title: Measuring the authority of local public health directors in the context of organizational structure:  an exploratory, multimodal approach.
abstract: BACKGROUND
  Studies have reported a relationship between the organization of public health services and variability in public health practice at the local and state levels. A national research agenda has prioritized practice-based research to understand pathways that lead to this variation and examine the impact of these differences on outcomes.
  
  
  OBJECTIVE
  To measure the extent to which Minnesota local health directors report having key authorities and examine the relationship between organizational structure and authority of local health directors.
  
  
  METHODS
  : Multimodal.
  
  
  METHODS
  Minnesota local health departments.
  
  
  METHODS
  Directors of Minnesota local health departments.
  
  
  METHODS
  Director authorities.
  
  
  RESULTS
  Most Minnesota local health directors reported having 6 key authorities related to budget preparation and modification and interaction with local elected officials (n = 51, 71%). Twelve directors (16%) reported that they have 4 or fewer of the 6 authorities. The authority most commonly reported as lacking was the authority to initiate communication with locally elected officials (n = 15, 21%). The percentage of directors who reported having all 6 authorities was higher among those in stand-alone departments (82%) than those in combined organizations (50%).
  
  
  CONCLUSIONS
  This descriptive study illustrates that emerging practice-based research networks can successfully collaborate on small-scale research projects with immediate application for systems development. Study findings are being used by local public health officials to help articulate their role, aid in succession planning, and inform elected officials, who need to consider the public health implications of potential changes to local public health governance and organization. More studies are needed to refine measurement of authority and structure.
authors.affiliation: Office of Performance Improvement, Minnesota Department of Health, St. Paul, MN 55164, USA.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Miner Gearin
authors.forename: Allison M Rick
authors.initials: AM
authors.lastname: Thrash
authors.forename: Renee
authors.initials: R
authors.lastname: Frauendienst
authors.forename: Julie
authors.initials: J
authors.lastname: Myhre
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Gyllstrom
authors.forename: William J
authors.initials: WJ
authors.lastname: Riley
authors.forename: Janelle
authors.initials: J
authors.lastname: Schroeder
mesh_terms: D003657:Decision Making; D019538:Health Care Surveys; D006298:Health Services Administration; D006801:Humans; D009111:Local Government; D008910:Minnesota; D011635:Public Health Administration