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AbstractCalifornia's Public Health Laboratories: Inter-organizational cooperation models to bolster laboratory capacityBackground: California has 61 local health departments that are currently served by 37 local public health laboratories. These laboratories act as the first line of defense against health threats by providing community disease surveillance, food and environmental safety testing, newborn disease screening, identification of causal agents during an outbreak, and national disease screening for biological agents of warfare, resulting in a decreased burden on the health care system. In January 2009, the Little Hoover Commission released a report "First Year Checkup: Strategies for a Stronger Public Health Department" to address ways in which the California Department of Public Health can improve public health and safety. One of the five major recommendations made was for the California Department of Public Health to continue to provide leadership to strengthen the state's laboratory capacity by helping to facilitate consolidation of county public health laboratories into regional laboratories. Due to the California budget crisis and the shortage of public health laboratory directors qualified to run laboratories, regionalization has been proposed as a strategy to address resource constraints as well as to obtain economies of scale in the provision of laboratory services. However, there is resistance from a subset of county public health laboratory directors as well as county health officers to regionalize local public health laboratories. In addition, neither the California Department of Public Health nor the state has the legal authority or financial resources to enforce county public health laboratory regionalization. The rationale and the feasibility of implementing the Little Hoover Commission's recommendation need to be more thoroughly explored. Purpose: This dissertation research was conducted to incorporate the perspectives of county public health laboratory directors, county health officers, and state public health officials in order to assess whether reorganization of county public health laboratories is a feasible solution to bolster California's public health laboratory capacity. Methodology: Case studies of inter-organizational forms of cooperation among public health laboratories in California were conducted to assess necessary "factors of success" when engaging in an inter-organizational partnership between public health laboratories. Qualitative interviews were also conducted with public health laboratory directors, health officers, and state public health officials to assess 1) the feasibility of public health laboratories engaging in inter-organizational partnerships and 2) the impact that an inter-organizational partnership will have on addressing the state's insufficient PHL capacity. Lastly, policy options aimed at bolstering the state's laboratory capacity were proposed based on findings from the case studies and the interviews. Findings: Analysis of the data collected through the case studies and qualitative interviews with public health laboratory directors, county health officers and state public health officials suggests that an inter-organizational form of cooperation such as a regionalization effort of local county public health laboratories led by the state is not a feasible solution to help bolster laboratory capacity. However, a consolidation effort of public health laboratories led by county administrators and public health laboratory directors through a joint powers agreement is a potential solution for 1) ensuring affordable and continuous provision of public health laboratory testing services for all public health departments and 2) a short-term measure to address the shortage of board certified, doctoral level public health laboratory directors available to supervise laboratories located in rural counties. The three policy options that would be effective at addressing the state's insufficient laboratory capacity include 1) amend the state PHLD requirements, 2) promote locally driven PHL consolidation efforts through utilization of joint powers agreements and 3) provide state funding for PHL services in rural counties.