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A Strategic Approach To Workforce Development For Local Public Health

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A Strategic Approach To Workforce Development For Local Public Health

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fncalfonso
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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INNOVATIONS IN POLICY AND PRACTICE

A strategic approach to workforce development for local public


health
Beverley Bryant, BScN, MEd,1 Megan Ward, MD, MHSc, FRCPC2

ABSTRACT
SETTING: In 2009, Peel Public Health set a vision to transform the work of public health from efficient delivery of public health services as defined by
provincial mandate to the robust analysis of the health status of the local population and selection and implementation of programming to achieve best
health outcomes. A strategic approach to the workforce was a key enabler. PPH is a public health unit in Ontario that serves 1.4 million people.

INTERVENTION: An organization-wide strategic workforce development program was instituted. It is theory-based, evidence-informed and data-driven.
A first step was a conceptual framework, followed by interventions in workforce planning, human resources management, and capacity development.
The program was built on evidence reviews, theory, and public health core competencies. Interventions spread across the employee work-life span.

OUTCOMES: Capacity development based on the public health core competencies is a main focus, particularly analytical capacity to support decision-
making. Employees gain skill and knowledge in comprehensive population health. Leadership evolves as work shifts to the analysis of health status and
development of interventions. Effective human resource processes ensure appropriate job design, recruitment and orientation. Analysis of the workforce
leads to vigorous employee development to ensure a strong pool of potential leadership successors.
IMPLICATIONS: Theory, research evidence, and data provide a robust foundation for workforce development. Competencies are important inputs to
job descriptions, recruitment, training, and human resource processes. A comprehensive workforce development strategy enables the development of a
skilled workforce capable of responding to the needs of the population it serves.
KEY WORDS: Public health; evidence-based practice; evidence-based medicine; professional competence; health personnel

La traduction du résumé se trouve à la fin de l’article. Can J Public Health 2017;108(4):e403–e408


doi: 10.17269/CJPH.108.5864

P
eel Public Health (PPH) is a public health unit in Ontario public health methods to identify the most pressing problems,
that serves the 1.4 million residents of Peel Region in the analyze their “size and shape” and choose interventions to address
areas of population health assessment, chronic disease and them. This report describes the development of the workforce
injury prevention, family health, environmental health, and strategy and the resultant tools and processes.
communicable disease control. The 650-plus workforce is PPH’s 2009 strategic plan1 identified eight other priorities. Some,
multidisciplinary and includes public health nurses, medical such as Evidence-Informed Decision Making (EIDM), have been
officers of health, public health inspectors, nutritionists, described extensively elsewhere.2–4 Taken together, these priorities
epidemiologists, research and policy analysts, health promoters, demanded that staff work in new ways, some of which were
oral health practitioners and community development workers. dramatically different for both front-line employees and the
In 2009, Peel Public Health set a vision to transform the work of leadership team. Workforce Development became the framework
public health from efficient delivery of public health services as for leading this change.
defined by the provincial mandate to the robust analysis of the Investing in a large workforce transformation initiative was not a
health status of the local population and selection and common choice for strategy, but PPH leaders were keenly aware of
implementation of programming to achieve best health its potential benefits. They had seen it championed at the federal
outcomes. Ontario at the time had a public health mandate level in the wake of SARS and Walkerton5 with the development of
outlined in provincial legislation, and our health unit was trying to the public health core competencies and were ready to engage with
act on it comprehensively. However, we were under-resourced,
largely because of rapid population growth, and we needed to set
priorities based on the actual needs of the local population. We Author Affiliations

found ourselves without the right mix of skills to move from a 1. Manager, Education and Research, Peel Public Health, Mississauga, ON
2. Associate Medical Officer of Health, Peel Public Health, Mississauga, ON
general mandate to a Peel-specific set of priorities. Correspondence: Beverley Bryant, 7120 Hurontario Street, P.O. Box 667, RPO
Streetsville, Mississauga, ON L5M 2C2, Tel: 905-791-7800, ext. 2438, E-mail:
During PPH’s 2009 strategic planning process, Workforce
[email protected]
Development was identified as a priority to develop a workforce Acknowledgements: Dr. Ivy Lynn Bourgeault, CIHR Chair in Gender, Work and
Health Human Resources and Fellow of the Canadian Academy of Health Sciences
with the right knowledge, skills and role-mix for such a (CAHS), for her work on the conceptual model for workforce development.
transformation. We envisioned practitioners who would use Conflict of Interest: None to declare.

© 2017 Canadian Public Health Association or its licensor. CANADIAN JOURNAL OF PUBLIC HEALTH • VOL. 108, NO. 4, 2017 e403
STRATEGIC WORKFORCE DEVELOPMENT

the transformative processes that would enhance capacity Capability Development. The system interacts with the education
throughout the organization. and training sector and the broader public health system.
In addition to the main components, the model includes
elements that touch an employee across the lifespan of
THREE KEY PILLARS OF A SYSTEMATIC APPROACH
employment and even in some cases pre-employment, such as
TO WORKFORCE DEVELOPMENT: A CONCEPTUAL
with student placement initiatives.
MODEL, USE OF CHANGE THEORY, AND PUBLIC
Use of the model has demonstrated several benefits:
HEALTH CORE COMPETENCIES
• provides stakeholders or key informants with a quick visual
The use of a conceptual model guide to the conceptual framework for workforce development;
In 2009, little had been written about the elements of a workforce • provides context setting and makes it easier to speak about
development system for local public health. The department complex subject areas that have many interdependencies;
commissioned a scan, review and synthesis of the literature6 of • supports leaders to act on strategic opportunities, without the
public health workforce development models. The authors noted risk of losing sight of elements that require intentional
the scarcity of published and grey literature and considered the activity, such as succession planning.
results indicative of the cutting-edge nature of the work. Three key
models were identified and promising elements were synthesized
with input from PPH. A model was developed and refined Use of change theory
(Figure 1). The model depicts three main system elements: Setting an organization-wide strategic direction for workforce
Workforce Planning, Human Resource Management, and development was bound to provoke change. For example, we

Figure 1. Workforce development model for Peel Public Health

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STRATEGIC WORKFORCE DEVELOPMENT

decided to build capacity in EIDM. Staff with program proposals assess consequences for employees and prepare for potentially
were asked to present the research evidence in a robust way to challenging conversations within the context of their relationship
decision makers. It became apparent that new skills and knowledge with the employee.
were needed. We turned to a variety of theories to support the
change. Implicit and explicit use of public health core
At the level of organization-wide change, we found the work of competencies
John Kotter7 instructive. In our application of Kotter’s theory for In 2003, the Public Health Agency of Canada (PHAC) was
workforce development, we created a clear vision through our considering the Naylor10 report that said more attention was
strategic plan and reinforced it with our conceptual model. Also, his needed to develop capacity within the Canadian public health
theory suggests that in order to get change off the ground, leaders system. A consensus approach to public health competencies
need to create a sense of urgency, build a guiding team and emerged. The document, Core Competencies for Public Health in
communicate a compelling vision of the change. Rather than a fully Canada: Release 1.0,11 was instrumental in developing elements of
planned change initiative, the theory proposes a more opportunistic the Peel workforce system. Core competencies are used to:
approach of generating quick wins and then sustaining the change
• build awareness of the full scope of public health practice
with wave after wave of new initiatives. Following this approach, we
among all staff,
have tried many different initiatives, keeping those which were
• create a vision and shared language for public health work,
successful and quickly discarding the rest.
• add specific knowledge and skills to job descriptions,
The Normalization Process Theory (NPT)8 developed by
recruitment processes and orientation protocols, and
Dr. Carl May, a sociologist in Great Britain, has been useful in
• form a basis for learning and development plans.
understanding the diffusion of change through the organization.
The theory proposes four steps to normalize interventions in
Discipline-specific core competencies are also used. For example,
complex environments.
the Public Health Nursing Discipline-Specific Core Competencies12
• Build coherence: ensure the change makes sense; create a developed by the Community Health Nurses of Canada are essential
story of how the organization arrived at this point and how to our work with public health nurses (PHNs). We refer to this
this change is the logical next step. document to evolve PHN roles and responsibilities to the full scope
• Appraise potential outcomes through cognitive of public health nursing practice. In Canada, baccalaureate nursing
participation: think through all the steps of enacting the training remains largely clinical. The core competencies provide a
change from various points of view, discern potential focus on additional population-level skills to be integrated
consequences, and make plans to alleviate unintended throughout the employee’s work-life. In this way, we gradually
effects. broaden the skill set of an employee and the entire team.
• Take collective action: implement the change.
• Reflexively monitor the outcomes: collect information, THE WORKFORCE DEVELOPMENT SYSTEM IN ACTION:
assess impacts, adjust as necessary, and then reflect these WORKFORCE PLANNING, HUMAN RESOURCES
outcomes back to the participants. MANAGEMENT, AND CAPABILITY DEVELOPMENT

We have applied NPT to assist managers in thinking through Workforce planning


how to implement complex change. Although it may seem Workforce planning assesses and analyzes characteristics of the
surprising, often the steps that need the most attention are the workforce, such as education, types of roles, retirement projections
first two. These involve making the change explicit for staff and and turn-and-churn rates. This informs processes such as the
working through potential outcomes before implementation. This identification of recruitment and student placement priorities,
makes implementation more straightforward and takes into team needs for new skills and knowledge, and development of
account the valuable perspective of the affected staff. Reflexive succession planning initiatives.
monitoring or adjusting after the change has been in place for a PPH recently conducted a review of pension plan data to identify
while allows for on-the-ground improvements. leaders eligible to retire within 2, 5 and 10 years. These data are
Essential practices of middle managers9 is a literature review then complemented with one-on-one discussions between leaders
completed by our staff that delved more deeply into the specific and their reporting staff to build individual development plans.
behaviours required of managers as they implement change These analyses and conversations create a solid understanding of
initiatives (see Figure 2). The review draws from the business and potential gaps in business continuity and underscore the
sociology literature and highlights the importance of middle importance of active and focused staff development.
managers as they connect the strategy and direction of senior The department has a strategic approach to student placements.
leaders with the activity and the initiative of the front line. We aim for a win-win whereby the student experiences public
They are the sense-makers of the organization and must do this health practice and the organization may identify a potential
through three practices: reframe work, clarify roles and engage in employee. Our rapid review, Organizational Student Placement
dialogue. We also learned that middle managers must spend time Practices and Recruitment,13 identified core elements of an optimal
garnering a deep understanding of the change, the organizational student placement strategy. These elements inform our policies
context into which the change is introduced, and the impacts of and practices. For example, PPH is pursuing intentional
the change at the organizational and individual level. They connections with educational institutions whose curricula

CANADIAN JOURNAL OF PUBLIC HEALTH • VOL. 108, NO. 4, 2017 e405


STRATEGIC WORKFORCE DEVELOPMENT

Figure 2. Essential practices of middle managers in managing complex change

complement our strategic direction. Particular attention is given to 2009 strategic plan. We undertook a literature review, New Employee
job roles where we know impending vacancies are high. Once in Understanding of Public Health Practice,14 to understand employee
the organization, students are assigned work that contributes to orientation processes that had the most impact on workforce
desired health outcomes. Successful students are assessed and outcomes both for the employee and the organization.
streamed towards upcoming vacancies. In this way, we can hire The research indicated that helping a new employee transition
new employees who are already partially trained and socialized to from an outsider to an insider could be a year-long process, referred
the organization. to as organizational socialization. When undertaken intentionally,
the process can have important outcomes, such as reduced
Human resources management intention to quit, decreased levels of anxiety and stress in new
Job Descriptions employees and increased overall satisfaction and engagement with
Job descriptions are a foundation of human resources management. the organization.
When we began, job descriptions were inconsistently available and The review identified key elements of an orientation program,
often contained job elements that reflected an old way of working, how to structure the process and coach supervisors about their role
rather than the work envisioned in the core competencies and our and that of their team. We developed a curriculum that stretches
strategic plan. Detailed review of job descriptions is allowing us to over nine months and covers key elements of the Peel approach to
adjust the skill mix on teams. Additionally, we created multi- public health practice, organizational goals and values, and
incumbent job descriptions, for example at the manager and foundational skills and knowledge.
specialist level, to ensure the consistency of roles across the The program was implemented in 2015 and early outcomes
organization. include a high degree of satisfaction from new employees and
positive feedback from supervisors and managers. More distal
New Staff Orientation outcomes named in the literature, such as overall satisfaction,
Underlying the need for a formal approach to staff orientation was engagement, reduced intention to quit, anxiety, and stress, will be
the substantial transformative change occurring as a result of the assessed over time.

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STRATEGIC WORKFORCE DEVELOPMENT

Capability development IMPACT


The third pillar of the workforce model, capability development,
was the one launched first in the organization and at that time Are we achieving the vision?
focused on the application of research to practice. In 2008, we The workforce development strategy is entering its ninth year. We
completed an organizational assessment and identified three see impact on several levels.
main areas for development: capacity to find and access research, One of the main goals of the strategy was to build analytical
skill in critically appraising it, and shifting work to include time capacity to support decision-making. Determining strategy still
for these activities. Based on the change theory by Kotter,7 we involves analysis of community needs, assessment of resources,
provided intensive training and support for 100 staff in the balancing of potential outcomes, and seasoned leadership.
processes of EIDM. Eight years later, more than 130 have the skills However, decisions taken today at PPH are also based on
to robustly apply research to practice questions and lead their thorough analysis of the local public health problem and reviews
teams in EIDM. of the literature to determine best options.
This approach was replicated in numeracy and data analysis, At the level of the individual employee, we find that team
using training and mentoring as well as hiring of individuals with members are gaining a greater sense of the full scope of public
strong epidemiological skills. These more advanced skills were health practice. They are more focused on the health status of the
embedded primarily in leadership roles and specialist positions, whole population and the role of evidence at all points of decision-
such as epidemiologists and research and policy analysts. This making. A shift in thinking is emerging. It is a shift from a
model works well to ensure strong technical expertise for specific program-based mindset focused on the effective delivery of a
processes that are outside the job descriptions of many staff. provincially prescribed intervention to one that is focused on the
In addition to these strategies, we took advantage of other public health problem we are aiming to solve and the population level
learning opportunities offered nationally or through local outcome we are trying to achieve.
universities. An example that supported both leadership and For management staff, the changes in their roles have been
strategy development was the Executive Training Program for complex. Day-to-day operations continue as data and evidence
Research Application (EXTRA)15 offered through the Canadian analysis is added to the work of the team. At times, this analysis is
Foundation for Healthcare Improvement. This national fellowship conducted through centralized supports, but more and more, we
trains mid-career leaders in the application of research to practice believe the optimal situation is one where the multidisciplinary
and is available at low cost to participants. PPH participated in six team is deeply involved in the analysis of the health status,
EXTRA Fellowships from 2008 to 2015. identification of the problem, and development of new solutions.
This involves the development of new skills at the supervisory level
OnCore to manage and direct the work of employees.
In 2012, in response to a need for front-line staff to “catch up” on Questions arise as to the cost of this initiative. It started with the
skill development, we began development of a new program with transfer of one full-time vacancy into a manager role for workforce
many partners and sponsored by PHAC. OnCore16 is a professional development. Shortly thereafter, the library was expanded by one
development program to build foundational public health skills for position and an analyst and coordinator were added. Some funds
front-line staff. It focuses on public health sciences, assessment and were spent on training, especially in the capacity building, but
analysis, and the application of research to practice. This program much of the mentoring was handled internally, using a just-in-
supports front-line staff to address the kinds of questions that arise time approach. The biggest cost is time for employees to learn new
in their work, such as: skills. We believe these costs are recouped through more effective
interventions.
• What does a PHN need to understand about the rates of For our corporate partners within Regional government, we are
breastfeeding at various times in the first year post-partum? seen as leaders with capacity and insight into practices that are
• How does shifting the curve apply to work in obesity often centralized in the human resource function. The work on
prevention? orientation, student placements, job descriptions and succession
• What is the difference between incidence and prevalence and planning positions us as key informants for related Regional
how does that affect program planning in Hepatitis B initiatives.
management? One of Kotter’s tenets for leading change is to create a powerful
vision and then relentlessly communicate and enact that vision
OnCore is nationally available and has been promoted through many small wins and wave after wave of initiatives. This is
throughout 2016. By the end of 2017, all PPH staff will have the case with PPH’s vision of public health practice and the
completed the three modules of OnCore. Early evaluation of workforce development needed to support it. All of the activities
participants demonstrates an increased understanding of these mentioned in this report as well as many other smaller initiatives
public health core competencies, and supervisors say that OnCore and context-setting conversations contribute to the evolution of
is “changing the conversation” in the team. the whole system. This systematic approach to workforce
OnCore builds on PPH’s vision that teams of public health development has proven effective in guiding the changes needed
practitioners, with some centralized expert support such as that on strategic and operational levels. Our experience is that when an
from our population health assessment unit, will have the skills organization makes the effort to implement a comprehensive
and knowledge to analyze and solve public health problems. workforce development strategy, the outcome is a workforce that

CANADIAN JOURNAL OF PUBLIC HEALTH • VOL. 108, NO. 4, 2017 e407


STRATEGIC WORKFORCE DEVELOPMENT

conducts robust analyses of the health issues facing the population 15. Canadian Foundation for Healthcare Improvement: Executive Training Program
and oversees the implementation of targeted and effective (EXTRA). Available at: http://www.cfhi-fcass.ca/WhatWeDo/extra (Accessed
January 11, 2017).
programs and services. 16. Region of Peel, Institut National de Santé Publique, Durham Region Health
Department. OnCore-EnCours: Core Skills for Public Health Practice. Waterloo,
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