Current interest in controlling costs of health care and improving systems of health services leads state governments to consider reorganizing units of government responsible for health. Based on a case study of the 1989 establishment of the Washington State Department of Health, concepts from political science and organizational theory are linked into a process model useful in planning and supporting reorganization of executive branch agencies. With the model in mind, public health professionals can work more effectively to ensure that the paradigm on which a reorganization is based fits desired public health goals, and can make lobbying more effective.