using qualitative methods to identify public health competencies kristine gebbie, rn, drph,...

Using Qualitative Methods to Identify Public Health

Competencies

Kristine Gebbie, RN, DrPH,

Jacqueline Merrill, MPH, RN,C

Center for Health PolicyColumbia University School of Nursing

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Project Goals

Aim 1--Identify competencies most needed by the the individual public health worker responding to an emergency situation, including bio-terrorism

Aim 2--Assess the identified competencies with local and state public health agency representatives.

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Importance

448,254 public health workers are a key first response to emergencies of all kinds

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Why qualitative methods?

No documented knowledge base on individual competencies in this practice area

Delphi Panel is an iterative technique to create opinion consensus in a topic area in which empirical information is limited

Focus group with experienced but non-expert practitioners to assess utility of expert findings

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Delphi panel composition

80 identified through organizations and publications

72 invited based on geography, expertise & level of practice

56 accepted

3 clerical/support experts added during Round I

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Round I instrument based on:

• State public health system: Draft performance assessment instrument. CDC /PHPPO (9/99)

• Local public health performance assessment: Pilot instrument. CDC /PHPPO (3/99)

• The public health workforce: An agenda for the 21st century. U.S. DHHS (1997)

• Current literature on emergencies and emergency response.

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Instrument 1 Organized by:

• Essential Services of Public Health for consistency with infrastructure thinking

• Levels of staff consistent with enumeration and workforce studies

• Leader/administrator• Professional• Technical• Support/clerical

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Items scored by:

Scale of importance:

Very important

Somewhat important

A little important

Not important at all

Pilot tested with 4 individuals

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Round I results

• Response rate 98%• All items were deemed important or very important

for leaders and professionals• About half of items were deemed important for

technicians• No items were deemed important for support staff• One new item suggested by several comments

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Panel Expansion

Experience suggested support staff are important

3 persons with support staff experience added to panel

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Round II instrument development

• Feedback• Percentage score• Comments from Round I

• Forced choice• Yes or No on each item for each category of worker

• Question format again tested with pre-test panel

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Round II results

Response rate 85%

Competencies that were identified as very important by 75% of respondents were retained

43 of 43 for administrators 43 of 43 for professionals 28 of 43 for technicians 7 of 43 for clerical support

– for clerical support 21 of 43 scored higher than 75% as NOT necessary

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Assessment of identified competencies

• At CDC• Two groups of local, state, and fed reps• Approximately 15 people in each group• With and without recent ER training

• At two BT training exercise sites• Colorado and New Hampshire• Two groups each: leadership/professionals and

technical/support

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Focus group questions Do staff of federal, state and local health agencies

generally agree that the identified competency statements are an appropriate statement of what staff should be able to do in the area of emergency preparedness?

To what degree can the existing staff of state and local public health agencies perform the identified competencies?

To the extent that staff cannot now meet the identified competencies, what should be the priority for staff development and training?

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Focus group findings

Competencies identified are appropriate, but poorly organized for use

Many public health workers do not now have the needed competencies

Competencies in planning and communicating are the most critical gaps

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

9 Core competencies that apply for ALL WORKERS

1. DESCRIBE the public health role in emergency response in a range of emergencies that might arise.

2. DESCRIBE the chain of command in emergency response.

3. IDENTIFY & LOCATE the agency emergency response plan (or the pertinent portion of the plan).

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Core competencies for ALL WORKERS (cont’d)

4. DESCRIBE his/her functional role(s) in emergency response and DEMONSTRATE his/her role(s) in regular drills.

5. DEMONSTRATE correct use of all communication equipment used for emergency communication (phone, fax, radio, etc.).

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Core competencies for ALL WORKERS (cont’d)

6. DESCRIBE communication role(s) in emergency response:

• Within agency

• Media

• General Public

• Personal (family, neighbors)

7. IDENTIFY limits to own knowledge/skill/authority and IDENTIFY key system resources for referring matters that exceed these limits.

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Core competencies for ALL WORKERS (cont’d)

8. APPLY creative problem solving and flexible thinking to unusual challenges within his/her functional responsibilities and EVALUATE effectiveness of all actions taken.

9. RECOGNIZE deviations from the norm that might indicate an emergency and DESCRIBE appropriate action (e.g. communicate clearly within the chain of command).

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Additional competencies

7 additional competencies specific to leaders 3 additional competencies specific to professionals 2 additional competencies specific to

support/clerical staff

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Assessment of process and project

The product has immediate utility in public health practice

The process is an effective approach to competency development

October 23, 2001 Center for Health PolicyColumbia University School of Nursing

Columbia University

School of NursingCenter for Health Policy

http://cpmcnet.columbia.edu/dept/nursing/institute-centers/chphsr/

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