Center of Excellence in Public Health
Workforce Research and Policy
at the
University of Kentucky
College of Public Health
Co-Directors: F. Douglas Scutchfield, MD
and Cynthia D. Lamberth, MPH, CPH
COEWRP
•Objectives:
•Foster growth and interest in workforce research and
policy to assure public health system has a competent
workforce
•Support national effort to evaluate public health
workforce issues
•Sister COE for Public Health Workforce Studies
at University of Michigan School of Public Health
•Director: Matthew L. Boulton, MD, MPH
Today’s Presenters
• Carol A. Gotway Crawford, PhD
Acting Director, Division of Measurement & Analytic Methods,
Epidemiology and Analysis Program Office (proposed),Centers
for Disease Control and Prevention
Project Officer for Centers of Excellence
• Kristine M. Gebbie, DrPH, RN
Joan Hansen Grabe Dean
School of Nursing Hunter College, CUNY
•
Hugh H. Tilson, MD, DrPH
Senior Advisor for Public Health Workforce to HRSA Bureau of
Health Professions, and
Adjunct Professor, UNC Gillings School of Public Health, and
Duke University School of Medicine
Public Health Workforce Research:
Status and Future Directions
Carol A. Gotway Crawford, PhD
Epidemiology and Analysis Program Office (proposed)
Centers for Disease Control and Prevention
June 8, 2010
4
CDC Research Guide:
Workforce Research Theme
Workforce and Career Development
Conduct research to improve public health
workforce-related recruitment, retention,
and training.
Source: CDC. Advancing the nation’s health: a guide to public health research
needs, 2006–2015. Atlanta, GA: US Department of Health and Human Services,
CDC; 2006. Available at: http://www.cdc.gov/od/science/PHResearch/cdcra/.
5
Multiple Broad Areas

Identify and assess
—
Best practices for recruitment, training, and
retention
—
Strategies to create and sustain a workforce
that is capable of meeting public health needs
—
Information gaps, resources, and other areas
needing improvement
—
Impacts of trained public health professionals
on specific outcomes (e.g., improved health or
improved public health practice)
6

Determine and define
—
Current public health workforce needs
—
Skill competencies needed and best methods
for updating and validating these
competencies
—
Organizational variables that support
development and application of skill
competencies
—
Best indicators of workforce performance
—
How best to facilitate collaboration among
academia and community-based groups and
integrate with public health practice
7

Monitor and evaluate
—
Workforce trends, including size, distribution,
qualifications, and tenure
—
The role of labor market forces on recruitment,
retention, wage, salary, benefits, and
personnel-system characteristics
—
Best indicators of workforce performance
—
Future workforce needs (forecasts)
8
Research Goals

Support public health workforce planning, programs,
and policies with research that is
— Empirically
driven
— Evidence-based
— Strategic

Identify best practices for workforce and career
development

Coordinate existing public health workforce research
with academia and sector partners
9
Research Themes and Objectives

Derived as a general organizing approach

Developed themes that are broad, not unique,
but consistent with those developed previously

Focused on key outcomes of interest

Defined objectives that are exemplary, not
completely exhaustive

Based on Cioffi, Lichtveld, and Tilson (2004),
the CDC Research Guide, and literature reviews
10
Eight Research Themes
1. Workforce size and composition
2. Workforce diversity
3. Workforce effectiveness and health impact
4. Recruitment, retention, separation, and retirement
11
Research Themes (cont.)
5. Worker pay, promotion, performance, and job
satisfaction
6. Demand for the public health workforce
7. Education, training, and credentialing the public
health workforce
8. Public health workforce policy
12
Coordinated Efforts
•
Public health workforce research previously
uncoordinated and fragmented
•
CDC expected by partners to play a leadership role
•
How to move an entire field forward?
 Need a strategic partnership approach that
supports evidence-based, policy-focused
research
13
Public Health Workforce Research: Strategic Development
GOAL: To provide public health decision makers with the scientific research necessary
to support coordinated, systematic, empirically driven, evidence-based
public health workforce and career development planning,
program, and policy efforts that ensure a competent, diverse, sustainable,
and prepared public health workforce necessary to improve health outcomes.
Develop and
promote a
universal
language,
shared
priorities, and
standards
II.
Data
Build an empirical
foundation for
decision making
III.
Methodology
IV.
Evaluation
V.
Policy analysis
Create general
methodologic
approaches for
measurement and
analysis
Develop a
comprehensive
evaluation
framework
Conduct
research to
establish the
connection
between
policies and
outcomes
VI.
Dissemination
and translation
THE PROCESS
I.
Definitions
Disseminate/
translate research
findings to guide
development
of recommendations/
guidelines, and
future direction
Outcome: Evidence-based recommendations for programs and policymakers
on workforce investments.
14
Current Activities

Identify and develop workforce best practices
—
Policy research with Univ of Chicago
—
Traditional partners: ASTHO, NACCHO, ASPH, SPHs
—
New partners: BLS, RAND, policy researchers,
sociologists, economists
—
CDC Workforce Research Conference, Social Science
Perspectives on Workforce Policy: Opportunities to
Inform Public Health Workforce Policy, August 2008
—
Special issue of J Public Health Manag Pract
15
Current Activities (cont.)

Center of Excellence in Public Health Workforce
Research and Policy (U. Kentucky CPH and
PHF)
—
Define in the context of public health systems research
—
Measure and forecast workforce size and composition to
match community needs (data harmonization)
—
Determine how workforce components affect public
health services
16
Current Activities (cont.)

The University of Michigan Center of Excellence
for Public Health Workforce Studies

Focus on the development of analytic,
quantifiable, conceptual models of workforce
Define best practices for recruitment and
retention of the public health workforce
 Consider the supply and demand for the public
health workforce in terms of occupations,
staffing models, competencies
 Enumeration of the public health workforce (with
HRSA)?

17
Future Directions

Use methods from such other disciplines as
economics and sociology

Unite key partners in research to make
strategic decisions and to leverage funding

Establish extramural research program

Public health workforce enumeration?

Continue to unite and engage all partners
18
Workforce Research Agenda:
Vexing Questions and How
Answers Might Help
Kristine Gebbie
Current situation is a way-station
• Studies of the public health workforce go back
to the 1920’s
– Goldmark’s study of public health nursing
education
– Enumeration as a way to monitor the effort to get
a public health agency in every county
• Key document: Public Health Workforce for
the 21st Century (DHHS/ODPHP, 1994)
– http://www.health.gov/phfunctions/pubhlth.pdf
Definition of the workforce
• Anyone who performs essential services of
public health as a part of regular work
responsibilities, regardless of
location/employer
– Does not include occasional, incidental public
health work (e.g., reporting TB once in a while)
– Does include significant public health work done
in departments of agriculture, environment,
transportation, NGO’s, others
Who are we?
– A degree?
–
–
–
–
MPH
DrPH
MSN
MD
– A place to work?
–
–
–
–
Laboratory
Office
Clinic
street
– A world view?
– Population, not
individuals
– Prevention first and
foremost
– Everyone
–
–
–
–
Executives
Professionals
Technical staff
Support staff
What we do?
– Activities?
– Run meetings
– Inspect facilities
– See individual patients
– Programs?
– Family planning
– Food safety
– Vital records
– Units of work?
– People seen/touched?
– Papers filed?
– Outbreak stopped?
Why do the questions matter?
• Information about workforce provides a key
component in our search to describe and
improve
– Outputs: services rendered, activities completed
– Outcomes: health status improved
– Quality: done in the most effective AND efficient
manner
• Avoiding public health errors
Examples of the struggles
• Epidemiology
– Lots of head counts—but what’s a ‘unit’ of
epidemiology?
– What about an RBRVS for epidemiology?
• A core unit which is multiplied for more complex
investigations or data management?
• Public Health Nurses
– Overlap with clinical activities, and generalists in
most settings
– Do PHN’s ‘do’ vaccinations differently than nurses
in hospitals?
– What about community mixing and mingling?
• Environmental health
– What’s the preparation and does it matter?
– If the degree isn’t common, what defines the
person?
… and finally, THE VERY LATEST
THINKING FROM THE PUBLIC
HEALTH WORKFORCE CENTERS OF
EXCELLENCE
Summary of the Survey and
ThinkTank of the National Advisors
Keeneland, 20 April, 2010
Hugh H. Tilson MD, DrPH
But first...
a word from
our sponsors!
But first...nothing I say
represents the opinion of …
Or any persons
Living or dead!
Question one: what needs to be added
to the research agenda(s)?
• TOP PRIORITY: Definition and Enumeration by
location, discipline, type of service
• Diversity, mix and competencies
• Effectiveness and Impact: association between
size and mix and metrics (outcomes)
Question one: the research agenda
• Pipeline dynamics: recruitment, retention,
separation and retirement
• Impact of workplace conditions: Pay,
promotion, performance, satisfaction
• Demand: excess demand at current price and
if so, incentives and costs
• Education, training, credentialing (re-tooling)
• Public policy to address the above
Research agenda strategies
• Taxonomy and common vocabulary
• “free up information exchange” … i.t. public
health informatics research agenda,
syndromic surveillance, dashboards tied to
individuals
Question one (a): REVISIT the
workforce research agenda(s)
• Re-examine the data on what we know
• Identify the big gaps
• Figure out how to fill them (new reporting
requirements, surveys)
• Find a source to fund …
Question two: who are the key
partners?
•
•
•
•
•
•
•
Schools of Public Health and Grad. Programs
PH Research Organizations
Professional Schools; Business Schools
State and Local Health Departments
Federal Agencies
Foundations (RWJ of course, but then who …?)
“consider a model similar to the Economic
Research Initiative on the Uninsured …”
ERIU model/partners
• Labor economists
• Social scientists
• Regenstrief model … build on the current
emphasis on clinical prevention … and find
scholars/champions there
Partners (cont)
• HR Directors
• Institutes
• Unions
3: …best way to advance and sustain a
coordinated … effort?
• Think along the whole continuum
• Link to “underservice”, i.e. Public health worker
shortage areas
• Project funding for scholars; grad student and
young researchers support
• Concerted effort: Agree on the agenda and find a
champion
• Business case: Show the link between the
questions we research and the impact of the
answers
4: Beyond the Current C.O.E.s?
• GOOD model, but needs time to prove itself
and evidence that it works (and a little funding
certainty might help)
• Two centers are not enough … but how many?
• PH Workforce caucus at APHA or national PH
workforce council to consider
• ADD PH Research targets within broader
“health workforce research centers”/PBRNs
• … other partners/strategies (HRSA, AHRQ,
NIH)
5: Leadership?
• CDC is “the logical leader” …
• Joint CDC, HRSA, CMS
• DHHS for PHSSR of which PHW is a
component
• Funding from “…any credible source”
• … how does this tie into AAMC’s “Coalition for
HSR?”
• … and a Federal Statistical Agency
6: How to Organize?
• ASH at HHS to coordinate CDC, HRSA, AHRQ,
NIH, and others concerned with workforce
• RE-invent the Public Health Functions
Leadership and Work Group: parlay health
reform context; ASTHO/NACCHO advocacy
• A standing national council … at the DHHS
level…. Maybe part of the Health Reform
Council
• Vision, direction, deliverables and funding
7: Leverage the funding
• ASH to convene
• Keep everyone talking together
• Develop a consistent message; distinguish PH
workforce research from (the rest of) PHSSR
(and others); link to important outcomes of
health care reform;
• IOM Study “WHO … ten years later”
• Engage HRSA with its workforce mandate and
new funding
7: STRATEGIES (cont)
• HP 2020 … PHSSR Chapter overarching
framework in the introduction
• Existing Centers to “partner” with the broader
research community/labor economics, social
scientists
• HRSA: cooperative agreements; fifty
workforce centers … across the full spectrum
(ask the same question across state lines and
across all professions)
Why talk about the public health
workforce research workforce
HERE/NOW?
…because the Nation and States need
help from our leadership …a.k.a. YOU!
And because DHHS is in the throes of
its own health care reform!!
THANKS
• Now, it’s in YOUR hands …
• Where do we go from here?