The first known field application of the Public Health Workforce Calculator in conjunction with an FPHS workforce capacity self-assessment and a structured prioritization process in NNPH has showcased the value of these tools to inform a comprehensive workforce investment planning process.
Brief Introduction to the Issue
Few public health issues are less sexy yet more critical than public health infrastructure. Study groups formed after the Great Recession attempted to address this deficit and formulated a “minimum package” of public health services. This concept subsequently morphed into the Foundational Public Health Services (FPHS) framework. Studies have shown the public health enterprise is severely understaffed, requiring another 80,000 positions to deliver the FPHS nationwide.
New tools have been developed that allow individual health departments to determine their specific FPHS and programmatic workforce needs. These include the Public Health Workforce Calculator (calculator) and several FPHS workforce capacity self-assessments. Northern Nevada Public Health (NNPH), assisted by the Public Health Foundation (PHF), undertook a full inventory of its workforce needs.
What We Learned
Our first major takeaway was that the calculator and FPHS self-assessment tools yielded complementary results regarding FPHS workforce capacity gaps. This increased our confidence with the use of both tools. Importantly, some of the capacity self-assessment instruments offer greater opportunity to adjust initial results to consider the local context and the public health system. However, greater time must be invested compared with the calculator alone.
Second, the critical information provided by the calculator and FPHS self-assessment did not yield the complete workforce inventory desired by NNPH. This required an additional assessment effort focused on Community Specific Services (CSS), the programs and services tailored to meet unique community needs as determined via a community health assessment and planning effort.
Third, data provided courtesy of the calculator and the FPHS capacity self-assessment yielded valuable inputs for comprehensive workforce development planning purposes.
Additionally, this information was utilized for a successful request to the board of health to increase workforce investment by adding a number of needed positions. It also bolstered a statewide request for public health infrastructure funding in Nevada.
Fourth, documentation of the infrastructure/workforce gap alone proved insufficient. How should NNPH operationalize its priorities so that investments could be made strategically as resources become available? PHF collaborated with NNPH to develop a prioritization matrix model. This tool is based upon the PHF Electronic Prioritization Matrix located at http://www.phf.org/resourcestools/Pages/Electronic_Prioritization_Matrix.aspx (see also page 93 of the Public Health Quality Improvement Encyclopedia).
So, What Does this Mean for Me and My Health Department?
For purposes of comprehensive workforce planning, our perspective is that a health department can proceed with confidence utilizing either the calculator or capacity self-assessment tools. Given their complementary findings, our team suggests their use in tandem.
In some jurisdictions, simply requesting infrastructure needs without considering programmatic gaps in community service may be a strategic blunder. Governing boards and funding entities have too often associated infrastructure with negative connotations. Coupling the FPHS assessment with a CSS analysis not only provides a more comprehensive workforce portrait, but it also enhances the planning and funding request processes.
Start with the end in mind. What outcome is desired from an FPHS workforce capacity assessment? Adjunct tools such as the PHF prioritization matrix can facilitate guiding the organization in terms of selecting priorities and staffing needs to pursue. Consider the transparency of the workforce capacity assessment processes. NNPH chose to involve multiple levels of leadership and to proceed in a consensus-based approach. One early byproduct was broad buy-in for the workforce assessment.
Conclusion
The utilization of the public health workforce calculator and an FPHS workforce capacity self-assessment in a structured process such as that used by NNPH to identify staffing priorities holds promise as an approach that could be used to support key infrastructure decision making. It can also strengthen the justification for additional staffing resources.
Call to Action
For more detailed findings and recommendations, please read our article “Northern Nevada Public Health: Utilizing the Public Health Workforce Calculator and Workforce Capacity Self-Assessment Tools to Develop a Framework for Workforce Investment” in the Journal of Public Health Management and Practice.
Leslie Beitsch, MD, JD, has recently retired from full time academic and public health practice. He remains affiliated with Florida State University and the Public Health Foundation. He previously served in leadership positions for the Florida Department of Health and the Oklahoma State Department of Health.
Matthew Stefanak is a faculty member at the Kent State University College of Public Health. Prior to this he served as the Health Commissioner of Mahoning County, Ohio for 25 years. He volunteers as a site visitor for CEPH and PHAB. Matt received his MPH degree from Johns Hopkins University.
Carol Moehrle has served for 32 years as District Health Director for Public Health – Idaho North Central District. She has been active in NACCHO as well as PHAB and PHF. Carol is an RN with a BSN from Idaho State University.
Kevin Dick served as District Health Officer of Northern Nevada Public Health (NNPH) from 2013 to 2024. Prior to his appointment he held positions at the NNPH Air Quality Management Division, the University of Nevada, Reno, and at the US EPA. He has a BS from Cornell University.
Ron Bialek has been President and CEO of the Public Health Foundation (PHF) since 1997. He focuses PHF’s efforts on improving performance of public health agencies and system. This includes creating the Nation’s most comprehensive population health learning network – TRAIN, with more than 5 million users.