Information outreach to a local public health department: a case study in collaboration.

The delivery of essential public health services depends on the effective use of relevant information by public health employees [1, 2]. Yet, despite the importance of information to the practice of public health, the complex information needs of the public health workforce are not well met [3–8]. This paper describes how the New York Medical College Health Sciences Library and School of Public Health (NYMC) and the New York Academy of Medicine (NYAM) successfully collaborated in collecting data for two separate projects that addressed the information needs of employees in the Dutchess County Department of Health (DCDOH) in New York's Hudson Valley. NYAM additionally partnered with researchers at Columbia University in the Department of Biomedical Informatics and School of Nursing. 
 
Each project required all DCDOH employees to fill out a lengthy survey, and some data elements were common to both surveys. Both projects were funded by the National Network of Libraries of Medicine with the charge that the projects “collaborate when appropriate” because they targeted the same population. DCDOH welcomed the collaboration because it reduced the response burden for its employees.


INTRODUCTION
The delivery of essential public health services depends on the effective use of relevant information by public health employees [1,2]. Yet, despite the importance of information to the practice of public health, the complex information needs of the public health workforce are not well met [3][4][5][6][7][8]. This paper describes how the New York Medical College Health Sciences Library and School of Public Health (NYMC) and the New York Academy of Medicine (NYAM) successfully collaborated in collecting data for two separate projects that addressed the information needs of employees in the Dutchess County Department of Health (DCDOH) in New York's Hudson Valley. NYAM additionally partnered with researchers at Columbia University in the Department of Biomedical Informatics and School of Nursing.
Each project required all DCDOH employees to fill out a lengthy survey, and some data elements were common to both surveys. Both projects were funded by the National Network of Libraries of Medicine with the charge that the projects ''collaborate when appropriate'' because they targeted the same population. DCDOH welcomed the collaboration because it reduced the response burden for its employees.

TARGET POPULATION AND RESEARCH GOALS
The NYMC project aimed to measure and enhance the informatics competencies of public health workers by completing a needs assessment and tailoring a training program to meet the determined needs. It utilized a pretest and posttest survey based on public health informatics competencies from the Centers for Disease Control and Prevention and a Vanderbilt benchmarking instrument [6,9]. The unit of analysis was the individual employee.
The NYAM project aimed to assess the feasibility of modeling the relationship between information use by a health department's employees and the organizational effectiveness of the department using organizational network analysis. The unit of analysis was the organization.
In 2004, NYMC and NYAM independently solicited health officers of the 7 counties in New York's Hudson Valley to participate in their respective projects. * These projects were funded in part with federal funds from the National Library of Medicine, National Institutes of Health, under contract no. N01-LM-1-3521. New York Academy of Medicine data collection and analysis were funded in part by the Center for Evidence-Based Practice in the Underserved (National Institute of Nursing Research, P20 NR007799).
NYMC obtained a commitment from Orange and Putnam Counties to participate in the competency assessment and training project. Subsequently, NYAM obtained a commitment from Dutchess County to participate in the organizational network analysis project. DCDOH, which had 156 employees who delivered a full range of public health services to a population of about 277,000 in a suburban/rural county [10], agreed to participate in the NYMC project as well.

INTERVENTION
The NYMC and NYAM research teams met several times to devise a collaboration that included: (1) dual presentation of the research protocols to DCDOH staff, (2) joint data collection, and (3) data sharing. The project teams grappled with two significant challenges: administering the NYMC and NYAM surveys simultaneously and resolving intellectual property issues.

Survey administration
The NYMC and NYAM survey instruments were developed independently. The NYMC survey collected demographic information and data on job level (front line, senior/technical, supervisory/management, and clerical), public health informatics competencies (selfscored proficiency and relevance to the employee's job for each prescribed proficiency, and a resulting ''gap score''), and a needs assessment. Representative questions from the needs assessment included: What is your job? What information resources do you use or need? What types of informatics training do you need and want?
The NYAM survey asked standard organizational network analysis questions such as: From whom do you get information? To whom do you give information? Who helps you think about problems posed by your work? Do you understand the knowledge and skills this person has? The organizational network analysis was conducted using Organizational Risk Analyzer (ORA), a computational tool for studying complex systems [11]. ORA analyzes relationships between employees, as well as relationships between employees and the tasks they perform and the knowledge and resources they use.
Many variables in the NYMC survey (such as selfreported competencies) were suitable for conversion and import into ORA. This allowed NYAM researchers to test the feasibility of organizational network analysis techniques in a public health department using data elements already established for studying public health organizations. However, NYMC's study was designed to guarantee anonymity, while NYAM's study depended on identifying individuals and their specific  organizational roles and relationships. This methodological problem was resolved by defining a unique identifier for each employee (using birth month and day and four digits of the social security number) and putting it on both surveys to allow post-collection data matching, while preserving the anonymity required by NYMC's pretest/posttest research design. Employees were informed of human subjects' protections for both studies through an information sheet developed in consultation with the DCDOH Human Resources Department. The surveys were jointly administered between May 20 and June 7, 2005. Data collection presented logistical challenges. Scheduling required close collaboration with DCDOH staff in Poughkeepsie and two other sites fifteen to twenty miles away. To encourage a high response rate, nominal gifts were given to all employees who completed the NYMC survey, and a chance to win one of ten $25 gift certificates was offered to all employees who completed both surveys. Survey administration was planned around coffee breaks or lunch with food provided by the research team to minimize disruption of work routines. Figure 1 shows a snapshot of a survey being administered to Dutchess County Department of Health employees.
The surveys were administered six different times on four dates. NYMC and NYAM researchers ran as integrated relay teams, with one team giving out the survey and moving on to the next site and the other team picking up the completed surveys and handing out the incentives.

Intellectual property
Discussions between the researchers resolved issues of intellectual property resulting from the intermingled projects. A formal subcontract between NYAM and NYMC was executed, giving NYAM a limited subset of NYMC's data elements and its data dictionary. The researchers agreed to publish results separately but to acknowledge data sources and collaborating partners.

RESULTS
The collaboration (1) reduced the response burden for DCDOH staff, (2) allowed NYMC to add a third county to its project, and (3) enabled NYAM to acquire data for secondary analysis, producing a win-win-win situation for all. The joint administration of surveys was successful as demonstrated by the high response rates ( Table 1).
The NYMC project found that public health employees both desire and need informatics training that is relevant to their jobs, but that many public health informatics competencies have no relevance for them [12][13][14][15]. The data collected by NYMC led to the development of specialized training programs conducted in targeted sessions. All sessions were hands-on in computer labs, were problem based, and encouraged team interactions. The sessions were highly rated by the participants [13].
The NYAM study demonstrated that organizational network analysis indeed has potential for public health information management [16][17][18][19][20][21][22]. These network insights helped DCDOH managers understand how information flowed in their units as well as throughout the entire organization and supplied evidence they could use to plan for improved performance.

FUTURE DIRECTIONS
Both NYMC and Columbia are independently continuing the work that started in the projects described in this paper. Columbia's organizational network analysis research has expanded to a national focus, while NYMC's work continues its service focus in the Hudson Valley, a target area for both institutions. The willingness of health officials in the seven Hudson Valley counties to participate in joint projects has led to continuing collaboration. The strategic partnership that began with this collaboration continues to focus on ways to achieve public health information outreach. ed surveys; Columbia University: Kristine Gebbie and Suzanne Bakken; the New York Medical College School of Public Health and Health Sciences Library: Deborah Viola, Paul Visintainer, Haldor Lougee-Heimer, and Naveen Deenadayalu; and the New York Academy of Medicine: Lily Pregill, Joan Seidman, and Janie Kaplan.