The Governmental Public Health Workforce in 26 Cities: PH WINS Results From Big Cities Health Coalition Members.

CONTEXT: More than 80% of Americans live in urban areas. Over the past 20 years, an increasing number of local governmental public health departments, particularly those in big cities, have taken pioneering action to improve population health. This article focuses on members of the Big Cities Health Coalition (BCHC) who participated in the 2017 Public Health Workforce Interest and Needs Survey (PH WINS). If the impact of these health departments is to be sustained, they will require a workforce prepared for the challenges of 21st-century public health practice. OBJECTIVE: To characterize workforce interests and needs among staff in 26 large, urban health departments who are BCHC members. DESIGN: Administered PH WINS survey to staff in BCHC member health departments to assess perceptions about the workplace environment and job satisfaction; training needs; awareness of national trends; and demographics. SETTING: In total, 26 of 30 BCHC member health departments, United States. PARTICIPANTS: In total, 7453 of 17 613 staff members (response rate 43.4%) from participating departments. RESULTS: The workforce consists predominantly of women (75%) and people of color (68%). Staff is satisfied with their job (81%), the organization (71%), and pay (59%), but more than a quarter are considering leaving within the year. The agency's mission drives staff, but it lacks an environment fostering creativity and innovation. Training needs include budgeting/financial management, change management, and strategic thinking. CONCLUSIONS: BCHC departments must improve retention, provide opportunities for advancement, enhance communication between leadership and staff, foster creativity and innovation, and align labor allocation with disease burden in local communities. Findings from the second iteration of PH WINS allow a comprehensive, comparable analysis of the workforce across the 26 BCHC member health departments that participated. These data expand upon the ability to assess and monitor improvement in the workforce environment, job satisfaction, awareness of national trends, and training needs.

Considering Leaving, But Deciding to Stay: A Longitudinal Analysis of Intent to Leave in Public Health.

CONTEXT: Public health has been hit by the first wave of the "silver tsunami"-baby boomers retiring en masse. However, thousands of staff members say they are considering voluntarily leaving for other reasons as well. OBJECTIVE: To identify characteristics of staff who said they were planning on leaving in 2014 but stayed at their organizations through 2017. DESIGN: Data from the 2014 and 2017 Public Health Workforce Interests and Needs Survey (PH WINS) were linked by respondent, and characteristics associated with intent to leave were analyzed. Longitudinal logistic models were fit to examine correlates of intent to leave, with job and pay satisfaction, demographic variables, and workplace engagement perceptions as independent variables. SETTING AND PARTICIPANTS: Respondents from state health agency-central offices and local health departments that participated in the PH WINS in 2014 and 2017. MAIN OUTCOME MEASURES: Intent to leave (excluding retirement), demographic measures, and changes in the perceptions of workplace engagement. RESULTS: Among all staff members responding in 2014 and 2017, 15% said they were considering leaving in 2014, excluding retirement, compared with 26% in 2017 (P < .001). Overall, 21% of those who were not considering leaving in 2014 indicated they were doing so in 2017. Comparatively, 57% of those considering leaving in 2014 said they were still considering it in 2017. The regressions showed those who were somewhat or very satisfied were significantly more likely to indicate they were not (or were no longer) considering leaving. CONCLUSIONS: Among staff members who have been considering leaving but have not yet left their organization, improvements to workplace engagement perceptions and job satisfaction were highly associated with not considering leaving their job.

Mixed-methods research revealed the need for dementia services and Human Resource Master Plan in an aging Philippines.

OBJECTIVE: To determine the status of dementia care services and workforce in selected public and private hospitals and geriatric care facilities in the Philippines. STUDY DESIGN AND SETTING: Framework analysis of 54 key informant interviews, 4 focus group discussions, and survey of 167 workers in 26 purposively selected facilities. RESULTS: Three dementia care models emerged: (1) separate unit, seen in 2 facilities, (2) partial dementia services, 9 facilities, and (3) integrated with the general services, 15 facilities. Only 1 of 26 facilities had specific outpatient services; only 1 provided care exclusively to dementia patients. Community day care services were rare. Physicians, nurses, and nursing assistants were available in all institutions. Nutrition and physical therapy services were generally available. There was a scarcity of physician specialists (e.g., geriatrics) and occupational therapists. Half of the workers surveyed rated the quality of their service at 80 or higher, 27% defined dementia correctly. Attitude toward dementia was very positive, in the form of willingness to care for and willingness to learn more. CONCLUSION: Mixed-methods research helped identify service and health workforce needs and elucidate understanding of health workers' attitude and perceptions toward a disease of which there is low knowledge and awareness.

Analysis of EU-USA cooperation opportunities on IT skills for healthcare workforce.

An overview about the state of the art about IT skills education for the healthcare workforce in the EU and USA, making a specific analysis about the current educational programmes from different perspectives (technologies, users, IT skills, policies) is presented. Main result of this paper is a recommendation plan to address current needs on the field. Authors end with a set of conclusions and references that can provide the background enough for any reader interested on these subjects, creating awareness about the importance of transnational IT educational programmes for the EU-US healthcare workforce.

Public health workforce taxonomy.

Thoroughly characterizing and continuously monitoring the public health workforce is necessary for ensuring capacity to deliver public health services. A prerequisite for this is to develop a standardized methodology for classifying public health workers, permitting valid comparisons across agencies and over time, which does not exist for the public health workforce. An expert working group, all of whom are authors on this paper, was convened during 2012-2014 to develop a public health workforce taxonomy. The purpose of the taxonomy is to facilitate the systematic characterization of all public health workers while delineating a set of minimum data elements to be used in workforce surveys. The taxonomy will improve the comparability across surveys, assist with estimating duplicate counting of workers, provide a framework for describing the size and composition of the workforce, and address other challenges to workforce enumeration. The taxonomy consists of 12 axes, with each axis describing a key characteristic of public health workers. Within each axis are multiple categories, and sometimes subcategories, that further define that worker characteristic. The workforce taxonomy axes are occupation, workplace setting, employer, education, licensure, certification, job tasks, program area, public health specialization area, funding source, condition of employment, and demographics. The taxonomy is not intended to serve as a replacement for occupational classifications but rather is a tool for systematically categorizing worker characteristics. The taxonomy will continue to evolve as organizations implement it and recommend ways to improve this tool for more accurate workforce data collection.

Understanding the local public health workforce: labels versus substance.

BACKGROUND: The workforce is a key component of the nation's public health (PH) infrastructure, but little is known about the skills of local health department (LHD) workers to guide policy and planning. PURPOSE: To profile a sample of LHD workers using classification schemes for PH work (the substance of what is done) and PH job titles (the labeling of what is done) to determine if work content is consistent with job classifications. METHODS: A secondary analysis was conducted on data collected from 2,734 employees from 19 LHDs using a taxonomy of 151 essential tasks performed, knowledge possessed, and resources available. Each employee was classified by job title using a schema developed by PH experts. The inter-rater agreement was calculated within job classes and congruence on tasks, knowledge, and resources for five exemplar classes was examined. RESULTS: The average response rate was 89%. Overall, workers exhibited moderate agreement on tasks and poor agreement on knowledge and resources. Job classes with higher agreement included agency directors and community workers; those with lower agreement were mid-level managers such as program directors. CONCLUSIONS: Findings suggest that local PH workers within a job class perform similar tasks but vary in training and access to resources. Job classes that are specific and focused have higher agreement whereas job classes that perform in many roles show less agreement. The PH worker classification may not match employees' skill sets or how LHDs allocate resources, which may be a contributor to unexplained fluctuation in public health system performance.

Changes in public health workforce composition: proportion of part-time workforce and its correlates, 2008-2013.

BACKGROUND: State and local public health department infrastructure in the U.S. was impacted by the 2008 economic recession. The nature and impact of these staffing changes have not been well characterized, especially for the part-time public health workforce. PURPOSE: To estimate the number of part-time workers in state and local health departments (LHDs) and examine the correlates of change in the part-time LHD workforce between 2008 and 2013. METHODS: We used workforce data from the 2008 and 2013 National Association of County and City Health Officials (n=1,543) and Association of State and Territorial Health Officials (n=24) profiles. We employed a Monte Carlo simulation to estimate the possible and plausible proportion of the workforce that was part-time, over various assumptions. Next, we employed a multinomial regression assessing correlates of the change in staffing composition among LHDs, including jurisdiction and organizational characteristics, as well measures of community involvement. RESULTS: Nationally representative estimates suggest that the local public health workforce decreased from 191,000 to 168,000 between 2008 and 2013. During that period, the part-time workforce decreased from 25% to 20% of those totals. At the state level, part-time workers accounted for less than 10% of the total workforce among responding states in 2013. Smaller and multi-county jurisdictions employed relatively more part-time workers. CONCLUSIONS: This is the first study to create national estimates regarding the size of the part-time public health workforce and estimate those changes over time. A relatively small proportion of the public health workforce is part-time and may be decreasing.

2012 rural Medicare Advantage quality ratings and bonus payments.

Key Data Findings. (1) The average rural Medicare Advantage (MA) plan enrollee in 2012 experienced a quality rating of 3.60 stars (of a potential 5.0), compared with a rating of 3.71 stars experienced by urban enrollees. (2) The measured rural-urban difference in the MA plan quality is a result of the difference in the composition of the enrollment and plan availability in MA markets, rather than differences between MA plans of the same type. (a) In general, rural Medicare beneficiaries often have limited MA plans available from which to choose, and typically have lower quality ratings than urban MA plans. (b) Rural MA beneficiaries are more likely to be enrolled in preferred provider organization (PPO) plans than in health maintenance organization (HMO) plans. (c) PPO plans have lower quality ratings on average than HMO plans. (d) HMO plans had the highest average quality rating at 3.83 and 3.78 stars, respectively, in rural and urban areas. PPO plans had lower quality ratings, at 3.52 and 3.50, respectively. (3) In rural areas, 32% of the MA population is enrolled in a plan with a star rating of 4.0 or higher, and 92% are enrolled in a plan with a star rating of at least 3.0, as contrasted to urban enrollment of 36% and 94% respectively, making these plans eligible for quality based bonus payments. (4) The quality rating of rural MA plans varies significantly across the country, with the highest quality ratings in rural areas in Minnesota, Iowa, Wisconsin, Oregon, Pennsylvania, and Maine.

Gestão de carreiras na Secretaria Municipal de Saúde São paulo: avanço e valorização nos processos de trabalho / Career management in the Municipal Health Secretary of São Paulo: advancement and exploitation in work processes

Os eventos que compõem a carreira do servidor foram redimensionados, após a implantação dos planos de cargos, carreiras e salários da Prefeitura Municipal. Frente a isto foi necessária uma análise de situação e da legislação, um processo de informação e um planejamento de ações para uma efetiva gestão de carreiras. O objetivo foi instrumentalizar o trabalhador frente aos eventos de carreira, antecipar a realização de capacitações para a melhoria dos processos de trabalho, atingir metas e articular possibilidades de evolução na carreira. Através de oficinas temáticas desenvolvemos os temas pertinentes à proposta e o resultado final foi a transformação de uma proposta em um processo contínuo de análise de contexto e capacitações.

Enumeration and composition of the public health workforce: challenges and strategies.

The field of public health needs a comprehensive classification data system that provides a better assessment of the size and composition of its workforce. Such a data system is necessary for understanding the capacity, trend projections, and policy development critical to the future workforce. Previous enumeration and composition studies on the public health workforce have been helpful, but the methodology used needs further improvements in standardization, specificity, data storage, and data availability. Resolving this issue should follow a consensus-based course of action that includes public and private stakeholders at the national, state, and local level. This prime issue should be addressed now, particularly in the current environment of comprehensive health care reform.

County-level estimates of mental health professional supply in the United States.

OBJECTIVE: This study compiled national county-level data and examined the geographic distribution of providers in six mental health professions and the correlates of county-level provider supply. METHODS: Data for six groups--advanced practice psychiatric nurses, licensed professional counselors, marriage and family therapists, psychiatrists, psychologists, and social workers--were compiled from licensing counts from state boards, certification counts from national credentialing organizations, and membership counts from professional associations. The geographic distribution of professionals was examined with descriptive statistics and a national choropleth map. Correlations were examined among county-level totals and between provider-to-population ratios and county characteristics. RESULTS: There were 353,398 clinically active providers in the six professions. Provider-to-population ratios varied greatly across counties, both within professions and overall. Social workers and licensed professional counselors were the largest groups; psychiatrists and advanced practice psychiatric nurses were the smallest. Professionals tended to be in urban, high-population, high-income counties. Marriage and family therapists were concentrated in California, and other mental health professionals were concentrated in the Northeast. CONCLUSIONS: Rural, low-income counties are likely candidates for interventions such as the training of local clinicians or the provision of incentives and infrastructure to facilitate clinical practice. Workforce planning and policy analysis should consider the unique combination of professions in each area. National workforce planning efforts and state licensing boards would benefit from the central collection of standardized practice information from clinically active providers in all mental health professions.

Where are healthcare providers? Exploring relationships between context and human resources for health Madhya Pradesh province, India.

OBJECTIVE: In India, heterogeneous healthcare providers in the public and dominant private sectors serve a diverse population, including those from vulnerable groups, the scheduled castes and tribes. We explored relationships between the distribution of different categories of healthcare providers (public and private); and contextual socioeconomic and demographic variables. Access to healthcare providers for scheduled castes and tribes was specifically studied. METHOD: Set in Madhya Pradesh province (60.4 million), India. Dependent variables included district-wise densities of physicians and paramedics (public and private separately); and unqualified providers (private). Contextual variables included infrastructure, urbanization, economy, female literacy and proportion of scheduled castes and tribes. RESULTS: Urbanization was strongly correlated with private physician density; and negatively with paramedical density (public and private). Private paramedical density variation was partially explained by economy. Public physician and paramedical density were positively correlated to district proportions of scheduled tribes. All provider densities (public and private) were negatively related to proportions of scheduled castes. CONCLUSIONS: Overall density of qualified providers was low. Qualified physicians tended to be more densely situated in the relatively more urban districts. Access to healthcare providers for scheduled castes and tribes is different. More targeted approaches are necessary for improving access for scheduled castes.

Race-neutral versus race-conscious workforce policy to improve access to care.

Access to care for racial and ethnic minority groups, low-income populations, and the un- and underinsured has been problematic despite expansion in the health workforce. Workforce policies that improve access to care are needed, as is funding to support them. Reviewing evidence related to providers' patterns of service to the underserved, this paper concludes that underrepresented minority health professionals have consistently been more likely than those from low socioeconomic backgrounds or the National Health Service Corps to deliver health care to the underserved. These findings have implications for policies and programs that might leverage the workforce to better meet the needs of disadvantaged patients.

Caracterización de los recursos humanos del sector salud / Characterization of human resources in the health sector

El presente trabajo describe los principales aspectos del mercado de trabajo del sector salud, considerando los principales prestadores, las Instituciones de Asistencia Médica Colectiva y la Administración de Servicios de Salud del Estado. La caracterización de los recursos humanos se realiza tomando en cuenta las siguientes dimensiones: dotación de recursos humanos en relación a la población afiliada, su composición por categorías y especialidades, la distribución de los mismos por nivel asistencial, los niveles salariales, considerando variables como el sexo y la edad, la relación de dependencia con la institución. En el estudio se constata que el subsector privado cuenta con mayores recursos humanos que el público en relación a la población que atienden, aunque para poder comparar el número de cargos de ambos subsectores habría que ajustar por las cargas horarias de los subsectores ya que existen diferencias importantes en esta materia. (AU)

How are health professionals earning their living in Malawi?

BACKGROUND: The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. METHODS: The present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods. RESULTS: Health professionals identified the following as some of the challenges there faced: inequitable and poor remuneration, overwhelming responsibilities with limited resources, lack of a stimulating work environment, inadequate supervision, poor access to continued professionals training, limited career progression, lack of transparent recruitment and discriminatory remuneration. When asked what kept them still working in Malawi when the pressures to emigrate were there, the following were some of the ways the health professionals mentioned as useful for earning extra income to support their families: working in rural areas where life was perceived to be cheaper, working closer to home village so as to run farms, stealing drugs from health facilities, having more than one job, running small to medium scale businesses. Health professionals would also minimize expenditure by missing meals and walking to work. CONCLUSION: Many health professionals in Malawi experience overly challenging environments. In order to survive some are involved in ethically and legally questionable activities such as receiving "gifts" from patients and pilfering drugs. The efforts by the Malawi government and the international community to retain health workers in Malawi are recognized. There is however need to evaluate of these human resources-retaining measures are having the desired effects.

Numbers of minority health professionals: where do we stand?

This overview has pointed to a continuing racial and ethnic imbalance in the health professions that applies to North Carolina as well as the nation. Great strides have been made early in the development of programs to enhance racial and ethnic representation, but they have generally reached a plateau in terms of growth and progress. Resistance to affirmative action programs and subsequent uncertainty over their legal standing can be cited as one factor thwarting progress, but that issue has been resolved and schools, professions, and the North Carolina General Assembly can move forward with a clear understanding of how to proceed. A full generation has matured with the benefit of positive emphasis on increasing the proportion of minorities in the health professions. The coming generations must build and expand on the programs and initiatives that brought the nation and the state to where we are now. But these goals must be re-stated, and intensified efforts are required if any reasonable parity in representation of minorities among the health professions is to be achieved.