Kimberley Isett | Georgia Institute of Technology (original) (raw)

Papers by Kimberley Isett

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r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r... more r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r Context: Americans spend more than 90% of their time indoors, so it is important that homes are healthy environments. Yet many homes contribute to preventable illnesses via poor air quality, pests, safety hazards, and others. Efforts have been made to promote healthy housing through code changes, but results have been mixed. In support of such efforts, we analyzed International Code Council's (ICC) building code change process to uncover patterns of content and context that may contribute to successful adoptions of model codes. Objective: Discover patterns of facilitators and barriers to code amendments proposals. Design: Mixed methods study of ICC records of past code change proposals. N = 2660. Setting: N/A. Participants: N/A. Main Outcome Measure(s): There were 4 possible outcomes for each code proposal studied: accepted as submitted, accepted as modified, accepted as modified by public comment, and denied. Results: We found numerous correlates for final adoption of model codes proposed to the ICC. The number of proponents listed on a proposal was inversely correlated with success. Organizations that submitted more than 15 proposals had a higher chance of success than those that submitted fewer than 15. Proposals submitted by federal agencies correlated with a higher chance of success. Public comments in favor of a proposal correlated with an increased chance of success, while negative public comment had an even stronger negative correlation. Conclusions: To increase the chance of success, public health officials should submit their code changes through internal ICC committees or a federal agency, limit the number of cosponsors of the proposal, work with (or become) an active

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Background: Health in All Policies (HiAP) is a framework requiring that the promotion of health b... more Background: Health in All Policies (HiAP) is a framework requiring that the promotion of health be embedded in all substantive policy areas to have a comprehensive approach to the health and well-being of local citizens.

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Health Care Management Review, 2002

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We examined the impact of organizational and network factors on agencies' new relationships w... more We examined the impact of organizational and network factors on agencies' new relationships within interorganizational networks. Analyses used secondary data from nine health and human service networks. A model including both organization-level and network-level predictors provided a better explanation than did a model with system-level predictors alone. At the service sector level, organization focus and time exposed to innovations; at the network level prior relationships and overall network centralization; and at the organizational level location of the organization in the network, status as a government agency, and being a sub-unit of an organization influence the addition of new interorganizational relationships.

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Public Management Review, 2013

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This article assesses the structural choices for the proposed tobacco endgame strategies. I focus... more This article assesses the structural choices for the
proposed tobacco endgame strategies. I focus on the
issues associated with particular structural choices for
the location of the implementation. Specifically, I discuss
issues related to implementation of the endgame within
a specific single agency, and issues related to a more
widespread, broad implementation involving several
agencies. Where appropriate, I provide examples of how
the dynamics discussed would apply to particular
endgame strategies. Issues related to design,
administration, authority and finances are raised.

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This article presents a comparative analysis of the evolution of two community mental health netw... more This article presents a comparative analysis of the evolution of two community mental
health networks that both have similar contracts from the State of Arizona. One of the
networks is governed by a for-profit firm that buys needed services from a network of largely
nonprofit agencies. The other network is governed by a community-based nonprofit that
contracts with four separate nonprofit agencies to provide services directly or through
a network of other providers, most of which are nonprofit. These two networks are analyzed,
using social network analysis, when each system was first formed and again, 4 years later.
The for-profit governed network is then compared to the nonprofit governed network on
four dimensions: sector, nonprofit or for-profit, relationships and trust, the evolution of the
structure of the networks, and a limited comparison of the two networks’ performance.

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This article examines the evolution of a community-based network of mostly nonprofit health and h... more This article examines the evolution of a community-based network of mostly nonprofit
health and human service agencies providing services to people with mental illness. The
network was formed in response to a major shift in the state’s funding mechanism from
fee-for-service to managed care. When confronted with conflicting institutional pressures
from the state and the profession, the response was one of strategic balancing and
compromise through development of an interorganizational network rather than by the
passive conformity of individual agencies. How this network evolved and how compromise
was achieved was examined. Data were collected shortly after the new system was
first introduced and then 4 years later to allow longitudinal analysis of network
evolution.

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Th is article examines the stability of street-level bureaucrats’ negative perceptions regarding ... more Th is article examines the stability of street-level bureaucrats’
negative perceptions regarding a newly implemented
managed care system on quality of care and service delivery
in a publicly funded behavioral health care system.
Overall fi ndings indicate that the generally negative perception
of managed care did not diff er between staff in
the two programs, indicating a weak eff ect on attitudes
of frontline workers. More proximal variables to the
caregiver, such as service type and job title, show more
infl uence on attitudes. Th e conclusion discusses the implications
of these fi ndings for practicing administrators and
academic researchers.

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Performance management and citizen participation are being used by local governments to improve g... more Performance management and citizen participation are
being used by local governments to improve government
accountability and responsiveness. In some cases, local
governments are integrating these two trends. One area
of local government in which this trend has not been
assessed is special districts. Th is paper uses data from a
study of nine special districts in the state of Texas to fi ll
this void. To assess citizen participation in performance
management among the districts, we interviewed district
managers, analyzed minutes from governing board
meetings, and conducted citizen focus groups in three
regions of the state. Our fi ndings suggest that although
districts may not yet be in tune with the latest performance
management trends, they are making eff orts to
engage citizens in other ways. We recommend ways that
districts can build on these experiences and more
eff ectively incorporate citizens in the development,
analysis, and reporting of performance measures.

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Institutional theories, which explain how rules, norms, and shared strategies shape human behavio... more Institutional theories, which explain how rules, norms, and shared strategies shape human behavior, have been used
to examine why public and private organizations look different structurally, why actors decide to coordinate the provision
of goods and services, or how characteristics of a political system shape public management strategies. Many
institutional scholars have recognized the importance of developing accurate institutional theories and models to
explain policy and management decision making, yet the authors find that few scholars have attempted to bridge
institutional theories coming from the political science and organization theory disciplines. In this article, they present
a model of operational decision making in public organizations that integrates concepts from these two institutional
schools of thought. The authors then apply this model to two distinct cases—one in the field of water resource
management and the other in the field of mental health provision—to demonstrate the usefulness of this integrated
approach to institutional analysis.

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The venerable but amorphous concept of stewardship has lately gained prominence in discussions of... more The venerable but amorphous concept of stewardship has lately gained prominence in discussions of public policy and management and is sometimes offered as a “strategy” with a distinctive potential to mobilize effective public leadership in the service of broad social missions. In this article we explore how stewardship may be useful to the theory and practice of mental health policy, and, reciprocally, how examples from mental health policy may elucidate the dynamics of stewardship. After examining its key political ingredients — authority, advocacy, and analysis — we discuss the practical challenges in moving stewardship from moral inspiration to institutional reality.

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Researchers concerned with organizational change have consistently emphasized the role that the w... more Researchers concerned with organizational change
have consistently emphasized the role that the work
environment plays in employee acceptance of change.
Underexamined in the public management literature,
however, is the role that employee values, particularly
public service motivation (PSM), may play in employee
acceptance of change. Some scholars have noted a positive
correlation between employee PSM and organizational
change eff orts; this article extends this work by attempting
to isolate the mechanisms that explain this relationship.
Using data from a survey of employees in a city
undergoing a reorganization and reduction in workforce,
the authors fi nd that only employees who scored high on
a single dimension of PSM—self-sacrifi ce—were more
likely than others to support organizational change.
Rather than support changes for their potential to
improve public service, this fi nding suggests that employees
with higher PSM may simply be less likely to resist
changes that might disadvantage them personally.

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Objectives: To ascertain any lessons learned about how public health reforms undertaken in New Yo... more Objectives: To ascertain any lessons learned about how public
health reforms undertaken in New York City during the
Bloomberg Administration were shepherded through the public
policy and administration gauntlet. The question is, how feasible
is this approach and would it work outside of New York City?
Design/Setting/Participants: Using a theoretically grounded
case study approach, 3 initiatives were examined that were
proposed and/or implemented during a 10-year period of the
Mayoralty of Michael Bloomberg (2002-2011): transfats
restrictions, clean bus transportation policies, and a
sugar-sweetened beverages tax (as a counterfactual). The
investigation began by performing a comprehensive public
documents search and was followed with interviews of 27
individuals involved in the selected policy initiatives. Interviews
were coded in Nvivo using an iterative, grounded methodology.
Results: Using a theoretical lens, the case study illustrates that
the multifaceted role of leadership was not confined to the
executives in the City or the Agency. Instead, leadership
extended to other administrative officials within the agency and
the Board of Health. Second, New York City used reorganization
and coordinative mechanisms strategically to ensure
achievement of their goals. This included creation of new departments/bureaus and coordinating structures across the
City. Evidence of the explicit use of incentives, as initially
anticipated from the theoretical framework, was not found.
Conclusions: While some aspects of this case study are unique
to the context of New York City, 2 approaches used in New York
City are feasible for other jurisdictions: harnessing the full scope
and breadth of authority of the agency and its associated boards
and commissions, and remobilizing existing workforce to explicitly focus on and coordinate targeted policies for issues of
concern. Questions for further consideration are posed at the
conclusion of the article.

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This paper examines the implementation of large, transformative change in the Medicaid offices in... more This paper examines the implementation of
large, transformative change in the Medicaid
offices in New York City to improve efficiency
and consumer-friendliness. A bottom-up
process was engaged to design and implement
the needed changes from those who
were most affected by the change. Key
informant interviews and observational site
visits were conducted to assess the extent to
which the change efforts were successful. We
found that the changes impacted both
quantitative measures of success (such as
client processing times and number of clients
served) as well as less tangible qualitative
indicators of success such as staff attitudes
and office climate.

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How eff ective was organizational reform implemented inside one critical New York City health age... more How eff ective was organizational reform implemented
inside one critical New York City health agency?
Specifi cally, we examine the extent to which the
reorganization of the HIV/AIDS Services Administration
(HASA) into the Medical Insurance Services
Administration (MICSA) achieved three goals: (1)
realizing synergies among the component MICSA
programs; (2) cross-fertilizing ideas among MICSA
agencies; and (3) facilitating HASA operations through
the lens of organization change theory. Qualitative
methods including interviews, site visits, and document
analysis triangulate the eff ects of the reorganization.
Implications for organization change literature are
explored, especially highlighting where more theoretical
and empirical studies are needed.

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Health Care Management Review, 2002

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Public Management Review, 2013

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