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Using Bayesian influence diagrams to assess organizational performance in 4 California county health departments, April-July 2009.

A Bayesian influence diagram is used to analyze interactions among operational units of county health departments. This diagram, developed using Bayesian network analysis, represents a novel method of analyzing the internal performance of county health departments that were operating under the simultaneous constraints of budget cuts and increased demand for services during the H1N1 threat in California, April-July 2009. This analysis reveals the interactions among internal organizational units that degrade performance under stress or, conversely, enable a county health department to manage heavy demands effectively.