Jacqueline Merrill

Public Health Worker Competencies for Emergency Response

Emergency preparedness is an expectation of public health organizations and an expectation of individual public health practitioners. Organizational performance standards for public health agencies have been developed during the last several years, providing a foundation for the development of competency statements to guide individual practice in public health program areas, like emergency response. This article provides results from a project that developed emergency preparedness and response competencies for individual public health workers. Documentation of the qualitative research methods used, which include competency validation with the practice community, can be applied to competency development in other areas of public health practice.

Emergency preparedness training for public health nurses: a pilot study

The Columbia Center for Public Health Preparedness, in partnership with the New York City Department of Health, recently developed an emergency preparedness training program for public health workers. A pilot training program was conducted for a group of school health nurses and evaluated using a pre/posttest design. A surprising finding was that 90% of the nurses reported at least one barrier to their ability to report to duty in the event of a public health emergency. The most frequently cited barriers included child/elder care responsibilities, lack of transportation, and personal health issues. These findings suggest that it may be prudent to identify and address potential barriers to public health workforce responsiveness to ensure the availability of the workforce during emergencies.

Effectiveness of an emergency preparedness training program for public health nurses in New York City.

A public health workforce that is competent to respond to emergencies is extremely important. We report on the impact of a training program designed to prepare public health nurses to respond appropriately to emergencies. The program focused on the basic public health emergency preparedness competencies and the emergency response role of public health workers employed by the New York City School Department of Health and Mental Hygiene School Health Program. The evaluation methods included pre/post-testing followed by a repeat post-test one month after the program. The program resulted in positive shifts in both knowledge and emergency response attitudes.

Role of Exercises and Drills in the Evaluation of Public Health in Emergency Response

INTRODUCTION Public health agencies have been participating in emergency preparedness exercises for many years. A poorly designed or executed exercise, or an unevaluated or inadequately evaluated plan, may do more harm than good if it leads to a false sense of security, and results in poor performance during an actual emergency. At the time this project began, there were no specific standards for the public health aspects of exercises and drills, and no defined criteria for the evaluation of agency performance in public health. OBJECTIVE The objective of this study was to develop defined criteria for the evaluation of agency performance. METHOD A Delphi panel of 26 experts in the field participated in developing criteria to assist in the evaluation of emergency exercise performance, and facilitate measuring improvement over time. Candidate criteria were based on the usual parts of an emergency plan and three other frameworks used elsewhere in public health or emergency response. RESULTS The response rate from the expert panel for Delphi Round I was 74%, and for Delphi Round II was 55%. This final menu included 46 public health-agency level criteria grouped into nine categories for use in evaluating an emergency drill or exercise at the local public health level. CONCLUSION Use of the public health-specific criteria developed through this process will allow for specific assessment and planning for measurable improvement in a health agency over time.

Identifying Individual Competency in Emerging Areas of Practice: An Applied Approach

Competency designation is important for any discipline to define individual performance expectations. Although public health (PH) agencies have always responded to emergencies, individual expectations have not been specified. The authors identified individual competencies necessary for organizations to meet performance standards. In the first stage, a Delphi survey served to identify competencies needed by staff to respond to any emergency, including bio-terrorism, yielding competency sets for four levels of workers. In the second stage, focus groups were used to assess the competencies with public health agencies. This feedback validated the Delphi-identified competencies as accurate and necessary for emergency response. The authors demonstrate the feasibility of using these methods to arrive at statements of value to PH practice at a reasonable investment of resources.

The public health workforce in the year 2000.

It has been 20 years since the last estimate of the public health workforces size and composition. This study provides a best estimate through secondary analysis of existing workforce reports, summaries, and information gathered from chief health officials in 50 states and 6 territories, public health organizations, and federal agencies. Results indicate that the workforce consists of some 448,254 persons in salaried positions as follows: 44.6 percent professionals, 4 percent officials/administrators, 14 percent technicians, and 13 percent clerical/support. Workforce size may have decreased by as much as 10 percent over the last 20 years, despite a 25 percent increase in population and rising health hazards.

Findings from an Organizational Network Analysis to Support Local Public Health Management

We assessed the feasibility of using organizational network analysis in a local public health organization. The research setting was an urban/suburban county health department with 156 employees. The goal of the research was to study communication and information flow in the department and to assess the technique for public health management. Network data were derived from survey questionnaires. Computational analysis was performed with the Organizational Risk Analyzer. Analysis revealed centralized communication, limited interdependencies, potential knowledge loss through retirement, and possible informational silos. The findings suggested opportunities for more cross program coordination but also suggested the presences of potentially efficient communication paths and potentially beneficial social connectedness. Managers found the findings useful to support decision making. Public health organizations must be effective in an increasingly complex environment. Network analysis can help build public health capacity for complex system management.

A system dynamics evaluation model: implementation of health information exchange for public health reporting

OBJECTIVE To evaluate the complex dynamics involved in implementing electronic health information exchange (HIE) for public health reporting at a state health department, and to identify policy implications to inform similar implementations. MATERIALS AND METHODS Qualitative data were collected over 8 months from seven experts at New York State Department of Health who implemented web services and protocols for querying, receipt, and validation of electronic data supplied by regional health information organizations. Extensive project documentation was also collected. During group meetings experts described the implementation process and created reference modes and causal diagrams that the evaluation team used to build a preliminary model. System dynamics modeling techniques were applied iteratively to build causal loop diagrams representing the implementation. The diagrams were validated iteratively by individual experts followed by group review online, and through confirmatory review of documents and artifacts. RESULTS Three casual loop diagrams captured well-recognized system dynamics: Sliding Goals, Project Rework, and Maturity of Resources. The findings were associated with specific policies that address funding, leadership, ensuring expertise, planning for rework, communication, and timeline management. DISCUSSION This evaluation illustrates the value of a qualitative approach to system dynamics modeling. As a tool for strategic thinking on complicated and intense processes, qualitative models can be produced with fewer resources than a full simulation, yet still provide insights that are timely and relevant. CONCLUSIONS System dynamics techniques clarified endogenous and exogenous factors at play in a highly complex technology implementation, which may inform other states engaged in implementing HIE supported by federal Health Information Technology for Economic and Clinical Health (HITECH) legislation.

A Comparative Study of 11 Local Health Department Organizational Networks

CONTEXT Although the nations local health departments (LHDs) share a common mission, variability in administrative structures is a barrier to identifying common, optimal management strategies. There is a gap in understanding what unifying features LHDs share as organizations that could be leveraged systematically for achieving high performance. OBJECTIVE To explore sources of commonality and variability in a range of LHDs by comparing intraorganizational networks. INTERVENTION We used organizational network analysis to document relationships between employees, tasks, knowledge, and resources within LHDs, which may exist regardless of formal administrative structure. SETTING A national sample of 11 LHDs from seven states that differed in size, geographic location, and governance. PARTICIPANTS Relational network data were collected via an on-line survey of all employees in 11 LHDs. A total of 1062 out of 1239 employees responded (84% response rate). OUTCOME MEASURES Network measurements were compared using coefficient of variation. Measurements were correlated with scores from the National Public Health Performance Assessment and with LHD demographics. Rankings of tasks, knowledge, and resources were correlated across pairs of LHDs. RESULTS We found that 11 LHDs exhibited compound organizational structures in which centralized hierarchies were coupled with distributed networks at the point of service. Local health departments were distinguished from random networks by a pattern of high centralization and clustering. Network measurements were positively associated with performance for 3 of 10 essential services (r > 0.65). Patterns in the measurements suggest how LHDs adapt to the population served. CONCLUSIONS Shared network patterns across LHDs suggest where common organizational management strategies are feasible. This evidence supports national efforts to promote uniform standards for service delivery to diverse populations.

Toward standardized, comparable public health systems data: a taxonomic description of essential public health work.

OBJECTIVE To identify taxonomy of task, knowledge, and resources for documenting the work performed in local health departments (LHDs). DATA SOURCES Secondary data were collected from documents describing public health (PH) practice produced by organizations representing the PH community. STUDY DESIGN A multistep consensus-based method was used that included literature review, data extraction, expert opinion, focus group review, and pilot testing. DATA EXTRACTION METHODS Terms and concepts were manually extracted from documents, consolidated, and evaluated for scope and sufficiency by researchers. An expert panel determined suitability of terms and a hierarchy for classifying them. This work was validated by practitioners and results pilot tested in two LHDs. PRINCIPAL FINDINGS The finalized taxonomy was applied to compare a national sample of 11 LHDs. Data were obtained from 1,064 of 1,267 (84 percent) of employees. Frequencies of tasks, knowledge, and resources constitute a profile of PH work. About 70 percent of the correlations between LHD pairs on tasks and knowledge were high (>0.7), suggesting between-department commonalities. On resources only 16 percent of correlations between LHD pairs were high, suggesting a source of performance variability. CONCLUSIONS A taxonomy of PH work serves as a tool for comparative research and a framework for further development.