Appendix C: Network Analysis
A. Overview
of Network Analysis1
The Collaborative aims to help the nine participating firms
work together to reduce racial and ethnic disparities among their members. To
understand more fully the relationships between participants in the
Collaborative and learn how the Collaborative functions, we conducted network
analyses of the Collaborative. The analyses provide tools for assessing
whether the support organizations are offering assistance (and through what
channels) and whether participating firms are interacting with one another.
The analyses also provide a means of examining whether the sponsor
organizations are perceived as visible and active participants in the
Collaborative. In addition, the analyses offer some indication as to whether
certain organizations contribute more to the Collaborative than others and/or
benefit more from their participation. Specifically, the network analyses
allow us to capture organizations' perceptions of contributions and benefits,
and whether these contributions and benefits are equal across participating
organizations.
Brief Overview of Findings. The results of the network
analysis indicate that the sponsor organizations and primary support
organizations play a central role in the Collaborative. They have the most
contact with participating firms and form the primary pathways that link
participants (including both firms and nonfirm organizations). Firm-to-firm
relations are much less prevalent than firm-to-nonfirm relations. In fact,
interactions and influence between firms are generally quite limited outside
the Collaborative, a result that may be expected and even appropriate given the
competitive environment in which participating firms operate. Nonetheless,
most organizations participating in the Collaborative find each other
important, and most respondents report that other organizations are carrying
out their responsibilities and commitments to the Collaborative, at least to a
small extent. A few of the firms—namely, one national and one regional
firm—stand out as more important and influential members of the Collaborative
than other firms.
Background. Network theory focuses on the
relationships and ties among actors or organizational entities (Wasserman and
Faust 1994). Even though network analysis may capture individual actors'
attributes, its focus is on relational patterns between actors. Such analysis
can be used as a purely descriptive tool, but we relied on the analysis to
develop an understanding of the relationships that promote or impede the
Collaborative's ability to work effectively in addressing concerns related to
disparities. We applied the tools of network analysis to describe the
relationships among the organizations participating in the Collaborative and to
identify relevant network properties that shed light on the Collaborative's
outcomes.
The network analyses for the evaluation focus on relationships
and perceptions between participating organizations in the Collaborative
rather than within participating organizations. While the Collaborative
hopes to affect the internal workings of participating organizations, our focus
on relationships between participants is appropriate given that the
Collaborative is most committed to developing inter-organizational ties.
Moreover, an analysis of the network structure within each participating
organization was not possible given the size and complexity of participating
firms (especially the national firms) and the scope of the evaluation.2
Methods. To collect information on the relationships
between and perceptions of organizations participating in the Collaborative, we
developed a network feedback form based roughly on an instrument developed by
Van de Ven and Ferry (1980). We used questions from the instrument that were
most relevant for assessing the Collaborative and modified question wording to
make sense in the context of the Collaborative. The feedback form included two
primary sets of questions:
- Nine questions about the Collaborative overall,
such as whether the Collaborative has been worthwhile and whether it has
influenced the organization's activities.
- Eight questions (including one two-part question) about
relations between and assessments of other Collaborative participants,
such as the extent of communication between the respondent's organization and
each of the other organizations outside of Collaborative meetings and the
influence of other organizations on the respondent's organization with respect
to disparities.
Select for the feedback form.
We asked the lead contact at each firm, support organization,
and sponsor organization to complete the feedback form in late
2005—approximately 15 months after the start of the Collaborative. Although we
did not receive some forms until January 2006, we achieved a 100 percent
response rate (15 organizations). Some respondents, however, did not complete
certain portions of the feedback form—particularly questions that asked
respondents to assess the contributions of other organizations participating in
the Collaborative—leading to substantial item nonresponse on a few questions.
In fact, we dropped Question 15 ("To what extent has your organization changed
or influenced other organizations with respect to disparities?") from the
analysis because half of the Collaborative's 15 organizations did not answer or
answered "cannot assess." Question 13 ("To what extent has each organization
carried out its responsibilities and commitments involving disparities in
regard to the Collaborative during the past six months?") also resulted in
relatively high non-response, with 6 organizations rating few or no other
organizations. We still present the results of Question 13, however, noting
the missing data. For other questions in which respondents were asked to rate
other organizations, two organizations often did not provide ratings.
Even though we achieved full cooperation on the network
feedback form among Collaborative participants, the number of respondents
remains small (15). Therefore, while a systematic analysis of national versus
regional firms (as well as other types of participating organizations) would be
interesting, the sample size does not support it. However, we do observe some
interesting differences in firms versus nonfirm organizations (i.e., sponsor
and support organizations) and draw such distinctions in this chapter where
appropriate. We also distinguish among key support organizations (CHCS and
RAND), other support organizations (GMMB and IHI), and sponsors (AHRQ and RWJF)
on certain dimensions of the analysis as appropriate as the three sets of
organizations have distinct roles in the Collaborative.
Caveats. An important caveat in examining the network
analyses relates to the reliance on self-reported data. While analyses of
networks frequently rely on self-reports, any given organization's frame of
reference varies from that of other organizations. Moreover, some
organizations may be more forthcoming or unbiased in their ratings than
others. In some ways, the fact that organizations are asked to rate one
another for our network analyses provides a partial check on self-reports; for
example, Organization A may report that it fulfilled its commitments to the
Collaborative, but other organizations may report that Organization A did not
fulfill its commitments. Such unreciprocated claims may provide clues about the
appropriate operation (or not) of the Collaborative.
An additional caveat is that an effective collaboration can
occur in many different ways. Not all participants need to be highly
communicative or influential. An extremely "dense" network—in which all
participants communicate with all others—is actually inefficient. Therefore,
while we draw out certain findings in this chapter, our analysis is not
necessarily meant to be normative but rather is descriptive of the
Collaborative process and its early outcomes as far as resulting action and
change.
The remainder of this chapter focuses on participating
organizations' overall perceptions of the Collaborative, followed by various
analyses of the Collaborative network.
B. Overall Perceptions of the
Collaborative
The network feedback form first asked the lead contact from
each participating organization to provide feedback on the Collaborative as a
whole by responding to a core set of nine questions as follows:
- Overall, how important was the Collaborative in attaining the
goals of your organization?
- To what extent has the Collaborative carried out its
responsibilities and commitments?
- To what extent has your organization carried out its
responsibilities and commitments to the Collaborative?
- To what extent do you feel the relationship between your
organization and the Collaborative is productive?
- To what extent is the time and effort spent in developing and
maintaining the relationship with the Collaborative worthwhile?
- Overall, to what extent are you satisfied with the relationship
between your organization and the Collaborative?
- To what extent has your organization changed or influenced the
activities of the Collaborative?
- To what extent has the Collaborative changed or influenced the
activities of your organization?
- Are the payoffs of the Collaborative for your organization
reasonable relative to your contribution?
As presented in Table C.1, all but one participating
organization felt that the Collaborative was at least somewhat important to
attaining organizational goals (Question 1). In fact, 10 of the 15
organizations in the Collaborative (6 of the 9 firms and 4 of the 6 nonfirm
organizations) reported that the Collaborative was very important or crucial
for achieving organizational goals with regard to reducing health disparities.
On average, organizations felt that the Collaborative has carried out its
responsibilities and commitments "to a considerable extent," with firms
slightly more positive than other (nonfirm) organizations (Question 2).
When asked to rate their own organization on carrying out
responsibilities and commitments to the Collaborative, almost all organizations
were very positive (Question 3). Two of the firm representatives (both from
national firms), however, indicated that their organizations carried out their
responsibilities and commitments only to "a little extent" (one) or "some
extent" (one). Almost all respondents reported that the relationship between
their organization and the Collaborative is productive and worthwhile
(Questions 4 and 5); support and sponsor organizations were somewhat more
positive than firms on these dimensions. Likewise, all organizations reported
that they were satisfied with the relationship between their organizations and
the Collaborative to at least some extent (Question 6).
Support and sponsor organizations reported changing or
influencing Collaborative activities more than firms did (Question 7), a
response that is probably not surprising given these organizations' roles in
shaping the Collaborative and working with firms on a one-on-one basis. In
comparison, firms were more likely than other organizations, however, to say
that the Collaborative had changed or influenced their organization's
activities, with 6 of the 9 firms saying to a "considerable extent" or "great
extent" (Question 8). All organizations said that the payoffs of the
Collaborative were reasonable relative to contribution, with firms somewhat more positive on this
dimension than sponsor and support organizations (Question 9).
Clearly these responses paint a positive picture of the
Collaborative overall. Although there was relatively little variation in the
average response across questions, respondents across all organizations were
most positive about the time and effort required by the Collaborative being
worthwhile and least positive about the extent to which the Collaborative
influenced the respondent's own organization (the latter of which was driven by
the responses of sponsor and support organizations rather than by those of
firms).
C. Relationships
in the Context of Collaborative Goals
The network feedback form also included a series of eight
questions to assess the presence and strength of relationships between Collaborative participants, and the corresponding answers provide the data for
our network analyses. These questions asked respondents to rate all other
participating organizations on various dimensions, such as their influence, the
extent to which they carried out their responsibilities and commitments, and
their contribution of good ideas to the Collaborative. For each question,
respondents assessed each of the other 14 organizations using an ordered
response scale (such as to no extent, to a little extent, to some extent, and
to a considerable extent).
The following section describes four categories of findings
from our network analyses: (1) the strength of pre-existing ties, (2) how the
Collaborative works, (3) the perceived contributions to organizational action,
change, and influence, and (4) the overall standing of participating
organizations. We mapped Questions 10 through 17 from the feedback form into
the first three categories above (based on the dimension reflected in each
question). In addition, we use information from Questions 10 through 17 to
create measures of overall standing. A large amount of missing data led to the
exclusion of Question 15 ("To what extent has your organization changed or
influenced other organizations?") from our analyses.
1. Strength of Pre-existing
Ties
The feedback form queried respondents about relationships that
existed prior to the start of the Collaborative between an organization's
participants in the Collaborative and those of each of the other
organizations. While prior relationships are not a prerequisite for a
successful collaborative, they do reveal information about the extent of
existing relationships and provide information about the relations formed
during the Collaborative. They suggest relationships that were needed in order
to undertake joint work for the Collaborative.
A two-part question (Question 10 of the network feedback form)
captured: (1) any personal acquaintance with the key Collaborative staff from
each organization before formation of the Collaborative and (2) if that
acquaintance existed, the extent to which the respondent's organization had an
effective working relationship with the other organizations. The main findings
include the following:
- The sponsor organizations reported a prior acquaintance with all or
almost all other participants before the start of the Collaborative. The
support organizations each had prior acquaintance with at least 8 of the other
14 organizations, though the key support organizations reported knowing fewer
organizations than other support organizations prior to the start of the
Collaborative.
- Conversely, at least 10 organizations (and more than 10 for some
organizations) reported a prior acquaintance with the sponsor organizations and
key support organizations before the start of the Collaborative.
- One national firm reported a prior acquaintance with all other members
of the Collaborative. In general, however, firms varied substantially in the
number of organizations with which they had a prior acquaintance, with the
average firm acquainted with four other organizations before the
Collaborative.
- Eleven of the 14 other organizations in the Collaborative (including 6
of the 8 other firms) indicated a prior acquaintance with one particular
national firm. (This was not the same firm that reported a prior
acquaintance with all members of the Collaborative.)
- In only a few instances did two firms both report mutual acquaintance
with one another (firm-to-firm "reciprocated" ties), perhaps reflecting the
competitive environment between firms or maybe a difference in perceptions
across respondents about the definition of a prior acquaintance.
- When asked whether their organization had an effective working
relationship before the Collaborative with organizations for which respondents
reported an existing acquaintance, participants most commonly reported
effective working relationships with the sponsor organizations. Participants
also reported effective working relations with the key support organizations on
a relatively frequent basis. That is, before the Collaborative began, firms
were more likely to have effective working relations with sponsors or support
organizations than with one another.
2. The Collaborative
Process
Understanding the Collaborative process—including if and how
much participants communicate and share information with one another—is
essential to uncovering the ways in which the Collaborative might effect
change. Three questions included in the network feedback form provide
information on the Collaborative process and the way the Collaborative
functions (Questions 11, 13, and 17). The questions provide some sense of the
success of the Collaborative process in terms of communicating, carrying out
commitments, and providing ideas. These questions are:
- During the past six months—outside of formal Collaborative meetings—how
frequently have people from your organization who are involved in the
Collaborative communicated or been in contact with people in the organizations
listed below?
- To what extent has each organization carried out its responsibilities
and commitments involving disparities in regard to the Collaborative during the
past six months?
- Which organizations provide good ideas for dealing with disparities at
meetings of the Collaborative?
Communication. Sponsor and support
organizations reported a substantial amount of communication with each other
outside of formal Collaborative meetings; in fact, communication between
nonfirm entities represents the most "dense" part of the communication network.
A fair amount of communication also occurs between the two key support
organizations and firms. This result is not surprising and is consistent with
what we understand to be the way the Collaborative works—an approach that lends
itself to extensive consultation between individual support organizations and
firms and then among the support organizations in order to coordinate efforts.3 A number of organizations
also reported communication with GMMB, though substantially fewer than the
number reporting communication with the two key support organizations. This
finding is consistent with the fact that GMMB has communicated about media
toolkits with firms' communications departments, particularly in late 2005
(when the feedback form was distributed).
Outside of formal Collaborative meetings, firm-to-firm
communication was limited. Only a few firms reported communicating with other
firms, with regional firms reporting the large share of such communications.
Three firms (two national and one regional) reported no communication with any
other firm outside of Collaborative meetings. It is possible that the lack of
such communication explains why firms found it valuable to rely on sponsors to
convene the Collaborative as a vehicle for addressing competitive or other
barriers to communication.
Figure C.1 provides an illustration of communication between
participants. The first six rows of the figure correspond to the 6 sponsor and
support organizations (labeled s1 through s6 and listed in a random order), and
the remaining nine rows correspond to the firms (labeled f1 through f9 and
listed in a random order).4
The rows represent how a given organization rates each of the organizations
listed in the columns (which represent the 6 sponsor and support organizations,
followed by the 9 firms, from left to right). For example, boxes 2 through 15
of the first row show how support organization 1 rated all other organizations
(S2, S3, and so forth) in the Collaborative. The shaded blocks in the figure
represent some level of communication, with darker shades indicating more
frequent communication. The black squares represent the strongest ties between
Collaborative organizations. White boxes indicate no communication between
organizations, and red boxes indicate missing data. (Blocks on the figure's
diagonal are in light red, given that organizations did not rate themselves.) Consistent with the discussion above, the figure shows that most
communication occurs between nonfirm organizations and between firms and nonfirms
rather than between firms.
Carrying Out Responsibilities and Commitments. With
the caveat that a substantial amount of data is missing for the question on
responsibilities and commitments, most organizations that rated other
organizations felt that others were carrying out their commitments and
responsibilities to at least a little extent. (In terms of missing data, four
of the nine firms rated few or no other organizations, and two of the support
organizations did not rate other organizations.) Only one organization, a
national firm, reported that four other (mostly national) firms were not
carrying out their responsibilities and commitments. Generally, firms tended
to rate other firms as carrying out their responsibilities "to a little extent"
or "to some extent" and rated other (nonfirm) organizations more favorably.
Support and sponsor organizations rated firms much more favorably on
commitments and responsibilities than firms rated each other.
Figure C.2 provides an illustration of the network analysis of
commitments and responsibilities. Again, darker shading indicates that the
rated organization is seen as carrying out its responsibilities and commitments
to a greater rather than lesser extent (with the darkest boxes indicating "to a
considerable extent" and white boxes indicating "to no extent"). It is
important to note the large amount of missing data, shown in red.
Providing Good Ideas. When asked to rate other
organizations on whether they provided many, some, or no good ideas (Question
17), most organizations were rated by others as providing the Collaborative
with at least "some good ideas" (Figure C.3). Firms and nonfirm organizations
alike often rated the two key support organizations and the two sponsors as
providing many good ideas. In addition, one national firm and one regional
firm were identified by over half of the other organizations in the
Collaborative as providing many good ideas. Conversely, two national firms
were identified by nearly half of the other organizations as providing no good
ideas. One firm saw only three other Collaborative organizations (all support
organizations) as a source of good ideas. Six of the participating
organizations saw all other organizations as sources of good ideas. The red
diagonal squares reflect the undefined "self-ties" in the network.
3. Perceived Contributions
of Collaborative Participants to Action and Change
While understanding the Collaborative process is important,
the Collaborative's ultimate aim is to bring about outcomes, namely,
organizational action and change in reducing racial and ethnic disparities
among participating firms. We therefore wanted to assess whether any
organizations were particularly important or influential (or not) with respect
to the Collaborative, perhaps spurring others to action. Three questions in
the network feedback form help provide information on the perceived
contribution of other participating organizations to a given organization's
actions and goals (Questions 12, 14, and 16) in terms of each organization's
importance, productivity, and influence relative to the other organizations.
These questions are:
- Overall, how important was each organization's work through the
Collaborative in attaining the goals of your organization with respect to
disparities?
- To what extent do you feel the relationship between your organization
and each of the other organizations with respect to disparities is productive?
- During the past six months, to what extent has each of these other
organizations changed or influenced the activities of your organization with
respect to disparities?
While many other factors unrelated to the Collaborative's
structure—including external and internal factors—could influence whether a
given organization sees its relationships with other organizations as
productive or influential, the three questions provide some information on the
Collaborative's possible effects or outcomes.
Importance of Others. Firms generally rated
nonfirm organizations as at least moderately important in helping the firms
attain their disparities-related goals (where the scale included not at all
important, somewhat important, moderately important, very important, and
crucial). However, few firms identified other firms as important to their
organizational goals, with the most common ratings "not at all important" and
"somewhat important." Firms' ratings of nonfirms make sense given that sponsor
and support organizations were directly involved with helping firms with their
work on disparities. It may be that most firms did not find other firms
important in meeting their organizational goals, given that firms may have
different goals and may be uncomfortable sharing their goals (given the
competitive environment).
Sponsor and support organizations generally rated each other
as at least moderately important to attaining organizational goals. Similarly,
sponsor and support organizations tended to rate firms as at least moderately
important to organizational goals. Thus, all three groups perceived that
sponsors and support organizations were at least moderately important to the success
of the Collaborative, but firms were less likely than the other groups to
perceive other firms as important to them.
Figure C.4 provides an illustration of the importance of other
organizations. (Note that one nonfirm organization did not rate other
organizations.) Again, boxes with darker
shading indicate stronger relationships, and white boxes show cases where an
organization is "not at all important." Assessments of other organizations as
not important are concentrated in the firm-to-firm ties. Again, it is important
to stress that this result is not necessarily an adverse finding because
participants bring different objectives to their participation in the
Collaborative.
Productive Relationships with Others. When asked about
the productivity of relationships with other Collaborative participants, most
organizations saw their relationships with others as productive at some level
(i.e., at least "to a little extent"). This finding suggests that participants
see value in their participation. Collaborative participants most frequently
reported considerably productive relationships with the key support organizations and the sponsor
organizations. All other organizations received only a few nominations (three
or four at most) for providing a relationship that is productive to a
considerable extent. Conversely, four organizations—three national firms and
one regional firm—viewed relationships with a handful of other firms as not
productive.
Figure C.5 provides a graphic representation of organizations
reporting considerably productive relationships with other organizations
participating in the Collaborative. Sponsor and support organizations are
shown as rectangles and firms as ovals. The lines or "ties" between
organizations with a single arrow reflect one of the two organizations in the
pair reporting a productive relationship with the other organization (with the
receiving organization being the one with which the relationship is
considerably productive). Lines or ties with no arrows indicate that both
organizations reported considerably productive relations with one another. The
figure reflects the fact that, as described above, many organizations report
considerably productive relationships with the sponsor and support
organizations (shown as rectangles). Most firms are viewed as offering
considerably productive relationships by only a few other organizations in the
Collaborative.5
Influence of Others. Collaborative participants were
asked to assess the extent to which other organizations in the Collaborative
changed or influenced the activities of their own organizations relative to
disparities. The sponsor and support organizations are reported to have the
most influence on other Collaborative members (one of the key support
organizations and one of the sponsors have the most influence). Only one
organization (a regional firm) reported no external influence from any other
Collaborative members. The results indicate that, with one possible exception,
all of the organizations in the Collaborative have been influenced by other
participants.
4. Overall Findings of
Organizational Standing
To understand where participating organizations fit relative
to one another, we also developed a general index of relative standing (Doreian
1986; Doreian 1987) of Collaborative members. Standing is determined by three
factors. First, organizations have greater standing if they receive more
"nominations," that is, many others identify them as
influential or important. Second, greater standing is associated with
nominations of greater strength (e.g., influence is "considerable" rather than
"little"). Third, organizations have greater standing if their nominations
come from other organizations with high standing. While we computed relative
standing for several dimensions (importance, responsibilities and commitments, productive
relationships, source of good ideas), we report only on overall findings in the
interest of brevity.
Consistent with the findings above, the analysis of relative
standing revealed that the two key support organizations and two sponsors
generally have the highest standing in the Collaborative. (The same did not
hold for the measure of standing related to source of good ideas; some firms
rated higher than nonfirm organizations on this measure.) In addition, one of
the national firms consistently had relatively high standing across several
dimensions, as did one of the regional firms.
The analysis of relative standing also revealed some important
information on the Collaborative as a whole. Most notably, there are no
outliers in the distributions of relative standing.6 In other words, even though
participating organizations vary in their standing, no one organization stands
out as extremely important or extremely unimportant to the Collaborative. For
many social networks, where choices tend to concentrate on a small number of
network actors, standing measures produce skewed distributions in which a few
actors are viewed as extremely important or extremely unimportant.7 The analysis of standing
suggests that the National Health Plan Collaborative has good potential for
collaborative learnings, given the relative equality in standing across
organizations.
D. Review of Key Findings and
discussion
Several important findings emerged from our network analyses
as follows:
- First and foremost, the key support organizations and sponsor
organizations play a central role in the Collaborative. Not only are they
visible and active participants in the Collaborative process, but they also
appear to act as the "glue" that holds the Collaborative together. They have
the most contact with participating firms and form the primary pathways that
link participants. The sponsor and support organizations also engage in a
substantial amount of contact with one another. Key support and sponsor
organizations also play an important role in contributing to action and change
among other organizations.
- Firm-to-firm relations are much less prevalent than firm-to-nonfirm
relations. In terms of process measures such as communication, interactions
between firms are limited (though a few firms are seen as providing many good
ideas to the Collaborative process). Regarding firm-to-firm measures of action
and influence, only a few firms reported considerably productive relationships
with other firms, and influence between firms is limited.
- Still, most organizations participating in the Collaborative find each
other important, and most respondents report that other organizations are
carrying out their responsibilities and commitments to the Collaborative, at
least to a small extent.
- As suggested in the discussion of participants' overall standing, a few
of the firms—namely, one national and one regional firm—stand out as more
important and influential members of the Collaborative than other firms.
Conversely, several firms consistently ranked toward the bottom of the measures
of standing. These results likely suggest that some firms are contributing
more than others. Organizations' ratings of whether the Collaborative is
productive and worthwhile and whether it yields a reasonable payoff compared
with the level of organizations' contributions are all fairly favorable and do
not appear to vary greatly with by organizational standing (though one national
firm with low standing tended to rate the Collaborative lower than other firms).
Given these findings, what are the implications for the
Collaborative? And does the current structure represent a "healthy" network?
While our network analyses reveal that firms rarely communicate with each
other, such an approach may be completely appropriate. Contact and
communication occur through other pathways, namely, the support and sponsor
organizations. Interactions between organizations consume time, and it would
be highly inefficient for all organizations in a network to communicate with
each other. In fact, organizations interacting in a network face several
strategic issues in securing resources or access to resources and obtaining
favorable network locations (Burt 1990). In seeking favorable locations, no
organization can afford to communicate with all other organizations unless
required by its role. It follows, in general, that networks requiring
substantial resources to form and maintain relationships should not be
complete. In addition, given the competitive nature of the health plan
industry, it is not surprising that firms generally do not communicate with one
another outside of formal Collaborative meetings. Unless firms operate in
different markets (as is the case with regional firms) or have some business
imperative for additional collaboration, they may well limit their contact with
one another. Moreover, it is probably unrealistic to expect higher levels of
cross-firm contact in the future, particularly between national firms.
Nonetheless, despite the possibility of logical reasons for limited
firm-to-firm contact, some firms—namely, regional firms, which may be less
concerned about competition—may be less satisfied than other organizations with
the Collaborative's network structure.
Participating organizations came to the Collaborative with
different motivations, as confirmed by the findings of the network analysis.
Several firms reported in interviews that they wanted to learn what other firms
were doing in the area of racial and ethnic disparities while fewer firms explicitly
expressed an interest in making changes. Further, though firms did not
necessarily say that they were reluctant to share information, the way they
described their internal clearance processes made it clear that release of
firm-specific information is an important threshold decision for a firm. These
motivations and constraints therefore reveal some information as to why the
Collaborative's network structure looks as it does.
1. While MPR staff drafted this chapter, Patrick Doreian, a consultant to the
project based at the University of Pittsburgh, guided the overall analysis and
design of the network component of the evaluation. Mr. Doreian helped identify
relevant items and is responsible for most of the analysis that we considered
in framing findings from the work.
2. To understand firms' internal relationships related to reducing disparities, we
employed the less formal approach of structured interviews with firm
participants. We had originally hoped to explore communications systematically
among senior executives and various line managers in order to develop a sense
of the existence and strength of relations but found that the organizational
structures were so complex and our interviews too limited to fully support
this. However, Chapter III provides an analysis of how the Collaborative is
positioned within each firm and the degree to which the firm is known for its
work related to the Collaborative or, more generally, for its work on
disparities.
3. The Collaborative was structured so that RAND provided technical assistance to
firms—particularly on geocoding and surname analysis activities—and CHCS
organized meetings of the Collaborative and collected periodic status reports
from firms. Often, staff from several support organizations participated
together as a team on individual calls with a firm, and frequent conference
calls (known as "operational committee" calls) were conducted to help support
and sponsor organizations prepare and coordinate their activities as part of
the Collaborative.
4. Although organizations are de-identified and listed in a random order in the
figures presented in this chapter, we do use the same ordering of organizations
in Figures C.1 through C.4.
5. The absence of a line or tie between organizations indicates that a given
organization either reported that its relationship with the other organization
is not productive to a considerable extent or did not answer the question.
6. For this analysis, we used box plots and interquartile ranges (refer to Koopmans
1987). The interquatile range is the difference between the first and third
quartiles. Any data points more than 1.5 times the interquartile range above
the third quartile (or the corresponding distance below the first quartile) are
sufficiently extreme to be regarded as outliers.
7. An example of organizations in a social service delivery network with such a
distribution of a small number of high outliers is provided in Doreian (1999).
Return to Contents
Current as of December 20, 2006
Internet Citation:
Evaluation of a Learning Collaborative's Process and Effectiveness to Reduce Health Care Disparities Among Minority Populations. Program Evaluation. December 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/evaluations/learning/
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