More than a decade has passed since a conceptual framework was introduced to guide public health services and systems research (PHSSR) and elucidate the relationships associated with system performance. Since then, research has primarily focused on performance, standards, and key processes, with less emphasis on identification of measures or methods. Capacity lies at one end of the conceptual framework, although little emphasis has been placed on measuring and defining “capacity” of the public health system. This is striking, given organizational capacity is a critical determinant of performance and is necessary for understanding systematic effectiveness, sustainability, or generalizability. As a nascent field, PHSSR needs to develop a definition of organizational capacity and elucidate its relationship within a research framework. Evidence must be developed on the temporal and causal relationships between capacity, process/performance, and outcomes. The purpose of this article was to review research frameworks and capacity measures in various disciplines to expand the existing PHSSR conceptual framework.
The article describes the myriad capacity constructs within public health and other research fields and proposes an expanded conceptual model for public health systems and services research (PHSSR) that emphasizes capacity within a systems framework. Also, a list of measures has been highlighted to begin developing a capacity construct specifically for PHSSR.
Lineberger Comprehensive Cancer Center (Dr Meyer), Cecil G. Sheps Center for Health Services Research (Dr Meyer), and Center for Public Health Preparedness (Ms Davis), University of North Carolina, Chapel Hill; and Department of Health Services Management, Center for Public Health Services and Systems Research, University of Kentucky, Lexington (Dr Mays).
Correspondence: Anne-Marie Meyer, PhD, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599 (firstname.lastname@example.org).
The authors thank Dr Edward Baker, Milissa Markiewicz, Jennifer Hegle, Pia MacDonald (North Carolina Institute for Public Health), and Reha Uzsoy (North Carolina State University) for their thoughtful comments and literature suggestions.
This research was carried out by the North Carolina Preparedness and Emergency Response Research Center at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health and was supported by the Centers for Disease Control and Prevention (CDC) grant 1PO1 TP 000296-01. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. Additional information can be found at http://nccphp.sph.unc.edu/ncperrc/.
The authors declare no conflicts of interest.