title: Current and planned shared service arrangements in Wisconsin local and tribal health departments.
abstract: OBJECTIVE
  The objective of this study was to explore current and future use of shared service arrangements as a management strategy to increase capacity to provide public health essential services in Wisconsin.
  
  
  METHODS
  An online cross-sectional survey of 99 local and tribal health departments in Wisconsin was conducted. Select variables from the 2010 Wisconsin Local Health Department Survey were merged. Other data sources included results from a Board of Health governance analysis and the Wisconsin Department of Health Services region data. Descriptive analysis was performed of current and future shared service arrangements and the characteristics of the types of arrangements and agreements in place.
  
  
  RESULTS
  Ninety-one of 99 Wisconsin local and tribal health departments responded, yielding a 92% response rate. Seventy-one percent of respondents currently share services with 1 or more other health departments. More frequent arrangements were present in programmatic areas than in departmental operations. Most frequently reported motivators include making better use of resources, providing better services, and responding to program requirements. Extensive qualitative comments indicate arrangements accomplished what the local health department hoped it would with perceived gains in efficiency and effectiveness.
  
  
  CONCLUSIONS
  There is widespread use of shared services among health departments in Wisconsin. Extensive qualitative comments suggest participant satisfaction with what the arrangements have accomplished. Motivating factors in developing the arrangements and limited mention of expiration dates suggest continued study of how these arrangements may evolve. Further examination of shared services as a potential mechanism to advance service effectiveness and efficiency is needed.
authors.affiliation: Institute for Wisconsin's Health, Madison (Ms N. Young and Mr D. Young); Eau Claire City-County Health Department, Eau Claire, Wisconsin (Ms Giese); Medical College of Wisconsin, Milwaukee (Mr Brandenberg); and School of Nursing, University of Wisconsin-Madison (Dr Zahner). Dr Madamala is an independent public health systems consultant.
authors.forename: Kusuma
authors.initials: K
authors.lastname: Madamala
authors.forename: Nancy
authors.initials: N
authors.lastname: Young
authors.forename: Dustin
authors.initials: D
authors.lastname: Young
authors.forename: Lieske
authors.initials: L
authors.lastname: Giese
authors.forename: Terry
authors.initials: T
authors.lastname: Brandenberg
authors.forename: Susan
authors.initials: S
authors.lastname: Zahner
mesh_terms: D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D014481:United States; D016549:United States Indian Health Service / Q000458:organization & administration* / Q000706:statistics & numerical data*; D014922:Wisconsin