Health System Organization
Session 4:
Health Care Workforce
Public Health Competencies
Race Against Time: Group 2 Presentation
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Health Care Workforce
• Who are they?
• How are they trained/educated?
• Where do they come from?
• Where do they go?
• WHY?
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Functions of Health Education
• Governance
• Educational services
• Selection of staff
• Financing
• Infrastructure and Technology
• Information and Knowledge
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Access and quality depend on the number
and training of health professionals
Source: The looming crisis of the health workforce: How can OECD countries respond? (OECD, 2008).
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Medicine
• MD – allopathic
• DO – osteopathic
• Others
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Naturopathic
Chiropractic
Psychologist
Podiatrist
Optometrist
• Traditional Healer
• Physician Assistant
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Nursing
• Advanced Practice (Registered) Nurse (APN/APRN)
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NP
CNM
CRNA
CNS
• Registered Nurse (RN)
▫ BSN
▫ ADN
▫ Diploma
• Licensed Practical Nurse (LPN)
• Nursing Aide/Assistant (CNA)
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Allied Health Professionals
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Dentist/Dental Hygienist
MPH
Pharmacist
Physical/Occupational/Speech Therapist
MSW
Technologist (laboratory, biomedical, radiology)
Dietician
Audiologist
Optician
Etc., etc.
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The Markets for Health Professions
Education
Health Services
Labor
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Public Health Workforce Challenges
• Increased federal workforce -- bioterrorism dollars
• Decreased state and local positions
• Change in worker productivity due to technologies
• Administrative and bureaucratic obstacles to
growth and recruitment
Gebbie & Turnock, 2006
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Workforce Development
• Development of core competencies for public
health workers
• Competency-based training
• Competency-oriented job descriptions
• Credentialing individuals
• Accreditation of public health agencies
Gebbie & Turnock, 2006
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Public Health Functions
• Assess & Monitor
1. Monitor health status to identify community
health problems.
2. Diagnose and investigate health problems and
health hazards in the community.
3. Inform, educate and empower people about
health issues.
• Formulate Public Policies
4. Mobilize community partnerships to identify
and solve health problems.
5. Develop policies and plans that support
individual and community health efforts.
Institute of Medicine, The Future of Public Health, National Academy of Sciences, 1988.
Public Health Functions Steering Committee, 1994 (multiple organizations).
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Public Health Functions
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Assure Access to Care
6. Enforce laws and regulations that protect health
and ensure safety.
7. Link people to needed personal health services
and assure the provision of health care when
otherwise unavailable.
8. Assure a competent public health and personal
health care workforce.
9. Evaluate effectiveness, accessibility and quality of
personal and population-based health services.
10. Research for new insights and innovative
solutions to health problems.
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What Is a Competency?
• Reflects knowledge
• Reflects skills
• Continuum of expertise
• Develops with application and experience
• Can be measured or observed
• Basis for performance assessment
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Multiple Sets of Competencies
• Association of Schools of Public Health, Core
Competency Project
• Council on Linkages -- public health
• National Center for Healthcare Leadership -health administration
• Veterans Health Administration High
Performance Development Model -- health
administration
• ACGME -- postgraduate medicine
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Core Competency Project, ASPH
• Five discipline-specific sets of competencies
▫ Biostatistics
▫ Environmental health sciences
▫ Epidemiology
▫ Health policy and management
▫ Social and behavioral sciences
• Upon graduation, a student with an MPH should
be able to … [list of abilities related to each of
five areas]
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Interdisciplinary Competencies
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Communication and informatics
Diversity and culture
Leadership
Public health biology
Professionalism
Program planning
Systems thinking
Relevant to ALL graduates with an MPH!
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Council on Linkages:
Public Health Competencies/Skills (2001)
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Analytic assessment skills
Policy development/program planning
Communication
Cultural competency
Community dimensions of practice
Public health sciences
Financial planning and management
Leadership and systems thinking
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National Center for Healthcare Leadership:
Competencies for Health Management (2002)
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Learning and performance improvement
Professionalism
Personal and community health systems
Leadership
Collaboration and communication
Management practice
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VA High Performance Development
Model Competencies (HPDM)
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Interpersonal effectiveness
Customer service
Systems thinking
Flexibility/adaptability
Creative thinking
Organizational stewardship
Personal mastery
Technical competency
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Postgraduate Medicine
(ACGME, 2001)
• Patient care
• Medical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• Systems-based practice
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National Board of Public Health Examiners:
Public Health Credentialing
• New effort by National Board of Public Health
Examiners
• Ensure MPH graduates have mastered
prescribed set of skills/competencies
• Voluntary exam started summer 2008
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Competencies and Credentialing
• Competencies
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Are these useful?
Which ones appeal/are not useful?
Do they transcend borders?
How would you use these?
• Credentialing
▫ Is it necessary?
▫ Since voluntary, will people take it?
▫ How much effect will it have?
• OMPH position statement on exam