Inter-organizational network analysis: A systems approach to health research & practice

1. Inter-organizational network analysis: A systems approach to health research & practice Center for Tobacco Policy Research Saint Louis University School of Public Health Douglas Luke, PhD Jenine Harris, MA

2. I should venture to assert that the most pervasive fallacy of philosophic thinking goes back to neglect of context. • John Dewey, 1931 • Generalizations decay. • - Lee Cronbach, 1975

3. Context dependency of health behavior

4. From systems theory to health promotion via organizational networks • Society must be reconceptualized as a complex network of groups of interacting individuals whose membership and communication patterns are seldom confined to one such group alone. • —Diana Crane, Invisible Colleges (1972) • Health promotion activities (such as tobacco control) can be seen as a complex network of individuals, groups, and organizations. • Network analysis is a tool that connects systems theory to health promotion.

5. Definition • An inter-organizational network is a social structure that connects a collective: group, community, agency, organization, etc. • The connection can be of many types: communication, transmission, affiliation. • The connection can be about many things: money, knowledge, relationship, influence.

7. Katrina – Failure of inter-organizational networks • Inability to communicate between first responders from different agencies • Conflicts and poor communication between levels of government (federal, state, local) • Difficulty integrating private aid and voluntary efforts into official Katrina response

8. Public Health Systems

9. Public Health Systems

10. Public Health Systems

11. Public Health Systems

12. Public Health Systems

13. Three examples • Identifying the core tobacco control program ‘blueprint’ • Charting how inter-organizational networks change in response to challenging fiscal and political conditions • Mapping federal tobacco control leadership to aid in strategic planning

14. Example 1 – Identifying TC organizational blueprint • Use network analysis to examine communication, partnership networks to identify commonalities, differences • Use a technique called block-modeling to identify and present common underlying inter-organizational patterns • Examine fit of individual states to the general blueprint

15. CTPR Evaluated States

16. Contact Network

17. Cooperation Collaboration Not Linked Communication Coordination Partnership Fully linked or integrated Integration Network Not linked or integrated at all- We do not work together at all and have separate program goals. Communication- We share information only when it is advantageous to either or both programs. Cooperation- We share information and work together when any opportunity arises. Coordination- We work side-by-side as separate organizations to achieve common program goals.(e.g., efforts are coordinated to prevent overlap but perform our tasks as separate organizations) Collaboration- We work side-by side and actively pursue opportunities to work together as an informal team. (e.g., attempt to find ways to work together but do not establish a formal agreement or contract- “in the spirit of collaboration”) Partnership- We work together as a formal team with specified responsibilities to achieve common program goals. (e.g., have formally identified common goals and areas of responsibility for each organization, usually outlined in a Memorandum of Understandingor other type of agreement) Fully linked or integrated- We mutually plan, share staff and/or funding resources and evaluate activities to accomplish our common goals. Based on the continuum below, please choose the response that best describes the current relationship between your agency and…

18. Types of agencies in eight state TC programs

19. Florida & Oregon Contact Florida 2004 Oregon 2004

20. Contact Blueprint

21. Integration Blueprint

22. Goodness of fit between individual state networks and general blueprint

23. Example 2 – Charting inter-organizational network changes • What happens to TC networks when funding is cut, or political support changes? • Collect organizational network data at multiple timepoints • Examine how changes may be in response to external conditions

24. Indiana FY04 FY05 FY03 Stability 73% Stability 97% Stability -- -- Density Density Density 0.61 0.48 0.59 Betweenness Betweenness Betweenness 0.14 0.30 0.23 $850M State Budget Deficit $33.8M Tobacco Control Funding $595M State Budget Deficit $300M State Budget Deficit $18.2M Tobacco Control Funding $12.4M Tobacco Control Funding

25. FY03 Stability -- Density 0.61 Betweenness 0.14 Indiana 2003

26. FY04 Stability 73% -- Density 0.48 Betweenness 0.30 Indiana 2004

27. FY05 Stability 97% Density 0.59 Betweenness 0.23 Indiana 2005

28. Example 3 - Mapping the US DHHS tobacco control leadership The Department of Health and Human Services (DHHS) is responsible for planning, guiding, and funding much of the tobacco control and research activity in the US. The activities are carried out within various DHHS agencies. The aim of this Project was to create a map of the tobacco control leadership within the US DHHS. Using social network analysis, we: • Identified the tobacco control leadership network within DHHS • Described five different relational networks within DHHS • Identified individuals who play unique or critical roles in the networks • Identified knowledge and communication gaps in the networks • Examined the characteristics of the networks A map of this sort is important to guide strategic planning for tobacco policy by identifying strengths and challenges related to intra- and inter- agency awareness, communication, and partnerships.

29. Participating Agencies • Administration for Children and Families (ACF) • Agency for Healthcare Research Quality (AHRQ) • Centers for Disease Control and Prevention (CDC) • Centers for Medicare and Medicaid Services (CMS) • Food & Drug Administration (FDA) • Health Resource and Services Administration (HRSA) • Indian Health Services (IHS) • National Institutes of Health (NIH) • National Cancer Institutes (NCI) • Office of the General Counsel (OGC) • Office of the Secretary (OS) • Substance Abuse and Mental Health Services Administration (SAMHSA)

30. Methods and Survey Items Respondents were asked to answer five questions about their colleagues and other DHHS agencies in tobacco control. The responses to these questions were used to develop five networks in five areas: • Awareness of tobacco work • Contact frequency • Formal partnerships • Individual influence • Agency importance We used a web-based survey to collect data; the response rate was 92.5% (50/54 respondents).

31. Awareness Network

32. Contact Network

33. Collapsed Contact Network

34. Inter & Intra Agency Contact

35. What we found • There is a high degree of awareness of tobacco work among individuals across all agencies in DHHS. • CDC, OS, and NCI play central roles in the tobacco leadership networks. • The network maps reveal communication and partnership gaps that might be addressed by future DHHS strategic planning. • This type of network analysis is a useful tool for revealing interorganizational capacity.

36. Why should you care? • First steps in describing the structure of public health systems • System diagnostics – How to improve the system • System access – How to work with the system • Very useful tool for working with organizations, communities – The ‘Ideal Network’ exercise

37. Miscellany • Funding for these projects was provided by NCI, CDC, the American Legacy Foundation, and the Chronic Disease Directors Association. • Copies of this presentation (and other associated works) are available at: http://ctpr.slu.edu • If you have further questions, contact me at dluke@slu.edu