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 1 062 out of 1 239 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.

Objective. To identify taxonomy of task, knowledge, and resources for documenting the work performed in local health departments (LHDs). Data Sources. Secondary data were collected from documents describing public health (PH) practice produced by organizations representing the PH community. Study Design. A multistep consensus-based method was used that included literature review, data extraction, expert opinion, focus group review, and pilot testing. Data Extraction Methods. Terms and concepts were manually extracted from documents, consolidated, and evaluated for scope and sufficiency by researchers. An expert panel determined suitability of terms and a hierarchy for classifying them. This work was validated by practitioners and results pilot tested in two LHDs. Principal Findings. The finalized taxonomy was applied to compare a national sample of 11 LHDs. Data were obtained from 1,064 of 1,267 (84 percent) of employees. Frequencies of tasks, knowledge, and resources constitute a profile of PH work. About 70 percent of the correlations between LHD pairs on tasks and knowledge were high (40.7), suggesting between-department commonalities. On resources only 16 percent of correlations between LHD pairs were high, suggesting a source of performance variability. Conclusions. A taxonomy of PH work serves as a tool for comparative research and a framework for further development.

Background Public health systems and services research (PHSSR) examines the organization, financing, and delivery of public health services and the impact of these activities on population health. An accurate description of this PHSSR is needed to empower funding agencies and other stakeholders, to coordinate PHSSR activities, and to foster the development of the field. Purpose To characterize the emerging community of researchers engaged in PHSSR. This study 1) describes dynamics of this growing community; and 2) identifies distinct topics being researched, communities of practice within PHSSR, and collaboration among groups. Methods Co-authorship network visualization of selected research publications in the Medline bibliographic database. Results PHSSR has emerged gradually since 1988, with noticeable growth after 1994 and after 2004. The network of PHSSR research has a core-periphery structure. The core of this network includes highly collaborative researchers focusing on topics pertaining directly to PHSSR, such as the public health workforce, quality improvement and performance, law, and information infrastructure. The periphery consists of groups publishing either more generally on various health services research topics, or on epidemiologic, clinical, or health sciences topics. Conclusions While a nucleus group of productive and engaged individuals participate in PHSSR, most authors are also involved in general health services research, issues of population health, or health science topics unrelated to PHSSR. An overview of collaboration in PHSSR is an important step in advancing a coordinated research agenda and attracting sustainable funding streams for this field.