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