Cynthia D. Lamberth

Public Health Delivery Systems: Evidence, Uncertainty, and Emerging Research Needs

The authors review empirical studies published between 1990 and 2007 on the topics of public health organization, financing, staffing, and service delivery. A summary is provided of what is currently known about the attributes of public health delivery systems that influence their performance and outcomes. This review also identifies unanswered questions, highlighting areas where new research is needed. Existing studies suggest that economies of scale and scope exist in the delivery of public health services, and that key organizational and governance characteristics of public health agencies may explain differences in service delivery across communities. Financial resources and staffing characteristics vary widely across public health systems and have expected associations with service delivery and outcomes. Numerous gaps and uncertainties are identified regarding the mechanisms through which organizational, financial, and workforce characteristics influence the effectiveness and efficiency of public health service delivery. This review suggests that new research is needed to evaluate the effects of ongoing changes in delivery system structure, financing, and staffing.

Public Health Performance

This review examines past, current, and future issues in developing and using public health performance data for improving the public health system. Issues are explored relating to public health performance data collection and analysis, and inferences made from those data, largely by examining public health performance data collected since the Year 2000. More research is needed to improve understanding of the context in which public health systems operate and how that context affects performance and its relationship to health outcomes. There are major areas of concern that must be addressed by the public health practice organizations, governmental public health entities, and the public health systems research communities, such as ensuring that data are collected on public health infrastructure, practice, and performance and that data from various sources are collected in a harmonious fashion. At issue also is the examination of the impact of new arrivals to the public health system, such as accreditation and credentialing of the public health workforce, on public health system performance.

Public Health Systems and Services Research: Bridging the Practice-Research Gap.

Public health practitioners understand the principles of evidence-based prac-tice and the science that should drive their efforts to improve the community’s health through the implementation of science-driven public health programs. However, the translation of research to practice still has numerous barriers. This commentary provides suggestions to strengthen the link between research and practice.

The Influence of Instructor-Student Rapport on Instructors’ Professional and Organizational Outcomes

Students and teachers have relational goals and needs, yet little research has examined the relational goals of instructors and how achieving those goals may affect instructor outcomes. This study examined instructors’ perspectives on instructor-student rapport. Results revealed that instructors who build rapport with students are likely to experience teaching satisfaction, affective commitment to the institution, and enhanced teaching efficacy. However, instructor-student rapport was not related to instructor morale. The findings in this study highlight the importance of positive instructor-student relationships in the classroom and the implications for both instructors and administrators.