Jonathan W. Keeling

A Comparative Study of 11 Local Health Department Organizational Networks

CONTEXT Although the nations local health departments (LHDs) share a common mission, variability in administrative structures is a barrier to identifying common, optimal management strategies. There is a gap in understanding what unifying features LHDs share as organizations that could be leveraged systematically for achieving high performance. OBJECTIVE To explore sources of commonality and variability in a range of LHDs by comparing intraorganizational networks. INTERVENTION We used organizational network analysis to document relationships between employees, tasks, knowledge, and resources within LHDs, which may exist regardless of formal administrative structure. SETTING A national sample of 11 LHDs from seven states that differed in size, geographic location, and governance. PARTICIPANTS Relational network data were collected via an on-line survey of all employees in 11 LHDs. A total of 1062 out of 1239 employees responded (84% response rate). OUTCOME MEASURES Network measurements were compared using coefficient of variation. Measurements were correlated with scores from the National Public Health Performance Assessment and with LHD demographics. Rankings of tasks, knowledge, and resources were correlated across pairs of LHDs. RESULTS We found that 11 LHDs exhibited compound organizational structures in which centralized hierarchies were coupled with distributed networks at the point of service. Local health departments were distinguished from random networks by a pattern of high centralization and clustering. Network measurements were positively associated with performance for 3 of 10 essential services (r > 0.65). Patterns in the measurements suggest how LHDs adapt to the population served. CONCLUSIONS Shared network patterns across LHDs suggest where common organizational management strategies are feasible. This evidence supports national efforts to promote uniform standards for service delivery to diverse populations.

Toward standardized, comparable public health systems data: a taxonomic description of essential public health work.

OBJECTIVE To identify taxonomy of task, knowledge, and resources for documenting the work performed in local health departments (LHDs). DATA SOURCES Secondary data were collected from documents describing public health (PH) practice produced by organizations representing the PH community. STUDY DESIGN A multistep consensus-based method was used that included literature review, data extraction, expert opinion, focus group review, and pilot testing. DATA EXTRACTION METHODS Terms and concepts were manually extracted from documents, consolidated, and evaluated for scope and sufficiency by researchers. An expert panel determined suitability of terms and a hierarchy for classifying them. This work was validated by practitioners and results pilot tested in two LHDs. PRINCIPAL FINDINGS The finalized taxonomy was applied to compare a national sample of 11 LHDs. Data were obtained from 1,064 of 1,267 (84 percent) of employees. Frequencies of tasks, knowledge, and resources constitute a profile of PH work. About 70 percent of the correlations between LHD pairs on tasks and knowledge were high (>0.7), suggesting between-department commonalities. On resources only 16 percent of correlations between LHD pairs were high, suggesting a source of performance variability. CONCLUSIONS A taxonomy of PH work serves as a tool for comparative research and a framework for further development.

Evolution of Coauthorship in Public Health Services and Systems Research

CONTEXT Public health services and systems research (PHSSR) focuses on the structure, organization, and legal basis of domestic public health activities and their effect on population health. An accurate description of the field is needed to empower funding agencies and other stakeholders to coordinate PHSSR activities and to foster the development of the field. The purpose of the study is to characterize the emerging community of researchers engaged in PHSSR. This study (1) describes dynamics of this growing community and (2) identifies research themes, subgroups within the field, and collaboration among groups. EVIDENCE ACQUISITION Coauthorship network visualization of selected research publications in the MEDLINE bibliographic database between 1988 and May 2010. EVIDENCE SYNTHESIS PHSSR has emerged gradually with noticeable growth after 1994 and after 2004. The network of PHSSR research has a core-periphery structure. The core includes highly collaborative researchers focusing on topics pertaining directly to PHSSR, such as workforce, quality improvement and performance, law, and information infrastructure. The periphery consists of groups publishing either on general health services research topics or on epidemiologic and clinical topics. CONCLUSIONS Although a nucleus group of productive and engaged individuals participate in PHSSR, most also publish broadly on health services research and population health. This trend suggests that this emerging field cannot yet support a singular focus on PHSSR. Lack of funding sources and defined career paths likely contribute to this pattern. An overview of collaboration in PHSSR is an important step in advancing a coordinated research agenda and attracting sustainable funding streams for this field.

Growth of a scientific community of practice public health services and systems research.

BACKGROUND Public health services and systems research (PHSSR) is an emerging discipline that examines the organization, financing, and delivery of public health services. PURPOSE The objective of this descriptive study is to provide insight into the disciplines growth by examining the researchers, practitioners, and policymakers who are engaged in PHSSR and their expertise, sources of funding, collaboration patterns, productivity, and challenges. METHODS A 27-item online survey was conducted and analyzed in 2010. It targeted 2067 individuals who had participated in PHSSR groups, meetings, and events since 2004. The response rate was 41%. Descriptive statistics characterized demographics, expertise and mentoring, funding, publication, and collaboration. RESULTS Half of the community members became involved in 2004 or after. More than 40% of the community collaborates in some form. Challenges include knowledge distribution, an agenda to secure ongoing funding, and translating research evidence to public health practice. CONCLUSIONS A clear resource for the community is a nucleus of productive and engaged members who foster its growth.

Examination of the Relationship between Public Health Statute Modernization and Local Public Health System Performance

OBJECTIVES Wide variation in performance of public health (PH) systems, coupled with national interest in improving PH system quality, makes it a priority to identify factors associated with performance. One factor may be congruence between a states PH enabling statutes and the obligations outlined in Public Health in America-the collaboratively developed framework that defines the mission and essential services (ESs) of PH. SUBJECTS This research examined the relationship between (1) the degree to which language in a states PH enabling statutes reflects PHs mission and ESs and (2) the performance of local public health systems in delivering ESs, measured by National Public Health Performance Standards scores in 207 local jurisdictions. METHODS Binary logistic regression demonstrated that a high degree of congruence between statutory language and public healths mission increased the odds of above-average system performance for 5 of 10 ESs. RESULTS High levels of congruence between statutory language and the ESs themselves increased odds of above-average system performance for 6 of 10 ESs. Results yielded modest odds ratios (<2.0). CONCLUSIONS Limitations of the data make it impossible to draw firm conclusions; however, these modest results suggest that statutory language may account for little of the variation in local public health system performance.

Preliminary Findings from an Interventional Study using Network Analysis to Support Management in Local Health Departments in Florida

Management is the core service that integrates and coordinates essential public health services. Managers of local health departments (LHDs) are experts in practice but may not have expertise in organizational management. We conducted an evidence-based training intervention in 10 LHDs in Florida to support managers’ decision-making on organizational integration and coordination. We deployed a standard survey to collect organizational network measurements pre and post intervention. We presented results as evidencebased performance feedback and interviewed managers to document how they used the results in the context of each organization. Post intervention we found unexpected, significantly higher network centralization in daily work. We attributed this increase in hierarchical communication to preparations for a statewide accreditation initiative. When QI initiatives are undertaken globally within a state, managers and leaders need to be alert for possible impact on autonomous decision-making of professionals at the point of service which could affect service delivery. Cover Page Footnote Acknowledgement This study was supported by Florida State Department of Health Contract # A5530C and # A5F4B5. This article is available in Frontiers in Public Health Services and Systems Research: http://uknowledge.uky.edu/frontiersinphssr/ vol2/iss6/6 anagement is the core service that integrates and coordinates essential public health services. Managers of local health departments (LHDs) are experts in practice but may not have expertise in organizational management. We conducted an evidence-based training intervention in 10 LHDs in Florida to support managers’ decision-making on organizational integration and coordination. We deployed a standard survey to collect organizational network measurements pre and post intervention. We presented results as evidence-based performance feedback and interviewed managers to document how they used the results in the context of each organization. Post intervention we found unexpected, significantly higher network centralization in daily work. We attributed this increase in hierarchical communication to preparations for a statewide accreditation initiative. When QI initiatives are undertaken globally within a state, managers and leaders need to be alert for possible impact on autonomous decision-making of professionals at the point of service which could affect service delivery.