Public Health Core Competencies

State: CO Type: Model Practice Year: 2019

Denver Public Health (DPH) is an innovative, nationally recognized public health department located in Denver, Colorado. Denver's estimated population of 704,621 is rapidly growing and diverse; 54% identify as White, 30% Hispanic, 10% Black, and 4% Asian (2017 census estimates). DPH collaborates with partners to inform, educate, offer services, and promote policy change to make Denver a healthy community for all people. DPH issues birth and death certificates; monitors and creates reports about the health of Denver; promotes data sharing to improve Denver's capacity to assess disease, conditions, and behaviors; trains the next generation of public health professionals; and responds to disease outbreaks and other health emergencies. With many partners, DPH supports policy and systems change, promotes healthy behaviors, and prevents health problems, such as unintentional injuries, tobacco-related illnesses, and obesity. The department also provides specialty clinical services to the most vulnerable community members in the following areas: STD, family planning, routine and travel immunizations, tuberculosis, hepatitis C, and HIV/AIDS. More information is available online at A changing public health landscape and commitment to improving health equity requires a workforce that is competent across varying skillsets and an organization that is committed to personal and departmental professional development. The Core Competencies for Public Health Professionals (Core Competencies), developed by the Council on Linkages between Academia and Public Health Practice (Council on Linkages), can provide a meaningful baseline to public health agencies assessing workforce development needs. While the current Core Competencies are the result of more than two decades of work by the Council on Linkages, consistent feedback to the Public Health Foundation (PHF) is that local and state health departments need assistance in operationalizing the competencies and making them relevant to their staff. The impact of practice resulting from DPH's approach to the Core Competencies is a replicable survey process that can guide a health department's efforts in ensuring their workforce is competent and trained to address contemporary public health issues; DPH's roadmap for survey creation and workforce development planning can benefit other public health agencies that struggle to meaningfully use the Core Competencies. DPH's work to adopt the Core Competencies began in 2013 when the department made the decision to pursue public health accreditation. DPH's Workforce Development Committee (WFD Committee), a diverse group of staff representing varying program areas and positions, led the department through two years of survey preparation activities before the survey launched for the first time; notable milestones included: 1) contracting with the PHF to create staff organizational groups that would guide the paring down of the Core Competencies (December 2014), 2) DPH staff participating in conversations with the PHF to select competencies specific to their job function (February 2015), 3) competencies were revised, when appropriate, to increase staff comprehension (April 2016), 4) DPH launched its first annual Core Competency Survey (June 2016), 5) workforce development plans were created to address gaps in staff knowledge and skills (October 2016), and 6) DPH developed a plan for annual competency revision (January 2018). In addition to meeting an accreditation standard, the goal of the WFD Committee's work in revising and customizing the Core Competencies was for DPH to have annual data that could inform individual, programmatic, and department workforce development plans. To meet this goal, the committee developed objectives that include: 1) update the Core Competency survey biennially so that it is reflective of contemporary trends in public health, 2) engage representatives from the department biennially in survey revision specific to job classification, so that competencies are directly related to each employee's job function and competency language is easy to understand, 3) achieve 100% annual staff survey participation, and 4) provide survey results in individual and aggregate form to every employee, manager, program area, and the department to make training recommendations. DPH has conducted a Core Competency survey three times since 2016 and has created processes and standard work to ensure that each of these objectives are met. The only objective that hasn't been met is 100% staff participation; notably, we have had 99% participation each year (with just one staff member out of approximately 165 employees not completing the survey). Success of the survey can be attributed to a variety of factors, including: representation from staff at all levels during the revision process, a detailed communication plan for employees and managers about the focus of Core Competencies, easy-to-read results that are able to be filtered by length of employment, program area, and managerial status, and a volunteer committee that analyzes results to make departmental recommendations.
The Core Competencies for Public Health Professionals (Core Competencies) are a set of skills desirable for the broad practice of public health. They were originally developed by the Council on Linkages between Academia and Public Health Practice in 1998 (Council on Linkages), and are the result of 20 years of work via a collaboration of 23 national organizations (including APHA, NACCHO, and the CDC). Updated three times within the 20 years of their inception, the current version Provides a framework for workforce development planning and action, and can serve as a starting point for public health professionals and organizations as they work to better understand and meet workforce development needs, improve performance, prepare for accreditation, and enhance the health of the communities they serve.” (The Public Health Foundation, Core Competencies for Public Health Professionals”) The Core Competencies are divided into eight areas of public health practice: analytical/assessment skills, policy development and program planning skills, communication skills, cultural competency, community dimensions of practice, public health science skills, financial planning and management skills, and leadership and systems thinking skills. Within each of these areas, a competency is organized into one of three tiers; these tiers represent career stages for public health professionals. Tier 1 competencies are tailored to front line staff or entry level employees. Tier 2 competencies are for program managers or supervisors, or professionals that are involved in the development, implementation, and evaluations of programs. Tier 3 competencies are for senior managers or executive suites that are responsible for overseeing major programs or organizational operations. While the Core Competencies themselves are self-explanatory, feedback to the Council on Linkages shows health departments are struggling to understand ways to operationalize the competencies. With Public Health Accreditation (Standards and Measures 1.5) requiring an assessment of current staff competencies against the adopted core competencies,” and this assessment being integrated fully into a workforce development plan, DPH felt an engaging approach to utilizing the Core Competencies was necessary. DPH wanted to create an implementation plan for the Core Competency survey that would address staff's collective capacity and use staff-driven feedback to mitigate gaps in capabilities. The target population for the Core Competency survey is DPH's permanent” staff. For the purposes of the Core Competency survey, only employees with a .5 or greater FTE status, who are not students, fellows, interns, or contractors, are prioritized to take the survey. In the past three years that the survey has been implemented, the number of employees participating was 163 (for 2016), 164 (for 2017), and 166 (for 2018); each year, everyone except one employee completed the survey, for a consecutive 99% completion rate. DPH employs skilled, dedicated, and diverse staff. As of 2018, workforce demographics of permanent employees included: 76% of employees identifying as female, 24% male, and 1% transgender; 62% of employees identifying as White/Caucasian, 29.3% Hispanic/Latino, 3.4% African American, 3.4% Asian/Pacific Islander, and 1.7% other; 14% of staff is between the ages of 20-29, 33% between 30-39, 27% between 40-49, 14% between 50-59, and 12% age 60 or older. Of this staff, 17 are medical directors or physicians, 37 are supervisors, 27 are nurses, 7 work in informatics, 9 work in epidemiology/emergency preparedness, 13 in community health promotion, 6 in prevention training, 13 in linkage to care/patient navigation/social work, 11 as healthcare support staff, 40 as administrative support staff, 2 in DPH's dental clinic, and 7 in DPH's pharmacy (some staff are counted in multiple categories). DPH conducted informational interviews with other local and state health departments, as well as the PHF, to see how others were approaching the problem of implementing the Core Competencies. The feedback was varying and concerning; some health departments were asking employees to complete a core competency checklist at their annual review, many health departments asked only one portion of their staff to complete the survey, other health departments had all staff complete a version of the survey but didn't know how to do anything with the results, and worse, some health departments were deciding to forgo public health accreditation because the new tasks associated with it, including implementing a Core Competency survey, felt insurmountable. Hearing this feedback, DPH developed a new and better way to assess staff skills. The assessment would still use the widely known and accepted Public Health Core Competencies, but it would have a robust implementation plan that would consider maximum staff involvement and honest reflection, competencies that are directly related to the mission, vision, and values of DPH, and a comprehensive, multi-level plan for using the results. DPH's implementation of the Core Competencies started with the conceptualization of what an all-staff survey could look like. Many employees were involved in conversations about the importance of the Core Competencies and how they could influence professional development. Rather than taking the approach of tying this assessment into an annual review—which could lead to artificially inflated results for fear of negative performance evaluations—the decision was made to survey the department at one point in time. Essential to this launch was messaging about the purpose of the survey: that staff can be provided a meaningful way to engage in professional development specifically related to foundational public health skills. Staff were encouraged to answer each question honestly, knowing that Core Competencies are meant to be developed over the course of a career within public health. DPH set the expectation that not everyone needs to be an expert” in all of the competencies, rather, an awareness or understanding of each competency might be sufficient depending on an individual's job function. Staff shared feedback that surveying on all 92 Core Competencies felt daunting, and there was a desire for the competencies to be pared down to what was most relevant to the work of the department. To select meaningful competencies, DPH's staff were grouped into one of six job classifications that best fit the skills and duties of their job (classifications discussed below). Volunteer representatives from these job classifications reviewed all 92 Core Competencies and used a voting process to determine which were most important to their roles. Each of the six job classifications selected between six and ten competencies. In addition to job classifications selecting specific competencies for staff who share similar roles, DPH's Workforce Development Committee (WFD Committee) selected 15 competencies (in 2016 and 2017, 14 in 2018) that they felt all staff should work towards mastering. Guiding this selection was a thorough examination of documents and resources that are pertinent to 21st century public health work; for DPH, this included the department's strategic plan, community health assessment, community health improvement plan, and broader public health documents such as Healthy People 2020, Public Health 3.0, and Chief Health Strategists articles. After paring down the original competencies, the department had a survey that consisted of no more than 25 questions per staff member (the actual length varied across job classifications). The next step was to revise language to increase staff comprehension. Rather than using the tiered language, DPH selected the Tier 2 language for all competencies and worked with staff at all levels to adapt it, which included creating DPH specific examples and competency rephrasing. DPH developed a custom scale for staff to consider when self-assessing. The scale highlighted key behaviors, such as the ability to explain a topic, the ability to apply knowledge from the topic to their work, or the ability to teach the topic to others, and included a rating scale from none” to expert.” Upon completion of the month-long survey period, the results were downloaded from SurveyMonkey in three forms: individual, program area, and aggregate (across the whole department). The results were transcribed into three templates. The first template was sent to the employee via email with the employee's manager copied on the correspondence. This template included both the employee's job classification and department-level competencies. Managers were asked to review each individual's results in a future one-on-one meeting to identify themes, strengths, and areas of opportunity related to competency development. Managers received a guide on how to successfully navigate these conversations and staff were asked to set a new professional development goal, if applicable, at the conclusion of the conversation. Another example of an innovative use of the Core Competency results on an individual level was the development of an internal mentoring program. In the application for mentees, staff are asked which Core Competency domain they would like to further develop. DPH's Core Competency survey had a question at the end that asked staff, If you rated yourself an expert in any of these competencies, can we contact you about becoming a mentor?” Sorting out the staff who answered yes” to this question allowed the WFD Committee to assist in recommendations for mentorship pairings. Since the inception of the mentorship program, almost two-thirds of DPH's employees have participated in mentorship. The second template transcribed results for each program area via a Core Competency Scorecard. The scorecard showed the aggregate score of the area, per competency, and how it related to the overall department score (using a 0-4 scale for the none” to expert” ratings). Managers received their area's scorecard and were asked to hold a meeting with their team to review the results. Managers were instructed that the purpose of the meeting was to celebrate the strengths of the team while identifying a competency or domain the team would like to prioritize for training. An example of using a scorecard to create a training plan can be seen within DPH's Epidemiology and Emergency Preparedness team. This team chose to uplift the competency, Communicate in writing and orally with linguistic and culture competency.” Team members brainstormed questions related to communication skills and abilities for diverse audiences. Audience diversity for this team includes individuals with different levels of technical and subject matter expertise, individuals from different backgrounds, and individuals identifying with different socio-economic groups. Through a series of brief trainings and education sessions provided during regularly scheduled team meetings (through the use of guest speakers), the team learned more about: how to use the language line with non-English speaking patients, how to use risk communication in their work, how to speak with media, how to identify key messages for external communication, how to facilitate small and large groups, how to present technical content effectively, and how to make slides that convey the intended message effectively. After focusing on these topics through a year, when re-surveyed, the team's communication skills scorecard numbers reflected a large jump above the department's average score (program score = 2.92 with n=13; department aggregate score = 2.52 with n=161). The development of the third template for all department staff in aggregate was addressed through the departmental competencies selected by the WFD Committee. In 2016 and 2017, the selected competencies focused on staff being able to describe, provide, and participate in professional development. The 2016 survey weighted results (on a scale of 0-4) showed DPH averaging a 2.36 score in participating in professional development; this was one of the lowest scoring competencies. To uplift this competency, the WFD Committee created a department-wide training plan that focused on key activities, including: defining professional development on a department-wide level, training managers about how to coach employees on professional development goals, developing guides for annual reviews to assist in setting professional development goals, and clarifying department guidelines around time and financial assistance for goals. After two years of uplifting, the department's score was 2.72, a 15.3% increase in competence. With limited guidance available at the start of DPH's Core Competency implementation, DPH relied on the evidence-based competencies from the Council on Linkages, as well as other evidence-based quality improvement tools (including prioritization tools for survey design and follow-up action plans). DPH has become a nationally recognized leader for modeling evidence-based approaches for the Core Competency survey due to our diligent evaluation of survey responses, recommendations for staff development, and cyclical updating of the survey based on a quality improvement Plan, Do, Study, Act (PDSA) cycle.”
Given that accreditation standards require public health departments to adopt the Core Competencies into their work, understanding tangible ways to approach the Core Competencies is both timely and crucial. The Council on Linkages encourages organizations to tailor their competency selection to meet organizational and individual goals and needs; however, the path to adapting and operationalizing competencies is not always clear. In addition to meeting an accreditation standard, DPH's WFD Committee wanted to adopt the Core Competencies in a meaningful way that could influence the professional development of all department staff. The goal in revising and customizing the Core Competencies was for DPH to have annual data that could inform individual, programmatic, and department workforce development plans. Involving a wide variety of department staff through the creation and implementation of the Core Competencies helps to ensure that each member in the department feels engaged and participates fully in surveying activities. Outlined within the objectives described below are the activities conducted from 2014 to today that helped DPH implement a successful survey launch. Objective 1: Update the Core Competency survey biennially so that it is reflective of DPH staff needs and contemporary trends in public health. Activities: Give the WFD Committee jurisdiction over survey revision, launch, and workforce development planning. DPH's WFD Committee exists to identify trends and training needs for our public health workforce, ensuring DPH staff are equipped to meet the demands of a changing public health landscape. The WFD Committee strives to include representation from each of the six DPH Core Competency job classifications (outlined below), with members appointed annually to the committee through a blinded application process. Diverse representation within a committee (including job titles, job classifications, length of employment, and managerial status) allows the department to consider all public health trends and needs our staff encounter. It also ensures that many voices and opinions are considered in implementation efforts. Create a survey revision schedule that maintains longitudinal data but still allows for new trends in public health to be addressed. DPH's approach to launching the Core Competency survey has two parts: competencies that are specific to staff member's job function, and competencies that are prioritized by the department that are important for all employees—regardless of their title or job classification—to possess. DPH consciously updates only one part of the survey each year (either the job classification competencies, or the department competencies). By having two years of data for prioritized competencies, longitudinal trends can be observed. Review contemporary literature to identify trends in public health. Literature reviewed in 2018 included DPH's Strategic Plan, DPH's vision, mission, and values, Denver's Community Health Assessment and Community Health Improvement Plan, Healthy People 2020, Chief Health Strategist Framework (NACCHO and the PHF), and customer experience data. Using the literature review, identify what themes should guide the narrowing down of DPH's department-wide (all staff) competencies. In 2018, the WFD Committee identified the following themes: Collaboration (examples include community engagement, information and data sharing, partnerships, and sharing skills and abilities across the department) Continuous Improvement and Innovation (examples include quality improvement and research and education) Customer-Focused Service (examples include access to care and change management) Equity (examples include health disparities, social determinants of health, and workforce diversity) Leadership (examples include leadership development and policies) Workforce (examples include engagement, recruiting and building a diverse workforce, and staff retention) Review all 92 Core Competencies (from the Council on Linkages) and select department-wide competencies that meet the following criteria: The competency aligns with one of DPH's identified themes The competency is something the WFD Committee feels it can take action on (via a training plan) The competency will benefit all of DPH's workforce The WFD Committee reviewed all 92 competencies and selected a few (15 in 2016/2017, 14 in 2018) that would be asked of all DPH employees, regardless of their job classification Revise selected competencies to increase comprehension. After narrowing down the competency list and identifying what felt most relevant to their work, representatives of each job classification fine-tuned the wording of each competency. This revision process included brainstorming DPH specific examples of each competency, and simplifying the competency language so that it could be understood by all employees within the department. Pilot test new competency language with staff across various levels in the department. The WFD Committee put out a call for volunteers across the entire department for staff to review the newly revised competencies and provide feedback. If changes were suggested, the WFD Committee made updates and pilot tested again before a complete survey launch. Objective 2: Engage representatives from the department biennially in survey revision specific to job classification so that competencies are directly related to each employee's job function and competency language is easy to understand. Activities: Through a contracted partnership with the PHF and the WFD Committee, all DPH employees have been classified into one of six job classifications.” The job classifications” are: Directors (staff that set the vision and direction for the department and programs) Program Support (administration and those that support programs) Patient Support (staff that work directly with customers/patients) Healthcare Providers (licensed staff that directly provide treatment and care to patients) Data Drivers (staff that work with data and research) Public Health Specialists (staff that primarily run programs) Find representatives from each of the job classifications to select Core Competencies specific to their job function. Rather than surveying every staff member on all 92 of the Core Competencies, DPH wanted to identify the skills that were more frequently utilized by some of our employees to ensure that we were measuring competencies directly related to the needs of our staff. Representatives from each job classification used quality improvement tools to prioritize anywhere from six to ten competencies specific to their roles/job functions. Revise selected competencies to increase comprehension. After narrowing down the competency list and identifying what felt most relevant to their work, representatives of each job classification fine-tuned the wording of each competency. This revision process included brainstorming DPH specific examples of each competency, and simplifying the competency language so that it could be understood by all employees within the department. Pilot test new competency language with staff across various levels in the department. The WFD Committee put out a call for volunteers across the entire department for staff to review the newly revised competencies and provide feedback. If changes were suggested, the WFD Committee made updates and pilot tested again before a complete survey launch. Objective 3: Achieve 100% staff participation in the annual survey. Activities: Create a communication plan for all department staff, regarding the purpose and usage of the Core Competency survey. Key messages included: The Core Competencies are foundational public health skills and are not specific to any discipline,” The Core Competencies are important to your professional development, Healthy People 2020 Objectives, and the Accreditation Process,” and The survey should be seen as an opportunity for professional development, and should not be viewed as a punitive activity.” Communication was driven at the executive and mid-manager levels. Staff were reminded that they had one month to complete the survey. Provide short presentations two months in advance of the survey launch at department, manager, and program meetings. Presentations at clinical staff meetings were especially important, as this time was used to discuss the difference between clinical competencies and the Public Health Core Competencies and why both are important to an employee's professional development and growth. Identify which staff members should take the survey. In addition to full-time employees, DPH's diverse workforce includes contractors, students, interns, and fellows. Knowing that the results are meant to influence department training plans, permanent” staff members were asked to complete the survey; contractor, student, intern, and fellow participation was optional. Allow adequate time for all staff to complete the survey. DPH's annual Core Competency survey is open from June 1 to June 30. By using SurveyMonkey, skip patterns were built into the survey for job classifications; this made taking the survey less laborious, as employees only had to click through three pages of questions: the first page was demographic questions such as name, program area, job classification, and length of employment; the second page was competencies specific to the job classification; and the final page was competencies asked of all employees within the department. Pilot testing for the survey each year helps to ensure that the survey only takes ten minutes or less to complete and questions are revised for quick comprehension. Provide personalized updates through email and in-person communication to managers regarding staff participation rates. Survey participation was not anonymous; using the SurveyMonkey platform, DPH's WFD Committee could track which employees still needed to complete the survey. Throughout the month of June, employees receive reminder emails if they had not completed the survey. Managers were copied on the emails and given talking points on how to encourage staff participation. Reminder emails were sent after 10 days, 20 days, and 25 days. Objective 4: Provide survey results in individual and aggregate form to every employee, manager, program area, and the department to make training recommendations. Activities: Provide all employees and their managers personalized individual results. Every employee in the department receives a summary of their self-assessment. It is emailed to them and their manager within 30 days of completing the survey. The personalized results present their strongest self-assessed competencies first, so that the conversation around the results can stay strengths-based. In addition to the scores for competency self-assessment, the personalized results template includes recommendations on competency domains (such as leadership and systems thinking skills,” or analytical and assessment skills”) to consider. By broadening the scope of competencies to larger skills, each staff member can think creatively about professional development goals. Managers were asked to meet with each of their employees (using their coaching guide) to have conversations about the self-assessment. Managers were coached to help their employees consider what competencies were most applicable to their job function, and which competencies were most important to develop. The expectation is not that all employees be experts in all things, but that they at least have a level of knowledge and understanding within each competency; the need for expertise for specific competencies is decided by the manager and the employee. At the end of the conversation with the manager, all employees are encouraged to set an additional or new professional development goal (as appropriate) around a competency or competency domain. DPH requires that every employee have at least one professional development goal each year, and this survey helps staff think creatively about meaningful goals. DPH is committed to supporting staff in their professional development goals through financial assistance and/or devoted time to work on those goals. If an employee requires financial assistance to complete their professional development goal (such as conference registration), they are asked to complete an application prior to the event. The application helps the department track what professional development opportunities staff are seeking and creates a repository of activities for other staff to consider in the future. A newly created mentoring program aligns with the personalized individual results. Timing for the mentoring program includes: applications due by the end of August, and mentorship matches made by September. Mentors and mentees are paired based on the Core Competency survey (either through a selected competency for development, or a selected competency domain (such as Financial Planning and Management Skills.”) The formal mentoring program allows staff to meet with someone from within DPH who is not in their job classification or division to enhance their skills, and for their increased in competence to be measured in June (on the next year's survey) when the mentorship program is complete. Create and update (annually) a coaching guide to support department managers in discussing individual Core Competency results with their staff members. All managers are asked to review survey results with their direct reports to identify professional development opportunities within 60 days of receiving the results. The coaching guide helps managers think through expectations of where staff should prioritize their professional development efforts. The coaching guide highlights Do's” of Core Competency conversations, including: reassuring the employee that the self-assessment will not be used within the context of their annual review; reminding the employee that competencies can take a career to develop; using strengths-based language and approaches to opportunities for training; giving recognition for accomplishments and desirable behaviors that should be continued. Managers were trained not to talk about known performance issues while discussing the Core Competencies, so that staff doesn't feel the need to artificially inflate their comfort/knowledge around each competency. Provide each program area with aggregate results in the form of a score card” from their staff self-assessments. Managers receive aggregate data for their program/clinical areas. This data helps to inform decisions about program-specific trainings to increase organizational competence. It is recommended that managers schedule a meeting with their entire team, and send their program area's scorecard to all team members ahead of the meeting. As the team reviews the results they are encouraged to focus on strengths and concerns, taking time to celebrate the things they do well while discussing areas where they'd like to improve as a whole. Managers were coached to consider what level of competency comprehension was appropriate for their team; teams do not have to be experts” in all competencies. Considering all staff input, teams should decide what is within their control and pick one area of focus for the following year. Using a SMART goal framework, teams should create an action plan and delegate leadership and responsibility to a variety of staff members. Solicit feedback from all department staff to make a department-wide, competency-based training plan. The WFD Committee reviews the results of the departmental competencies, and selects the lowest scoring competencies to elevate for department feedback. Competency results are shared through a variety of outlets, including internal communications, manager and director meetings, and the department's intranet. The department, with the support of the Executive and Associate Directors, holds a series of Town Halls” to ask staff for their feedback on the lowest scoring competencies. Specifically, staff are asked what they would like to see prioritized (which competency or domain), and their ideas for how to build staff capacity around that competency. Town halls generally have a 75% or higher department attendance. Using the feedback collected at the Town Halls, the WFD Committee prioritizes and sequences ideas (using quality improvement tools, such as a PICK Chart) to create a department-level action plan. The action plan includes the action items (what steps will be taken to improve organizational competence), achievement indicators (how we will know that we were successful), department leaders, and target dates for execution. The training plan is then operationalized by the WFD Committee and the department leaders named in the plan. This allows for increased staff involvement and ownership over the process. Planning for DPH's first annual Core Competency Survey took just under two years. Because DPH applied for Public Health Accreditation under Standards and Measures Version 1.0, our workforce development plan included a section that highlighted our intention to adopt the Core Competencies. This approach was different than health departments who applied/are in the process of applying for accreditation under version 1.5, which dictates that the Core Competency survey should be conducted first, and a workforce development plan should be created around those needs. Throughout 2017 and 2018, DPH's WFD Committee revised its approach to implementing the Core Competencies so that it fits the criteria for a reaccreditation process under Standards and Measures 1.5. Therefore, two timelines are applicable to our practice: a timeline for our initial launch and a timeline for annual survey updates. The timeframe for initially launching the Core Competency survey included the following key milestones and activities: December 2014—January 2015: DPH contracted with the PHF to discuss initial steps necessary for a survey launch. DPH began the process of categorizing all permanent staff (DPH's workforce, minus students, fellows, contractors, and interns) into one of six job classifications (Director, Data Driver, Public Health Specialist, Healthcare Provider, Patient Support, Program Support). The goal of creating these six job classifications was to identify roles that have common themes and needs for skill development. The WFD Committee reviewed a roster of all DPH staff to accomplish this task in preparation for a spring workshop. February 2015: The PHF conducted an onsite workshop to identify skills and competencies essential to the work of Denver Public Health. The agenda for the day included an overview (for the 60+ staff in attendance) about the importance of surveying competencies (why essential skills are important to a public health workforce), descriptions and fine-tuning of job classifications, an overview of the competency selection process, and group breakout work to identify and vote for essential skills and competencies within each of the eight Core Competency domains. The end result of the workshop was a list of six to ten competencies, prioritized by staff, specific to each of DPH's six job classifications. March 2015—April 2016: DPH's WFD Committee reviewed the recommendations/voting from the February 2015 workshop and finalized competency selection and language. The committee cross-walked the competencies selected for each job classification to identify skills that were repeated multiple times. From this crosswalk, as well as a general review of all 92 Core Competencies, the committee selected 15 competencies that would be surveyed of the entire department, regardless of their job classification. After finalizing the list of selected competencies, the committee began working on revising the language used within each of the competencies to ensure maximum staff comprehension. This included focus groups with representatives from each job classification to solicit feedback about competency wording and examples, and a series of survey pilot tests with various members of the department. Additionally, the committee worked to finalize a scoring scale” for the survey launch. Feedback from pilot surveys indicated that staff preferred a scoring scale that utilized key words indicative of comprehension, rather than numbers on a Likert scale. The scoring scale that was created included five indicators of competency comprehension and practice: None—I am unaware or have no knowledge of this topic Aware—I have limited knowledge of this topic Knowledgeable—I understand and can explain this topic Experienced—I can apply knowledge and skills related to this topic Expert—I am proficient in this topic and could teach this to others April 2016—May 2016: The WFD Committee drafted and launched a Core Competency Communication plan. This plan included staff messaging (themes: this survey is meant for professional development and growth and should not be seen as a punitive activity) and identified channels and times for advertising the survey (manager meetings, director meetings, staff meetings, director updates, newsletter announcements, and personalized emails). June 2016: DPH launched its first annual Core Competency survey. The survey was hosted on Survey Monkey, and emailed to every staff member with key reminders about the importance of participation. Staff were given one month to complete the survey, and managers received multiple emails with updates on their team's participation rates. By the end of June 164 of 165 DPH employees completed the survey. Following the launch of the survey, DPH adopted an annual schedule of activities to ensure that the Core Competencies stay contemporary and are fully embedded into workforce development efforts: July—August: Staff in DPH's Planning and Performance Improvement Office work to transcribe results from Survey Monkey into templates for individuals, programs, and the department. The personalized results templates are emailed out to each employee (and their manager), managers/directors receive aggregate results for their program or clinical area, and the WFD Committee looks at aggregate results of the department competencies. September—October: At the individual level, staff review their competency assessment with their manager to identify professional development needs. Staff can set a new professional development goal at this time, or make a note to set a new goal at their annual review. Within department programs, managers convene their staff to review aggregate scores and identify a group training plan. Programmatic trainings plans are recorded in each area's semi-annual report, which is shared with department leadership. At the department level, the WFD Committee reviews aggregate data to select a competency (or competency domain) that will be the focus of the following year's workforce development plan. November—December: Using the competency selected at a September/October WFD Committee meeting, the WFD Committee brainstorms and sequences training activities for the department. Although these activities are sequenced and finalized by December, the implementation of them will extend into the future (thereby informing future workforce development plans). For example, in 2016, the identified competency to uplift was Describing and/or providing professional development opportunities.” Brainstormed training activities were prioritized and sequenced, resulting in a 2017-2018 plan that included: Creating a DPH definition of professional development (PD) (January 1, 2017—March 31, 2017) Creating a PD huddle/information sheet for staff distribution (March 1, 2017—April 4, 2017) Presenting and vetting the PD definition with program managers (March 1, 2017—April 5, 2017) Clarifying and updating department guidelines for PD funding (March 1, 2017—July 31, 2017) Creating a PD internal Sharepoint site (August 1, 2017—November 30, 2017) Creating standard work to support setting PD goals at annual reviews (August 1, 2017—November 30, 2017) Training managers on how to assist staff in setting PD goals (August 1, 2017—February 28, 2018) Educating the department on new PD goal guidelines (annual PD should include one quality improvement goal and one personal/departmental focused goal) (August 1, 2017—April 30, 2018) Develop a structure for systematically reminding employees and managers about PD resources (January 1, 2018—April 30, 2018) Explore a PD goal tracking system (January 1, 2018—June 30, 2018) January—April: The WFD Committee reviews survey competencies biennially (job classification competencies one year, department competencies the next) for updates. Similar to the initial startup process for DPH, this phase of revision includes identifying contemporary public health themes and trends to guide competency selection, as well as a robust revision process that pilots survey language with various employees throughout the department. April—May: The communication plan is updated, new communications are drafted/sent out, employee tracking lists are compiled (who should take the survey, and who is their manager), and the SurveyMonkey is updated. June: Starting June 1st, the new Core Competency survey is emailed to all eligible staff with a one-month period for staff to participate and updates to be given to managers. After the survey period is completed, this process repeats itself. Because the ultimate goal of the Core Competency survey is for DPH to have annual data that can inform individual, programmatic, and department workforce development plans, it was decided that all permanent” DPH employees participate in the practice. By permanent DPH employees, the department means staff with a .5 or greater FTE who are not students, fellows, contractors, or interns. The decision to not prioritize involvement from students, fellows, contractors, and interns is that these groups have a more transient length of employment, and their training needs may skew the data of the department. Although these groups are not prioritized to participate, they do have the option (which many exercise) to participate at manager discretion. The PHF has been a key stakeholder in DPH's Core Competency work. DPH's relationship to the PHF has transitioned over the years, just as its approach to the Core Competencies has evolved. The PHF was first a vendor to DPH, providing technical assistance through the form of workshops and phone calls, giving DPH a framework for thinking through the prioritization of competencies. It was through these workshops that DPH learned job classifications can bring together positions at varying levels and that all 92 Core Competencies do not need to be asked of every employee. After successfully launching its first Core Competency survey, DPH became a partner to the PHF in sharing best practices for approaching the competencies. This partnership has included national presentations (for example, a June 2017 webinar for determining essential core competencies for job positions, a shared presentation at the Public Health Improvement Training in 2017 regarding the alignment of job descriptions and workforce competencies, and a highly anticipated presentation at the National Network of Public Health Institute's Open Forum in March of 2019). DPH's work has helped to inform examples for the PHF's downloadable guide for prioritizing core competencies within job classifications. Fostering collaboration with the PHF allows DPH to share best practices on a national level, while staying informed of updates to the Core Competencies (DPH has a representative that serves on the PHF's national taskforce for Core Competencies). The startup cost for DPH to implement its first Core Competency survey was $37,000. This is the approximate amount that DPH paid to contract with the PHF for technical assistance and staff workshops to determine job classifications and prioritize competencies. After this initial investment, the cost for continuing the program is staff time; DPH staff members serving on the WFD Committee spend approximately one to four hours per month on workforce efforts, including the Core Competency survey. Additionally, DPH has one staff member on the Planning and Performance Improvement Team dedicated to uplifting workforce development and customer experience activities. This .8 FTE staff member dedicates part of their time to leading the WFD Committee and implementing the Core Competency survey.
Evaluation metrics were considered throughout the implementation of DPH's Core Competency survey launch, revision, and action planning. The objectives of the survey were: 1) update the Core Competency survey biennially so that it is reflective of DPH staff needs and contemporary trends in public health, 2) engage representatives from the department biennially in survey revision specific to job classification so that competencies are directly related to each employee's job function and competency language is easy to understand, 3) achieve 100% staff participation in the annual survey, and 4) provide survey results in individual and aggregate form to every employee, manager, program area, and the department to make training recommendations. DPH's evaluation plan assessed a number of important parameters such as staff participation rates (across all survey activities), meeting effectiveness, and change in Competency confidence. More information about process and outcome metrics is listed below. Objective 1: Update the Core Competency survey biennially so that it is reflective of DPH staff needs and contemporary trends in public health. Survey revisions are captured manually in excel tracking sheets and then uploaded to SurveyMonkey, the online platform DPH uses to administer the Core Competency survey. In 2016 the survey was initially launched, in 2017 the survey remained the same to preserve longitudinal data in both job classification competencies and department competencies, and in 2018, the department competencies were updated. Plans for updating job classification competencies are drafted for 2019. The 2016/2017 survey included six competencies for Patient Support,” six competencies for Program Support,” fifteen competencies for Directors,” seven competencies for Public Health Specialists,” seven competencies for Data Drivers,” and six competencies for Healthcare Providers.” These job classification competencies remained the same in 2018, but the number of department competencies changed from 15 in 2016/2016 to 14 in 2018. In 2018, all of the department competencies were new with the exception of one; the competency that was repeated was centered on professional development, as the WFD Committee wanted to continue tracking progress on this because so much of the committee's work focused on uplifting professional development within the department in 2017. To achieve this objective's outcome metric (that the survey was updated in 2018, with a revision schedule planned for 2019 and beyond) many process metrics were tracked. Notable process metrics included: the number of meetings held by WFD Committee members to review all Council on Linkages Competencies (eight meetings held, including four WFD Committee meetings with full participation, and four sub-committee meetings); the number of secondary resources consulted when selecting new competencies (eight resources, including DPH's strategic plan, Community Health Assessment, Community Health Improvement Plan, Healthy People 2020 documents, Public Health 3.0 documents, articles about becoming a community's Chief Health Strategist, and DPH's vision/mission/values); and the number of revisions in competency selection, including language and examples (four revisions were conducted, including an initial identification of new competencies in March of 2018, a first revision in April of 2018, a second revision in May of 2018, and a final revision at the end of May of 2018). Objective 2: Engage representatives from the department biennially in survey revision specific to job classification, so that competencies are directly related to each employee's job function and competency language is easy to understand. Data related to the number of representatives engaged in survey revision was captured manually through meeting minutes and sign in sheets. For the 2016 initial survey creation, DPH had 70 staff members (42% of the department) involved in selecting the job classification and department competencies (eleven staff comprised the WFD Committee at the time, helping to guide department efforts and 59 additional staff members participated in conversations with the PHF via focus groups). The initial group of participants selected 50 competencies for department consideration. After this initial selection was completed, five program assistants from the department provided feedback on the survey. They noted that the reading level was too high, there was confusion around what was being asked and the context, and suggested that specific area examples should be included. The 50 core competencies were then divided amongst two WFD Committee workgroups who met two times each to update/revise the competencies. Objective 3: Achieve 100% staff participation in the annual survey. In the past three years that survey has been implemented, the department achieved a consecutive 99.4% completion rate. In 2016, 163 employees were prioritized for survey participation, with 162 successfully completing the survey; in 2017, 163 of 164 employees participated; and in 2018, 165 of 166 employees participated. The data was collected through SurveyMonkey. While the goal of 100% participation fell short by 0.6% each year, many process activities helped contribute to each year's 99.4% participation. Communication activities were prioritized each year, with a number of multimodal touchpoints established (each year there were three email messages from DPH's executive director, three internal message board updates, four mentions of the survey in DPH's internal newsletter, and three in person trainings provided at program manager or director meetings). Additionally, DPH's Workforce Development Specialist monitored staff participation throughout the month of June, and emails were sent to program managers to highlight staff participation with prompting for employees who had not yet participated to do so. In 2016, 67% (110 of 163) of DPH staff completed the survey prior to the first email reminder to managers; 88% had completed it prior to the second email reminder sent to managers; and 99.4% completed it by the end of the month. In 2017, 46% of staff participated prior to the first email reminder to managers (75 of 164); 73% prior to the second email reminder (110 of 164); and 99.4% by the end of the month (163 of 164). In 2018, 37% of staff completed the survey prior to the first reminder email (61 of 166); 77% participated prior to the second email reminder (128 of 166); and 165 of 166 completed the survey by the end of the month. The email reminders, which were manually and personally addressed to the staff members (and had their manager copied) largely helped with staff participation. Objective 4: Provide survey results in individual and aggregate form to every employee, manager, program area, and the department to make training recommendations. This objective was the most complex for evaluation, as there were multiple outcome measures that DPH measured. The first set of outcome measures included that 100% of individual staff and program areas received their results. This was achieved for individual staff by the use of a template that organized competencies from highest self-assessment to lowest-self assessment. The template was also customized to make individual recommendations based on competency domains, so that employees could identify a domain (such as Communication skills”) for professional development, rather than a specific competency. Each year since 2016, every employee that took the survey received their personalized results. Program areas also received a scorecard” that showed their aggregate scores for each of the department competencies compared to the overall department score for each competency. This allowed programs to identify a competency or domain where their team could use extra training, and to create a training plan. In 2016 and 2017, DPH did not track the training plans that program areas created; a lesson learned was the importance of having a systematic way to collect each area's training goals. In 2018, nine out of nine program areas created a training plan with action items and achievement indicators to track an increase in their staff's comprehension around a specific competency. For example, DPH's Tuberculosis Clinic chose to prioritize Communication Skills” and Leadership and Systems Thinking Skills” and the broad objectives they selected included Working on increasing team huddles and opportunities for staff to communicate in open forums,” and Utilizing team meeting time to discuss interactions and collaborations with other health care systems.” The action items to meet these objectives will have achievement indicators attached to them, such as Number of huddles conducted,” or Number of staff sharing at a team meeting.” For the department competencies, since the surveys initial launch in 2016, the WFD Committee chose to follow the metric of staff competence related to professional development. Using the survey prompt, Participating in and/or ensuring the use of professional development opportunities,” the committee set a goal of increasing the percentage of survey respondents, employed greater than one year, who self-assessed as informed,” experienced,” or expert.” The 2016 survey weighted results (on a scale of 0-4) showed DPH averaging a 2.36 score in this competency. After a detailed action plan (with process items including the creation of a definition of professional development, educating the department on professional development, clarifying and updating department guidelines for accessing professional development funding, creating an internal Sharepoint site to host all professional development resources, creating resources to support the setting of professional development goals at annual reviews, and exploring a professional development goal tracking system), the outcome of staff competence increased by 15.3%, to a weighted score of 2.72. The data was analyzed using basic Microsoft statistics and graphs. Keeping with DPH's departmental culture of quality improvement, there have been a number of modifications made to DPH's survey process. These modifications came from our PDSA” cycles (plan, do, study, act), and were related either to survey design/revisions or results sharing and action planning. In 2017, DPH modified the survey to consider additional demographic questions. The first survey only asked demographic questions about program area,” and job classification,” but the WFD Committee wanted to be able to sort data by length of employment and whether or not the staff member was a manager. Having these two options to crosstab the data allowed for specific recommendations to be made to DPH's New Employee Orientation (for competencies where new employees consistently self-assessed lower), or to target trainings to managers on how to support their staff in competency development. Additionally, DPH modified its revision process by including secondary sources to help guide the competency selection (as opposed to staff just voting on what they felt was most important). Modifications to results sharing included the creation of program scorecards and the addition of themes to personal results templates. In 2016 and 2017, each program manager was given a download of their program area's data. There were two documents provided: one had every individual's personal responses and the other had the average scores of each competency. The feedback from managers was that these documents were overwhelming and that they needed help prioritizing where to focus training efforts. A scorecard was created in 2018 that only showed the department competencies and the team's average against the department average. The scorecard was color-coded to help managers quickly identify areas where their team's score might be lower than the department score. Another change in 2018 was that program managers were asked to share with department leadership at their fall semi-annual report their plan for competency development for 2019. This helped keep program areas accountable to the professional development of their staff. As for individuals, the feedback received was that the competencies felt too overwhelming (or too specific) to use when selecting a new professional development goal. DPH broadened what was given to each employee so that they received competency domains in addition to their competency scores. For example, employees individual results listed the top three themes to consider for development, such as communication skills. This helped employees set a new professional development goal that was more specific to their program area and individual needs, rather than one competency that might not be as relevant to their work.
Sustainability was an important consideration when DPH began the process of implementing a Core Competency survey.While DPH is continuing to learn lessons in sustainability, a few key areas of focus have helped to ensure that the survey stays relevant, current, and referenced by staff.Those lessons include: the importance of staff involvement in survey creation, revision, and action planning, the importance of a volunteer committee to oversee ownership of workforce development efforts, the necessity of leadership support to create a culture where the survey is embedded into staff development at all levels, and detailed standard work. Having a variety of staff involved through the startup, revision, and survey follow up has contributed to the sustainability and success of DPH's Core Competency efforts.This is for a number of reasons, including: increased staff buy-in, disbursement of work, and engagement in post-survey activities.DPH intentionally reaches out to staff from varying programs and clinics with a wide range of titles and length of employment, to assist with the selection of competencies most relevant to each job classification.Rather than taking a top-down approach of telling staff where to focus their professional development efforts, asking the staff what they need to do their jobs successfully increases the likelihood of their participation in the assessment. Another benefit of having a variety of staff involved in the implementation of the survey is that the work of reviewing and revising competencies is shared between many people.Having a customized survey has increased staff engagement, but building a customized survey takes a significant amount of time; for health departments without specific staff dedicated to workforce development efforts, assigning this task to one person could be overwhelming.Reading all 92 competencies (including their three-tiered language versions) and cross-walking them with themes and strategic department visioning is not a small task.It is also a task that is best done with others so that lively discussion can assess a department's current state and future state. An important lesson related to surveying and staff involvement is the timely and transparent sharing of results.A best practice in customer feedback collection is to share back to the customer what you've learned and what you plan to do with the information collected; DPH published survey results internally but also hosted a series of departmental town halls to share back the survey results.With over 75% of staff in attendance, and small breakout groups for staff to offer feedback on opportunities for growth, a workforce development plan could be built that truly reflected the wants and needs of our staff.The sharing wasn't just conducted at a department level; managers shared results at a programmatic and individual level as well.When managers took the time to thank staff for participating, celebrate successes, and engage in conversations about growth, excitement around the survey grew. There is no doubt that staff involvement at many levels is an important lesson and best practice.Held in tandem with this, however, is the need for ownership of the process.Within DPH, the department's WFD Committee and Planning and Performance Improvement Office hold this ownership.It is these two groups that help oversee the schedule of activities related to survey implementation and follow up, make recommendations for staff members to be involved in the process, and ensure the ultimate plans derived from conversations align with the department's strategic plan and other organizational initiatives.DPH's WFD Committee is a volunteer group of staff elected to the committee through a blinded application process; membership commitment requires that they commit to identifying and promoting professional development opportunities, have a flexible and collaborative nature and interest in increasing workforce development and engagement, and are able to attend meetings and complete required work between meetings.DPH's committee limits participation to no more than 12 members and requires team members to be employed in their position for at least 90 days before applying. The importance of leadership support is also valuable lesson and best practice.At DPH, executive leadership support has included the creation of a Planning and Performance Improvement Office to ensure that strategic planning, quality improvement, workforce development, and customer experience are embedded at all levels and across all programs.The work of this team has helped to chair department committees (such as Workforce Development) and liaise between executive leadership and staff regarding new initiatives.Executive leadership support was also paramount in the forms of advertising the importance of the Core Competency survey, encouraging managers to achieve 100% staff participation, and conducting the department-wide town halls.While executive leadership support helps set a vision for the department, mid-level managers help employees navigate the day to day work of growth and development.Support at this level is just as important as executive support, because managers hold the power to influence staff development both individually and for their program areas.Managers can coach and guide staff, make time for trainings during staff meetings, share resources, make connections, and help employees grow. Perhaps one of the most important lessons learned in this practice, and tied into partner collaboration, is the importance of standard work.Standard work is a clear, concise, written description of how to perform a particular process or task so that the outcome will be efficient and of the highest quality.It represents the best practice known at a point in time, and is a living document that is continuously improving.Within the context of the Core Competencies, many standard work documents were created.These documents included checklists for cross-walking competencies to departmental themes (in the revision process), job breakdowns that detailed who would be performing each action step (and why it was important), flow charts to show the steps necessary for a successful survey launch, and standard work maps to document DPH's precise sequence of tasks and required time frame for completion.Having detailed standard work allowed DPH to share best practices with other health departments and with the PHF.The lesson DPH learned (as related to standard work) from external collaboration is the importance of sharing consistently updated information.It has been much easier to revise standard work and share it rather than start from scratch each time.This has helped to alleviate questions from other health departments about What comes next,” as the next steps are always outlined. Rather than having all of the content knowledge in the mind of a single staff member, it allowed for the broad sharing of information.Additionally, with staff transitions at DPH (to new roles, or in 2018, a key member being on maternity leave), the work never had to stop. DPH did not do an official cost/benefit analysis for the implementation of the Core Competency survey, but the opportunity costs of not conducting a survey are apparent: DPH would not have achieved national public health accreditation without it, and our workforce would not continue to grow and thrive in a contemporary, forward-thinking environment.When existing staff feel they are learning and growing personally and professionally and performing well they are more likely to stay with an organization and provide continuity by teaching and training others to become great employees. DPH has identified gaps in knowledge, skills, and abilities through the assessment of both organizational and individual needs, and addresses these gaps through targeted training and development activities. With our largest stakeholders being our staff, there is no doubt that there is commitment to sustain, update, and implement an annual survey.Staff appreciates the opportunity to set new professional development goals, and DPH's visionary leadership challenges staff to continue growing.The practice will remain sustainable through the detailed standard work that has been drafted and updated.The ownership of the survey will continue to first reside with DPH's Planning and Performance Improvement Office, and be executed in action by DPH's WFD Committee.
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