Residents of rural communities have poorer health status than people living in more populated areas. For example, The Urban and Rural Health Chartbook notes that the age-adjusted death rate among younger (1-24 years of age) persons who live in the most rural counties is 31 percent higher than those who live in the most urban counties and 65 percent higher for those who live in suburban counties (Eberhardt, Ingram, Makuc et al., 2001). Explanation for the health disparity experienced by rural residents is complex due to the influence of both community factors and the socioeconomic and behavior patterns of individuals. Access to health care, including preventive care, as well as substantial challenges with health literacy, higher instances of smoking, and lack of health insurance among rural residents, are some of the main causes of this disparity. Rural health networks have been touted by many involved with rural health issues as an effective way to address the health disparity experienced by rural areas. The last fifteen years have seen a growth in the development of rural health networks, with a growing number of grantors, e.g. the Health Resources and Services Administration, The Robert Woods Johnson Foundation and states such as New York, Florida, and West Virginia, funding their development. However, little research has been done on the effectiveness of rural health care networks. While some have evaluated rural health networks, Wellever explains that many questions are left unanswered with "the most fundamental question — whether rural health networks benefit either their members or the rural residents they serve" (1999, p. 133). Thus, it needs to be determined if health networks are in fact a viable means for improving the disparity in rural health and, more importantly, what can be done to make them more effective. This research provides insight into the correlates of effectiveness for a type of health network, vertically integrated rural health networks. Provan and Milward's (2001) framework for evaluating the effectiveness of public-sector organizational networks, which proposes three levels of analysis, i.e., the community, network, and organization/participant, was adapted to analyze the effectiveness of vertically integrated rural health networks. One-on-one interviews, questionnaires, and archival data were used to collect data on the networks sampled. Primarily, data was collected from four networks that were chosen from a larger sample of twenty-one networks to serve as best practices. Analysis of the data collected revealed a few significant predictors for the effectiveness of vertically integrated rural health networks. Financing was found to be the most important predictor, as it was significant at both the community and network levels. Both cohesiveness and the number of problems in the rural environment were also found to be significant predictors but only at the network level. No significant predictors were found at the organizational level; however, organizational and network-level effectiveness were found to be strongly correlated with each other. Overall, networks were found to be more favorable about their effectiveness at the network and organizational levels. / Ph. D.

While government contracting out its work continues to proliferate and studies about this phenomenon have increased during the past two decades, still little is known about how effective government sponsored networks are at managing broad and complex networks of primarily non-governmental entities. This dissertation reports the results of one such investigation, which examined a U.S. federal agency's contracting experiences in evidence-based health care. The Agency for Healthcare Research and Quality (AHRQ) is a unit of the U.S. Department of Health and Human Services (HHS). Among other tasks, AHRQ supports the development and dissemination of evidence about current best practices in health services delivery through its Evidence-based Practice Center (EPC) programs that contract out its work and operate in broad and complex network. The purpose of this study was to examine the extent to which AHRQ's EPC Program I was effective in supporting the translation of evidence reports and disseminating the products to the public by contracting with public and non-profit entities to do the work. This dissertation also sought to examine the extent to which the evidence reports and derivative products were publicly accessible by operationalizing the objectives articulated in AHRQ's authorizing legislation in a manner consistent with theories of representative democracy and exploring Program I's effectiveness using William T. Gormley's ideas (1989; Gormley & Balla 2003) of bureaucratic control. The results from this dissertation suggest that a decentralized network was related to overall higher translation and dissemination network effectiveness. Specifically, the findings from this study suggest that a decentralized network was related to overall higher translation and dissemination network effectiveness. Also, weak ties among the network actors when transferring complex knowledge was associated with higher translation and dissemination network effectiveness on the whole. The findings from this dissertation also contribute to network theory by extending Gormley's bureaucratic control typology (1989; Gormley & Balla 2003) to the network level, and also to the type of control that was available to the Agency over the network. Finally, the results contribute to better understanding of the dynamics that can be associated with the effectiveness of similar programs. / Ph. D.

The fight against terrorism and organized crime require strong collaboration between public security organizations. Public security networks include several agencies that are not bound to each other with strong hierarchical ties. Because of a lack of the strong hierarchical structure, managing public networks is not similar to managing a single government agency. This study aims to examine the factors influencing network effectiveness in the public security sector. The main research questions of the study are: Which factors are important for effectiveness in public security networks? What is the role of inter-organizational trust among partner agencies? Which kind of leadership style will achieve the highest performance in public security networks? What is the relative importance of goal convergence and organizational culture in network effectiveness? How does the relationship between inter-organizational trust, leadership style, goal convergence and organizational culture impact network effectiveness? In order to find these relations, a self-reported survey was sent to 2,095 current and previous Turkish public security network managers. The study found that inter-organizational trust and goal convergence have a positive relationship with network effectiveness. Although facilitator leadership is found to be the most common leadership style in Turkish public security networks, it is found as inappropriate to achieve higher network effectiveness. According to the results, the co-producer network leadership is the most convenient leadership style in terms of network effectiveness. While the results of the descriptive statistics confirm that six specific features of organizational culture in public security sector have negative influence on network effectiveness, the hypothesis testing with the covariance structure model only support the negative impact of competition among partner organization. This study contributes to the literature on network effectiveness with particular proposals for the public security managers and practitioners.

Crisis management has become one of the most important public policy areas in recent decades with greater numbers of manmade and natural disasters. History showed that well-implemented crisis management policies can save lives and reduce costs in a disaster. Literature offered various suggestions for more effective crisis management policies with different techniques utilizing different theoretical frameworks. Informal relationships among crisis management employees were suggested to have a positive impact on crisis management effectiveness. Yet it was not demonstrated with advanced statistical tools if there is such a relationship. This study considers crisis management effort as a network effort and employs complex adaptive systems theory in order to understand factors influencing effectiveness of crisis management networks. Complex adaptive systems theory presents that more open communication lines in a given network or an organization would increase effectiveness of it since inner processes of the network or organization would obtain more information from the chaotic environment. Quality of informal relationships (casual relationships, social capital etc.) was hypothesized as a tool to open more communication lines within an agency which would eventually increase effectiveness of the network constructed by the organization. Based on the theoretical framework, adaptiveness capacity of the agencies was also tested in order to understand a correlation between adaptation and effectiveness of crisis management networks. Multiple case-study method was employed to identify incidents that can represent crisis management in full perspective. Terrorist attacks carried upon by the same terrorist network hit New York in 2001, Istanbul in 2003, Madrid in 2004, and London in 2005 were selected. First response phase of crisis management and policy changes after and before the attacks were discussed. Public administration processes and other social-economical conditions of countries were examined in terms of crisis management structure. Names of key agencies of selected crisis management systems were suggested by a social network analysis tool-UCINET. Six key agencies per incident were targeted for surveys. Surveys included a nine-item-quality of informal relationships, four-item-adaptiveness capability, and ten-item-perceived effectiveness of crisis management networks-scales. Respondents were asked to fill in online surveys where they could refer to their colleagues in the same incidents. 230 respondents were aimed and 246 survey responses were obtained as a result. Surveys formed a structural equation model representing 23 observed factors and 2 latent constructs. Confirmatory factor analysis was utilized to validate hypothesis-driven conceptual models. Quality of informal relationships was found to have a significant positive impact on perceived crisis management network effectiveness (Standardized regression coefficient = .39). Two of the adaptiveness variables, openness to change and intra-organizational training were also positively correlated with the dependent variable of the study (Standardized regression coefficient = .40 and .26 respectively). Turkish and American groups' differences suggested a social-economical difference in societies. Majority of the respondents were some type of managers which made it possible to generalize the results for all phases of crisis management. Discussions suggested improved informal relationships among crisis management employees to provide a better crisis management during an extreme event. Collaborative social events were offered to improve crisis management effectiveness. An agency's openness to change proposed that a crisis management organization should be flexible in rules and structure to gain more efficacy. The other adaptiveness variable, intra-organizational training efforts were proposed to have certain influence on effectiveness of crisis management network. Factors built latent construct of perceived crisis management effectiveness were also found out to be important on crisis management, which of some are ability to carry out generic crisis management functions, mobilize personnel and resources efficiently, process information adequately, blend emergent and established entities, provide appropriate reports for news media etc. Study contributed to the complex adaptive system theory since the fundamentals of the theory were tested with an advanced quantitative method. Non-linear relationships within a system were tested in order to reveal a correlation as the theory suggested, where the results were convincingly positive. Crisis management networks' effectiveness was demonstrated to be validated by a ten-item-scale successfully. Future research might utilize more disaster cases both natural and manmade, search for impact of different communication tools within a system, and look at the relationships among members of crisis management networks instead looking within an organization.