hennepin CHB
  5. Isanti-Mille Lacs CHB
  6. North Country CHB
  7. Olmsted CHB
  8. Scott CHB
Updates March 2013


The national kickoff meeting was held in Kansas City, MO on March 13-14. The grant paid for the MN SSLC to send 10 people to this meeting, including the team leads and a policy maker from each of the four Level 1 teams, plus two MDH-OPI staff. The goal of the meeting was to create a “vibrant, synergistic environment that enhances the potential for all [grant participants] to create and share knowledge”. It was a “getting to know you meeting”, which encouraged attendees to network with other public health professionals and policy makers from around the country. The meeting content was presented through a series of panel discussions, followed by small group sessions. The panelists challenged attendees to consider the range of different motivations for CJS and the challenges and opportunities of working cross jurisdictionally.

An “a-ha moment" from this meeting for the MN SSLC team was recognizing that “change management” is as critical as “project management” when it comes to making cross jurisdictional service sharing work. The quote of the month comes from Kandiyohi County Commissioner Harlan Madsen who, after attending the national meeting said, “I have never been so proud to be from Minnesota.” While there is always room for improvement, it was clear that Minnesota has a big head start on CJS thanks to the LPH Act and the strength of the state-local partnership. We have a legal framework for and a long history of working in multi-jurisdictional arrangements. The strength of our state-local partnership in our state is unparalleled in the U.S.

Calendar March 2013

  • Mini Collaborative Kickoff Video Conference
    April 1, 10:00 a.m. – 2:00 p.m. {All grant partners}
  • Level 1 Team Leads Conference Call
    April 9, 3:00 – 4:00 p.m. {Level 1 partners only}
Resources March 2013


Each month we will feature two CJS related resources. Let us know if your local project has resources to share!

Report: "Success Factors for Implementing Shared Services in Government" (PDF: 701KB / 49 pages). This report was published in 2008 by the IBM Center for the Business of Government. It presents research findings and identifies five key success factors for a successful shared services project.

Video: "A conversation with the co-directors" from Center for Sharing Public Health Services (Run Time: 8:20). This video gives a brief introduction to the Center. The co-directors leading the national grant share their thoughts on CJS (run time 8:20).

Questions? March 2013


Please contact Allison Thrash at 651-201-3964 or allison.thrash@state.mn.us.

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Members of Minnesota’s SSLC team, Top Row (L to R): Commissioner Harlan Madsen (Kandiyohi County), Debra Burns (MDH), City Councilor Karen Nordstrom (City of Bloomington), Commissioner Jon Evert (Clay County), Commissioner Karen Ahmann (Mahnomen County), Sarah Reese (Polk County). Bottom Row: Allison Thrash (MDH), Karen Zeleznak (City of Bloomington), Diane Thorson (Otter Tail County), Jill Bruns (Renville County).