#  Ensuring a Competent Workforce and Sustaining Program Improvements in Environmental Health

# 2006 - 2007 

#  Environmental Public Health Leadership Institute Fellow(s):

#  Jennifer L. Pinnow, REHS/RS

*Assistant Environmental Health Director,*

*Yellowstone City-County Health Department*

*P.O. Box 35035, Billings, Montana, 59107*

*(406) 256-2770, jenniferp@ycchd.org*

# Mentor(s):

### **Sarah B. Kotchian, EdM, MPH, PhD**

*Research Assistant Professor;* Department of Family and Community
Medicine,

University of New Mexico School of Medicine; Associate Director for
Planning, Institute for Public Health

# (Acknowledgements):

### **John Felton**

*Chief Operating Officer;* Yellowstone City-County Health Department

### **Doug Moore, MD**

*Chief of Public Health Services;* Yellowstone City-County Health
Department

### **Ted Kylander, REHS/RS**

*Environmental Health Director;* Yellowstone City-County Health
Department

> ![](media/image1.jpeg){width="1.3756944444444446in"
> height="0.6368055555555555in"}

# EXECUTIVE SUMMARY:

If an environmental health program lacks competent staff or the capacity
to provide essential environmental health services, the community
doesn't have adequate protection from environmental health risks. In an
effort to ensure a competent workforce and sustain program improvements,
the agency undertook an initiative to create workforce development plans
and individual professional development plans. A system was developed to
annually assess employee competency. In addition, a reporting format was
developed for routinely documenting and reviewing the integration of the
Ten Essential Environmental Health Services in an attempt to build
program capacity. Establishing a system to routinely assess staff
competencies and program improvements through integration of the Ten
Essential Environmental Health Services and the Core Competencies for
Environmental Public Health Professionals is essential in ensuring a
competent workforce and sustaining program improvements.

# 

# INTRODUCTION/BACKGROUND:

On November 5, 2002, Yellowstone County voters passed a 4.75 mill
increase for public health activities. The Yellowstone City-County
Health Department was the first health department in the State of
Montana to pursue a voter approved mill levy. To assure appropriate
utilization of the local tax dollars the goal was to improve access to
and availability of health department services. In an effort to
accomplish this goal, additional staff were needed with a specific
knowledge of and focus on public health.

Since May 2003, the Yellowstone City-County Health Department's
Environmental Health (EH) Program has grown from 4.0 FTE Registered
Sanitarians and .5 FTE support staff to 8.0 registered Sanitarians, 1.0
FTE Environmental Specialist and 1.5 FTE support staff.

During this same time period, the EH budget increased from \$221,500 in
fiscal year 2002-03 to nearly \$800,000 in fiscal year 2005-2006. Prior
to the increases in the staff and funding, the number of activities
required of EH staff had grown to a level where minimum standards were
being met, but the quality of service and ability to take a proactive
approach to local environmental health concerns were beginning to
suffer.

Adding staff positions was essential to meeting the goals of improving
access and availability, but with the addition of staff came the
challenge of ensuring a competent workforce and demonstrating
sustainable program improvement. The organization did not anticipate the
additional struggles related to training, continuing education,
assessing competency and measuring improvement that emerged once the
positions had been filled.

####### ***Problem Statement:***

Without a competent staff or the capacity to provide essential
environmental health services, a community doesn't have adequate
protection from environmental health risks.

####### ***Behavior Over Time Graph:***

![](media/image2.wmf)

####### ***As the number of registered sanitarians in the program increased, so did the community expectation to provide quality service. However, without a system to measure staff competency and integrate training into practice, program improvements were not sustained.*** 

####### ***Causal Loop Diagrams and applicable archetype:***

![](media/image3.wmf)

####### 

Traditionally employee development problems were solved by sending
employees to training classes (B1) rather than developing and
implementing an overall EH workforce development plan (B2). Over time,
staff thought that attendance at trainings equaled increased knowledge
and competency which reduced their commitment to participating in an
ongoing workforce development program, and also increased program
dependence on training attendance as a way to increase employee
competency (R1).

####### ***10 Essential Environmental Health Services:***

The primary focus of this project was assuring a competent workforce; in
addition emphasis was placed on program assessment & development based
on the overall integration of all of the Ten Essential Environmental
Health Services.

![](media/image4.png){width="3.75in" height="3.8125in"}

####### 

####### ***National Goals Supported*** 

[National Strategy to Revitalize Environmental Public Health
Services]{.underline}

**Goal I (Build Capacity)** intends to improve and support environmental
public health services. This project supports the integration of the Ten
Essential Environmental Health Services as a means to build capacity in
a local environmental health program.

**Goal V (Develop the Workforce)** promotes the development of a
competent and effective environmental public health workforce including
defining performance standards and competencies. The goals of this
project directly support the assessment of workforce competency and
improving the environmental health professional's ability to perform the
recommended core competencies.

[Environmental Health Competency Project: Recommendation for Core
Competencies for Local Environmental Health Practitioners]{.underline}

The competency assessment used in this project is based on each
employee's ability to perform the 14 recommended Core Competencies for
Local Environmental Health Practitioners. This allows agencies to
identify overall development opportunities for their environmental
health workforce and allows individuals to customize personal
development plans based on their need to improve their ability to
perform these competencies.

####### ![](media/image5.wmf)

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

####### ***Program Goal***

Ensure a competent workforce and sustain program improvements in
environmental health

####### ***Health Problem***

If an environmental health program doesn't have competent staff or the
capacity to provide essential environmental health services, the
community doesn't have adequate protection from environmental health
risks.

####### ***Outcome Objective***

Create workforce development plans and individual professional
development plans for environmental health staff and align these with
program needs and goals through integration of the Ten Essential
Environmental Health Services and the Core Competencies for
Environmental Public Health Professionals.

####### ***Determinant***

The number of employees that demonstrate an increase in their ability to
perform the Core Competencies for Environmental Public Health
Professionals and integrate the Ten Essential Environmental Health
Services into their daily work.

####### ***Impact Objective***

By January 1, 2008 establish a system to routinely assess staff
competencies and program improvements through integration of the Ten
Essential Environmental Health Services and the Core Competencies for
Environmental Public Health Professionals. By January 1, 2008 establish
a standardized training program for newly hired environmental health
professionals.

####### ***Contributing Factors***

There has been no standardized procedure for defining training needs
according to agency goals, for training new staff, or a systematic
approach to providing continuing education. In addition the agency did
not routinely assess staff competency, as performance evaluations are
not aligned with the Core Competencies for Environmental Public Health
Professionals. There is limited opportunity to formally share new
materials amongst staff and ensure that this material is incorporated
into program activities.

Although the current budget supports staff training and educational
opportunities there is currently no systematic approach to assessing
staff competencies, or seeking opportunities to improve these
competencies.

By developing a systematic approach to determining who attends what
training sessions, an agency can better develop their workforce, share
the information learned, and get the most out of their education budget.
These issues can be addressed through the use of an ongoing workforce
development plan which aligns the goals of the agency with the
individual development needs of employees. This reduces the perception
of favoritism that can occur when there is no systematic way of
selecting training attendees. This type of plan provides a consistent
understanding of how and why employees are selected to attend trainings.
Helping employees manage their careers, builds loyalty and trust; makes
for more efficient workers; and can help manage conflict, reduce stress,
and improve staff attitudes^1^.

####### ***Process Objectives***

1\. By December 31, 2006 100% of Environmental Health staff shall
demonstrate the ability to integrate the Ten Essential Environmental
Health Services into their areas of responsibility.

2\. By July 1, 2007 75% of environmental health staff shall participate
in workforce development through improving core competencies.

3\. By July 1, 2007 a systematic approach will be used for all training
and continuing education activities.

4\. By December 31, 2007 workforce development plans will be developed
for 75% of environmental health staff.

# METHODOLOGY:

**Activities:**

**1. Integration of Ten Essential Environmental Health Services**

-   Conduct an assessment of employee's current knowledge of the Ten
    Essential Environmental Health Services

-   Educate staff on the Ten Essential Environmental Health Services

-   Conduct a post-assessment of employee's knowledge of the Ten
    Essential Environmental Health Services

-   Develop a system to routinely review how the Ten Essential
    Environmental Health Services are being integrated into
    environmental health programs

**2. Core Competency Assessment & Development**

-   Educate staff on Core Competencies for Environmental Public Health
    Professionals

-   Establish a routine method of assessing staff abilities to perform
    the Core Competencies for Environmental Public Health Professionals
    (self-report & supervisor review)

-   Conduct a gap analysis for each EH professional to identify which
    trainings are highest priority for each sanitarian

-   Help employees formulate an individual development plan to improve
    core competencies

-   Develop a system to follow-up with employees, including management
    oversight

# RESULTS:

**1. Integration of Ten Essential Environmental Health Services**

The Knowledge and Practice Questionnaire and Pre/Post Test of Training
provided in the *Essential Services of Environmental Health: A Training
Module Developed by Carl Osaki, RS, MSPH^2^* were used to evaluate each
employee's current knowledge of the Ten Essential Environmental Health
Services. This Training Module was then used to provide education on the
Ten Essential Environmental Health Services. Average test scores
increased from 68.3% to 84.9% from the pre-test to the post-test
indicating an increase in knowledge gained from the training. Monthly
reporting documents were developed to assist staff in tracking their
program activities in terms of the Ten Essential Environmental Health
Services. All staff members are responsible for the completion of these
documents. Two individual Environmental Health staff have been assigned
the responsibility of summarizing these activities by program, and will
be involved in the assessment, gap analysis, and development of action
plans to further integrate the Ten Essential Environmental Services into
the programs for which they have oversight.

**Next Step:** Quarterly assessments of these monthly activity reports
will be used to identify gaps and develop action plans to further
integrate the Ten Essential Environmental Services into each program
area.

**2. Core Competency Assessment & Development**

Employees were presented with the Recommendations for Core Competencies
for Local Environmental Health Professionals^3^. A questionnaire was
designed as an objective, non-performance based assessment of each
individual's ability to perform the non-technical core competencies for
Environmental Health professionals. Self assessments were conducted by
each of the staff members, and the EH Director completed an assessment
of each person as well. Each person was asked to indicate the level of
one's ability to perform each competency in terms of no ability, some
ability, significant or complete ability.

The results of the individual assessments were averaged to identify
development needs of the environmental health staff as a group. In
addition, each employee was able to identify their individual
competencies that need further development.

An annual staff development calendar was created to address the
competency areas identified as needing the most improvement. Each staff
member also selected an individual core competency and created an
individual development plan outlining activities that will assist them
with the goal of improving their ability to perform this competency over
the next year.

**Next Step:** The self-assessment and supervisor assessments will be
used annually to identify program and individual development needs. An
annual staff development plan and individual development plans will be
created annually as a means to continuously improve employee ability to
perform the Core Competencies for Local Environmental Health
Professionals. Comparisons will be made with the previous year's
assessment to monitor improvement in these areas.

**FUTURE ACTIVITIES:**

**3. Staff Training & Continuing Education**

-   Develop programmatic goals and conduct a gap analysis to identify
    which training is highest priority for the organization

-   Develop a standardized training model for new hires.

-   Align continuing education opportunities with programmatic goals and
    develop systems to measure program improvement

-   Involve staff in designing a system to support ongoing continuing
    education

-   Integrate new learning into procedures and activities

-   Ensure new learning is shared with other staff

**4. Workforce Development Plans**

-   Routinely assess agency vision, employee professional and personal
    goals, and provide feedback on skills and abilities

-   Help employees formulate individual development plans

-   Select training and other opportunities that match
    job/organizational needs and employee career development objectives

-   Follow-up with employees after a learning experience to integrate
    new skills and acquired knowledge into their responsibilities

-   Implement a system to share new knowledge with the rest of the staff

# CONCLUSIONS:

Establishing a system to routinely assess staff competencies and program
improvements through integration of the Ten Essential Environmental
Health Services and the Core Competencies for Environmental Public
Health Professionals is essential in ensuring a competent workforce and
sustaining program improvements. Such a system assists employees in
managing their careers, provides a platform to measure employee growth
in non-technical competencies, and establishes a workforce development
program that offers on-going program improvement. This type of system
requires cooperation and commitment from all staff involved. Thoroughly
educating staff in the areas of the Core Competencies and Ten Essential
Environmental Health Services is important in establishing a strong
framework upon which to build future improvement plans.

# 

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Jennifer L. Pinnow***

Participation in the Institute provided a platform to develop ideas and
provided credibility and support for these initiatives. By encouraging
me to engage an executive sponsor to provide feedback for my project,
the Institute presented me with the opportunity to network with our
department's upper adminsitration. This increased my confidence in
presenting new ideas and solutions to long-standing problems.

The time we spent in self-reflection was very enlightening. The
self-assesment tools and use of a personal coach provided by the
Institute not only gave me the opportunity to understand myself better,
but additionally provided examples and suggestions for implementing
long-term change. Not only did I learn from the curriculum, self-study,
instructors, my wonderful mentor and supportive team, but also from
other fellows, and ultimately myself.

Special thanks to the Yellowstone City-County Health Department, it's
administration and my program director for not only nominating me for
the Insitute, but also for giving me the time and support needed to get
the most out of this wonderful experience. I will continue to use the
systems thinking methods and problem solving abilities I've gained from
the Institute to research, develop, and implement innovative solutions
to environmental health problems. I'd also like to thank the many
agencies involved in supporting and administering the Institute for
their commitment to education and developing future leaders in
environmental public health.

# 

# ABOUT THE EPHLI FELLOW(s)

Jennifer Pinnow has been a Registered Sanitarian with the Yellowstone
City-County Health Department since 1992 and holds a Registered
Environmental Health Specialist credential from the National
Environmental Health Association. She has served as Assistant
Environmental Health Director since 2000. Ms. Pinnow is a certified
instructor with the National Restaurant Association's Educational
Foundation ServSafe Program, a National Environmental Health Association
Certified Food Safety Professional, and a Certified Pool Operator. Her
current duties include workforce and program development, coordinating
industry and staff trainings in the areas food service and children's
environmental health, and general oversight of the food service program.

She was responsible for the 2003 Yellowstone County Environmental Health
Needs Assessment, and the subsequent formation of the Yellowstone County
Food Safety Advisory Group which solicits broad spectrum input as to
specific local concerns as they related to food safety in Yellowstone
County.  

Ms. Pinnow was recently awarded the 2006 William G. Walter Outstanding
Sanitarian Award from the Montana Environmental Health Association.

# REFERENCES

1.  Campbell, Mark. Society of Professional Consultants. "Ten Keys for
    Successfully Coaching Employees". \[Online\] Available at
    <http://www.spconsultants.org/articles/mcampbell.htm>

2.  University of Washington. Northwest Center for Public Health
    Practice, School of Public Health & Community Medicine. Essential
    Services of Environmental Health, A Training Module Developed by
    Carl Osaki, R.S., MSPH. \[Online\] Available at
    [http://www.nwcphp.org](http://www.nwcphp.org/)

3.  CDC. Environmental Health Competency Project: Recommendations for
    Core Competencies for Local Environmental Health Practitioners.
    Atlanta (GA):Dept. of Health and Human Services (US), CDC; 2001

# ADDITIONAL RESOURCES

Atchison, Tom. Followership: Aligning Leaders and Followers, Chicago
(IL): Foundation of the American College of Healthcare Executives; 2004.

CDC. A National Strategy to Revitalize Environmental Public Health
Services. Atlanta (GA): Dept. of Health and Human Services (US) CDC;
2003. \[Online\] Available at
<http://www.cdc.gov/nceh/ehs/Docs/nationalstrategy2003.pdf>