A NETWORK APPROACH TO OUTPATIENT SERVICE DELIVERY SYSTEMS - RESOURCESFLOW AND SYSTEM INFLUENCE

Objective. The study tests a path model for the effects on organizatio nal influence of an organization's centrality in four resource exchang e networks in order to gain insight into the network relations that ma y affect coordination and effectiveness of outpatient health and menta l health service systems. Data Sources. Primary data are used from fac e-to-face interviews with the directors of every organization in the p redefined service systems in three urbanized counties in Oregon. Each system consisted of 19 to 20 organizations. Data were collected during 1986 and 1987. Study Design. The path model contains five variables: the major dependent variable is attributed organizational influence; t he independent variables are three sets of primary resource exchanges: funds allocation, client referrals, and client inflow. An intervening variable of general network contacts, as an informational resource, i s modeled as an outcome of the three primary resource exchanges, as we ll as one of the predictors of influence. Data Collection. Organizatio ns were identified as system members through a modified snowball sampl ing procedure. Measures of organizational influence and centrality in each of the exchange networks were derived from interviews with all di rectors about their interactions with each organization in the system. Multiple regression analysis was used to test the path model. Princip al Findings. The most important resource in predicting centrality in a general contact network is centrality in a client referral network, w hile contacts and funds allocation centrality are significant predicto rs of organizational influence. Conclusions. The organization with the greatest influence within the system (because of its ability to alloc ate funds) may not be the organization that takes the largest role in terms of coordinating routine contacts (because of its ability to refe r clients). This disjuncture may signal a weakness in the coordination network and system effectiveness, since the more influential organiza tion may not be the most knowledgeable one in terms of the needs of th e system.