Two Accreditations, One Workforce Development Plan: How PHAB and PPHR Can Drive an Agency's Workforce Development

State: MI Type: Model Practice Year: 2016

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The development and systematic implementation of a formal public health workforce development plan is a key component of both the national accreditation process through the Public Health Accreditation Board and NACCHO’s Project Public Health Ready for emergency preparedness programs. In 2012 the Kent County Health Department (KCHD) initiated both accreditation efforts simultaneously. Because of the concurrent timeline, the KCHD was able to create a comprehensive three-year workforce development plan that effectively met the requirements for both accreditation programs, while also improving staff knowledge, skills, and abilities in a number of public health competencies.

 

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Kent County Health Department
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Two Accreditations, One Workforce Development Plan: How PHAB and PPHR Can Drive an Agency's Workforce Development
The Kent County Health Department (KCHD, www.accesskent.com/health) operates within Kent County, Michigan and serves more than 629,000 residents with 193,000 of residents living within the urban core and county seat – the City of Grand Rapids. There is a main campus building and three satellite clinics located strategically throughout the county. Kent County’s population is approximately 83% white, 10% African American, and 10% Hispanic/Latino. More than 25% of Kent County residents are under the age of 18 years and about 12% are 65 years or older. Nearly 90% of residents 25 years or older have at least a high school diploma, and more than 30% of the population 25 years and older have a bachelor’s degree or higher. The median household income in Kent County is $51,667 and the unemployment rate is 7.0% (US Census, 2014 Population Estimate). As of June 2015, KCHD employed 243 people, 224 of which were full-time equivalents. Eighty-four percent of the workforce at KCHD is female. About 80% of all staff are white, 9% are African American, and 7% are Hispanic/Latino. More than half of KCHD staff have been employed by the agency for 10 or more years, and 36% of staff have five or fewer years until they are eligible to retire. The development and systematic implementation of a formal public health workforce development plan is a key component of both the national accreditation process through the Public Health Accreditation Board (PHAB) and NACCHO’s Project Public Health Ready (PPHR) for emergency preparedness programs. In 2012 KCHD initiated both accreditation efforts simultaneously and realized that demonstrating the required efforts associated with workforce development was going to be a challenge with what was currently in place for the agency. Prior to accreditation preparation, KCHD staff had access to training and development opportunities through Kent County Human Resources for improved job performance, but not public health-specific training. Many staff were hired without formal training in public health and KCHD did not have the infrastructure in place to provide this type of training for new employees. The main goals of this practice include (1) become a nationally accredited health department through PHAB, (2) achieve PPHR recognition through NACCHO, (3) regularly evaluate competency-based staff training and development needs, (4) develop training curricula that adequately address priority training needs, and (5) improve staff competency and capacity in key public health and emergency preparedness topics. The KCHD workforce development plan was developed through collaboration of the KCHD Accreditation and Emergency Preparedness Coordinators utilizing PHAB’s Standards and Measures Version 1.0 and NACCHO’s PPHR Version 7 Criteria. KCHD engaged a consultant to assist with initial planning and facilitation of staff-input sessions. Staff input was gathered through facilitated discussions with a multidisciplinary group of staff and an online survey. The online survey items were adapted from The Ohio State University College of Public Health and an assessment tool used by the Berrien County Health Department. Data collected from these processes was used to inform and prioritize the competency-based training curricula that was outlined in the workforce development plan loosely modeled on the template created by The Ohio State University College of Public Health. Based on two staff training needs assessments completed since the implementation of the workforce development plan, KCHD has improved the knowledge and awareness on numerous public health topics among all staff. Often, people hired into public health positions do not necessarily have the academic background or training to truly understand how the work they do aligns with the core functions and essential services of public health. These individuals are certainly well-trained to do the job for which they are hired, but when they have the understanding of how their work fits into the bigger picture of public health, they are able to impact not just the client being served, but the community as a whole. KCHD has been PHAB accredited since September 2014 and gained PPHR recognition in January 2015. The KCHD workforce development plan was recognized as a best practice through PPHR review and has since been added as a resource to the NACCHO PPHR Toolbox. The development and sharing of this plan through various conferences and technical assistance consultations between KCHD and other health departments around the state and country has made KCHD a sought after resource for workforce development planning and preparation associated with both PHAB and PPHR.    
The development and systematic implementation of a formal public health workforce development plan is a key component of both the national accreditation process through the Public Health Accreditation Board (PHAB) and NACCHO’s Project Public Health Ready (PPHR) for emergency preparedness programs. In 2012 KCHD initiated both accreditation efforts simultaneously and quickly realized that demonstrating the required efforts associated with workforce development was going to be a challenge with what was currently in place for the agency. Prior to going through accreditation preparation, KCHD staff had access to training and development opportunities through offerings provided through Kent County Human Resources, such as the Learning Ensures Achievement Program (LEAP) and Leadership Enrichment and Development (LEAD) programs. These programs offer learning and skill development for improved job performance, but not public health-specific training. Employees were also generally supported in attending conferences and other trainings, as appropriate, for continuing education related to job-specific roles. However, despite being a public health agency, many staff were hired without formal training in public health and KCHD did not have the infrastructure in place to provide this type of training for new employees. The target population for this public health problem could be defined as the population of Kent County, as well as the employees of KCHD. Being an accredited health department through PHAB and PPHR ensures that the people of Kent County are served by an agency that demonstrates conformity with national standards of public health performance and that continues to implement efforts aimed to improve programs, services, and operations. The population of Kent County is more than 629,000 people, all of which are entitled to seek services and programs for which they are eligible through the agency. The other key population affected by the public health issue of interest is the employees of KCHD. Prior to going through the accreditation processes of PHAB and PPHR, KCHD staff did not have adequate access to public health training that was competency-based and driven by staff-identified needs. According to the 2015 KCHD Workforce Development Needs Assessment, nearly 82% of staff agreed that their public health training needs were met during fiscal year 2014-2015. The current practice has established a formal workforce development plan and process for improving staff competency in the core functions and essential services of public health and emergency preparedness. Through implementation practices associated with the plan, staff are guaranteed at least four trainings linked the Core Competencies for Public Health Professionals each fiscal year, and managers are guaranteed at least two additional trainings that are related to the same set of competencies. Staff also receive quarterly emergency preparedness training. All of the topics covered are driven by staff interests and training needs identified through an annual training needs assessment process. This ensures the agency is engaging staff in the determination of training topics while also making sure these topics link to core competencies established through the workforce development plan. The current practice is innovative in the sense that KCHD was able to use one workforce development plan to achieve five different goals. While a workforce development plan in and of itself is not necessarily an innovative practice, developing one to achieve dual accreditation and improved public health competencies in the current workforce is a creative use of existing resources and tools. The current practice is not evidence-based. However, KCHD’s workforce development plan was recognized as a best practice through NACCHO’s Project Public Health Ready and is currently available as a resource through NACCHO’s PPHR Toolbox.    
Several goals and objectives were associated with the proposed practice. The main goals and objectives of this practice include: 1.     Become a nationally accredited health department through the Public Health Accreditation Board (PHAB), 2.     Achieve Project Public Health Ready designation through NACCHO, 3.     Regularly evaluate competency-based staff training and development needs, a.     Complete workforce needs assessment survey by July 30 of each year b.     Analyze, interpret, and report assessment findings to all staff by August 1 of each year c.     Prioritize training needs/topics for following fiscal year by September 30 of each year. 4.     Develop training curricula that adequately address priority training needs, a.     Ensure each of the four All-Staff meetings per fiscal year offer training in one of the four core competency areas of focus for that given year b.     Ensure each of the four Management Pay Plan (MPP) meetings per fiscal year offer training on one of the four core competency areas of focus for that given year c.     At least 75% of staff who participate in workforce development opportunities will report annually that the Health Department has adequately fulfilled their priority public health training needs 5.     Improve staff competency and capacity in key public health and emergency preparedness topics. a.     At least 75% of staff will report increased competency in: Key communication knowledge and skills, Cultural competency knowledge and skills, Public health science knowledge and skills, Leadership and systems thinking knowledge and skills, Emergency preparedness knowledge and skills, Analytical and assessment knowledge and skills, Policy development and program planning knowledge and skills.  To accomplish goals one and two, KCHD reviewed PHAB and PPHR accreditation requirements and assembled a plan of action for writing a workforce development plan to address these requirements. This included reviewing guidance documents, such as PHAB Standards and Measures Version 1.0 and PPHR Version 7 Criteria to determine what needed to be included in the plans. One of the key components identified through both accreditation requirements was the agency adoption of core competencies. KCHD chose to adopt the Council on Linkages Core Competencies for Public Health Professionals and the Bioterrorism and Emergency Readiness Competencies for All Public Health Workers. KCHD then conducted an extensive staff input and needs assessment process to assess and prioritize staff training needs in the different competency areas covered through the adopted core competencies. The input process was facilitated by an external consultant. An online survey was developed using adapted survey items from Ohio State University College of Public Health’s Public Health Workforce Training Needs Assessment to assess public health competencies and items from an assessment conducted by Berrien County Health Department to determine emergency preparedness competencies. Once KCHD had all of the necessary data, a plan was drafted. This plan included key terminology; an agency profile; a workforce profile; a description of competencies and requirements for continuing education by profession; training needs; goals, objectives, and an implementation plan; competency-based training schedule; a plan for evaluation and tracking; and a section for conclusions and other considerations. Goals three through five and their associated objectives were accomplished by implementing the workforce development plan. A workforce development committee has been formed at KCHD, and includes members from each of the agency’s four Divisions – Administration, Community Clinical Services, Community Wellness, and Environmental Health. This group meets as needed to plan all staff and management trainings that align with the competency-based training curriculum outlined in the workforce development plan. The committee uses annual workforce development training needs assessment data to prioritize training topics. Efforts to complete the workforce development plan began in early 2013 and concluded when the plan was signed into effect by KCHD’s health officer in October 2013. The first all staff meeting planned under the workforce development plan was also held in October 2013. This is an ongoing practice, with quarterly all staff meetings and quarterly management meetings. As previously noted, KCHD was able to hire an external consultant to assist with initial planning and facilitation of staff input processes. Since the plan has been implemented, however, many additional community organizations have contributed to the success of KCHD’s workforce development efforts. For example, Grand Valley State University has supplied speakers for at least two of the all staff meetings that have occurred since October 2013. Professors from the university have educated staff on a variety of topics, including health literacy and effective communication practices. Bethany Christian Services, a local nonprofit organization, has also contributed by offering their expertise on refugee populations in Kent County. These types of relationships allow KCHD to ensure staff are learning information associated with core competencies from people who are qualified and experienced in their respective topics. The KCHD workforce development committee discusses topics and then seeks experts in the community and in other county departments to provide learning sessions for staff through all staff and management meetings. KCHD has shared strategies for creating and implementing a workforce development plan with other local health departments through conferences, presentations, and by writing a Story from the Field for NACCHO on the topic. By sharing our experiences, KCHD has received numerous direct requests for technical assistance from other local health departments.  Costs associated with KCHD’s workforce development efforts were minimal. KCHD was awarded a $10,000 mini-grant from the Michigan Department of Health and Human Services to support development of the workforce development plan. A portion of these dollars were used to hire the external consultant. All other support for plan development came from KCHD’s agency budget. Workforce development plan implementation does not currently have a set account within the agency budget. However, if speaker fees are incurred the KCHD Administration Division supports those costs to bring in a relevant speaker for all staff or management meetings. KCHD also funds the staff time associated with the workforce development committee to implement the workforce development plan.    
The practice is evaluated through an annual online workforce development training needs assessment completed by staff. Questions used in the assessment are a combination of items adopted from an assessment tool originally developed by The Ohio State University College of Public Health and items adopted from an assessment originally developed by the Berrien County Health Department. The survey is administered by the KCHD Accreditation Coordinator. The assessment is typically launched through an email soliciting responses from all KCHD staff. The assessment remains open for responses between seven and 10 business days. At the conclusion of this time period, the survey is closed and data is downloaded from Survey Monkey into a Microsoft Excel file. This data is then analyzed in the Excel program by the KCHD Accreditation Coordinator using simple descriptive statistics, such as frequencies. Graphs, tables, and charts are created, when possible, to report the most pertinent findings. A detailed report is then created and shared with key stakeholders, such as all KCHD staff and leadership. This report includes an introduction, method, results, and discussion section. No secondary data sources are used to evaluate this practice. At the conclusion of each workforce development training needs assessment report, there is a section of recommendations. These recommendations are derived from staff input and feedback gathered through the assessment process. Most of the recommendations focus on larger process and departmental actions, rather than changes to the training itself. To date, no major changes to the practice have been implemented.  The workforce development plan created by KCHD successfully met requirements for both national accreditation through the Public Health Accreditation Board (PHAB) and recognition through Project Public Health Ready (PPHR). National accreditation through PHAB was conferred in September 2014, and PPHR recognition was awarded in January 2015. Numerous objectives associated with workforce development plan implementation were established as part of this practice. These objectives include: (3a) complete workforce needs assessment survey by July 30 of each year, (3b) analyze, interpret, and report assessment findings to all staff by August 1 of each year, (3c) prioritize training needs/topics for following fiscal year by September 30 of each year. All of these objectives have been achieved annually since the plan was adopted in October 2013. Workforce needs assessments were conducted in 2014 and 2015 and reports have been published with the analyzed result of each. The data from these reports has been used to assist the workforce development committee with the prioritization of training topics and the engagement of speakers qualified to address the priority training topics. All trainings offered through KCHD all staff and management pay plan meetings are aligned with core competencies for public health and for emergency preparedness. Additionally, the workforce development plan was established to (4a) ensure each of the four All-Staff meetings per fiscal year offer training in one of the four core competency areas of focus for that given year and (4b) ensure each of the four Management Pay Plan (MPP) meetings per fiscal year offer training on one of the four core competency areas of focus for that given year. Since the plan’s adoption in October 2013, each of the all staff meetings have focused on one emergency preparedness topic and one public health core competency. KCHD has had more challenges with achieving the second objective – making sure that all of the MPP meetings each year focus on core competencies. As KCHD has worked to implement the workforce development plan, the workforce development committee has come to realize that there are too many management-related topics that need to be covered in addition to core competency-related topics. Therefore, a compromise was made to make two of the four MPP meetings competency-based, while the remaining two are based on “practical skills” for managers to assist them with leading others and managing programs. This approach has worked well for KCHD, and has helped to diversify training topics for managers. Lastly, workforce development efforts were intended to result in (4c) At least 75% of staff who participate in workforce development opportunities reporting annually that the Health Department has adequately fulfilled their priority public health training needs, and at least 75% of staff reporting increased competency in (5a) key communication knowledge and skills, (5b) cultural competency knowledge and skills, (5c) public health science knowledge and skills, (5d) leadership and systems thinking knowledge and skills, (5e) emergency preparedness knowledge and skills, (5f) analytical and assessment knowledge and skills, and (5g) policy development and program planning knowledge and skills. Data collected from staff has demonstrated that KCHD’s workforce development efforts have been successful in impacting staff knowledge and skills related to the core competencies for public health and emergency preparedness. Based on the training needs assessment conducted in 2013-2014, 83.5% of staff reported significant or some change in knowledge and skills associated with communication; 81.6% of staff reported significant or some change in knowledge and skills associated with cultural competency; 75.4% of staff reported significant or some change in knowledge and skills associated with public health science; 76.7% of staff reported significant or some change in knowledge and skills associated with leadership and systems thinking skills; and 92.2% of staff reported significant or some change in knowledge and skills associated with emergency preparedness. The training needs assessment completed in 2014-2015 showed similar findings. More than 85% of staff reported significant or some change in knowledge and skills associated with analytical and assessment skills, while 77% of staff reported significant or some change in knowledge and skills associated with program planning and policy development. Reassessment of cultural competency, public health sciences, and emergency preparedness was completed during this assessment, as well because these topics are covered annually rather than on a three-year rolling basis like the other competency areas. More than 94% of staff reported significant or some change in knowledge and skills associated with cultural competency; 81.6% of staff reported significant or some change in knowledge and skills associated with public health sciences; and 93.3% of staff reported significant or some change in knowledge and skills associated with emergency preparedness. Both years of assessment data have shown KCHD’s workforce development efforts are achieving intended goals and objectives.      
The workforce development plan has become a key driver in the provision of staff and management training at KCHD. The workforce development committee is comprised of staff from all four KCHD Divisions, as well as the agency’s Deputy Director, to ensure commitment to the implementation of this plan. Fortunately, the agency’s budget has dollars to support any reasonable costs incurred through workforce development efforts, though it is on rare occasion that dollars are required to bring in an appropriate speaker. Kent County is a community where collaboration is strong, and subject matter experts from external agencies are usually more than willing to speak to KCHD staff on their topics of expertise at no cost. A cost/benefit analysis was not completed for this practice. Having a written multi-year workforce development plan also helps with sustainability in the long-term, as there is enough guidance and detail included in the plan to assist future staff in continuing this work when the originators of the practice are no longer at KCHD. Guidance for plan maintenance and the development of future workforce development plans is provided through standards and measures established by the Public Health Accreditation Board and Project Public Health Ready. With this guidance, and the input of staff through the annual workforce development training needs assessment, KCHD should be well equipped to continue this work at a high level of quality while continuously meeting the ever-evolving training needs of the people employed by this agency. KCHD learned several key lessons during the assessment and plan development process related to workforce development. Involving staff in the process of identifying training and workforce development needs was important. As a result of staff inclusion during data collection and throughout plan development, there has been significant buy-in and participation in plan implementation. Staff input also helped the Accreditation and Emergency Preparedness Coordinators recognize that repurposing existing all-staff meetings and management meetings was the most effective way to deliver necessary training without further burdening staff or taking them away from their day-to-day responsibilities. Furthermore, involving staff from all four KCHD Divisions in the workforce development committee ensures that training topics are as broadly applicable as possible to the variety of professionals working at KCHD. This approach also ensures that all staff are represented at the workforce development committee table as training topics are being selected and arranged. Identifying and addressing training and workforce development needs through one coordinated effort was both efficient and successful in helping KCHD achieve two different sets of accreditation requirements in a short period of time. The annual assessment allows staff the opportunity to voice input in the upcoming year’s training topics, and data from the assessment is shared with all staff so that they have an increased awareness about workforce development efforts at the health department. Coordinating the efforts of emergency preparedness and public health training has been a huge factor in ensuring there is minimal staff confusion about the workforce development plan and its purpose. Additionally, there is only one plan to update and maintain and the responsibility for those tasks can be shared. Partnership and collaboration between the Emergency Preparedness Coordinator and the Accreditation Coordinator was key in making this project successful. It was very important to have the two people who best understand workforce development plan requirements at the head of the table to ensure the project was mutually beneficial to the accreditation processes, but also to the true intended recipients of the offered trainings – the KCHD staff. Having these individuals as the leaders in the creation of the workforce development plan also best certified conformity to the requirements put forth by PHAB and PPHR for not only the plan itself, but also in the implementation of the plan’s activities. Another important lesson learned through this process is that there are many existing resources available for workforce development planning available through national, state, and local organizations. Learning to modify what is available to meet the needs of your specific agency can be very beneficial when developing a plan from scratch, however it is incredibly important to give credit to the originators of the resources. Every time the KCHD workforce development plan is discussed or shared with other agencies or audiences, the agencies from which KCHD borrowed components for the workforce development needs assessment or plan layout are referenced and recognized. These agencies range from other local health departments, universities, and national organizations such as NACCHO, ASTHO, and the Public Health Foundation. KCHD has also learned that utilizing core competencies for public health and emergency preparedness as the basis for workforce development has helped create increased awareness of and interest in the emergency preparedness program and the role KCHD plays in the delivery of the essential services of public health among our own staff and the community. By engaging external speakers to educate KCHD staff on a variety of topics, we not only learn about the work the speaker’s agency or organization is doing in a particular area of public health, but the speaker also walks away having a positive interaction with KCHD. This helps spread awareness about public health throughout the community, while also affording KCHD staff the opportunity to learn from an expert from another agency or organization. Lastly, KCHD has taken steps to become a leader in public health workforce development planning and implementation. As noted throughout this application, KCHD’s workforce development plan has been recognized as a best practice by NACCHO through PPHR review and is now available as a resource for other health departments through the NACCHO PPHR Toolbox. Additionally, KCHD presented on the agency’s workforce development plan at the NACCHO Annual Conference in July 2015 and a Story from the Field has since been solicited from the agency by NACCHO staff. As a result sharing our experiences, KCHD has become a sought after subject matter expert on workforce development planning from both a PPHR and national accreditation standpoint. The efforts KCHD has made to share the workforce development plan successes has further solidified the need for communicating best practices like this one to other audiences, while also providing technical assistance for other local health departments.  
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