Workforce Taxonomy
Room: Bluegrass Room I & II
Wednesday, April 22, 2015, 9:00 to 10:30 AM
Moderator: Michael Meit, MPH, MA, BS
Angela J. Beck, PhD, MPH
A Taxonomy to Standardize Collection of Public Health Workforce Data
Co-Investigator(s): Matthew L. Boulton, MD, MPH
Background: Characterization of the public health workforce is an important part of a larger effort to assess the U.S. health workforce overall. Developing an accurate assessment of the number and type of workers, their training, certification or educational background, and work setting is essential for public health officials in adapting to the changes demanded by the transformation of our nation’s health system while also ensuring policies are in place for maintaining and strengthening health care delivery. Public health workforce researchers have lacked both a standardized workforce terminology and a widely accepted methodology for organizing worker characteristics. The University of Michigan Center of Excellence in Public Health Workforce Studies (UM CEPHS), supported by CDC and HRSA, convened content experts to serve on its Public Health Enumeration Working Group (the Working Group) to develop a public health workforce taxonomy. A taxonomy is a framework that classifies concepts within hierarchical categories to organize it in meaningful ways. A summary of this project was presented at the Keeneland Conference early in its development; the consensus taxonomy was published in November 2014.This presentation describes the taxonomy and discusses the process for refining and developing future iterations. Research Objective: To develop a public health workforce taxonomy. Data Sets and Sources: Several data sources informed development of the taxonomy including: profile surveys conducted by the Association of State and Territorial Health Officials and National Association of County and City Health Officials; workforce studies epidemiologists, laboratory workers, public health nurses; and national employment data from the U.S. Office of Personnel Management and Bureau of Labor Statistics. In addition, examples of taxonomic frameworks utilized in medicine and health information were reviewed. Study Design: UM CEPHS convened regular meetings of the Working Group to develop and refine the taxonomy axes. The Working Group spent approximately 18 months developing the public health workforce taxonomy in an iterative, consensus process. Analysis: When possible, the taxonomic axes and the categories or subcategories therein were tested using existing workforce data. Principal Findings: Twelve taxonomy axes were developed: occupational category, workplace setting, employer, education, licensure, certification, job tasks, program area, public health specialization area or expertise, funding source, condition of employment, and demographics. Within each axis, multiple categories more precisely define the characteristics for the worker. Conclusions: The taxonomy presents a standardized framework for classifying public health workers. It is intended to be flexible in terms of how the axes are used to meet the needs and intent of the researcher or organization using the tool. Implications for Public Health Practice and Policy: The taxonomy has the potential to bring greater standardization and precision to characterizing public health workers as a necessary step for continuously monitoring the size and composition of the workforce to ensure sufficient capacity to deliver the essential public health services. The taxonomy will continue to evolve as organizations implement it into surveys and recommend ways to modify and improve this tool for more accurate workforce data collection.
Michael Meit, MPH, MA, BS
Analysis of Data Methods and Taxonomies Used to Assess the Public Health Workforce in the U.S.
Co-Investigator(s): Jessica O'Hara, MPP, BA
Background: The University of Michigan Center of Excellence in Public Health Workforce led the creation of the Public Health Workforce Taxonomy for Enumeration, with input from state and local health departments and support from the Centers for Disease Control and Prevention (CDC). The taxonomy consists of 12 axes, each focusing on a different category for describing public health workers. To examine the utility of this taxonomy, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with NORC at the University of Chicago to conduct the study, “Analysis of Data Methods and Taxonomies Used to Assess the Public Health Workforce in the U.S.” Research Objective: The purpose of the study was to vet the taxonomy in terms of its comprehensiveness, applicability, practicality, and potential as a tool for enumerating the workforce. Data sets and Sources: Qualitative data were collected during three focus groups -- two with HR and Workforce Development Directors from state health departments, and a third with representatives from Association of State and Territorial Health Officials (ASTHO) affiliated organizations. One HR and Workforce Development Director focus groups discussed the Occupational Category axis of the taxonomy, while the other discussed the Program Area axis. The ASTHO affiliates focus group provided feedback on the taxonomy more broadly, including specific feedback for each of the 12 axes. Study Design: Methods include an environmental scan of current and past public health enumeration efforts and qualitative data collection through focus groups. Analysis: The research team conducted qualitative content analysis and coding to identify themes and findings by key topics. Qualitative findings were summarized into a final report. Principal Findings: Findings show that overall the taxonomy accurately describes the public health workforce; however, many participants provided specific feedback and recommendations in terms of missing categories under each axis. Further, both HR Directors and affiliate representatives were open to incorporating the taxonomy into their current data systems to provide harmonization across data sources, but identified that modifications were needed for adoption to be feasible. For example, participants indicated that many staff would be difficult to categorize because workers fit into multiple categories for several axes due to overlapping job responsibilities. Respondents agreed that guidance (e.g., crosswalks or definitions) would be helpful and necessary to ensure consistency across health departments and organizations. Conclusions: This study has shown the potential of the taxonomy for harmonizing data collection efforts and for enumerating and describing the public health workforce. Feedback indicated that the 12 axes can be used to thoroughly describe public health workers, and may provide important data to help enumerate the workforce. With some modifications and supplemental materials, the taxonomy could be an effective reference for future data collection, promoting consistency across the field. Implications for Public Health Policy and Practice: The findings from this study can inform future updates to the taxonomy and provide insight into how the taxonomy can be adopted by public health organizations and researchers to ensure consistent and comparable data to describe and enumerate the public health workforce.
Katie Sellers, DrPH
Refining the Workforce Taxonomy: How 22,000 Public Health Employees Responded to the First Use of the Taxonomy
Co-Investigator(s): Angela Beck, PhD, MPH
Background: The University of Michigan Center of Excellence in Public Health Workforce led the creation of the Public Health Workforce Taxonomy for Enumeration, with input from state and local health departments and support from the Centers for Disease Control and Prevention (CDC). The taxonomy consists of 12 axes, each focusing on a different category for describing public health workers. The first use of the taxonomy in workforce research was the Public Health Workforce Interests and Needs Survey (PH WINS), which included eight of the 12 axes. Research Objective: The goal of this research was to describe the governmental public health workforce at the state and local level in terms of multiple demographic and job-oriented characteristics, and to test the use of the taxonomy in a major workforce study. Data Sets and Sources: PH WINS is the first, nationally representative survey of governmental public health workers at the state level. With over 22,000 responses from state and local public health workers, this dataset contains rich information on a variety of characteristics of the workforce. Incorporation of the eight axes into the survey questionnaire resulted in 13 multiple-choice questions. Five of these questions included an “other” response option, with an opportunity to specify the correct answer. Study Design: PH WINS was administered as a cross-sectional, online survey in September-December 2014. The survey was emailed to either a sample or a census of state health agency employees in 37 participating states, depending on the state’s preference. Local health department employees were also surveyed in 14 participating large city health departments and in local health departments throughout 7 states that participated in a pilot test of PH WINS at the local level. Weights were applied to the dataset to account for the complex sampling design. Analysis: Data analysis for this study consists of descriptive statistics (frequencies, cross-tabs, means and medians) to describe the characteristics of the workforce, as well as qualitative analysis of the comments entered into the survey by respondents. Content analysis will be used to analyze the qualitative data and to assess how well the taxonomy-derived questions performed. Principal Findings: The principal findings will include information on all eight taxonomy axes included in the questionnaire: demographics (gender, race/ethnicity, age), occupational classification, setting, employer, education, licensure, certification, and program area. This will provide a detailed characterization of the workforce, as well as a number of recommendations for how to refine the taxonomy (such as adding another occupational classification, revising the wording of a program area covered in the taxonomy, etc.). Conclusions: This study demonstrates the utility of the workforce taxonomy and contributes to its development as a comprehensive and effective tool for harmonized data collection by workforce researchers. Implications: The field of PHSSR has always lacked a mechanism for standardizing the collection of data on the public health workforce. This study confirms the feasibility of a new tool to accomplish this much-needed standardization.
Janna M. Wisniewski, MHA
Employee Perspectives on Working in Public Health Agencies: A Qualitative Analysis
Co-Investigator(s): Valerie A. Yeager, DrPH
Background: A satisfied, well-trained health workforce is critical for the protection of the nation’s health. It is therefore important to understand not only the factors that attract professionals to work in public health, but also to assess employee opinions about working in the public health setting and issues related to retention. Research Objective: This qualitative study examines the opinions of public health workers in regard to recruitment, workplace experiences, and retention. Data Sets and Sources: We used data from the Council on Linkages between Academia and Public Health Practice 2010 Survey of Public Health Workers, the largest survey of public health employees to date. Public health employees represented all 50 states with a total of 11,640 respondents. This study specifically examines qualitative responses to an open-ended survey question for which there were approximately 2,400 responses. Study Design: Cohort study using secondary data analysis Analysis: Using grounded theory, open-ended responses of public health employees were coded according to their main themes. Primary and secondary themes were recorded along with the general disposition of the primary theme within the opinion (neutral, negative, or positive). Inter rater reliability was tested and recorded. Findings: Preliminary findings suggest that responses encompass seven main themes with a variety of subthemes. The main themes include salary, benefits, funding, mission and culture change, policy environment, training needs, and workload. Subthemes include educational benefits, salary discrepancies, leadership and management issues, and private versus public working environments. Themes will be mapped and presented along with poignant quotes that exemplify the theme or subtheme. Conclusions and Implications for Practice and Policy: In general, preliminary findings suggest that respondents are concerned with seven main issues or themes within the public health work environment. This study represents the largest qualitative study of public health employee opinions to date. These findings will be of interest to policy makers and public health leaders making decisions that impact the workforce.