Catalysts of organizational change: What sparks and maintains interest in regional approaches to public health service delivery?

In 2010, the Massachusetts Department of Public Health received a “Strengthening Public Health Infrastructure for Improved Health Outcomes” grant from the Centers for Disease Control (CDC). A major objective of the grant is to form local public health districts. Massachusetts public health leaders have long grappled with the question of how to provide consistent, equitable, and high-quality public health services across the Commonwealth when each municipality (n=351) is responsible for funding and providing its own residents with mandated services. Few cities and towns have been able to consistently offer all state mandated services, and most have little capacity to meet national public health performance standards. The CDC infrastructure grant provides an historic opportunity to reorganize the local public health infrastructure and significantly increase the capacity of local public health authorities to perform essential services. Research conducted in rural public health jurisdictions suggests that regional approaches to public health service delivery can improve the quality and efficiency of services. Such approaches also have political and financial implications for public health services and municipal budgets. This paper will draw on a series of qualitative interviews and observations with local public health officials and municipal leaders who are participating in strategic planning meetings to form regional public health districts. Data presented will include an overview of the driving forces, strategies, and circumstances that influence whether and how change is made in the local public health infrastructure. Lessons learned will be of interest to researchers, policy makers, and local health practitioners considering infrastructure changes.