1. Preliminary Findings comparative organizational analysis of 11 local health departments Jacqueline Merrill Biomedical Informatics Columbia University AcademyHealth PHSR-IG June 7, 2008

2. Overview Sample Framework and data PH Work Preliminary correlations between network and performance

3. 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 Response rate 86 – 93%

4. 1240 workers surveyed NurseEnvironmentalAdmin Support % of sample 16%10%23% NACCHO 2005 24.4%10.2%25.8% Enumeration 2000 25%10%12%

5. Employee characteristics

6. AGE NURSE ENVIRONMENTAL ALL

7. The “organization” for network analysis

8. Data we collected — ‘the organization’ 1.Employee x Employee Information Exchange/Communication network 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

9. Task Knowledge Resource Minimum Data Set Terms extracted from accreditation & evaluation instruments workforce surveys competency sets operational definition PH business processes

10. Top 10 tasks% Use email90% Use internet85% Phone84% Manage files79% Meet w/ clients65% Process requests62% Educate public59% Post information48% Report data43% Serve on committees43% Top 10 knowledge items% Office skills83% Job descriptions83% Problem solving77% Chain of command77% Mission76% Workplace safety75% Policy and procedures72% HIPAA regs67% Data collection65% Diversity64% Top 10 adequate resources% Email access92% Internet access90% Computer89% Desk space89% List serve87% Co-workers86% Safe conditions86% Management team79% Staff directory78% IT staff76%

11. Top 10 inadequate resources % Translator27% PDA25% Directory community groups23% Consumer complaints23% County emergency plan23% Library of resources22% Translated information22% Staff development plan21% CE21% Medicare program staff20% Bottom 10 knowledge items % Genetics15% Biostatistics15% Ecological model16% Screening23% Contract requirements25% Strategies for partnership26% Grant requirements27% Risk commo27% Env Health27% Epidemiology28%

12. Top TASKS by occupation ADMIN Top 10 tasks% Use email88% Phone86% Manage files82% Use internet78% Process requests63% Register & enroll50% Manage inventory46% Post information45% Meet w/ clients45% Process billing41% ENV Top 10 tasks% Phone96% Use email95% Use internet94% Enforcement94% Manage files92% Investigation89% Schedule services88% Conduct site visits80% Process requests75% Educate public74% PHN Top 10 tasks% Meet w/ clients91% Use email88% Phone86% Use internet86% Educate public84% Deliver hlth services83% Review records83% Manage files71% Perform screenings66% Process requests62%

13. Task to employee drill down

14. Knowledge to employee drill down

15. Network measurements 1.Centralization 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

16. Left Divisions strongest Density.24 Centralization.29 Right Divisions all ties Density.11 Centralization.52 Admin Account Dental MCH Rantoul Inf Dx Env W&H

17. Left Divisions strongest Density.08 Centralization.06 Right Divisions all ties Density.19 Centralization.52

18. Density All Density Strong Complexity All Complexity Strong Centralization All Centralization Strong Reduced Block All Reduced Block Strong ES 4 MobilizeES 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 Strongest CORRELATIONS w/ Essential Service 4 EPHS4 0.79 0.82 0.52 0.71 -0.43 0.09 0.46 0.56 Ind 4.1Ind 4.2 0.730.75 0.690.83 0.430.53 0.600.72 -0.47-0.36 0.170.03 0.200.58 0.600.48

19. Are there commonalities between health departments?

20. LHD1LHD2LHD3LHD4LHD5LHD6LHD7LHD8LHD9LHD10 LHD 1 1.00 LHD 2 0.671.00 LHD 3 0.640.911.00 LHD 4 0.700.990.951.00 LHD 5 0.720.310.540.381.00 LHD 6 0.580.700.920.770.721.00 LHD 7 0.780.960.920.970.520.781.00 LHD 8 0.100.600.790.630.340.780.551.00 LHD 9 0.690.950.940.950.530.800.960.711.00 LHD 10 0.600.940.810.920.280.620.940.500.891.00 Correlation coefficients comparing network measures in 10 local health departments Pink = correlation ≥ 0.7 Yellow = correlation ≥ 0.5

21. Missoula Density.21 106 nodes Champaign Density.24 115 nodes Broome Density.19 122 nodes COCONINO Density.16 136 nodes

22. Orange* Density.24 165 nodes Putnam* Density.27 97 nodes StLucie Density.28 187 nodes Broome Density.19 122 nodes StJohn Density.31 115 nodes Champaign Density.24 115 nodes Missoula Density.21 106 nodes Burlington Density.16 138 nodes Garland Density.53 42 nodes

23. 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

24. 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

25. Thank you

26. What we asked 1)Information Exchange: Give/get work info not routine routine not frequent routine & frequent 2)Knowledge: better than average 3)Resources: for routine work relevant & available relevant not available not relevant 4)Tasks: assigned could fill in

27. Organizational network analysis tool for understanding complexity empirical, relational, non-linear used for assessment & management decision support

28. Network findings Correlations Performance general score with Density, complexity, centralization, block model density Performance factor scores with Density, complexity, centralization, block model density

29. 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

30. Two mode network