A comparative study of 11 local health department organizational networks

Abstract

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.

FIGURE 1. A Health Department Network at the Divisional Level on the Left Compared With a Traditional Organizational Charta

^a The size of the nodes in the network diagram is related to number of staff in the division. The nonlinear pattern of links between divisions in the network presents a striking contrast to the directed hierarchy of the organizational chart. From Merrill et al.

FIGURE 2. An Example of the Two-Mode Communication Structure in a Local Health Department (LHD): (a) All Ties Showing a More Centralized Network; (b) Strongest Ties Showing a More Decentralized Networka

^a Nodes represent employees, and links represent a relationship between employees (in this case, communication). Gray tones represent programmatic division within the LHD.

FIGURE 3. Bar Graphs Showing the Coefficients of Variation (a) and the Means (b) for 11 Local Health Departments (LHDs) Compared With a Set of Randomly Generated Networks*

*Comparisons are illustrated for employee communication networks. A set of five random networks was generated for each LHD on the basis of the same density. The y-axis in (a) represents a scale for the coefficient of variation, which is a relative term, in which a higher value indicates more variability. LHD networks exhibit much less variability in centralization of their all ties networks and in clustering than random networks. The y-axis in (b) represents mean network measurements (normalized between 0 and 1). LHD networks are more centralized and exhibit more clustering than expected in random networks.