A taxonomy of state public health preparedness units: an empirical examination of organizational structure.

OBJECTIVE: State public health preparedness units (SPHPUs) were developed in response to federal funding to improve response to disasters: a responsibility that had not traditionally been within the purview of public health. The SPHPUs were created within the existing public health organizational structure, and their placement may have implications for how the unit functions, how communication takes place, and ultimately how well the key responsibilities are performed. This study empirically identifies a taxonomy of similarly structured SPHPUs and examines whether this structure is associated with state geographic, demographic, and threat-vulnerability characteristics. DESIGN: Data representing each SPHPU were extracted from publically available sources, including organizational charts and emergency preparedness plans for 2009. A cross-sectional segmentation analysis was conducted of variables representing structural attributes. SETTING AND PARTICIPANTS: Fifty state public health departments. MAIN OUTCOME MEASURES: Variables representing "span of control" and "hierarchal levels" were extracted from organizational charts. Structural "complexity" and "centralization" were extracted from state emergency preparedness documents and other secondary sources. RESULTS: On average, 6.6 people report to the same manager as the SPHPU director; 2.1 levels separate the SPHPU director from the state health officer; and a mean of 13.5 agencies collaborate with SPHPU during a disaster. Despite considerable variability in how SPHPUs had been structured, results of the cluster and principal component analysis identified 7 similarly structured groups. Neither the taxonomic groups nor the individual variables representing structure were found to be associated with state characteristics, including threat vulnerabilities. CONCLUSIONS: Our finding supports the hypothesis that SPHPUs are seemingly inadvertently (eg, not strategically) organized. This taxonomy provides the basis for which future research can examine how SPHPU structure relates to performance measures and preparedness strategies.

Public health spending in 2008: on the challenge of integrating PHSSR data sets and the need for harmonization.

In recent years, state and local public health department budgets have been cut, sometimes drastically. However, there is no systematic tracking of governmental public health spending that would allow researchers to assess these cuts in comparison with governmental public health spending as a whole. Furthermore, attempts to quantify the impact of public health spending are limited by the lack of good data on public health spending on state and local public health services combined. The objective of this article is to integrate self-reported state and local health department (LHD) survey data from 2 major national organizations to create state-level estimates of governmental public health spending. To create integrated estimates, we selected 1388 LHDs and 46 states that had reported requisite financial information. To account for the nonrespondent LHDs, estimates of the spending were developed by using appropriate statistical weights. Finally, funds from federal pass-through and state sources were estimated for LHDs and subtracted from the total spending by the state health agency to avoid counting these dollars in both state and local figures. On average, states spend $106 per capita on traditional public health at the state and local level, with an average of 42% of spending occurring at the local level. Considerable variation exists in state and local public health funding. The results of this analysis show a relatively low level of public health funding compared with state Medicaid spending and health care more broadly.

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]. / O klassifikatsii organizatsionnykh tekhnologii v zdravookhranenii.

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.

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.

Respuestas a problemas y prioridades del sector público 1987-1992 / Replies to problems and priorities of the public sector 1987-1992

Se presenta la relación de solicitudes y planteamientos específicos formulados al Instituto Nacional de Salud Pública (INSP) de México, así como las respuestas a que cada una de ellas dío. Esta relación está dividida en las siguientes secciones: Secretaría de Salud, Servicios de Salud en los Estados, Institutos Nacionales de Salud, Instituto Mexicano del Seguro Social, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Otras Dependencias del Gobierno Federal e Instituciones Educativas. Los cuadros anexos presentan una visión cuantitativa del esfuerzo del INSP en este rubro. En total, el INSP ha atendido 115 solicitudes durante el lapso de 1987 a 1992