Identificación de las competencias actuales y futuras de los profesionales de la salud pública

Objectives

To identify current and future competencies (managers and technicians) for public health professionals in Catalonia (Spain).

Methods

Qualitative research with a phenomenological approach. Between November 2009 and February 2010, 31 semistructured interviews were completed with public health professionals working in Catalonia. We purposely used a theoretical sample to include the maximum multiplicity of discourses. We conducted a thematic content analysis.

Results

We obtained a wide range of current professional competencies, as well as those required for the future, classified according to professional profile. The participants highlighted transversal competencies, such as the importance of sharing a general theoretical framework of the discipline and the institution. Among the most frequently reported competencies were knowledge management, communication skills, teamwork, multidisciplinary and intersectoral orientation, legal knowledge, computer skills and languages, particularly English. It was also important for individual professionals to have specific skills in their areas of activity. In terms of differences between managers and technicians, the study showed that technicians prioritize management skills concerning human and material resources, while managers emphasize organizational and professional public health expertise.

Conclusions

There is a need for transversal and specific competencies in distinct areas. Public health is a multidisciplinary field, which collaborates with a wide range of professionals and organizations.     

The new health care paradigm: roles and competencies of leaders in the service line management approach

PURPOSE: The purpose of this paper is to discuss the need for the service line management approach in health care. Service line management is increasingly utilized by US health care organizations as an innovative method for providing the needed stimulus to increase viability and profitability for the ailing health care sector. DESIGN/METHODOLOGY/APPROACH: Using current literature, this study describes a paradigm shift from traditional health care management approaches to focus on the importance of a service line management approach with its specific emphasis on competencies of leaders. RESEARCH LIMITATIONS/IMPLICATIONS: Four essential competencies--conceptual, participation, interpersonal, and leadership--must be gained by leaders to bring about organizational growth. PRACTICAL IMPLICATIONS: Health care managers must understand and practice these four key competencies to become effective health care leaders. ORIGINALITY/VALUE: This paper provides useful information on the need for the service line management approach in health care.     

Factors predictive of successful learning in postgraduate medical education

PURPOSE: To establish which personal and contextual factors are predictive of successful outcomes in postgraduate medical education. METHOD: We performed a follow-up study of 118 doctors on a postgraduate occupational health training programme on the management of mental health problems. The following personal and contextual variables were measured as potential predictors of outcome: gender; age; years of experience as a doctor; university of graduation; learning style (Kolb); present employer (occupational health service), and educational format (problem-based or lecture-based). The main outcome measures were: scores on knowledge tests consisting of true/false and open answer questions, and performance in practice based on self-report and performance indicators. To determine the effect of potential predictive factors univariate analyses of variance and repeated measurement analysis of variance was applied. RESULTS: The mean scores of knowledge (P < 0.001) and performance (P = 0.001) of the participants increased after the educational programme. After multivariate analysis female gender was positively related to accruements in both knowledge and performance (both P < 0.05), independently of the influence of other factors. Accommodator learning style showed a relation with knowledge increase (P = 0.05), but had no influence on performance (P = 0.79). The problem-based educational format yielded a better performance outcome (P = 0.05), but had no influence on knowledge tests (P = 0.31). CONCLUSION: Gender and learning style were found to be related to an increase in knowledge. Gender was also found to be related to improvement in performance after a postgraduate medical education programme. We found no interactions with course design (i.e. problem-based or non problem-based learning formats), but further research could reveal other cues, suggesting practical consequences of student characteristics for course design in postgraduate training.     

Preparing health care professionals for quality improvement: the George Washington University/George Mason University experience

Seventy-seven medical, physician assistant, nurse practitioner, and health services management students were provided training in quality improvement, community-oriented primary care, and teamwork. These students were then formed into 13 interdisciplinary teams to apply their knowledge in underserved areas ("service learning") under a community and faculty preceptor.     

Total quality strategy in the formative process of the occupational physician.

Interest in applying the concepts of total quality management to the fields of health care and medical education is growing. This paper analyzes the field of education in occupational medicine to explore the relationships between teaching and the deliverance of a product or a service. Issues such as defining teaching customers, addressing customer needs, teaching processes, and assessing and improving quality teaching are described. The occupational physician is requested to act according to particular competencies. This demand implies the need to meet specific requirements. To assure the achievement of these goals, the implementation of a teaching process must include (i) targeting the learning objectives (the knowledge, skills, and attitudes the specialist should have), (ii) planning the evaluation system (ability of the course to assure the achievement of the objective), (iii) evaluating the curriculum (compliance of the acquired competencies to the needs).     

Applying learning principles to the development of health services managers

An Australian health services management program which leads to an M.H.A. for experienced managers was designed with a strong basis in principles of adult learning and management development. The program emphasizes management competencies, self-managed learning methodologies, team learning, learning contract processes, work-based projects, and choice for participants to undertake learning activities most relevant to their evolving careers.     

The managerial revolution: medicine as a business

Medicine and management should be more closely integrated not just at the level of health policy and health services management but also in matters of professional education and training. Learning is a continuous process from entering medical school to retirement and should reflect the transition from learning shaped by the curriculum to learning driven by the needs of the qualified professional in a career service post. The senior clinician does much more than practise clinically. He or she is a leader, a manager, a resource allocator, a teacher and team player. In these roles the values and priorities of the professional and the organization will not always coincide. In postgraduate training and in continuing medical education more joint activity should be developed around 'medicine for non-medical managers' and 'management for doctors'. Much of this shared learning and development will be local and problem-based around local issues of quality, resources and priorities. However, the 'regional' postgraduate dean will play an increasingly pivotal role in maintaining the balance between the needs of the individual and the organization. To achieve this objective of closer integration postgraduate medical education funding should be brought together under a national finance levy against purchasers and allocated through devolved budgets managed by 'regional' postgraduate deans against explicit performance criteria agreed between the professional organizations, universities and health services management.     

Identifying management competencies for health care executives: review of a series of Delphi studies

This analysis reviews a selected body of research that identifies the essential areas of management expertise required of future health care executives. To ensure consistency, six studies are analyzed, utilizing the Delphi technique, to query a broad spectrum of experts in different fields and sites of health care management. The analysis identifies a number of management competencies, i.e., managerial capabilities, which current and aspiring health care executives, in various settings and with differing educational backgrounds, should possess to enhance the probability of their success in current and future positions of responsibility. In addition, this review identifies the skills (technical expertise), knowledge (facts and principles) and abilities (physical, mental or legal power) required to support achievement of these competencies. Leadership and resource management, including cost and finance dimensions, are the highest-rated requisite management competencies. The dominant skills, knowledge and abilities (SKAs) are related to interpersonal skills. The lowest-rated SKAs are related to job-specific, technical skills. Recommendations include the review of this research by formal and continuing education programs to determine the content of their courses and areas for future research. Similarly, current health care executives should assess this research to assist in identifying competency gaps. Lastly, this analysis recommends that the Delphi technique, as a valid and replicable methodology, be applied toward the study of non-executive health care managers, e.g., students, clinicians, mid-level managers and integrated systems administrators, to determine their requisite management competencies and SKAs.     

Basic estimate of needs for training in evidence-based medicine in Slovakia

This study reports the findings of the first survey of the knowledge and needs for training in evidence based medicine (EBM) of health-care workers in Slovakia. This study was primarily qualitative and based on a triangular approach, which included: analysis of the situation in pre- and postgraduate education in Slovakia aimed at estimating needs in EBM and critical appraisal skills (CAS) training; analysis of questionnaires distributed in a sample of medical doctors and university educated public health workers undergoing postgraduate training; and focus group discussions. The findings revealed a real gap in knowledge in EBM and CAS in Slovakia and identified several areas as the focus for intervention. The results showed also some important behavioural and cultural aspects, including low individual responsibility for education; tendency to delegate responsibility to authorities (experts, top management, Ministry of Health); and persistence of the state paternalistic type of education. Concludes that managers planning to implement EBM in Slovakia should therefore consider a broader behavioural and cultural context for change, not just introduction of a training EBM module.     

Senior health managers in the new era: changing roles and competencies in the 1990s and early 21st century

Healthcare reforms and restructuring have been a global phenomenon since the early 1980s, driven by a number of factors such as increasing health expenditure and changing health needs, advancement of medical and information technology, and adoption of the new model of public health. More significant changes worldwide are the development of a new public management paradigm in the public sector. These changes were marked by the adoption of private sector management models and practices. It is widely believed that the healthcare reforms, the process of the reforms, and the instability brought about by the reforms may have not only resulted in the change of senior healthcare management practices, but also in the change of skills and competencies required for senior healthcare managers. In fact, a number of international, national, and local studies have examined the roles, skills, competencies and educational needs of health service managers since the 1980s. There are differences in findings from these studies in the 1980s, and 1990s, and early 2000s. This paper explores the above differences and their implications for further research and education development. The findings not only lead to the development of a number of questions for future research, but also indicate a new direction for healthcare managers in assisting them to acquire new skills and competencies in meeting the challenges in the new era.     

Problem-based learning versus lecture-based learning in postgraduate medical education

OBJECTIVES: The objective of this study was to investigate the effectiveness of problem-based learning in comparison with lecture-based learning in a postgraduate medical training program concerning the management of mental health problems for occupational health physicians. METHODS: A randomized controlled trial in 1999, with a mean follow-up of 14 months after the educational intervention, was used involving postgraduate medical education and training for occupational health physicians in The Netherlands, with 118 physicians in training as occupational health physicians. The experimental program was based on the principles of problem-based learning; the control program used the traditional lecture-based approach. Both programs were aimed at improving knowledge of and performance in the occupational management of work-related mental health problems. As the main outcome measures, knowledge tests consisting of true-or-false and open-answer questions and performance in practice based on self-reports and performance indicators were used. Satisfaction with the course was rated by the participants. RESULTS: In both groups, knowledge had increased equally directly after the programs and decreased equally after the follow-up. The gain in knowledge remained positive. The performance indicator scores also increased in both groups, but significantly more so in the problem-based group. The problem-based group was less satisfied with the course. CONCLUSIONS: Both forms of postgraduate medical training are effective. In spite of less favorable evaluations, the problem-based program appeared to be more effective than the lecture-based program in improving performance. Both programs, however, were equally effective in improving knowledge levels.     

Evidenced-based health management involving three hospitals in central and eastern Europe

Major health care reforms have been instituted in Georgia (Caucasus Region). Evidenced-based management focuses on developing the necessary and sufficient competencies for senior and middle managers in an applied hospital setting. Application and integration of knowledge, skills and abilities (KSAs) is demonstrated through achievement of pre-established outcomes. An innovative health management education (HME) model utilizes a combination of in-service education, workshops, short-courses, residencies, and on-the-job training. A trilateral hospital management team is used involving the Slovak Republic, USA and Georgia. Development and implementation of the model at Gudushauri National Medical Center in Tbilisi, Georgia is presented along with examining curriculum content, teaching methods, processes, and outcome indicators.     

Competencies for public health finance: an initial assessment and recommendations.

The purpose of the study in this article was to identify The needs of public health managers with regard to public health finance. A survey of public health practitioners regarding competencies was conducted and a review of course offerings in finance among schools of public health was performed. Most public health practitioners surveyed believe that a broad array of management competencies are required to administer the finances of a public health facility or department. Respondents added 35 competencies to those initially given to them for review. Most added competencies that were more specific than the original competencies or could be viewed as subpoints of the original competencies. Many schools offered no courses specifically addressing public health care finance, with a few offering at most only one public health finance course. All schools offered at least one corporate finance course, and the majority offered two or more courses. We conclude with a number of recommendations for education and competency development, suggesting several next steps that can advance the field of public health's understanding of what managers need to master in public health finance to effectively function as public health managers.     

Assessment of time management attitudes among health managers

These days, working people are finding it difficult to manage their time, get more done at work, and find some balance in their work and personal lives. Successful time management is often suggested to be a product of organizing skills, however, what works for one person may not work for others. Context current competence assessment formats for physicians, health professionals, and managers during their training years reliably test core knowledge and basic skills. However, they may underemphasize some important domains of professional medical practice. Thus, in addition to assessments of basic skills, new formats that assess clinical reasoning, expert judgment, management of ambiguity, professionalism, time management, learning strategies, and teamwork to promise a multidimensional assessment while maintaining adequate reliability and validity in classic health education and health care institutional settings are needed to be worked on. It should be kept in mind that institutional support, reflection, and mentoring must accompany the development of assessment programs. This study was designed to describe the main factors that consume time, effective hours of work, time management opportunities, and attitudes and behaviors of health professionals and managers on time management concept through assessment by the assessment tool Time Management Inquiry Form (TMIQ-F). The study was conducted at the State Hospital, Social Security Hospital, and University Hospital at Kirikkale, Turkey between October 1999 and January 2000, including 143 subjects defined as medical managers and medical specialists. According to the results, a manager should give priority to the concept of planning, which may be counted among the efficient time management techniques, and educate him/herself on time management.     

The hidden competencies of healthcare: why self-esteem, accountability, and professionalism may affect hospital customer satisfaction scores

Data from 103 for-profit, nonprofit, and government-owned hospitals, spread across about half of the United States clearly show that there are common elements and several core competencies in all hospitals, some probably driven by JCAHO accreditation standards, but others coming from universal experience stemming from the changes in healthcare. The common competencies that are not, in my opinion, driven directly by the JCAHO standards include professionalism, accountability, self-esteem, customer service/focus, communication, information management/using data in decision making, and teamwork. There are several possible connections among the core competencies that suggest that the effects of accountability and possibly self-esteem on such outcomes as patient satisfaction and quality of care should be the subject of more research in healthcare settings. There are, however, several possible interventions to increase the core competency base of any hospital, which can be applied without this research. Executives and managers who attempt to measure and change these common competencies through selection, assessment, organizational system change, or reward and compensation systems will change the competence base of their workforce in critical areas needed in the future healthcare economy. Using a competence model incorporating these competencies may change the culture of the organization toward that which will be needed for survival in the twenty-first century.     

Health care management competencies: Identifying the GAPs

This study examines issues around health care management competencies, as perceived by senior managers. A combination of questionnaire survey, focus group and in-depth interview methods was used to ascertain views on the importance of various competencies, current competency levels and thus the deficiencies or “GAPs.” GAPs are greatest at the frontlines, where managers are generally appointed from clinical roles. However, there are significant GAPs at all levels of management.     

Generic Versus Specific Competencies of Entry-Level Public Health Graduates: Employers’ Perceptions in Poland,the UK,and the Netherlands

Constant changes in society and the public health domain force public health professionals into new roles and the development of new competencies. Public health professionals will need to be trained to respond to this challenge. The aim of this comparative study among Poland, the UK and the Netherlands is to identify competence needs for Master of Public Health graduates entering the labour market from a European perspective. A self-administered questionnaire was sent to employers in the three countries, rating the importance of competency in public health on a master’s level. In all three countries, interpersonal competencies, like team working and communication skills, are rated as highly important. However, employers in the UK and Poland generally rate public health specific competencies as much more important than their Dutch colleagues. It is concluded that while public health specific knowledge is providing a useful starting point for entry-level public health professionals, employers increasingly recognise the value of generic competencies such as communication and team working skills. The results suggest a stronger emphasis on teaching methods that encourage active learning and the integration of skills, which is crucial for enhancing graduates’ employability, and foster an open attitude to multidisciplinary working, which is essential in modern health care.     

某市职业卫生管理人员职业病防治知-信-行相关性分析

目的 了解职业卫生管理人员职业病防治知识、态度和行为得分情况以及三者之间的相关性, 探讨职业健康教育对职业病防治工作的重要性。
方法 采用整群抽样的方法选取某市某区882名职业卫生管理人员进行线上调查, 对数据进行统计学分析。
结果 文化程度不同的管理人员在知识、态度、行为以及总分4个方面的得分差异均有统计学意义(P < 0.05), 且文化程度越高, 其得分也越高。不同年龄、性别、工龄、月收入的管理人员仅表现出部分得分的差异有统计学意义(P < 0.05), 在有差异的项目中, 均以年龄小者、男性、月收入低者、工龄短者较低。PPE选择正确组的职业卫生知识得分高于选择错误组(P < 0.01)。职业卫生管理人员的知识、态度和行为三者得分间均有弱的正相关关系(r_s=0.14~0.25, P < 0.01)。被调查的管理人员中喜欢以听专家讲座的形式来获得职业卫生知识的最多, 达54.88%。
结论 性别、年龄、月收入、工龄, 尤其是文化程度, 对管理人员的知-信-行得分均有一定的影响。职业卫生管理人员足够的职业病防治知识基础、积极的态度和恰当的行为之间存在一定的相互关系。