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Measuring the Authority of Local Public Health Directors in the Context of Organizational Structure: An Exploratory, Multimodal Approach

Gearin, Kimberly J. Miner PhD; Thrash, Allison M. Rick MPH; Frauendienst, Renee BSN; Myhre, Julie MS, RN, PHN; Gyllstrom, M. Elizabeth PhD, MPH; Riley, William J. PhD; Schroeder, Janelle BSN, PHN

Journal of Public Health Management and Practice: November/December 2012 - Volume 18 - Issue 6 - p 545–550
doi: 10.1097/PHH.0b013e31825fbbb3
Original Articles

Context: 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.

Objectives: 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.

Design: Multimodal.

Setting: Minnesota local health departments.

Participants: Directors of Minnesota local health departments.

Main Outcome Measure(s): 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.

This descriptive study illustrates that emerging practice-based research networks can successfully collaborate on small-scale research projects with immediate application for systems development.

Office of Performance Improvement, Minnesota Department of Health, St. Paul (Drs Miner Gearin and Gyllstrom and Ms Rick Thrash); Stearns County Department of Human Services, St. Cloud, Minnesota, (Ms Frauendienst); Carlton-Cook-Lake-St. Louis Community Health Board, Duluth, Minnesota (Ms Myhre); School of Public Health, University of Minnesota, Minneapolis (Dr Riley); Mille Lacs County Community and Veterans Services, Milaca, Minnesota (Ms Schroeder).

Correspondence: M. Elizabeth Gyllstrom, PhD, MPH, Office of Performance Improvement Freeman Building, 625 Robert St N, PO Box 64975, St. Paul, MN 55164 (

The authors thank the local health directors who participated in this study and acknowledge the crucial role of the Minnesota Public Health Research to Action Network. This practice-based research network includes members of the Minnesota Local Public Health Association, the State Community Health Services Advisory Committee, the Minnesota Department of Health, and the University of Minnesota, School of Public Health.

The authors are unaware of any conflict of interest from institutional or corporate affiliations. This study was supported by the national Public Health Practice–Based Research Network Program of the Robert Wood Johnson Foundation.

The views of the authors do not necessarily reflect the views of a specific county or local board of health.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.