Using Qualitative Methods to Identify Public Health Competencies

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Using Qualitative Methods to Identify Public
Health Competencies
Kristine Gebbie, RN, DrPH, Jacqueline Merrill,
MPH, RN,C
Center for Health Policy Columbia University
School of Nursing
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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.

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Importance

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

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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

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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

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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.

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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

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Items scored by

• Scale of importance
• Very important
• Somewhat important
• A little important
• Not important at all
• Pilot tested with 4 individuals

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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

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Panel Expansion

• Experience suggested support staff are important
• 3 persons with support staff experience added to
  panel

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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

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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

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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

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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?

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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

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9 Core competencies that apply for ALL WORKERS

• DESCRIBE the public health role in emergency
  response in a range of emergencies that might
  arise.
• DESCRIBE the chain of command in emergency
  response.
• IDENTIFY LOCATE the agency emergency response
  plan (or the pertinent portion of the plan).

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Core competencies for ALL WORKERS (contd)

• DESCRIBE his/her functional role(s) in emergency
  response and DEMONSTRATE his/her role(s) in
  regular drills.
• DEMONSTRATE correct use of all communication
  equipment used for emergency communication
  (phone, fax, radio, etc.).

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Core competencies for ALL WORKERS (contd)

• DESCRIBE communication role(s) in emergency
  response
• Within agency
• Media
• General Public
• Personal (family, neighbors)
• IDENTIFY limits to own knowledge/skill/authority
  and IDENTIFY key system resources for referring
  matters that exceed these limits.

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Core competencies for ALL WORKERS (contd)

• 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).

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Additional competencies

• 7 additional competencies specific to leaders
• 3 additional competencies specific to
  professionals
• 2 additional competencies specific to
  support/clerical staff

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Assessment of process and project

• The product has immediate utility in public
  health practice
• The process is an effective approach to
  competency development

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Columbia University School of Nursing Center
for Health Policy http//cpmcnet.columbia.edu/dep
t/nursing/institute-centers/chphsr/index.html