Renewing Public Health Systems: Public Health Human Resources Planning Processes Co-authors: Sandra Regan, Western University Marjorie MacDonald, University of Victoria Cheryl Martin, BC Ministry of Health Nancy Peroff-Johnston, ON Ministry of Health and Long-Term Care Sabrina Wong, University of British Columbia Canadian Public Health Association Conference May 28, 2014

Study Background CIHR-funded study - Renewal of Public Health Systems (RePHS) Principal Investigators: Marjorie MacDonald, Trevor Hancock, Bernie Pauly, & Ruta Valaitis Purpose of the study is to compare the implementation and impact of the BC Core Public Health Functions and Ontario Public Health Standards Focus on two public health programs in BC and ON – Chronic disease prevention (CDP) Sexually transmitted infection prevention (STIP)

Research Questions Question 1: What factors and contexts influence or affect the implementation of the BC Core Public Health Functions and Ontario Public Health Standards ? Question 2: What have been the impacts and effects of BC Core Public Health Functions and Ontario Public Health Standards on: staff, the organization, the populations served, other organizations, & communities? Cross-cutting themes: Equity, Health Human Resources, Primary Care/Public Health Collaboration

Study Participants Interviews with BC & ON Directors, Associate/Medical Officers of Health, Government Staff (N= 29) – 6 Ontario public health units – 4 BC regional health authorities – Both provincial governments Data collection in Phase 2 – – Focused questions regarding their approach to public health workforce planning Data Analysis - Inductive thematic analysis

Background – Public Health BC & ON Certain public health events highlighted system weaknesses, e.g.: Walkerton (2000); SARS (2003); and H1N1 (2009). Led to reviews, reports, recommendations about public health system: – Learning from SARS: Renewal of Public Health in Canada. (2003) – Development of a Draft Set of Public Health Workforce Core Competencies. Summary Report (2005) – Building the Public Health Workforce for the 21st Century: A Pan-Canadian Framework for Public Health Human Resources Planning. (2005) – Local Public Health Capacity Review Committee Interim Report (2005) and Final Report (2006).

PH Workforce Issues Shortages/supply Profile of public health Job instability Compensation Professional development Career paths, opportunities for advancement Workplace culture and conditions Professional support Leadership PHHR data and information Alignment of academic and practice fields Access to support services

Context: PH Workforce Planning British Columbia Provincial government – Ministry of Health Provincial agencies – BC Centre for Disease Control Regional Health Authorities – 5 geographic/1 provincial Provincial association – Public Health Association of BC Ontario Provincial government – Ministry of Health & Long-Term Care Provincial agencies – Public Health Ontario Local public health units – 36 units Provincial associations – Ontario Public Health Association – Association of Local Public Health Agencies (alPHa)

B.C.’s Guiding Framework In 2013, BC’s Guiding Framework for Public Health was released. Broad public health functions identified: Provincial-Level Functions and Infrastructure: The set of organizational resources and services that support the development and application of public health programs (e.g., public health human resources) The document identifies areas of focus including: Public health human resources, training and development.

Ontario Public Health Organizational Standards In 2011, the Ontario Public Health Organizational Standards were released Establish management and governance standards for boards of health Include organizational requirements for public health human resource planning and development

Interviews: Workforce Planning Activities Retirement projections Succession planning Predicting types of skills needed in the future Recruitment and retention Identifying trends and issues Workforce/staff development planning

Interviews: Workforce Planning Some degree of Workforce Planning was discussed by all participants. Typically, participants mentioned aspects of Workforce Planning but no one identified that their organization had a comprehensive plan. In BC, public health workforce planning is integrated into each regional health authority’s planning processes; PH may or may not be a priority within broader health care system planning In ON, public health workforce planning occurs both in the local public health unit and with the municipality; PH may compete with multiple demands on the municipality. Both BC and ON discussed the public health core functions/standards in relation to Workforce Planning – but this was more evident in BC interviews.

Interviews: Workforce Planning No comprehensive workforce “plan” was obtained from any regional health authority/public health unit. Most discussed having a “human resources” person in their regional health authority/ public health unit. Many discussed the need for a more formal plan that would combine key activities – projections, demand, education, recruitment and retention. References were made to provincial government level planning of the public health workforce

“…So they have some estimates [of the public health human resources ] but I think there’s some issue around defining public health professionals and the training that’s required and the different areas, etcetera. So I’m sure they would say that they do have [a plan] but from my perspective they aren’t able to accurately measure the public health workforce so they are not able to properly plan for their development.”

“We have somebody that’s working with [municipal] HR on looking at workforce development.” …there’s a process that’s going on right now and which will eventually, I think, yield a human resource plan for us for the next few years.”

Conclusions Public health renewal has led to the development of numerous documents calling for attention to and addressing aspects of PHHR planning such as competency development, enumeration of the workforce, recommendations for future PHHR-related work. However, participants were not able to point to a specific plan for the PH Workforce either at the regional/local or provincial levels. Data were collected in Phase 2 – Phase 4, just completed, asks about progress on Workforce Planning. In order to achieve the recommendations of the numerous public health recommendations of the 2000s, a comprehensive public health workforce plan is a necessity.

Acknowledgements Canadian Institutes of Health Research Emerging Team Grant CIHR/PHAC Applied Public Health Chair (Dr. Marjorie MacDonald) RePHS BC and ON Research Team – Investigators – Academic and PHU/government Decision-Makers

Thank you! Questions? Presenters: Sandra Regan Nancy Peroff-Johnston RePHS Project Contact: Diane Allan, RePHS Project Coordinator ntprojects/rephs/