Toward standardized, comparable public health systems data: a taxonomic description of essential public health work

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 (>0.7), 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.

The structure of state health agencies: a strategic analysis

Leaders in public organizations are adopting many private sector management practices to control costs and increase efficiency. Nowhere is this more evident than among state health agencies. State health agencies were encouraged to change the way they operate by the 1988 Institute of Medicine (IOM) report on The Future of Public Health. This report portrayed public health as being in disarray. To address major deficiencies identified by the IOM study, some public health leaders have reevaluated their environments, reconfigured their organizations, and adopted a strategic mindset. The purpose of this research is to explore the various organizational configurations of state health agencies. Replicating methods used in studies of private sector organizations, five distinct strategic configurations or archetypes were identified. This comprehensive public health agency taxonomy will assist future researchers in analyzing public health organizations' environments, structures, and strategies.

[Classification and organization technologies in public health]

The authors discuss the impact and main characteristics of organization technologies in public health and the processes of their development and evaluation. They offer an original definition of the notion "organization technologies" with approaches to their classification. A system of logical bases is offered, which can be used for classification. These bases include the level of organization maturity and stage of development of organization technology, its destination to a certain level of management, type of influence and concentration of trend, mechanism of effect, functional group, and methods of development.