Preliminary Findings
comparative organizational
analysis of 11 local health
departments
Jacqueline Merrill
Biomedical Informatics
Columbia University
Overview
•
•
•
•
Sample
Framework and data
PH Work
Preliminary correlations between network
and performance
AcademyHealth PHSR-IG June 7, 2008
Sample
• National sample 11 local health departments
–
–
–
–
–
3 mixed
2 centralized
5 independent
All but one served a designated “metro” area
Persons/sq. mile: 6 (AZ) – 526 (NJ)
• Site selection
– Size 36 – 186 employees
– Latest date of NPHPS assessment and score
– Willingness
1240 workers surveyed
Nurse
Environmental Admin
Support
% of sample
16%
10%
23%
NACCHO 2005
24.4%
10.2%
25.8%
Enumeration
2000
25%
10%
12%
• Response rate 86 – 93%
AGE
ALL
Employee characteristics
NURSE
ENVIRONMENTAL
The “organization” for network analysis
People
Data we collected — ‘the organization’
People
Knowledge
Resources
Tasks
Social network
Who talks to who
Knowledge Network
Who knows what
Resources Network
Who has access
Assignment Network
Who does what
1.
Employee x Employee
Information Exchange/Communication network
Knowledge
Information Network
Connection among
types of knowledge
Resources
Resources Usage
Requirements
Knowledge to use
resources
Knowledge
Requirements
Knowledge needed for
tasks
Interoperability
Requirements
Connections among
resources
Resource
Requirements
Resources needed for
tasks
Tasks
1.
Employee x Task = 44 tasks done for routine work
22 administrative tasks and 22 service tasks
2.
Employee x Knowledge = 53 knowledge “better than avg”
15 administrative, 22 program and policy, 6 analytic, 7 PH
science
4.
Employee x Resource = 54 resources adequate or not
18 general, 9 data and information, 15 documents, 12
outside partners
Precedence
Dependencies
Tasks related to tasks
A
B
C
D
A
0
0
1
1
B
0
0
1
0
C
1
1
0
1
D
1
0
1
0
Top 10 tasks
Task Knowledge Resource
Minimum Data Set
Terms extracted from
90%
Use internet
85%
Phone
84%
Manage files
Report data
79% Top 10 knowledge
items
65%
Office skills
62%
Job descriptions
59%
Problem solving
48%
Chain of command
43% Mission
Serve on
committees
Workplace safety
43% Policy and procedures
Meet w/ clients
accreditation & evaluation instruments
workforce surveys
competency sets
operational definition
PH business processes
%
Use email
Process requests
Educate public
Post information
HIPAA regs
Data collection
Diversity
%
83%
Top 10 adequate
83% resources
77% Email access
%
92%
77% Internet access
76%
Computer
75%
Desk space
72%
List serve
67%
Co-workers
65%
Safe conditions
64%
Management team
90%
Staff directory
78%
IT staff
76%
89%
89%
87%
86%
86%
79%
Top TASKS by occupation
Bottom 10
knowledge items
%
Top 10 inadequate
resources
%
27%
Genetics
15%
Translator
Biostatistics
15%
PDA
25%
Ecological model
16%
Directory community groups
23%
Screening
23%
Consumer complaints
23%
Contract requirements
25%
County emergency plan
23%
Strategies for partnership
26%
Library of resources
22%
Grant requirements
27%
Translated information
22%
Risk commo
27%
Staff development plan
21%
Env Health
27%
CE
21%
Epidemiology
28%
Medicare program staff
20%
PHN
Top 10 tasks
%
Meet w/ clients
91%
Use email
88%
Phone 86%
Use internet
86%
Educate public
84%
Deliver hlth services 83%
Review records
83%
Manage files
71%
Perform screenings
66%
Process requests 62%
ENV
ADMIN
Top 10 tasks
%
Top 10 tasks
%
Phone 96% Use email
88%
Use email
95% Phone 86%
Use internet
94% Manage files
82%
Enforcement
94% Use internet
78%
Manage files
92% Process requests
63%
Investigation
89% Register & enroll
50%
Schedule services 88% Manage inventory 46%
Conduct site visits
80% Post information
45%
Process requests 75% Meet w/ clients
45%
Educate public
74% Process billing
41%
Task to employee drill down
Knowledge to employee drill down
Left Divisions strongest
Network measurements
Right Divisions all ties
1. Centralization
Density
.24
Centralization
.29
Density
.11
Centralization
.52
Admin
Account
Dental
MCH
Rantoul
Inf Dx
Env
W&H
Hierarchy, decisions, dissemination
2. Density
Communication, cohesion
3. Complexity
Integration of organizational components
4. Between group (divisions) density
“silos”
FOUND A TWO MODE NETWORK STRUCTURE
Left Divisions strongest Density
Centralization
.08
.06
Early Int.
Strongest CORRELATIONS w/ Essential Service 4
Admin
EPHS4
MCH Nrsg
Right Divisions all ties Density
Centralization
.19
.52
HlthLiving
WIC
Clinic
Env
Density All
Density Strong
Complexity All
Complexity Strong
Centralization All
Centralization Strong
Reduced Block All
Reduced Block Strong
0.79
0.82
0.52
0.71
-0.43
0.09
0.46
0.56
Ind 4.1 Ind 4.2
0.73
0.75
0.69
0.83
0.43
0.53
0.60
0.72
-0.47 -0.36
0.17
0.03
0.20
0.58
0.60
0.48
ES 4 Mobilize community partnerships and action to identify and solve health problems
Indicator 4.1
Identify key constituents; encourage participation in community health activities;
maintain directory of community health organizations
Indicator 4.2
Establish community partnerships; local health improvement committee; assess
effectiveness of partnerships
Correlation coefficients comparing network measures in 10
local health departments
Pink = correlation ≥ 0.7
Yellow = correlation ≥ 0.5
LHD1 LHD2 LHD3 LHD4
Are there commonalities
between health departments?
LHD5 LHD6 LHD7 LHD8 LHD9 LHD10
LHD 1
1.00
LHD 2
LHD 3
0.67 1.00
0.64 0.91 1.00
LHD 4
0.70 0.99 0.95
1.00
LHD 5
0.72 0.31 0.54
0.38
1.00
LHD 6
0.58 0.70 0.92
0.77
0.72 1.00
LHD 7
0.78 0.96 0.92
0.97
0.52 0.78 1.00
LHD 8
0.10 0.60 0.79
0.63
0.34 0.78 0.55 1.00
LHD 9
0.69 0.95 0.94
0.95
0.53 0.80 0.96 0.71 1.00
LHD 10
0.60 0.94 0.81
0.92
0.28 0.62 0.94 0.50 0.89 1.00
Orange*
Putnam*
Garland
Density .24
Density .27
Density .53
165 nodes
97 nodes
42 nodes
Burlington
Champaign
COCONINO
Density .24
Champaign
Density .16
StLucie
Density .24
136 nodes
Density .28
Density .16
138 nodes
115 nodes
187 nodes
115 nodes
Broome
StJohn
Density .19
Density .31
122 nodes
115 nodes
Missoula
Density .21
106 nodes
Broome
Density .19
Missoula
122 nodes
Density .21
106 nodes
Management effects
“It has changed the way we think about the organization”
• COMMUNICATION--monthly all staff
meeting, all staff emails, recognizing
people, director reports at weekly meetings
• Re-organize space
• Hiring
• Data sharing
• Social initiatives
Ongoing
• Complete database
• Establish baselines
• Multiple regression to explain between
group variance
• Non linear regression to explain variability
in performance
• Repeat study w/ one LHD to determine
network effect of managerial change
• Exploratory data analysis
What we asked
1) Information Exchange: Give/get work info
Thank you
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not routine
routine not frequent
routine & frequent
2) Knowledge: better than average
3) Resources: for routine work
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•
•
relevant & available
relevant not available
not relevant
4) Tasks:
•
•
Organizational network analysis
• tool for understanding complexity
• empirical, relational, non-linear
• used for assessment & management
decision support
A
B
C
D
A
0
0
1
1
B
0
0
1
0
C
1
1
0
1
D
1
0
1
0
assigned
could fill in
Network findings
• Correlations
Performance general score with Density,
complexity, centralization, block model
density
Performance factor scores with Density,
complexity, centralization, block model
density
PH Work Findings
Top ten tkr backup and resources needed
Mean median & mode on # of PHN Env &
Admin staff
Mean median mode age, years in PH
Range # of prof, technicians, management &
admin staff
Pairwise correlations TKR between PHN
and Env, PHN & admin, Env & admin
Two mode network