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