Understanding the local public health workforce: labels versus substance.

BACKGROUND: The workforce is a key component of the nation's public health (PH) infrastructure, but little is known about the skills of local health department (LHD) workers to guide policy and planning. PURPOSE: To profile a sample of LHD workers using classification schemes for PH work (the substance of what is done) and PH job titles (the labeling of what is done) to determine if work content is consistent with job classifications. METHODS: A secondary analysis was conducted on data collected from 2,734 employees from 19 LHDs using a taxonomy of 151 essential tasks performed, knowledge possessed, and resources available. Each employee was classified by job title using a schema developed by PH experts. The inter-rater agreement was calculated within job classes and congruence on tasks, knowledge, and resources for five exemplar classes was examined. RESULTS: The average response rate was 89%. Overall, workers exhibited moderate agreement on tasks and poor agreement on knowledge and resources. Job classes with higher agreement included agency directors and community workers; those with lower agreement were mid-level managers such as program directors. CONCLUSIONS: Findings suggest that local PH workers within a job class perform similar tasks but vary in training and access to resources. Job classes that are specific and focused have higher agreement whereas job classes that perform in many roles show less agreement. The PH worker classification may not match employees' skill sets or how LHDs allocate resources, which may be a contributor to unexplained fluctuation in public health system performance.

The influence of management and environment on local health department organizational structure and adaptation: a longitudinal network analysis.

OBJECTIVE: The nation's 2862 local health departments (LHDs) are the primary means for assuring public health services for all populations. The objective of this study is to assess the effect of organizational network analysis on management decisions in LHDs and to demonstrate the technique's ability to detect organizational adaptation over time. DESIGN AND SETTING: We conducted a longitudinal network analysis in a full-service LHD with 113 employees serving about 187,000 persons. Network survey data were collected from employees at 3 times: months 0, 8, and 34. At time 1 the initial analysis was presented to LHD managers as an intervention with information on evidence-based management strategies to address the findings. At times 2 and 3 interviews documented managers' decision making and events in the task environment. RESULTS: Response rates for the 3 network analyses were 90%, 97%, and 83%. Postintervention (time 2) results showed beneficial changes in network measures of communication and integration. Screening and case identification increased for chlamydia and for gonorrhea. Outbreak mitigation was accelerated by cross-divisional teaming. Network measurements at time 3 showed LHD adaptation to H1N1 and budget constraints with increased centralization. Task redundancy increased dramatically after National Incident Management System training. CONCLUSIONS: Organizational network analysis supports LHD management with empirical evidence that can be translated into strategic decisions about communication, allocation of resources, and addressing knowledge gaps. Specific population health outcomes were traced directly to management decisions based on network evidence. The technique can help managers improve how LHDs function as organizations and contribute to our understanding of public health systems.

Development and evaluation of a prototype search engine to meet public health information needs.

Grey literature is information not available through commercial publishers. It is a sizable and valuable information source for public health (PH) practice but because documents are not formally indexed the information is difficult to locate. Public Health Information Search (PHIS) was developed to address this problem. NLP techniques were used to create informative document summaries for an extensive collection of grey literature on PH topics. The system was evaluated with PH workers using the critical incident technique in a two stage field evaluation to assess effectiveness in comparison with Google. Document summaries were found to be both helpful and accurate. Increased document collection size and enhanced result rankings improved search effectiveness from 28% to 55%. PHIS would work best in conjunction with Google or another broad coverage Web search engine when searching for documents and reports as opposed to local health data and primary disease information. PHIS could enhance both the quality and quantity of PH search results.

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 discipline's 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.

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.

A comparative study of 11 local health department organizational networks.

CONTEXT: Although the nation's 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.