Objectives. We assessed the effect of public health leadership training on the capacity of public health leaders to perform competencies derived from the list of “Ten Essential Public Health Services” presented in 1994 by the steering committee of the Public Health Functions Project.

Methods. Graduating scholars of the Northeast Public Health Leadership Institute were surveyed to determine differences in skill level in 15 competency areas before and after training. Surveys were completed after program completion.

Results. The training program improved the skill levels of participants in all 15 competency areas. A relation also was detected between the frequency of use of the competency and the improvement experienced.

Conclusions. Public health leadership training programs are effective in improving the skills of public health workers.

The aftermath of the September 11, 2001, terrorist attacks and the threat of further attacks by biological means have taken public health out of the shadows and cast it in a more visible role in protecting the nation.1 However, these threats have only compounded the need for an effective public health infrastructure, of which a competent leadership is an important element. Major changes, including managed care approaches to health care and changing demographics, are also affecting public health and require attention. Moreover, because public health agencies provide population-focused services to entire communities rather than individualized care,2 an increased need exists for public health personnel capable of leading efforts to ensure the effectiveness and quality of these services.

These existing and emerging responsibilities are presenting a challenge to the public health field to reevaluate and improve the competencies of its workforce. The need for competency building has been expressed by many who think that ongoing training in specific skill areas would better prepare public health practitioners and leaders to be more effective in responding to ever-changing public health challenges.3 Among these specific skill areas frequently mentioned are management and leadership competencies. Findings from a 1997 study showed that 78% of local public health leaders lacked public health graduate education, and many reported limited opportunities for continuing education.4 Porter et al.5 noted that the Institute of Medicine’s 1988 report, The Future of Public Health, alluded to the need for managerial and leadership training.6 Other studies cited a similar need and recommended that public health professionals be trained in several management and leadership competency areas.7,8

As a direct result of this obvious need for training, the public health field is witnessing a major effort by public health leaders to understand their roles and develop the knowledge and skills necessary to perform much-needed services.8 However, the multidisciplinary nature of public health requires training in a multitude of competency areas.2 For example, studies have shown that successful efforts that were aimed at improving management skills of public health administrators have included a wide array of management-related topics.5 This notion of multidisciplinary training has been enforced by the list of “Ten Essential Public Health Services” presented in 1994 by the steering committee of the Public Health Functions Project in a consensus statement titled Public Health in America.9 The list included community-oriented services that require an able public health workforce, as an infrastructure, with basic public health science, analytic, communication, and program planning and policy development skills and knowledge.

The Northeast Public Health Leadership Institute (NEPHLI) provides such comprehensive leadership training. Affiliated with the University at Albany School of Public Health and the New York State Health Department, NEPHLI fulfills the need for closer ties between schools of public health and health departments outlined in the report presented by the Pew Health Professions Commission.10,11 NEPHLI is part of a network of public health leadership institutes developed across the United States. It provides training that consists of a year-long experiential program aimed at building and improving the leadership skills of current and future public health practitioners. Participating scholars gain practical experience from experts in a variety of fields. Topics covered include influencing others, measuring and improving public health performance, developing collaborative relationships and partnerships, risk communication, team building, group problem solving, responding to the needs for cultural diversity and competence, and emergency preparedness training. The primary aim of NEPHLI is to train emerging leaders from state and local public health departments and allied public and private organizations to broaden their vision of public health policy, practice, and collaboration and to foster improved decisionmaking within their organizations. NEPHLI provides training to practitioners from Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.

The purpose of this study was to assess the effect of leadership training on a set of competencies derived from the “Ten Essential Public Health Services” outlined in the Public Health in America consensus statement.

Survey and Study Participants

The survey was designed to assess the effect of NEPHLI on the scholars’ competencies related to the “Ten Essential Public Health Services” outlined in the Public Health in America consensus statement.9 The competency areas examined in the study were tailored to reflect the mission and goals of NEPHLI. Fifteen competency areas were developed with an emphasis on leadership and administrative skills and knowledge. Each of the 15 items asked respondents to rate their competency level before and after receiving NEPHLI training, as well as the frequency of their use of each of the competencies. Responses were rated on an ordinal scale (1 = low, 5 = high).

The study population included all 114 NEPHLI scholars who graduated from the program in the years 1998 through 2001. A list containing contact information for all NEPHLI scholars (1998–2001) was developed. Follow-up contacts were made via telephone, e-mail, and regular mail. Some scholars were not contacted because current contact information was not available.

Analysis

The change in the level of each of the 15 competency areas before and after participating in the leadership training program was used to measure improvement (or decline). Student t tests were used to examine the statistical significance of these changes.

Another comparison was aimed at examining changes in the competency levels by frequency of use. Because of the relatively small sample size, the frequency of use of each of the competency areas was recoded into “high” (fairly often, very often) or “low” (sometimes, once in a while, never) use. The associations were tested for significance with t tests. Also examined was the relation between the scholar’s occupational position and the change in competency level. Positions were classified as “director/assistant director” or “other.”

To further analyze changes in competency levels, the study examined the change in the percentage of respondents who considered their skill level as “high” before and after the training program. Chi-square tests were used to assess whether the proportions were significantly different. The association between frequency of use of the competency and the proportion of scholars with “high” skill levels also was tested with χ2, as was the job position of the scholars.

The 114 study participants represented NEPHLI scholars from the classes of 1998, 1999, 2000, and 2001. There were 32 scholars from the class of 1998, 30 from the class of 1999, 30 from the class of 2000, and 24 from the class of 2001. Two scholars did not complete their year-long training and were not part of the evaluation. Women constituted more than half of the study cohort (69.3%). Sixty percent of the respondents had a master’s degree, of which one fifth possessed MPH degrees. A combined total of 15% had doctoral degrees in public health, medicine, philosophy, education, or nursing. Six percent of this group had MPH and doctoral degrees. Ninety-nine percent of the scholars were at least middle managers, identified for study purposes as directors or assistant directors. This cohort also included assistant commissioners and county health officers. Of the 114 scholars who completed training during the period 1998 through 2001, 81 (71.1%) responded.

Change in Competency Levels

Descriptive statistics on the skill level before and after the training program are presented in Table 1. As mentioned earlier, the responses ranged from high (5) to low (1). The results showed that scholars reported a significant improvement in their skill levels in all 15 competency areas examined.

The greatest improvements were reported in the scholars’ ability to “cope with and lead changes in public health practice” (an improvement in the mean score from 3.0 to 4.0) (P < .001) and “use the media and other forums to inform, educate, and empower people about health issues” (an improvement in the mean score from 2.7 to 3.7) (P < .001). Smaller improvements were detected in the scholars’ ability to “communicate clearly and effectively public health laws and regulations” (2.9 to 3.5) (P < .001), “accurately and effectively communicate information to a professional and a lay audience” (3.4 to 4.0) (P < .001), and “use visual representations of data to identify public health problems” (3.1 to 3.7) (P < .001).

Change in Competency Levels by Frequency of Use and Position

The association between the change in competency level and its frequency of use is presented in Table 2. Respondents who had a low frequency of use of “dealing with cultural and ethnic diversity in the context of access to health services” had a greater improvement in their skill level than did those who used it more frequently (1.0 vs 0.5) (P < .05). On the contrary, those who used the ability to “understand the administrative, social, and political implications of alternative policy options” more frequently achieved a greater improvement in that skill level (1.0 vs 0.5) (P < .01).

No association between the position of the scholar and changes in competency levels was evident (Table 3). A marginally significant relation was detected that showed that respondents who were not directors or assistant directors had a greater improvement in their ability to “understand the administrative, social, and political implications of alternative policy options” (1.0 vs 0.7) (P = .05). It is worth noting that the analysis of the association between position and frequency of use of competencies found a strong association between both in several competency areas examined. Directors were more likely to use these competencies than were “nondirectors.”

Change in the Proportion of High-Skill Scholars

Analysis was also done to examine the proportion of scholars reporting a high skill level before and after NEPHLI training. The results showed a significant increase in the proportion of respondents with high skill levels in all 15 competency areas examined (Figure 1).

Further analysis of the relation between frequency of use and change in the proportion of high-skill-level scholars showed a significant increase in the latter who more frequently used the skills to “communicate clearly and effectively public health laws and regulations”; “use visual representations of data to identify public health problems”; “collaborate with colleagues and the community to manage and investigate health problems”; “interact, inform, and educate individuals from diverse cultural, socioeconomic, educational, and professional backgrounds”; “accurately and effectively communicate information to a professional and a lay audience”; and “match the skills and knowledge of public health workers with appropriate tasks.” However, the analysis showed no association between the type of position and the change in the proportion of high-skill-level participants.

Until recently, the public health field has been quietly playing its role in addressing public health problems. However, recent events added to that role and placed public health at the center of the nation’s efforts to improve its readiness. Such a responsibility enhanced the need to upgrade the public health infrastructure. Developing qualified and able public health leaders is a critical step in building the infrastructure needed to address public health challenges.

In 1988, the Institute of Medicine report, The Future of Public Health, noted the importance of public health leadership development. This culminated in the Centers for Disease Control and Prevention establishing the National Public Health Leadership Institute and subsequently funding state and regional leadership institutes.

This study examined the effectiveness of a leadership training program in improving the skills of its graduates. Results showed that the program improved the skill levels of the scholars in all of the 15 competencies examined, which were derived from the “Ten Essential Public Health Services” outlined in the Public Health in America consensus statement. The greatest improvements were observed in the ability to cope and lead changes in public health practice and to use the media and other forums to inform, educate, and empower people about health issues. These 2 skills are relevant more than ever given the challenges that confront the public health workforce.

The results also found an association between the frequency of use and improvement in the skill levels for certain competencies. Such a relation highlights the importance of tailoring leadership programs to participants’ interests and needs. Individual leadership institutes will have to tailor the curriculum to respond to the needs of its constituents. For example, leadership training for public health workers located in areas with a high representation of minorities should highlight cultural and ethnic sensitivity topics. Leadership training in areas with a higher risk of terror attacks may consider concentrating training on mobilizing resources and collaboration with other public health and non–public health agencies and groups.

In conclusion, leadership development is an essential element in the nation’s efforts to improve the public health infrastructure. Training of public health professionals must incorporate leadership skills and knowledge to augment the overall competency of the workforce.

Table
TABLE 1— Change in Competency Levels Among the Study Respondents
TABLE 1— Change in Competency Levels Among the Study Respondents
 Competency Level, Mean (SD)
CompetencyBefore TrainingAfter Training
Cope with and lead changes in public health practice*3.0 (0.9)4.0 (0.6)
Match the skills and knowledge of public health workers with appropriate tasks*3.0 (0.8)3.7 (0.8)
Deal with cultural and ethnic diversity in the context of access to health services*3.1 (1.0)3.8 (0.7)
Mobilize resources in the community needed to increase access to public health services*2.8 (0.9)3.5 (0.7)
Communicate clearly and effectively public health laws and regulations*2.9 (0.9)3.5 (1.0)
Advocate for the enforcement of laws and regulations pertaining to public health*2.9 (1.0)3.6 (0.9)
Understand the administrative, social, and political implications of alternative policy options*2.9 (0.9)3.8 (0.9)
Work with, coordinate, and/or lead community efforts to address public health problems*3.1 (0.8)3.9 (0.7)
Build strong and ongoing relationships with the community*3.3 (0.9)4.0 (0.8)
Interact, inform, and educate individuals from diverse cultural, socioeconomic, educational, and professional backgrounds*3.3 (0.9)4.0 (0.8)
Use the media and other forums to inform, educate, and empower people about health issues*2.7 (0.8)3.7 (0.8)
Collaborate with colleagues and the community to manage and investigate public health problems*3.3 (0.9)4.2 (0.6)
Accurately and effectively communicate information to a professional and a lay audience*3.4 (0.8)4.0 (0.6)
Lead and participate in groups to identify public health problems*3.1 (0.8)4.0 (0.6)
Use visual representations of data to identify public health problems*3.1 (0.9)3.7 (0.7)

*P < .001.

Table
TABLE 2— Change in Competency Level, by Frequency of Use, Mean (SD)
TABLE 2— Change in Competency Level, by Frequency of Use, Mean (SD)
CompetencyLow FrequencynHigh Frequencyn
Cope with and lead changes in public health practice*1.2 (1.1)130.9 (0.6)68
Match the skills and knowledge of public health workers with appropriate tasks0.7 (0.7)180.7 (0.7)63
Deal with cultural and ethnic diversity in the context of access to health services*1.0 (0.9)170.5 (0.7)64
Mobilize resources in the community needed to increase access to public health services0.7 (0.8)230.7 (0.7)56
Communicate clearly and effectively public health laws and regulations0.5 (0.8)190.7 (0.7)61
Advocate for the enforcement of laws and regulations pertaining to public health0.9 (0.9)240.7 (0.7)55
Understand the administrative, social, and political implications of alternative policy options**0.5 (0.5)161.0 (0.6)65
Work with, coordinate, and/or lead community efforts to address public health problems0.8 (0.7)170.8 (0.7)64
Build strong and ongoing relationships with the community0.9 (0.7)150.6 (0.6)66
Interact, inform, and educate individuals from diverse cultural, socioeconomic, educational, and professional backgrounds0.4 (0.5)110.6 (0.7)70
Use the media and other forums to inform, educate, and empower people about health issues1.1 (0.9)241.0 (0.7)56
Collaborate with colleagues and the community to manage and investigate public health problems0.9 (0.6)80.9 (0.8)71
Accurately and effectively communicate information to a professional and a lay audience0.7 (0.7)90.6 (0.6)70
Lead and participate in groups to identify public health problems1.2 (0.8)60.9 (0.6)75
Use visual representations of data to identify public health problems*0.4 (0.6)200.8 (0.8)61

*P < .05; **P < .01.

Table
TABLE 3— Change in Competency Levels by Position
TABLE 3— Change in Competency Levels by Position
 Position
CompetencyDirector or Assistant Director (n = 40)Others (n = 41)
Cope with and lead changes in public health practice0.9 (0.7)1.0 (0.8)
Match the skills and knowledge of public health workers with appropriate tasks0.7 (0.6)0.7 (0.7)
Deal with cultural and ethnic diversity in the context of access to health services0.5 (0.7)0.7 (0.8)
Mobilize resources in the community needed to increase access to public health services0.8 (0.7)0.6 (0.7)
Communicate clearly and effectively public health laws and regulations0.6 (0.7)0.6 (0.7)
Advocate for the enforcement of laws and regulations pertaining to public health0.8 (0.7)0.7 (0.8)
Understand the administrative, social, and political implications of alternative policy options0.7 (0.5)1.0 (0.7)
Work with, coordinate, and/or lead community efforts to address public health problems0.9 (0.6)0.8 (0.8)
Build strong and ongoing relationships with the community0.6 (0.6)0.7 (0.7)
Interact, inform, and educate individuals from diverse cultural, socioeconomic, educational, and professional backgrounds0.5 (0.6)0.6 (0.7)
Use the media and other forums to inform, educate, and empower people about health issues1.0 (0.8)1.0 (0.8)
Collaborate with colleagues and the community to manage and investigate public health problems0.9 (0.7)0.9 (0.8)
Accurately and effectively communicate information to a professional and a lay audience0.6 (0.5)0.7 (0.7)
Lead and participate in groups to identify public health problems0.9 (0.6)0.9 (0.7)
Use visual representations of data to identify public health problems0.6 (0.7)0.7 (0.8)

The authors would like to thank Dr Kristine Gebbie for her invaluable input throughout the study.

Human Participant Protection No protocol approval was needed for this study.

References

1. Stapleton S. Public health’s role key to homeland security [American Medical News Web site]. 2002. Available at: http://www.ama-assn.org/sci-pubs/amnews/pick_02/hlsc0204.htm. Accessed December 14, 2002. Google Scholar
2. Gebbie KM. The public health workforce: key to public health infrastructure. Am J Public Health. 1999;89:660–661. LinkGoogle Scholar
3. Boedigheimer SF, Gebbie KM. Currently employed public health administrators: are they prepared? J Public Health Manag Pract. 2001;7:30–36. Crossref, MedlineGoogle Scholar
4. Gerzoff RB, Richards TB. The education of the local health department executives. J Public Health Manag Pract. 1997;3:50–56. Crossref, MedlineGoogle Scholar
5. Porter J, Johnson J, Upshaw VM, Orton S, Deal KM, Umble K. The Management Academy for Public Health: a new paradigm for public health management development. J Public Health Manag Pract. 2002;8:66–78. Crossref, MedlineGoogle Scholar
6. Institute of Medicine. The Future of Public Health. Washington, DC: National Management Academy Press; 1988. Google Scholar
7. Halverson PK, Mays GP, Kaluzny AD, House RM. Developing leaders in public health: the role of executive training programs. J Health Adm Educ. 1997;15:87–100. MedlineGoogle Scholar
8. Gebbie KM, Hwang I. Preparing Currently Employed Public Health Professionals for Changes in the Health System. New York, NY: Columbia University School of Nursing Center for Health Policy and Health Services Research; 1998. Google Scholar
9. The Public Health Workforce: An Agenda for the 21st Century. Washington, DC: US Dept of Health and Human Services; 1997. Google Scholar
10. Health Professions Education for the Future: Schools in Service to the Nation. Philadelphia, Pa: Pew Health Professions Commission; 1993. Google Scholar
11. Critical Challenges: Revitalizing the Health Professions for the Twenty-First Century. Philadelphia, Pa: Pew Health Professions Commission; 1995. Google Scholar

Related

No related items

TOOLS

SHARE

ARTICLE CITATION

Shadi S. Saleh, PhD, MPH, Dwight Williams, MSW, and Modinat Balougan, MPHThe authors are with the School of Public Health, State University of New York at Albany. Dwight Williams is also with the Northeast Public Health Leadership Institute, School of Public Health, State University of New York at Albany. “Evaluating the Effectiveness of Public Health Leadership Training: The NEPHLI Experience”, American Journal of Public Health 94, no. 7 (July 1, 2004): pp. 1245-1249.

https://doi.org/10.2105/AJPH.94.7.1245

PMID: 15226150