Co-Directors: F. Douglas Scutchfield, MD and Cynthia D. Lamberth, MPH, CPH

1. Center of Excellence in Public Health Workforce Research and Policyat the University of Kentucky College of Public Health Co-Directors: F. Douglas Scutchfield, MD and Cynthia D. Lamberth, MPH, CPH

2. COEWRP • Objectives: • Foster growth and interest in workforce research and policy to assure public health system has a competent workforce • Support national effort to evaluate public health workforce issues • Sister COE for Public Health Workforce Studies at University of Michigan School of Public Health • Director: Matthew L. Boulton, MD, MPH

3. Today’s Presenters • Carol A. Gotway Crawford, PhD Acting Director, Division of Measurement & Analytic Methods, Epidemiology and Analysis Program Office (proposed),Centers for Disease Control and Prevention Project Officer for Centers of Excellence • Kristine M. Gebbie, DrPH, RN Joan Hansen Grabe Dean School of Nursing Hunter College, CUNY • Hugh H. Tilson, MD, DrPH Senior Advisor for Public Health Workforce to HRSA Bureau of Health Professions, and Adjunct Professor, UNC Gillings School of Public Health, and Duke University School of Medicine

4. Public Health Workforce Research:Status and Future Directions Carol A. Gotway Crawford, PhD Epidemiology and Analysis Program Office (proposed) Centers for Disease Control and Prevention June 8, 2010

5. CDC Research Guide: Workforce Research Theme Workforce and Career Development Conduct research to improve public health workforce-related recruitment, retention,and training. Source:CDC. Advancing the nation’s health: a guide to public health research needs, 2006–2015. Atlanta, GA: US Department of Health and Human Services, CDC; 2006. Available at: http://www.cdc.gov/od/science/PHResearch/cdcra/.

6. Multiple Broad Areas • Identify and assess • Best practices for recruitment, training, and retention • Strategies to create and sustain a workforce that is capable of meeting public health needs • Information gaps, resources, and other areas needing improvement • Impacts of trained public health professionals on specific outcomes (e.g., improved health or improved public health practice)

7. Determine and define • Current public health workforce needs • Skill competencies needed and best methods for updating and validating these competencies • Organizational variables that support development and application of skill competencies • Best indicators of workforce performance • How best to facilitate collaboration among academia and community-based groups and integrate with public health practice

8. Monitor and evaluate • Workforce trends, including size, distribution, qualifications, and tenure • The role of labor market forces on recruitment, retention, wage, salary, benefits, and personnel-system characteristics • Best indicators of workforce performance • Future workforce needs (forecasts)

9. Research Goals • Support public health workforce planning, programs, and policies with research that is • Empirically driven • Evidence-based • Strategic • Identify best practices for workforce and career development • Coordinate existing public health workforce research with academia and sector partners

10. Research Themes and Objectives • Derived as a general organizing approach • Developed themes that are broad, not unique, but consistent with those developed previously • Focused on key outcomes of interest • Defined objectives that are exemplary, not completely exhaustive • Based on Cioffi, Lichtveld, and Tilson (2004), the CDC Research Guide, and literature reviews

11. Eight Research Themes • Workforce size and composition • Workforce diversity • Workforce effectiveness and health impact • Recruitment, retention, separation, and retirement

12. Research Themes (cont.) • Worker pay, promotion, performance, and job satisfaction • Demand for the public health workforce • Education, training, and credentialing the public health workforce • Public health workforce policy

13. Coordinated Efforts • Public health workforce research previously uncoordinated and fragmented • CDC expected by partners to play a leadership role • How to move an entire field forward? • Need a strategic partnership approach that supports evidence-based, policy-focused research

14. I. Definitions II. Data III. Methodology IV. Evaluation V. Policy analysis VI. Dissemination and translation Develop and promote a universal language, shared priorities, and standards Build an empirical foundation for decision making Create general methodologic approaches for measurement and analysis Develop a comprehensive evaluation framework Conduct research to establish the connection between policies and outcomes Disseminate/ translate research findings to guide development of recommendations/ guidelines, and future direction Public Health Workforce Research: Strategic Development GOAL:To provide public health decision makers with the scientific research necessaryto support coordinated, systematic, empirically driven, evidence-based public health workforce and career development planning,program, and policy efforts that ensure a competent, diverse, sustainable,and prepared public health workforce necessary to improve health outcomes. THE PROCESS Outcome: Evidence-based recommendations for programs and policymakerson workforce investments.

15. Current Activities • Identify and develop workforce best practices • Policy research with Univ of Chicago • Traditional partners: ASTHO, NACCHO, ASPH, SPHs • New partners: BLS, RAND, policy researchers, sociologists, economists • CDC Workforce Research Conference, Social Science Perspectives on Workforce Policy: Opportunities to Inform Public Health Workforce Policy,August 2008 • Special issue of J Public Health Manag Pract

16. Current Activities (cont.) • Center of Excellence in Public Health Workforce Research and Policy (U. Kentucky CPH and PHF) • Define in the context of public health systems research • Measure and forecast workforce size and composition to match community needs (data harmonization) • Determine how workforce components affect public health services

17. Current Activities (cont.) • The University of Michigan Center of Excellence for Public Health Workforce Studies • Focus on the development of analytic, quantifiable, conceptual models of workforce • Define best practices for recruitment and retention of the public health workforce • Consider the supply and demand for the public health workforce in terms of occupations, staffing models, competencies • Enumeration of the public health workforce (with HRSA)?

18. Future Directions • Use methods from such other disciplines as economics and sociology • Unite key partners in research to make strategic decisions and to leverage funding • Establish extramural research program • Public health workforce enumeration? • Continue to unite and engage all partners

19. Workforce Research Agenda: Vexing Questions and How Answers Might Help Kristine Gebbie

20. Current situation is a way-station • Studies of the public health workforce go back to the 1920’s • Goldmark’s study of public health nursing education • Enumeration as a way to monitor the effort to get a public health agency in every county • Key document: Public Health Workforce for the 21st Century (DHHS/ODPHP, 1994) • http://www.health.gov/phfunctions/pubhlth.pdf

21. Definition of the workforce • Anyone who performs essential services of public health as a part of regular work responsibilities, regardless of location/employer • Does not include occasional, incidental public health work (e.g., reporting TB once in a while) • Does include significant public health work done in departments of agriculture, environment, transportation, NGO’s, others

22. Who are we? • A degree? • MPH • DrPH • MSN • MD • A place to work? • Laboratory • Office • Clinic • street • A world view? • Population, not individuals • Prevention first and foremost • Everyone • Executives • Professionals • Technical staff • Support staff

23. What we do? • Activities? • Run meetings • Inspect facilities • See individual patients • Programs? • Family planning • Food safety • Vital records • Units of work? • People seen/touched? • Papers filed? • Outbreak stopped?

24. Why do the questions matter? • Information about workforce provides a key component in our search to describe and improve • Outputs: services rendered, activities completed • Outcomes: health status improved • Quality: done in the most effective AND efficient manner • Avoiding public health errors

25. Examples of the struggles • Epidemiology • Lots of head counts—but what’s a ‘unit’ of epidemiology? • What about an RBRVS for epidemiology? • A core unit which is multiplied for more complex investigations or data management?

26. Public Health Nurses • Overlap with clinical activities, and generalists in most settings • Do PHN’s ‘do’ vaccinations differently than nurses in hospitals? • What about community mixing and mingling?

27. Environmental health • What’s the preparation and does it matter? • If the degree isn’t common, what defines the person?

28. … and finally, THE VERY LATEST THINKING FROM THE PUBLIC HEALTH WORKFORCE CENTERS OF EXCELLENCE Summary of the Survey and ThinkTank of the National Advisors Keeneland, 20 April, 2010 Hugh H. Tilson MD, DrPH

29. But first... a word from our sponsors!

30. But first...nothing I say represents the opinion of … Or any persons Living or dead!

31. Question one: what needs to be added to the research agenda(s)? • TOP PRIORITY: Definition and Enumeration by location, discipline, type of service • Diversity, mix and competencies • Effectiveness and Impact: association between size and mix and metrics (outcomes)

32. Question one: the research agenda • Pipeline dynamics: recruitment, retention, separation and retirement • Impact of workplace conditions: Pay, promotion, performance, satisfaction • Demand: excess demand at current price and if so, incentives and costs • Education, training, credentialing (re-tooling) • Public policy to address the above

33. Research agenda strategies • Taxonomy and common vocabulary • “free up information exchange” … i.t. public health informatics research agenda, syndromic surveillance, dashboards tied to individuals

34. Question one (a): REVISIT the workforce research agenda(s) • Re-examine the data on what we know • Identify the big gaps • Figure out how to fill them (new reporting requirements, surveys) • Find a source to fund …

35. Question two: who are the key partners? • Schools of Public Health and Grad. Programs • PH Research Organizations • Professional Schools; Business Schools • State and Local Health Departments • Federal Agencies • Foundations (RWJ of course, but then who …?) • “consider a model similar to the Economic Research Initiative on the Uninsured …”

36. ERIU model/partners • Labor economists • Social scientists • Regenstrief model … build on the current emphasis on clinical prevention … and find scholars/champions there

37. Partners (cont) • HR Directors • Institutes • Unions

38. 3: …best way to advance and sustain a coordinated … effort? • Think along the whole continuum • Link to “underservice”, i.e. Public health worker shortage areas • Project funding for scholars; grad student and young researchers support • Concerted effort: Agree on the agenda and find a champion • Business case: Show the link between the questions we research and the impact of the answers

39. 4: Beyond the Current C.O.E.s? • GOOD model, but needs time to prove itself and evidence that it works (and a little funding certainty might help) • Two centers are not enough … but how many? • PH Workforce caucus at APHA or national PH workforce council to consider • ADD PH Research targets within broader “health workforce research centers”/PBRNs • … other partners/strategies (HRSA, AHRQ, NIH)

40. 5: Leadership? • CDC is “the logical leader” … • Joint CDC, HRSA, CMS • DHHS for PHSSR of which PHW is a component • Funding from “…any credible source” • … how does this tie into AAMC’s “Coalition for HSR?” • … and a Federal Statistical Agency

41. 6: How to Organize? • ASH at HHS to coordinate CDC, HRSA, AHRQ, NIH, and others concerned with workforce • RE-invent the Public Health Functions Leadership and Work Group: parlay health reform context; ASTHO/NACCHO advocacy • A standing national council … at the DHHS level…. Maybe part of the Health Reform Council • Vision, direction, deliverables and funding

42. 7: Leverage the funding • ASH to convene • Keep everyone talking together • Develop a consistent message; distinguish PH workforce research from (the rest of) PHSSR (and others); link to important outcomes of health care reform; • IOM Study “WHO … ten years later” • Engage HRSA with its workforce mandate and new funding

43. 7: STRATEGIES (cont) • HP 2020 … PHSSR Chapter overarching framework in the introduction • Existing Centers to “partner” with the broader research community/labor economics, social scientists • HRSA: cooperative agreements; fifty workforce centers … across the full spectrum (ask the same question across state lines and across all professions)

44. Why talk about the public health workforce research workforce HERE/NOW? …because the Nation and States need help from our leadership …a.k.a. YOU! And because DHHS is in the throes of its own health care reform!!

45. THANKS • Now, it’s in YOUR hands … • Where do we go from here?