A network approach to outpatient service delivery systems: Resources flow and system influence

Objective. The study tests a path model for the effects on organizational influence of an organization's centrality in four resource exchange networks in order to gain insight into the network relations that may affect coordination and effectiveness of outpatient health and mental health service systems. Data Sources. Primary data are used from face-to-face interviews with the directors of every organization in the predefined 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; the 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, is modeled as an outcome of the three primary resource exchanges, as well as one of the predictors of influence. Data Collection. Organizations were identified as system members through a modified snowball sampling procedure. Measures of organizational influence and centrality in each of the exchange networks were derived from interviews with all directors about their interactions with each organization in the system. Multiple regression analysis was used to test the path model. Principal Findings. The most important resource in predicting centrality in a general contact network is centrality in a client referral network, while contacts and funds allocation centrality are significant predictors of organizational influence. Conclusions. The organization with the greatest influence within the system (because of its ability to allocate funds) may not be the organization that takes the largest role in terms of coordinating routine contacts (because of its ability to refer clients). This disjuncture may signal a weakness in the coordination network and system effectiveness, since the more influential organization may not be the most knowledgeable one in terms of the needs of the system.