First Nations Health Managers Needs Assessment and Situational Analysis

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First Nations Health ManagersNeeds Assessment
and Situational Analysis

• A Review of Literature
• and Information

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Background

• This was the first major component of the FNHM
  Needs Assessment/Situational Analysis
• A literature review is frequently the first
  phase of a larger research project
• It involves locating, reviewing and reporting on
  what other researchers have found out about your
  topic

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• Conduct a literature and data review of
  best/promising practices, academic publications,
  public and private initiatives/strategies,
  training opportunities, etc relating to Health
  Managers and Health Human Resources (HHR).
• Although the research particularly addresses
  FNHMs, it is important to consider lessons
  learned and achievements relating to HHR
  nationally (under provincial/territorial
  jurisdictions) and internationally. The report
  should include best/promising practices in
  recruitment and retention strategies, and
  professional training/training opportunities
  which could benefit FNHMs.

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Outline of Presentation

• Health Leadership mainstream research and
  information
• Role of the Healthcare Manager/Leader
• Healthcare Management/Leadership Education and
  Professional Development
• 2. First Nations/Indigenous Health Leadership
  research and information
• International research on Indigenous Health
  Managers/Leaders
• Research on FNHMs in Canada
• Education and Professional Development
• 3. Conclusions and Recommendations

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Health Leadership Mainstream research and
information

• The Pan-Canadian Health Leadership Capability
  Framework Project (CHSRF, 2007)
• This project was commissioned by the Canadian
  Health Services Research Foundation (CHSRF), in
  collaboration with the Canadian Health Leadership
  Network (CHLNet). The objective of the project
  is described below
• The point of defining a common set of
  capabilities for health system leaders in Canada
  is to enable various organizations and agencies
  to set in motion an array of co-ordinated and
  mutually beneficial opportunities for people and
  organizations to develop those capabilities.

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• Major data sources for this study included
• key informant interviews
• focus groups with health leaders of major health
  organizations across the country
• a review of peer-reviewed and grey literature on
  leadership in public and private organizations
• an analysis of competency/ capability frameworks
  from selected international, Canadian and
  organizational jurisdictions.

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• Based on research and consultations, researchers
  developed the 5 C
• model
• CHAMPION caring
• Inspire and encourage a commitment to health
  show respect for the
• dignity of all persons act with compassion,
  fairness and a sense of
• justice
• CULTIVATE self and others
• Demonstrate self-awareness and self-management
  exhibit honesty,
• integrity, optimism, confidence and resilience
  enable others to grow
• create environments where people have meaningful
  opportunities to
• contribute(continued)

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• CONNECT with others
• Communicate effectively with a wide variety of
  stakeholders build
• effective multi-disciplinary teams develop
  networks and partnerships
• navigate socio-political environments
• CREATE results
• Develop a shared vision and translate it into
  action hold themselves
• and others accountable for results integrate
  quality improvement and
• evidence into decision making manage resources
  responsibly and
• creatively
• CHANGE systems
• Build personal and organizational understanding
  of the complexity of
• health systems mobilize knowledge to guide
  change lead changes
• consistent with vision, values and a commitment
  to health implement
• changes to improve health service delivery

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• Researchers also suggested potential approaches
• for adapting this broad framework to different
• contexts
• Organizations could use this framework as a
  unifying umbrella which defines common
  leadership competencies/capabilities
• Create a pan-Canadian health system leadership
  map that connects major provinces and
  organizations who wish to align their competency
  frameworks with the pan-Canadian one.

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Organizational Models in Community-Based Health
Care A review of the literature (National HHR
Advisory Committee, 1995)

• Community-based health care necessitates a high
  degree of integration of health care management
  and service delivery.
• This information is relevant to the current study
  of FNHMs, because community-based health care
  reflects the reality of First Nations health
  systems more closely than institutional health
  care settings.

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• The authors suggested six core capabilities for
  community-based
• health organizations
• Creating a New Management Culture - emphasis on
  managing across boundaries managing markets and
  networks of care across episodes of illness, and
  pathways of wellness greater emphasis on
  negotiation and conflict management systems
  thinking team building and blurring of the
  boundaries between line and staff roles
• Basing Decisions on Population Needs Assessment -
  to be held responsible for the health status of
  defined populations will require assessing the
  population needs, demands and preferences. This
  will require closer relationships with
  communities(continued)

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• An Integrated Information System - focused on
  ensuring continuity of care integration of
  clinical and financial data organized case
  management team management clinical guidelines
  and continuous quality improvement processes
• Integrated System for the Assessment and
  Management of Technology - formal system for
  assessing the cost/benefit ratios of alternative
  technologies
• Continuous Improvement Process - continuous
  quality improvement and total quality management
  allows the organization to respond more
  efficiently to the changing environment and
• Information Linkages and System Incentives -tie
  patients and providers together across the
  continuum of care, and reward collaborative
  behaviour.

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Health Leadership Development

• There are volumes of literature regarding the
  general concept of leadership. However, there
  are few studies that have attempted to assess the
  effectiveness of leadership programs.
• There is a lack of consensus on the ideal
  leadership framework or research demonstrating
  the effectiveness of various methods.

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• The Canadian Health Leadership Network (CHLNet)
  recently
• commissioned a study on leadership development
  practices in
• the Canadian health sector. Based on
  consultations with 48
• Healthcare organizations, they found the
  following types of
• programs were offered
• External Off the Shelf 79
• In House Leadership Programs 58
• Executive Education (at College/University) 58
• 360 Degree Assessments 46
• Coaching 44
• Mentoring 44
• Planned Career Assignments 44
• Action Learning (simulations) 25

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• Participants in the CHLNet study had mixed
  opinions about
• the effectiveness of leadership development
  practices
• currently used within their health organizations
• 31 felt that their practices for preparing
  leaders were either not at all effective, or only
  a little effective
• 33 felt that their practices were moderately
  effective
• 19 felt that their practices were highly
  effective and,
• 17 did not know if their leadership development
  practices were effective

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• There seems to be a general consensus in the
  literature that education
• and professional development for health managers
  should be
• competency-based.
• In reference to a Healthcare Management
  Leadership Competency
• Framework, developed by the U.S. National Center
  for Healthcare
• Leadership in 2003, Baker describes the
  importance of a competency
• model for health leadership development
• It provides a framework for a range of
  leadership activities, including the
  identification of necessary knowledge and skills
  at career-entry, mid-career and advanced-career
  stages. The competency model provides a
  conceptual framework, for educators, in
  universities, professional associations and
  elsewhere, in assessing learning needs and
  achievement. It will be useful in designing
  educational programs and clarifying the needs of
  organizations for leadership knowledge and
  skills. The competency model will also be a
  valuable component in the redevelopment of the
  accreditation standards for health administration
  education.

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First Nations/Indigenous Health Leadership
research and information

• Evaluation of the First Nations and Inuit Health
  Transfer Policy (2006)
• Findings re capacity development A majority
  (65.6) of HDs who participated in the evaluation
  process indicated that their organization had
  developed skills in the areas of administration,
  management, service delivery and programming
• However, the evaluation process also concluded
  that capacity development had been hindered by
  accountability requirements
• The current framework produces a large number of
  reports on financial expenditures and activities.
  It produces little information on the
  administrative and training needs (now termed
  capacity building) of First Nation and Inuit
  organizations, and no information on
  outcomes...The system is shifting First Nation
  and Inuit administrators time from program
  planning and management, to the writing of
  reports that serve few purposes, other than
  monitoring

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• The Evaluation also concluded that a national
  capacity
• building strategy may be difficult to local and
  regional
• diversity
• the needs of First Nations and Inuit are
  diverse, and better served by providing First
  Nation and Inuit Health Organisations with the
  opportunity to access professional and
  organisational development opportunities offered
  through a variety of sources including
  universities, technical colleges, consultants
  providing the training locally or participation
  in session offered by provincial authorities. The
  diversity of needs is unlikely to be well served
  by a national strategy with pre-determined
  priorities.

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• Appendix E, Health Management Structures, Health
  Services
• Transfer Handbook (FNIHB, 2004)
• The role of health coordinator/director includes
• Directing health programs
• Managing financial budgeting, planning and
  accounting
• Hiring
• Managing and developing staff
• Promoting community awareness of health issues
  and programs
• Preparing all mandatory reports and
• Managing facilities and materials.

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• Health Director/Health Manager Education and
  Training Needs Assessment Forum (AMC, 2007)
• Major roles/responsibilities and knowledge
  requirements for FNHMs
• 1. Human Resource Management
• 2. Financial Management
• 3. Program Management
• 4. Oversee Delivery of Health Programs
• 5. Overall Content Knowledge Required(continued)

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• 5. Overall Content Knowledge Required
• Communications and presentations
• Research
• Recruitment and Retention Issues (Health
  Director) and Strategies
• Governance working with Chief and Council
• Knowledge of Labour Laws/Policies
• Overall Training on Community Health plan
• Interdepartmental, Intergovernmental and
  Interagency Collaboration
• Jurisdiction issues
• Counselling and Mentoring
• Cultural Knowledge, Community Knowledge, Cultural
  Competency
• Promoting Traditional Lifestyle
• Public Relations and Advocacy
• Time management
• Prioritizing and,
• Delegating.

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• Other significant findings from the AMC forum
• The Health Directors/Health Managers agreed there
  is a need for a health management education /
  training program and would be interested in
  taking such as program.
• The greatest barrier to education was funding or
  financial considerations. In addition, for
  those from the northern Manitoba communities
  time away from family, children and community
  and time considerations were additional
  important barriers for them. Subsequently, if
  funding were available, Health Directors/Health
  Managers preferred to take one week each month as
  part of a cohort of students towards a
  certificate, diploma or degree.
• The biggest challenge Health Directors face in
  their work was not having enough funding/money
  and the next biggest challenge was not enough
  time.
• Most Health Directors/Health Managers who took
  part in the survey have a certificate, diploma or
  degree their postsecondary education is
  diverse(continued)

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• Most indicated that if a funded training program
  was developed for Health Directors/Health
  Managers, it was very important that it be
  accredited so that they could use credit hours
  toward a certificate, diploma or degree.
• Health Directors in northern communities
  preferred a combination of distance education and
  classroom and in the southern communities, it was
  a program taught all at once in a classroom
  setting.
• The second most popular choice was a program
  offered in a few shorter sessions throughout the
  year and comprised, for example of three sessions
  which are 2-3 days in length.

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• Taking Flight An Assessment of Health System
  Capacity Among
• First Nation Communities in Atlantic Canada (APC,
  2007)
• The study indicated that for this region the
  first priority elements
• That require development included
• Management element budgeting and financial
  management performance reviews
• Planning element survey design, data collection
  and analysis video conferencing technology,
  relationship with the provinces
• Delivery of services element facilities
  funding for replacement staff, use of Electronic
  Patient Records collaboration with local health
  authorities culturally appropriate patient
  material and,
• Evaluation element quantitative evaluation
  ability to create presentations ability to
  translate data into graphs and charts

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• Environmental Scan of the First Nations Health
  Sector Labour
• Force on Reserve in Saskatchewan Final Report
  (IPHRC,
• 2006),
• Twenty-eight health directors were also surveyed
  during the course of
• this regional scan. Major findings included
• Participants identified a number of important
  training needs including nurses, suicide
  prevention/intervention training, diabetes
  education, addictions and family violence
  education, FASD education and computer training.
• Eighty-two percent (82) of the health directors
  who were interviewed are dissatisfied with the
  current training available in their community
• During focus groups, Saskatchewan participants
  agreed that federal initiatives and funding take
  a long time to see anything come down to the
  community level.

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International Research on Indigenous Health
Managers

• Tactics at the Interface Australian and Torres
  Strait Islander Health
• Managers (Wakerman et. al., 2001)
• The findings of this qualitative examination
  suggest that
• Aboriginal health managers
• Have strong personal motivation to assist their
  own community
• Carry great responsibility in terms of their
  community role
• Place a high value on interpersonal relationship
• Report high levels of work related stress given
  professional demands and community
  expectations(continued)

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• View power within the organization as dependent
  on personal relations rather than organizational
  structure. The authority is not vested in the
  position, but in the person and their
  relationship with the community
• Believe that status, professional reputation,
  education and expertise may have little currency
  in the community context
• List key characteristics for managing effectively
  between the two cultures as commitment to the
  community, understanding their own cultural
  identity, understanding their role within a
  political and historical context and having the
  knowledge, skills and experience
• Are faced with competing values where their
  obligations to the family and community compete
  with professional roles.

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• Aboriginal Work and Managers. History, Emotional
  and
• Community Labour and Occupational Health and
  Safety in South
• Australia (Thorpe and Williams, 2003)
• Interviews revealed that Aboriginal managers
  (employed in health and other sectors of service)
  experience
• The highest levels of emotional exhaustion
  including feeling used-up at the end of the work
  day, fatigue and feeling emotionally drained
• High levels of chronic injury and illness, most
  of which was occupationally based
• Occupational bullying from various sources
  including bureaucrats, employees and clients
• Racism on both individual and institutional
  levels and,
• Gender issues, where female managers are
  scrutinized by their communities and are faced
  with issues by men who did not like dealing with
  Aboriginal women in positions of authority.

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• Thorpe and Williams found that Aboriginal
  managers have high demand jobs with low levels of
  control, given continual demands from
  non-Aboriginal superiors and Aboriginal board
  members.
• The managers involved with this study had high
  rates of work-related illness and injury.
  Suggested changes to their environments included
  the need for increased staffing and funding for
  basic amenities such as air conditioning.
• Further, the authors concluded that greater
  cultural understanding and training for
  non-Aboriginal superiors was needed, the creation
  of support networks for Aboriginal workers was
  required and that Aboriginal organizations needed
  to develop stronger occupational health and
  safety awareness as well as strategies to ensure
  worker well-being.

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First Nations Health Management Training

• In 2007, the AFN compiled lists of
• Accredited Health Leadership Post-Secondary
  Programs and
• 2. Accredited Health Post-Secondary Programs with
  significant Aboriginal content.
• It is noted that, generally, the Health
  Management academic programs
• do not appear to have an Aboriginal or First
  Nations health
• management focus, while health programs with
  Aboriginal content tend
• to focus on developing professional or health
  service delivery skills
• (e.g. nursing, pre-medical, counselling).

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• One significant exception is the University of
  British Columbias certificate program in
  Aboriginal Health Care Administration.
• Although program information was available from
  the UBC website, no other information or research
  was found to assess its impact or effectiveness.
• This program was subsequently cited by several
  respondents in the national FNHM survey

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Indigenous Health Management Training

• In the U.S., the Indian Health Services (IHS)
  offers a concentrated health executive leadership
  program which describes its goal as providing
  essential leadership training and support for
  Indian healthcare executives whether they work in
  Federal, Tribal, or urban settings.
• The program content is presented in three 4 ½ day
  sessions over a 12 month period.
• It is accredited by various health professional
  and educational associations in the U.S.

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• In Australia, an Aboriginal Health Management
  Training Program is coordinated by the Australian
  College of Heath Service Executives (ACHSE).
• A part time two year Masters in Health Services
  Management (through Charles Sturt University)
  provides theoretical and practical bases of
  health service management. The program delivers
  these learning opportunities through work
  placement, postgraduate studies and professional
  development and training at the College Study
  Days.
• Participants must be graduates with
  post-secondary qualifications in a variety of
  health and business related fields such as human
  resources, information management, law, economics
  and commerce or health disciplines (e.g. nursing
  and allied health).

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• In New Zealand, The National Maori Health
  Provider Association was created to improve
  Maori health through workforce development
  strategies, research and policy development. The
  website refers to bursary programs as well as
  management training courses including Graduate
  Diploma in Not-For-Profit Management and
  Workforce Development/Management Training for
  Maori
• The website is for members only thus no
  additional information could be obtained within
  the time limits of this search.

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Conclusions and Recommendations

• It is recommended that the initiatives undertaken
  by the National Centre for Healthcare Leadership
  (U.S.), the Canadian College of Health Service
  Executives (CCHSE) and the Canadian Health
  Leadership Network (CHLNet) with respect to
  health leadership development may provide useful
  examples of both process and content.
• Leadership development should be within a quality
  improvement framework and based on improved
  leader knowledge and organizational
  improvement/outcomes.
• There is a need to clearly define the role of a
  health leader through the development of core
  competencies. These would provide a strong
  foundation for the content of any future
  education, training or professional development
  initiatives(continued)

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• There is a need to develop in-house programs that
  would provide the learning required to become an
  expert health leader. On-the-job training or
  professional development opportunities could be
  based on a variety of models, including (but not
  limited to) mentoring, peer exchange processes,
  life long learning and competency-based skill
  development.
• The Aboriginal Health Care Administration Program
  at UBC should be examined more closely to assess
  its effectiveness and potential applicability for
  FNHMs in other regions across Canada.
• International Indigenous health leadership
  programs (i.e. U.S., Australia, New Zealand)
  should be examined more closely to assess their
  effectiveness and potential applicability for
  FNHMs.
• Given the lack of research and information
  pertaining specifically to First Nations health
  managers and leadership, it is strongly advised
  that any recommendations flowing from this report
  be validated and supplemented through direct
  consultations with FNHMs.