Ensuring a Competent Public Health Workforce

State: FL Type: Model Practice Year: 2009

Our project goal is to develop a coordinated program of continuing education for staff to ensure a competent public health workforce in preparation for national public health accreditation in 2011. Our project objectives are by September 2008, to have 50 percent of nonsupervisory/nonmanagerial staff complete Individual Development Plans (IDPs); to identify three areas of deficiencies common among nonsupervisory/nonmanagerial staff to create a coordinated program of continuing education; by November 2008, to provide at least two training sessions that will contribute to an improvement in skills and knowledge levels in 50 percent of the participants; to develop a plan for sustainability of accreditation preparation past end of project; to share lessons learned with key stakeholders. By implementing lessons learned throughout our performance improvement efforts using the Model for Improvement/PDCA framework, we were able to determine staff training needs through Individual Development Plans and to identify three areas of training deficiencies common across all staff. We focused efforts on nonsupervisory/nonmanagerial staff due to fewer training opportunities at this level. We were able provide two training sessions from the top areas identified and set a target of a 50 percent or greater increase in staff knowledge as determined through a pre- and post-training surveys. The first session (customer service) resulted in 41 percent improvement, and the second session (billing/coding) achieved 81 percent improvement. This NACCHO Accreditation Preparation and Quality Improvement Demonstration Sites Project has helped the OsCHD better understand our strengths and weaknesses through the self-assessment process and be able to implement a systematic quality improvement process to address those weaknesses. From the lessons we learned, we are better prepared to sustain our work past the end of the project with a goal of applying for national public health accreditation in 2011.
One of the 10 essentials of public health services as identified in NACCHO’s Operational Definition of a Functional Local Health Department is ES VIII—to maintain a competent public health workforce. Specifically, ES VIII, Operational Definition Indicator VIII-B #9—LHD provides a coordinated program of continuing education for staff, which includes attendance at seminars, workshops, conferences, in-service training, and/or formal courses to improve employee skills and knowledge in accordance with their professional needs. To determine this public health issue’s relevancy to our community, OsCHD conducted a self-assessment using NACCHO’s Operational Definition Prototype Metrics Assessment Tool. We held a series of roundtable discussions with multidisciplinary teams of staff to assess our scores for each operational definition indicator. We also collaborated with the Florida Department of Health Office of Performance Improvement (HPI) staff who led the four Florida NACCHO grantees through a series of brainstorming sessions to identify the needed illustrative evidence for each indicator. HPI staff developed links to databases that could provide the evidence and populated the self-assessment tool. Once OsCHD’s strengths and weaknesses were identified, we used a prioritization matrix to narrow a list of weaknesses to determine our key opportunity for improvement. The prioritization matrix included a criterion focused on weighting a score to identify the importance to our internal (staff) and external (public) stakeholders. Our practice addresses the issue of maintaining a competent public health workforce in several key activities. Included are assessing the areas of deficiencies in our current training program based on what our employees tells us is important to their professional development; developing a set of deficiencies common across all staff responses; establishing a coordinated program of continuing education to address these deficiencies; and measuring the improvement in staff skills and knowledge gained from the continuing education. Our PMM was determined to be an inventive use of existing tools or practices through literature reviews: The use of formal quality improvement methodologies in local health departments to improve their performance and their ability to protect, promote, and preserve health in the communities they serve is perhaps not as wide-spread as needed, particularly when trying to improve performance to meet accreditation standards. According to Robert Wood Johnson Foundation’s call for proposals entitled Public Health Practice: Evaluating the Impact of Quality Improvement, “...currently there is little published evidence on the value and impact of QI in public health, and only preliminary evidence exists about the factors that promote the successful implementation and spread of QI efforts in governmental health departments.” OsCHD proposes that by using the PMM, we have a tool to assist us in evaluating the impact of our QI efforts to improve our processes and to promote the implementation and spread of these efforts within all OsCHD departments as well as external agencies. Public health practice traditionally is viewed according to programmatic silos instead of looking at business processes across disciplines to actively manage those processes through a systematic process management methodology. According to the Public Health Informatics Institute/NACCHO publication Taking Care of Business, public health practitioners would benefit from analyzing their business processes (thinking about how the work is done) and redesigning those business processes by rethinking how the work should be done. OsCHD proposes that by using our PMM, we have a tool to assist us in analyzing our business/public health processes and redesigning them to manage across departments instead of traditional public health silos. OsCHD instituted a systematic Nine-Step Process Management Methodology Model with PDCA (PMM).
Agency Community RolesOsCHD project implementation staff was proactive in bringing a variety of multidisciplinary staff from within our agency together to work on this practice. We included our administrator, senior leadership, mid-level managers, front-line supervisors, and programmatic and front-line staff. We thought it was important to include all levels of staff, particularly becausse our opportunity for improvement, i.e., a coordinated program of continuing education, was identified as a weakness through our employee SWOT analysis during our strategic planning process early in 2008. Other partners that were involved in the planning of this practice were the Florida Department of Health’s Office of Performance Improvement (HPI) staff, various program staff at the state level, and the four other county health departments in Florida who were NACCHO grantees. We collaborated through a series of conference calls on sharing best practices pertaining to the self-assessment process: brainstorming best practices pertaining to the Operational Definition of a Functional Local Health Department, and exploring databases that could be used as illustrative evidence. OsCHD has long been a collaborative partner with many varied stakeholders in our community, including but not limited to county and city government, faith-based organizations, health care providers, hospitals, schools, senior citizen agencies, Emergency Medical Services, fire departments, law enforcement, private business, Healthy Start, state and national associations, and many others. A key OsCHD role is to foster collaboration within our community to achieve our mission to promote, protect, and improve the health of people in our community. Costs and ExpendituresNACCHO Grant: Staff time, $7,000; QI Consultant, $8,000 + OsCHD; In-kind: Staff time, $5,000; Training Vendor, $2,500; Total = $22,500. ImplementationOur project goal was to develop a coordinated program of continuing education for staff to ensure a competent public health workforce in preparation for national public health accreditation in 2011. Project Objective (1): By September 2008, 50 percent of nonsupervisory/nonmanagerial staff (233 staff) will complete Individual Development Plans (IDPs). Employee Training Team (ETT) researched IDPs samples, settling on the IDP that currently was being used for senior leadership, even though we were concerned it might be focused more on developing managerial staff. We thought this would be less confusing than trying to introduce a completely new IDP at this point. ETT team leader attended the next Department Head meeting in August to discuss surveying their staff to get input as to their training needs. Department Heads were asked to ensure their staff completed the IDP by September 5, 2008. Eighty-six IDPs were submitted by the due date, a return rate of 38 percent, below our goal of 50 percent. Because time was already blocked for a staff training session in October, ETT proceeded with the limited number of IDPs to have time to tally the results and identify the three areas of commonality. Project Objective (2): Identify three areas of deficiencies common among nonsupervisory/nonmanagerial staff to create a coordinated program of continuing education. Top three areas were billing/coding, CPR/Basic Life Support, and customer service. Project Objective (3): By November 2008, provide at least two training sessions that will contribute to an improvement in skills and knowledge levels in 50 percent of the participants. In October we contracted with a training vendor to provide a session entitled How to Handle Difficult People, Reduce Stress, and Build Stress Tolerance. In November, in-house sector experts provided training on billing/coding. ETT developed pre- and post-training surveys coordinated with the objectives each trainer specified. We focused on one question to measure staff’s perception of their improvement in knowledge. “After today’s training, my knowledge increased by: 25 percent, 50 percent, 75 percent, or 100 percent.” Project Objective (4): To develop a plan for sustainability of accreditation preparation past end of project. We will use the project work as a foundation for a systematic process to follow to continue addressing opportunities for improvement identified in our self-assessment. Set up multidisciplinary teams focused on replicating quality improvement steps in the project work we completed in this cycle. Teams will develop action plans based on short- and long-terms goals toward public health accreditation in 2011. We will ensure linkage of accreditation efforts to goals and objectives established in our annual updates to our 2008–2013 Strategic Plan. Resources will be identified and included in budget for FY 2009–2010. Project Objective (5): To share lessons learned with key stakeholders. We will generate project reports, develop presentations, submit abstracts for conference presentations. We will collaborate with Florida Department of Health to share best practices.
Lessons learned were that the barriers to obtaining a greater percentage of returned IDPs were determined using a fishbone diagram. Barriers were that staff didn’t understand how to fill out the form, the IDP was too long, supervisors were not consistent in requiring compliance. The root cause was lack of training for staff on how to complete an IDP. Modifications were made to shorten/simplify the IDP. ETT will provide training prior to next cycle of IDP review in March 2009 or as new employees are hired. Lesson learned from the October training were that based on a fishbone diagram exercise, the group (228) was too large for the interactive training; the sound system in the back of room failed and staff couldn’t hear, which lead to staff not being engaged; artificial distractions such as water bottles placed in front of room caused disruptions as staff got up to get water. Modifications made for the November training were reducing group to 77; sound system was not an issue; potential for artificial distractions were eliminated.
OsCHD’s administrator has made a strong commitment to perpetuate this practice by making accreditation and quality improvement strategic priorities for our agency. These priorities have been included in our 2008–2010 Strategic Plan as evidenced by the following: OsCHD 2008–2013 Strategic Plan: Strategic Priorities—3.0 Organizational Development; Strategic Goal—3.8, integrate a culture of performance excellence throughout the organization; Objectives—3.8.1, to develop a plan for further implementation of a Sterling (Baldrige) Performance Management System; 3.8.2, achieve national public health accreditation in 2011. A senior manager Process Owner has been charged with working with program level Strategic Champions to ensure the development of program level action plans/resources/measurable targets for achieving these goals and objectives as outlined in our Strategic Plan. Progress toward attaining these goals and objectives will be measured through a red light/green light reporting mechanism that will be presented to and discussed with our administrator and senior management. Resources will be identified as the program level actions plans are developed in January 2009, and will be presented to the administrator for approval. Once final approval is granted, resources will be added to the budget.