preliminary findings comparative organizational analysis of 11 local health departments
DESCRIPTION
Preliminary Findings comparative organizational analysis of 11 local health departments. Jacqueline Merrill Biomedical Informatics Columbia University AcademyHealth PHSR-IG June 7, 2008. Overview. Sample Framework and data PH Work - PowerPoint PPT PresentationTRANSCRIPT
Preliminary Findings comparative organizational analysis of 11 local health
departments
Jacqueline Merrill
Biomedical Informatics
Columbia University
AcademyHealth PHSR-IG June 7, 2008
Overview
• Sample
• Framework and data
• PH Work
• Preliminary correlations between network and performance
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%
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%
Employee characteristics
AGE
NURSE ENVIRONMENTAL
ALL
The “organization” for network analysis
Resource Requirements
Resources needed for tasks
Interoperability Requirements
Connections among resources
Resources
Precedence Dependencies
Tasks related to tasks
Tasks
Knowledge Requirements
Knowledge needed for tasks
Resources Usage Requirements
Knowledge to use resources
Information Network
Connection among types of knowledge
Knowledge
Assignment Network
Who does what
Resources Network
Who has access
Knowledge Network
Who knows what
Social network
Who talks to whoPeople
TasksResourcesKnowledgePeople
Resource Requirements
Resources needed for tasks
Interoperability Requirements
Connections among resources
Resources
Precedence Dependencies
Tasks related to tasks
Tasks
Knowledge Requirements
Knowledge needed for tasks
Resources Usage Requirements
Knowledge to use resources
Information Network
Connection among types of knowledge
Knowledge
Assignment Network
Who does what
Resources Network
Who has access
Knowledge Network
Who knows what
Social network
Who talks to whoPeople
TasksResourcesKnowledgePeople
A B C D
A 0 0 1 1
B 0 0 1 0
C 1 1 0 1
D 1 0 1 0
A B C D
A 0 0 1 1
B 0 0 1 0
C 1 1 0 1
D 1 0 1 0
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 not18 general, 9 data and information, 15 documents, 12 outside partners
Task Knowledge Resource Minimum Data Set
Terms extracted from
accreditation & evaluation instruments
workforce surveys
competency sets
operational definition
PH business processes
Top 10 tasks %
Use email 90%
Use internet 85%
Phone 84%
Manage files 79%
Meet w/ clients 65%
Process requests 62%
Educate public 59%
Post information 48%
Report data 43%
Serve on committees 43%
Top 10 knowledge items %
Office skills 83%
Job descriptions 83%
Problem solving 77%
Chain of command 77%
Mission 76%
Workplace safety 75%
Policy and procedures 72%
HIPAA regs 67%
Data collection 65%
Diversity 64%
Top 10 adequate resources %
Email access 92%
Internet access 90%
Computer 89%
Desk space 89%
List serve 87%
Co-workers 86%
Safe conditions 86%
Management team 79%
Staff directory 78%
IT staff 76%
Top 10 inadequate resources %
Translator 27%
PDA 25%
Directory community groups 23%
Consumer complaints 23%
County emergency plan 23%
Library of resources 22%
Translated information 22%
Staff development plan 21%
CE 21%
Medicare program staff 20%
Bottom 10 knowledge items %
Genetics 15%
Biostatistics 15%
Ecological model 16%
Screening 23%
Contract requirements 25%
Strategies for partnership 26%
Grant requirements 27%
Risk commo 27%
Env Health 27%
Epidemiology 28%
Top TASKS by occupationADMINTop 10 tasks %Use email 88%Phone 86%Manage files 82%Use internet 78%Process requests 63%Register & enroll 50%Manage inventory 46%Post information 45%Meet w/ clients 45%Process billing 41%
ENVTop 10 tasks %Phone 96%Use email 95%Use internet 94%Enforcement 94%Manage files 92%Investigation 89%Schedule services 88%
Conduct site visits 80%Process requests 75%Educate public 74%
PHNTop 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%
Task to employee drill down
Knowledge to employee drill down
Network measurements
1. CentralizationHierarchy, decisions, dissemination
2. DensityCommunication, cohesion
3. ComplexityIntegration of organizational components
4. Between group (divisions) density“silos”
FOUND A TWO MODE NETWORK STRUCTURE
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
Left Divisions strongest Density .08Centralization .06
Right Divisions all ties Density .19Centralization .52
Env
Clinic
WIC
HlthLiving
MCH Nrsg
Admin
Early Int.
Env
Clinic
WIC
HlthLiving
MCH Nrsg
Admin
Early Int.
Density AllDensity StrongComplexity AllComplexity StrongCentralization AllCentralization StrongReduced Block AllReduced Block Strong
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 organizationsIndicator 4.2Establish community partnerships; local health improvement committee; assess effectiveness of partnerships
Strongest CORRELATIONS w/ Essential Service 4
EPHS40.790.820.520.71
-0.430.090.460.56
Ind 4.1 Ind 4.20.73 0.750.69 0.830.43 0.530.60 0.72
-0.47 -0.360.17 0.030.20 0.580.60 0.48
Are there commonalities between health departments?
LHD1 LHD2 LHD3 LHD4 LHD5 LHD6 LHD7 LHD8 LHD9 LHD10
LHD 1 1.00
LHD 2 0.67 1.00
LHD 3 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
Correlation coefficients comparing network measures in 10 local health departments Pink = correlation ≥ 0.7 Yellow = correlation ≥ 0.5
Missoula
Density .21
106 nodes
Champaign
Density .24
115 nodes
Broome
Density .19
122 nodes
COCONINO
Density .16
136 nodes
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
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
Thank you
What we asked1) Information Exchange: Give/get work info
• not routine • routine not frequent • routine & frequent
2) Knowledge: better than average3) Resources: for routine work
• relevant & available • relevant not available • not relevant
4) Tasks: • assigned • could fill in
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
A B C D
A 0 0 1 1
B 0 0 1 0
C 1 1 0 1
D 1 0 1 0
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