Service Improvements through Intergovernmental Cooperation

ARTICLE | Jul 12, 2016

Don’t underestimate the commitment

In Washington County, we have worked to define one of our key results as “seeking opportunities for collaboration and shared services with public and private partners.”  We talk openly about collaboration with neighboring jurisdictions, sharing services and even merging functions when it makes sense for our residents.  Yet with large-scale collaboration, the level of commitment needed from a myriad of stakeholders to overcome hurdles still surprised me.

Ozaukee County, WI (87,054) and Washington County, WI (132,739) are regionalizing public health services with the formation of a new multi-county health department. The two existing county health departments will be formally merged in 2016. The Counties collectively serve 220,000 residents, are located north of Milwaukee, WI and border Lake Michigan. 

The merging of the Ozaukee County and Washington County Health Departments is one of the first genuine and complex department mergers in Wisconsin.  The total  combined budget will be just under $3 million which includes local tax levy, block grants to the individual entities (these portions of the budget need to be worked through with the State of Wisconsin), over $200,000 in fees for service and categorical funding for Women, Infants and Children (WIC).

The new agency will standardize and consolidate all public health services currently provided by each individual Department.  Services to be shared include but are not limited to Environmental Health including WI Food Safety and Recreational Licensing, Maternal and Child Health (MCH), Wisconsin Well Woman Program (WWWP), Communicable Disease, Epidemiology and Surveillance, Emergency Preparedness, Immunization, Prevention including Community Health Assessment and Community Health Improvement Planning, Heroin Task Forces, Child Death Review Teams, INVEST (Ozaukee County’s Community Health Coalition), Laboratory Services, and overall systems, administration and governance. 

A joint Board of Health as the new governing body will be comprised of nine (9) members: three (3) Washington County Supervisors, two (2) Ozaukee County Supervisors, and four (4) non-voting citizen members: two (2) appointed by Washington County and two (2) appointed by Ozaukee County to fully govern the operation and budget of the public health agency as required per Wisconsin Statute. 

As we started to collaborate and resolve issues, many administrative complexities surfaced that have never been encountered and require solutions.  As an example, Wisconsin State Statute 251.02(3) allowing for multi-county health departments as written would have made it financially and otherwise disadvantageous for Ozaukee County to pursue the regionalization requiring the counties to amend Wisconsin law in order to help realize the vision of the merger.


Photo Credit: Legislature Photographers

The unique formation of this multi-county health department will allow for numerous opportunities to improve public health services that will benefit the residents of both Counties. 

Benefits to Both Counties:

1.  Reduces the size of government.

2.  Creates staffing efficiencies and decreases expenditures.

3.  Improves the level of service to residents at a lower cost.

a. Potential to maintain Level II, or become a Level III health department, at the same or lesser cost to the tax payers.  With a properly credentialed Health Officer, the Food, Safety and Recreational Licensing (FSRL) program and more staff, the agency will be able to provide improved better services for the same investment. (Based on the number of programs a health department provides including mandated programs, the State of Wisconsin Division of Public Health (DPH) determines the Level of Service (Level) for a health department. DPH then formulates the appropriate allocation of state block grants and categorical dollars to local health departments based on their Level. The higher the Level of health department, the more funding received from the State.)

b. Potential to become an accredited health department by the Public Health Accreditation Board (PHAB), with a reduced cost.

Benefits to Washington County:

1.  Gains access to existing electronic health records, financial and payroll updates from Ozaukee County.

2.  Increases emphasis on coalition work and prevention.

3.  Development of a Child Death Review Team.

Benefits to Ozaukee County:

1.  Increases the number of staff and backup if needed in an emergency or an outbreak.

2.  Gains Food Safety and Recreational Licensing (FSRL) to Ozaukee County businesses and festivals.

Initial estimates show the regionalization will save $300,000 through staffing efficiencies and the reduction of administrative overhead. Reductions to each organization’s budget occurred in 2016 because of this merger.  The intent is to be more efficient while improving the level of service at a lower cost to residents. Other measureable successes in implementation to date include amending state law, execution of resolutions and an intergovernmental agreement in both counties, establishing the joint board of health and reviewing processes/procedures for best practices across counties.  A technology assessment was completed and work towards a common system is ongoing. The new department will also receive a $75,000 grant from the Robert Woods Johnson foundation to measure public health outcomes of the merged department. 

Staff brainstorming department name.

Many challenges providing for lessons relevant to other entities have been realized and we believe these will continue in the coming months.  These include program and policy specific concerns, service level expectations with the new Board of Health, funding unanticipated costs of the regionalization effort such as the purchase of new information systems or hardware and obtaining timely, favorable responses from the State that do not jeopardize grants and funding allocations to the Department. 

One factor that we continue to see as crucial for other entities is the strong relationships and trust that must exist between the Counties and between project leaders that will allow for critical analysis and ability to solve complex issues.  Financial commitment, political commitment and a collective determination to ensuring merger success is absolutely critical.

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