Regionalization of a Well Surveillance Program Enhances Health Protection and Economies of Scale

State: FL Type: Promising Practice Year: 2015

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The regionalization of a Well Surveillance Program has created economies of scale and increased public health effectiveness. Enhancing health protection is achieved by providing residents with well sampling results and associated health information, creating avenues for receiving state-funded water restoration, and the collection of data that can be applied to identifying and tracking groundwater contamination. Performing these services on a large scale has proven to be more cost-effective and efficient than a more fragmented localized system would allow. This greatly enhances the health protection that is part of the public health mission, and that the FDOH Alachua strives to deliver on a daily basis.

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Alachua County Health Department
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Regionalization of a Well Surveillance Program Enhances Health Protection and Economies of Scale
The Florida Department of Health in Alachua County (FDOH-Alachua) is located at 224 SE 24 Street on the eastside of Gainesville, in North Central Florida.  Alachua is a mediam sized county and is approximatly 875 square miles in area and is surounded by mostly rural counties. Alachua County and the City of Gainesville are an economic and service hub for the area, as well as home to the University of Florida and four major regional hospitals. The estimated population in 2013 was 253,451.  5.6% of this population is under five years of age, 18% is under 18 years of age and 12% is over the age of 65.  This population has an average annual income of $40,644 with 53.3% having home ownership and 23.8% living below poverty.  63.2% are White, 8.9% are Hispanic, 20.4% are Black and 5.7% are Asian. Because 92% of Florida's population relies on groundwater for potable supplies, accurate assessment of known or suspected contamination sites such as underground petroleum tanks or agriculture and industrial areas that can effect potable wells is crucial. Management of the data generated from these assessments provides the basis for appropriate public health responses while increasing  public health protection. This data can only be generated by an efficient and consistent well surveillance program with a comprehensive geographic scope. The dynamics associated with the coordination of an effective well surveillance program at the state level are complex. The inherent challenges require experience with protocols and equipment, while idle periods between well surveillance events inhibit efficient programmatic implementations. To overcome these and other challenges, the FDOH-Alachua has developed a regional Well Surveillance Program that maximizes the human and equipment capital available while providing consistent assessment services to a large rural area that includes thirteen counties covering an area of 8,494 square miles. Regionalization of this program has been going on for over ten years and the number of wells sampled and surveys completed has increased on an annual basis. The increased efficiency is illustrated by the 2013 well surveillance service rate that included 530 wells sampled and 122 well surveys completed. This was accomplished efficiently with the services of one full time employee along with centralized administrative and clerical support. Highlights of the Well Surveillance Program can be found at: http://alachua.floridahealth.gov/programs-and-services/environmental-health/drinking-water/well-surveillance.html    
Because 92% of Florida's population relies on groundwater for potable supplies, accurate assessment of known or suspected contamination sites such as underground petroleum tanks or agriculture and industrial areas that can effect potable wells is crucial. Management of the data generated from these assessments provides the basis for appropriate public health responses while increasing  public health protection. This data can only be generated by an efficient and consistent well surveillance program with a comprehensive geographic scope. The dynamics associated with the coordination of an effective well surveillance program at the state level are complex. The inherent challenges require experience with protocols and equipment, while idle periods between well surveillance events inhibit efficient programmatic implementations. To overcome these and other challenges, the FDOH-Alachua has developed a regional Well Surveillance Program that maximizes the human and equipment capital available while providing consistent assessment services to a large rural area that includes thirteen counties covering an area of 8,494 square miles. Alachua County is north central Florida's economic and service hub. Home to the University of Florida, four major regional hospitals, and the Florida Department of Health in Alachua, (FDOH-Alachua), it supports the region with an array of services, opportunities and amenities. In accordance, the FDOH-Alachua’s Well Surveillance Program is increasingly being tasked with serving surrounding rural counties with technical and staffing support, and programmatic functions that include the following: • Notification to well owners of sample analysis results• Submittal of well survey data to Department of Environmental Protection for scoring analysis and priority ranking• GPS & place FLUWID tags on all potable wells• Collection of water samples from up to 10 wells around a point source• Conducting regular sampling of private drinking water wells in areas impacted by petroleum and solvent contamination• Assisting well owners in well restoration • Completing requested well surveys in 28 days or less• Monitoring wells where there is contamination Assistance to the counties has evolved into a regional Well Surveillance Program managed by the FDOH-Alachua that soon became a model for other regions of the state. Currently, thirteen north central Florida counties rely on the FDOH-Alachua regional program for all of their well surveillance needs. With one point of contact for the Florida Department of Health, efficiencies are increased while equipment requirements and personnel costs have decreased. Consistency in programmatic implementations has resulted in an enhanced delivery of services, which in turn has increased the protection of regional public health.
Food Safety
FDOH-Alachua’s Well Surveillance Program was is increasingly being tasked with serving the surrounding rural counties with technical and staffing support, and programmatic functions. Assistance to the counties was done by request and formalized through a a memorandum of understanding or agreement that has evolved into a regional Well Surveillance Program managed by the FDOH-Alachua.  This soon became a model for other regions of the state. Currently, thirteen north central Florida counties rely on the FDOH-Alachua regional program for all of their well surveillance needs. With one point of contact for the Florida Department of Health, efficiencies are increased while equipment requirements and personnel costs have decreased. Consistency in programmatic implementations has resulted in an enhanced delivery of services and has increased the protection of regional public health.    
Economies of scale are realized when one regional resource replaces individual counties. Aspects of this shared resource model include: Sufficient work-load to have a staff become specialized and involved in the program full time Support staff specialization and full-time involvement Dedicated FTE’s resulting in a reduction of training needs Dedicated equipment that eliminates redundancy and idle time Consistent oversight Reduced turnaround time Consistent reporting and data tracking Reduced labor and equipment costs Regionalization of this program has been going on for over ten years and the number of wells sampled and surveys completed has increased on an annual basis. The increased efficiency is illustrated by the 2013 Well Surveillance Services service rate that included 530 wells sampled and 122 well surveys completed.  This was accomplished with the services of one full time employee along with centralized administrative and clerical support.  Enhancing health protection is achieved by providing residents with well sampling results and associated health information, creating avenues for receiving state-funded water restoration, and the collection of data that can be applied to identifying and tracking groundwater contamination.  Performing these services on a large scale has proven to be more cost-effective and efficient than a more fragmented localized system would allow. This greatly enhances the health protection that is part of the public health mission, and that the FDOH Alachua strives to do deliver on a daily basis.
Sustainability has been realized by the  growth of this regional program over the past ten years. The number of wells sampled and surveys completed has increased on an annual basis with a corresponding improvement in quality. The increased efficiency is illustrated by the 2013 well surveillance service rate that included 530 wells sampled and 122 well surveys completed. This was accomplished with the services of one full time employee along with centralized administrative and clerical support. A 2014 Evaluation of the Florida Department of Health-Alachua Well Surveillance Program from the Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Environmental Health, received 98 weighted percentage points out of a possible 100. Some of the accomplishments included: •    The percentage of requested well surveys completed on time for the past threeyears was 99%, exceeding the Surgeon General' s performance measure of at least 95% of all requested well surveys being completed within the requested time frame. •    The percentage of requested well samples completed on time for the past three years was 99%, exceeding the Surgeon General' s performance measure of atleast 95% of all requested samples being completed within the requested time frame. •    Field staff demonstrated proficiency in their ability to correctly collect samples and did an excellent job of marking bottles, filling out the Analysis Request forms, and packing the cooler. •   Staff demonstrated proficiency in the use of GPS technology, LaserFiche, Oculus, and ArcMap The Alachua Regional Well Surveillance Program received a 2014 Prudential Productivity Team Award for innovation and productivity levels that saved tax payer money.  The FDOH-Alachua will continue to be committed to delivering quality and efficient services to the residents and visitors of north central Florida.
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