Columbia University School of Nursing study finds “Clumps” and “Gaps” typify public health social network

At a time when the nation’s health care system is relying more than ever on the diffusion of innovative ideas and best practices to increase efficiency and decrease costs, a new study now shows that that the nation’s peer-to-peer network for public health executives to be more effective.

Research from the emerging field of social network analysis revealed that local health department executives tend to talk to each other in small groups of twos and threes, mainly within state boundaries.

“Professional social networks are recognized as an important vehicle for influencing ideas about practices that are valuable and effective,” says lead author Jacqueline Merrill, RN, MPH, DNSc, of Columbia University School of Nursing. “Overall, the gaps in information flow suggest that a direct peer-to-peer network is currently not the main way local health officials tend to communicate about administrative, professional and leadership issues in public health.”

The paper, “Topology of Local Health Officials’ Advice Networks: Mind the Gaps,” was recently published in the Journal of Public Health Management Practice.

The researchers investigated how top executives in local health departments communicate about substantive issues using the data from the National Association of County and City Health Officials 2010 National Profile Survey. Merrill and her colleagues constructed network diagrams representing communication links between local health departments which were augmented by attributes such as geographic location and size. Other characteristics were included to assess the overall terrain, or topology, of the communication network making visible communication patterns and the geographic distribution of links in the network.

In a typical diffusion model, health officials at the periphery of the information network would rely on communication and ideas spreading from a central well-connected core. In this case, researchers found that the connections were sparse at both the center and the periphery of the network, a pattern which could slow down the diffusion of ideas, but also suggests potential for improvement. Further, there was no sign that a central group of health officials served as thought leaders or coordinated the flow of information with the rest of the network. A picture emerges, says Merrill, which shows an average health official at the local level who has only a few direct ties to peers, and a small effective network within his or her local area.

In order to effectively spread the news about best practices and other innovations, the public health system could benefit from a communication network where health officials’ are connected to one another in greater numbers.

“The more information each health official knows about the activities of their public health peers, the more opportunities there are for best practices to spread through the system,” says Merrill. “Information and influence might focus on professional issues such as culture change regarding quality improvement, enhanced leadership techniques, or improved business practices,” she says.

“All public health practice is local, but not all innovation is local,” Merrill adds. Her team is now working on a computer simulation of communication flow that could guide interventions to increase the spread of information in the health officials’ advice network.