Perceptions of Public Health 3.0: Concordance Between Public Health Agency Leaders and Employees

CONTEXT AND BACKGROUND: The newest era of public health, deemed "Public Health 3.0," supports cross-sector collaborations to address social determinants of health. These activities often require collaborations with nontraditional public health entities. As this new era begins, it is important to understand perceptions of the public health workforce with regard to Public Health 3.0. OBJECTIVE: To assess perceptions of support toward Public Health 3.0 activities by the public health workforce, identify characteristics associated with support, and measure concordance in support between agency directors and the general workforce. DESIGN: This cross-sectional study utilizes the 2017 Public Health Workforce Interests and Needs Survey to understand support and concordance regarding Public Health 3.0 activities by a nationally representative sample of governmental public health employees. Logistic regression models are used to identify characteristics associated with support of each 3.0 activity and concordance. MAIN OUTCOME MEASURES: Governmental public health employees' opinions on how involved their agency should be in the K-12 education system, the economy, the built environment, transportation, housing, social connectedness, and health equity within their jurisdiction and concordance in support of involvement between agency directors and the general workforce. RESULTS: Overall, individual perceptions supporting involvement were highest for health equity and social connectedness and lowest for transportation. Supervisory status, education, and being at a local health department were associated with greater odds of supporting all 3.0 activities. Concordance with agency directors was greatest among other executives relative to nonsupervisors. CONCLUSIONS: There is overall generally high support of many 3.0 activities, but there are gaps in agreement by supervisory status, gender, race/ethnicity, education, role type, and jurisdiction. Findings may help support agency leaders in better communicating the role of their agencies in Public Health 3.0 activities, and workforce education regarding such activities may be necessary for the success of Public Health 3.0's success

The Relationship Between Health Department Accreditation and Workforce Satisfaction, Retention, and Training Needs

BACKGROUND: To improve quality and consistency of health departments, a voluntary accreditation process was developed by the Public Health Accreditation Board. Understanding accreditation's role as a mediator in workforce training needs, satisfaction, and awareness is important for continued improvement for governmental public health. OBJECTIVE: To compare differences in training needs, satisfaction/intent to leave, and awareness of public health concepts for state and local health department staff with regard to their agency's accreditation status. DESIGN: This cross-sectional study considered the association between agency accreditation status and individual perceptions of training needs, satisfaction, intent to leave, and awareness of public health concepts, using 2017 Public Health Workforce Interests and Needs Survey (PH WINS) data. Respondents were categorized on the basis of whether their agencies (at the time of survey) were (1) uninvolved in accreditation, (2) formally involved in accreditation, or (3) accredited. RESULTS: Multivariate logistic regression models found several significant differences, including the following: individuals from involved state agencies were less likely to report having had their training needs assessed; staff from accredited and involved agencies identified more gaps in selected skills; and employees of accredited agencies were more aware of quality improvement. While state employees in accredited and formally involved agencies reported less job satisfaction, there were no significant differences in intent to leave or burnout. Differences were identified concerning awareness of various public health concepts, especially among respondents in state agencies. CONCLUSIONS: While some findings were consistent with past research (eg, link between accreditation and quality improvement), others were not (eg, job satisfaction). Several self-reported skill gaps were unanticipated, given accreditation's emphasis on training. Potentially, as staff are exposed to accreditation topics, they gain more appreciation of skills development needs. Findings suggest opportunities to strengthen workforce development components when revising accreditation measures

The Multi-state Learning Collaborative Storyboards: Quality Improvement Lessons Learned from 162 Projects

The Multi-state Learning Collaborative (MLC) brought health departments in 16 states together with public health system partners to prepare for national voluntary accreditation and to implement quality-improvement (QI) practices. Data from each of the MLC participating states were collected through a comprehensive process over three years. An Excel database of several hundred pages was derived, categorized by individual target area, and organized into thematic domains for further study. Available data were culled and compiled for each MLC project and synthesized across MLC target areas. Two-hundred thirty-four health departments participated in 162 mini-collaboratives in nine of ten target areas. Public health QI projects generally made substantial progress toward achievement of stated objectives. Well-developed aim statements were the lynchpins of successful QI projects. Basic QI tools were utilized consistently and proficiently. Application of best and promising practices was limited. There were no appreciable differences in the QI results according to state public health structure, nor were outcomes related to differences in mini-collaborative leadership. Hundreds of health department staff members were introduced to QI tools and the opportunity to apply them immediately to public health problems

Impact of the Florida Birth-Related Neurological Injury Compensation Association (NICA) on Obstetrician and Attorney Practices

As health reform continues to unfold nationally, one ofthe more dramatic strategies for reform ofthe current medical liability system is to move towards a no-fault compensation system. Although, no state has established a comprehensive no-fault medical malpractice system, the Florida Birth-Related Neurological Injury Compensation Association (NICA) is a unique and rare working model ofa functioning no-fault insurance program. A cross-sectional design was utilized to survey obstetricians and health law attorneys practicing in Florida in 2011 to ascertain their knowledge and opinions of NICA and its impact on practice patterns and defensive medicine. The findings indicate that respondents believe NICA has had no effect on insurance rates among both obstetricians (39.8%) and attorneys(35.3%) nor did obstetricians (52.8%) or attorneys (35.8%) believe it has affected defensive medicine practices. Additionally, the findings further reinforced stereotypic expectations that obstetricians prefer an administrative process (35%) or arbitration (37.5%), while attorneys have a strong preference towards a standard courtroom venue (57.2%). With over two decades of experience with successful implementation of a no-fault obstetrical mal- practice model, Florida has a strong foundation for further bold experimentation. In addition, because of its large population size, the potential for a pilot study expanding the scope ofclinical practice coverage is promising. Further study and experi- mental models should be considered as possible next steps to explore in Florida

Maintaining a Competent Public Health Workforce: Lessons Learned From Experiences With Public Health Accreditation Domain 8 Standards and Measures

Context: Public health accreditation is an ongoing national movement to improve the quality of public health departments and the public health system in the United States; however, calls have been made for more evidence regarding best practices in the accreditation process. Objective: The purpose of this work is to provide evidence about best practices in the accreditation process, specifically within the workforce development domain. It is the first in-depth investigation into workforce development using data collected by Public Health Accreditation Board (PHAB). Design: Using deidentified accreditation application data from PHAB, this study employs a mixed-methods approach to examining practices, lessons learned, challenges, and strategies pertaining to workforce development planning for Domain 8. Setting: United States. Participants: US state (n = 19) and local health departments (n = 115). Main Outcome Measures: Public Health Accreditation Board assessment scores for the workforce measures and the relationship between the health department's approach to meeting a PHAB measure criteria and the PHAB assessment score. Results: Of the 9 different approaches identified as ways of encouraging the development of a sufficient number of qualified public health workers (version 1, measure 8.1.1), only 1 approach (local health department internship programs with schools of public health; B = 0.25, P < .03) was significantly related to higher scores. An opportunity for improvement identified for measure 8.2.1 was that plans missing a clear identification of the gap between current staff competencies and staff needs were associated with a 0.88-point decrease in the 4-point score (P < .001). Conclusions: Findings suggest that there are approaches adopted for meeting PHAB domain 8 measures that will impact the overall conformance assessment and score of a health department pursuing accreditation. There are several opportunities for improvement that health departments might consider when planning for accreditation or assessing their activities

Utilizing Performance Management to Harness the Power of Quality Improvement in Public Health

Widespread adoption of quality improvement activities in public health trails other U.S. sectors. Launching the national public health accreditation program of the Public Health Accreditation Board (PHAB) has propelled health department momentum around quality improvement uptake. Domain 9 of the PHAB standards focuses on evaluation and improvement of performance, and is acting as a strong driver for quality improvement and performance management implementation within health departments. Several performance management models have received broad acceptance, including among government and nonprofits, and have direct public health application. Turning Point is a model designed specifically for public health users. All models in current use reinforce customer centricity; streamlined, value added processes; and strategic alignment. Importantly, all are structured to steer quality improvement efforts toward organizational priorities, ensuring that quality improvement complements performance management

Rear-Facing Child Car Seats: Are Laws Requiring Them Effective?

Introduction: Motor vehicle crashes are a leading cause of death in children aged ≤ 2 years in the U.S. The American Academy of Pediatrics advised that children should remain in rear-facing child car seats to mitigate injury from the most common type of severe collision (frontal). Several states have passed laws following these recommendations. Methods: In 2013 publicly available statutes and comprehensive motor vehicle fatality data from the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System database were used to investigate whether there is a relationship between motor vehicle crash fatality rates for children under 1 year of age and state laws regulating the direction of car seat placement. States with known rear-facing car seat laws in place were analyzed in a two-step approach in 2014. Simple fatality rates per 100 million vehicle miles were calculated with 95% Poisson CIs. A negative binomial count model for infant deaths was calculated, with state fixed effects, adjusted for the exposure of vehicle miles in each state by year. Results: Unadjusted models showed a protective mortality effect for rear-facing car seat laws, while adjusted models demonstrated no beneficial effect. Implications: This preliminary study suggests that state rear-facing child restraint laws may be having an impact on infant motor vehicle mortality; however the current model is unable to determine their relative contribution given the overall decline in traffic mortality

Preliminary Findings from an Interventional Study using Network Analysis to Support Management in Local Health Departments in Florida

Management is the core service that integrates and coordinates essential public health services. Managers of local health departments (LHDs) are experts in practice but may not have expertise in organizational management. We conducted an evidence-based training intervention in 10 LHDs in Florida to support managers’ decision-making on organizational integration and coordination. We deployed a standard survey to collect organizational network measurements pre and post intervention. We presented results as evidence-based performance feedback and interviewed managers to document how they used the results in the context of each organization. Post intervention we found unexpected, significantly higher network centralization in daily work. We attributed this increase in hierarchical communication to preparations for a statewide accreditation initiative. When QI initiatives are undertaken globally within a state, managers and leaders need to be alert for possible impact on autonomous decision-making of professionals at the point of service which could affect service delivery

Using Information Systems to Improve a Mid-Sized Local Health Department’s Effectiveness in a Time of Rapid Change

Background: Informatics capacity building is resource and personnel intensive. Many local health departments (LHDs) face tradeoffs between using their resources to carry out existing mandates and using resources to build their capacity, for example, through informatics, to deliver essential services in a more effective and efficient manner. Objective: The purpose of this case study is to describe how a mid-sized LHD built and used information systems to support its strategic objectives, clinical services, and surveillance. Methods: The mid-sized LHD described here was chosen for its “best practices” in informatics capacity building and use by NACCHO\u27s study advisory committee. To conduct the case study, authors reviewed departmental documents and conducted semistructured interviews with key informants in the agency. Interviews were recorded, transcribed, thematically coded, and analyzed. Results and Conclusions: Findings from the case study suggest that including capacity building in informatics as a strategic priority is one of the most effective ways to ensure that informatics are assessed, updated, and included in resource decisions. Leadership at all levels is critical to the successful implementation of informatics as is proactive partnership with community partners who have overlapping goals. The efficiency and effectiveness of LHDs rely on informatics capacity, especially when resources are challenged