When the Forum is approached by local governments, school districts, and civic leaders to consider possibilities for service sharing and consolidation, we typically warn that such efforts should not be undertaken if the sole objective is to save substantial sums of money. Instead, the primary benefit may lie in the opportunity to enhance service levels and quality at no extra taxpayer expense.
Not surprisingly, that’s a key takeaway from the Forum’s new report on possible public health consolidation in Oak Creek and South Milwaukee, which we released earlier today.
On the program side, we find that a consolidated health department could help resolve existing staff recruitment challenges, enhance programming capacity and quality, improve billing and reimbursement, and eliminate redundant administrative functions. On the financial side, we find that while significant savings are unlikely to materialize, existing appropriations could be combined to produce higher-quality services.
The report was commissioned by the two cities last December. Since July 2016, they have maintained a temporary agreement under which South Milwaukee’s Public Health Officer is serving as interim Public Health Officer for Oak Creek. The study considers a broader spectrum of service sharing options, ranging from the long-term continuation of a shared Public Health Officer to full-scale health department consolidation.
We begin by analyzing general demographic and health-related data in the two cities as a means of assessing their potential compatibility for joint public health services. That analysis shows that while Oak Creek is larger in population and is likely to grow much faster than South Milwaukee, South Milwaukee’s public health needs are greater on a per capita basis than those of Oak Creek, and perhaps comparable overall.
The report next considers existing public health staffing in the two communities, as well as public health activity levels and budgets. We find that despite their differences in geographical size and population, South Milwaukee and Oak Creek provide similar types and levels of public and environmental health services and devote remarkably similar amounts of resources and staffing to deliver those services.
Overall, while similarity of service needs, levels, and expenses are not prerequisites for successful service sharing or consolidation initiatives, it can make it easier for communities to reach agreement on such initiatives. Clearly, such similarities exist between South Milwaukee and Oak Creek.
After discussing a series of service-level, organizational, and fiscal policy considerations, the report concludes by suggesting that the two cities enhance service sharing under a phased approach that ultimately could produce full consolidation.
Under Phase I, the two cities would move toward shared administration by formalizing the agreement to share a Public Health Officer; enhancing collaboration among their respective Deputy Public Health officers; merging Oak Creek’s environmental health function into the existing South Milwaukee Environmental Health Consortium, which includes Cudahy and St. Francis; and sharing a Public Health Specialist.
Phase II, which could occur concurrently or shortly after implementation of the first phase, would involve sharing of administrative services and initiation of joint programming in certain priority areas.
Phase III would consist of full consolidation, though the two cities could stop short in the event that governance and cost allocation details cannot be worked out. Our hypothetical consolidation model calls for a jointly appointed Board of Health; the continuation of fully staffed offices in both cities (though the department would be administratively housed in Oak Creek); and a staffing model that would boost nursing and environmental health staff capacity without an increase in cost. Among the potential benefits would be enhanced recruitment and retention of qualified staff in key positions; the ability to develop a nurse staffing model that emphasizes specialization in priority program areas; and enhanced programmatic capacity produced by economies of scale.
We also point out that Cudahy and St. Francis could be approached to consider participating in a larger consolidated South Shore Health Department given that the two cities already share environmental health services with South Milwaukee. The seven municipalities in the northern part of Milwaukee County similarly have formed a North Shore Health Department.
The report will be considered by public health boards and common councils in the two cities in the near future.