Public Health Workforce Development Project

PUBLIC HEALTH WORKFORCE DEVELOPMENT PROJECT

FUTURE VIEW REPORT

May 2006

Prepared By:

Karen Holland Karen Holland & Associates

Head Strategic On behalf of The Public Health Directorate of the Ministry of Health 2 Disclaimer: This report contains information from a variety of sources and the author’s work experience. The author has analysed, distilled and used that information to give one view of the short, medium, and longer term actions required to progress development of the New Zealand public health workforce.

3 CONTENTS

PART ONE: CONTEXT………………………………………………………………………………………………..4 Introduction…………………………………………………………………………………………………………………4 Purpose……………………………………………………………………………………………………………………….5 Methodology…………………………………………………………………………………………...... 5

PART TWO: 10 PRIORITY PROJECTS…………………………………………………………...... 6 Project Timeline…………….……………….……………………………………………………………………………7 Priority Project A: Adopt New Zealand Public Health Core Competencies……………………………8 Priority Project B: Maori Health Workforce Development………………………………………………….9 Priority Project C: Pacific Health Workforce Development……………………………………………….10 Priority Project D: National Training and Qualifications Framework………………………………….11 Priority Project E: Public Health Leadership Development……………………………………………….12 Priority Project F.1: Develop Health Protection Officer as a Profession……………………………..13 Priority Project F.2: Develop Health Promotion as a Profession……………………………………….14 Priority Project F.3: Develop a Community Health Worker Career Pathway……………………….15 Priority Project G: Develop a Public Health Multidisciplinary Organisation…………………………16 Priority Project H: Build Public Health Capacity of the Primary Care Workforce………………….17 Priority Project I: Develop Public Health Workforce Planning Tools………………………………….18 Priority Project J: Encourage Public Health Organisations as Learning Organisations…………19

REFERENCES…………………………………………………………………………………………………………..20

4 PART ONE: CONTEXT INTRODUCTION The New Zealand Health Strategy released by the Minister of Health during December 2000, ‘sets the platform for the Government’s action on health’. The Strategy identifies workforce development as a key issue needing attention in order to ‘ensure that the performance of health services, and the health system as a whole, results in better health outcomes and a reduction in health disparities’.

The framework for public health action for the New Zealand Health Strategy, titled ‘Achieving Health for All People’ was released in 2003 by the Ministry of Health. Its first objective described as, ‘strengthen public health leadership at all levels and across all sectors’ identifies the need to focus on workforce development.

During 2003/04 the Ministry of Health Public Health Directorate commissioned the development of the Public Health Workforce Development Plan (PH WDP). The PH WDP has a 10 year outlook to encourage a strategic approach to the management of public health workforce development. It includes a three to five year plan to research, and develop strategies.

By March 2005 the PH WDP released its ‘Public Health Workforce Development Plan Draft Discussion Document’. It describes the structure for discussing public health workforce development using the systems approach described by Kennedy and Moore (2001). Kennedy and Moore’s three components model has been adapted to the New Zealand public health context, and renamed the ‘three dimensions model’, namely:

 The Work – defining public health work in terms of core functions and essential services.  The Worker – determining the range of competencies of the workforce.  The Work Setting – assessing the performance of public health agencies and organisations (Dawe 2004).

From the outset the PH WDP commissioned some core research and by mid 2005 had identified a number of components within each of the above ‘three dimensions’ that required attention. The challenge was how to map the way forward to meet the wide range of public health needs, and the broader context of Governments health workforce development strategy.

5 The PH WDP commissioned this ‘Future View Report’ to signpost key initiatives that could bring its 10 identified priority strategies to fruition over a three to five year timeframe in a logical and connected way.

The tables on the following pages map a separate big picture project plan for each of the 10 priority strategies. For each of the priority strategies (titled priority projects) the key components and influencers are stated, the key interdependencies between each of the 10 strategies identified, and a ballpark budget suggested.

PURPOSE OF THE REPORT The brief for this report was to map a strategic pathway for how to move from the current state per the identified 10 priority projects to the required state across a three to five year timeframe and beyond.

The brief was to map the information in a practical ‘how to’ high level project plan per the 10 priority projects and to identify the interdependencies between projects.

METHODOLOGY The brief was not to produce an academic report but rather to analyse and distil the evidence into a ‘strategic project plan.’

A wide range of literature, interview, and anecdotal evidence was gathered, analysed, distilled and combined with the authors learning from several year’s workforce development experience, to propose the way forward per Priority Project, refer to the following pages.

The author wishes to state that the attached reference list is incomplete. It lists some of the several ‘literature’ sources both current and from previous years that have informed this report. Similarly information and ideas gleaned from several years of interaction with persons at various levels throughout the health sector and other sectors are too numerous to recall or list in the reference list. The author presents this report as one view of the short, medium and longer term workforce development actions required to progress the work of New Zealand’s Public Health services.

6 PART TWO: 10 PRIORITY PROJECTS – HIGH LEVEL PROJECT PLAN FOR A WAY FORWARD

7 PROJECTS TIMELINE:

The Suggested Timelines And Intersecting Dependencies Of The Priority Actions Per The 10 Priority Projects 01.07.06 – 30.06.07 01.07.07 – 30.06.08 01.07.08 – 30.06.09 01.07.09 – 30.06.10 01.07.10 – 30.06.11 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 A.1 A.1 B.1 B.1 B.1 B.1 B.3 → B.2 B.2 B.2 B.2 B.4 → C.1 → C.3 → C.4 → D.1 → E.1 E.1 E.1 E.1 E.2 → F.1. F.1. F.1. F.1. F.1. F.1. F.1. F.1. F.1. F.1. 1 1 2 2 2 2 2 2 2 2 F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. F.2. 3 3 3 3 3 3 3 3 4 4 4 4 4 4 F.3. F.3. F.3. F.3. F.3. F.3. F.3. 1 1 1 1 2 2 2 G.1 G.1 G.1 G.1 H.1 H.1 H.1 H.1 H.2 → H.3 → I.1 → I.2 → J.1 →

Key: Q = quarter Alpha Numeric entries relate to priority actions described on pages 8 – 19 that follow

8 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT A: ADOPT NZ PUBLIC HEALTH CORE COMPETENCIES

Priority Project A: Adopt New Zealand Public Health Core Competencies - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action A.1: - NZ Public Health Core - Project underway so - Project already - It is proposed that it is essential for the NZ - These are critical to - It is suggested that the Public Health (PH) Core - Complete Competencies not costed in this underway and Public Health Core Competencies to be adopted inform the intent and Competencies should apply to anyone who development of NZ adopted. report. comments on 1st draft in order to provide a foundation on which the content of all future delivers any component of Public Health in New Public Health Core due back to Public following 9 Priority Actions can be progressed in Public Health Zealand (NZ). However to ensure appropriate Competencies. Health Association by a logical and integrated way. Workforce implementation it is recommended that 05.05.06. Development (WFD). leadership and implementation of the PH Core Competencies should be the responsibility of the Ministry of Health Public Health Directorate and delivery on same should be written into the contracts of all Public Health Providers.

Projected Effect From This Project: An explicit platform to benchmark and guide all future public health action and interaction inclusive of: strategic and operational direction and content, workforce development, and resource requirements

9 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT B: MAORI HEALTH WORKFORCE DEVELOPMENT

Priority Project B: Maori Health Workforce Development - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action B.1: - ‘Publish’ a generic set Estimated 200 hrs @ - Ministry of Health - Iwi, hapu and whanau differences may - Maori health status. - A number of ‘for Maori by Maori’ providers - Develop a generic set of Maori Cultural $150/hr = $30,000 Maori Health & Public influence the cultural competencies practiced by - Individual and report that there is expectation put on their of Maori Cultural Competencies for Plus mtg attendee Health Directorates different ‘for Maori by Maori’ providers. However organisations organisations from funders, service users, and Competencies for Public Health ‘for Maori expenses @ Ministry - Both above will need it is suggested that having a generic set of Maori workloads. other providers that because staff identify as Public Health ‘for Maori by Maori’ providers. rate to identify other key Cultural Competencies for Public Health ‘for Maori they will automatically be culturally by Maori’ providers to stakeholders for this Maori by Maori should provide a helpful starting competent. This places significant pressure on guide them in the priority action. place from which individual providers can amend individual Maori staff and collectively on the development of and tailor the generic set to be appropriate for organisation to develop, implement and support Cultural Competencies their service. staff to develop these skills. appropriate for their organisations.

Priority Action B.2: - ‘Publish’ a generic set Estimated 200 hrs @ - Ministry of Health - Iwi, hapu and whanau differences may - Maori health status. - A number of staff who identify as Maori and - Develop a generic set of $150/hr = $30,000 Maori Health & Public influence the cultural competencies practiced by - Individual and work for mainstream providers report the of Maori Cultural Maori Cultural Plus mtg attendee Health Directorates different mainstream providers in different organisations expectation that they will automatically be Competencies and a Competencies and a expenses @ Ministry - Both above will need locations. However it is suggested that having a workloads. culturally competent and that they will provide Cultural Audit tool for Cultural Audit tool for rate to identify other key generic set of Maori Cultural Competencies and cultural competence guidance and support for Mainstream Public mainstream Public stakeholders for this Cultural Audit tools for mainstream Public Health the organisation and their work colleagues. This Health providers. Health providers. priority action. services should provide a helpful starting place places significant pressure on individual Maori from which individual providers can amend and staff and collectively if there is a group of Maori tailor the generic set to be appropriate for their staff, plus knowingly or unknowingly non Maori service. staff may release themselves from practicing and enhancing their cultural competence.

Priority Action B.3: - Refer to Priority - Refer to projects - Refer to projects - Refer to projects listed in box two of this row - Refer to projects - As per the two boxes immediately above and in - Provide opportunities Projects: D, E, F.1, F.2, listed in box two of this listed in box two of this listed in box two of this addition Maori Health Professionals frequently for Maori health F.3, G, H, I, & J row row row have their workloads further increased due to professionals as demand for them to represent Maori on a range described by other of local, regional, and national committees. Priority Projects in this report

Priority Action B.4: Increased numbers of Refer to Projects F.3 & Refer to Projects F.3 & - Refer to Projects F.3 & Project D. - Refer to Projects F.3 - As per the above boxes. Increase the numbers Maori taking up second Project D. Project D. & Project D. of qualified and chance education experienced Maori opportunities to obtain ?? whether course fees health professionals: health professional or the like would be As per Priority Project qualifications. paid to assist F.3 encourage and Community Health support Maori Workers as so often Community Health their wages are critical Workers to qualify in for their family / that role and as per whanau basic survival Priority Project D encourage and support Maori to step onto the ‘National Training & Qualifications Framework.

10 Possible Future Maori Public Health Workforce: Increased numbers of qualified and experienced Maori Public Health professionals at all levels and influencing all parts of the health, education, social services, and other related sectors

11 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT C: PACIFIC HEALTH WORKFORCE DEVELOPMENT

Priority Project C: Pacific Health Workforce Development - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action C.1: - ‘Publish’ a generic set Estimated 200 hrs @ - Ministry of Health - The ethnic groups that comprise the Pacific - Pacific health status. - A number of ‘for Pacific by Pacific’ providers - Develop a generic set of Pacific Cultural $150/hr = $30,000 Pacific Health & Public community have different languages and culture - Individual and report that there is expectation put on their of Pacific Cultural Competencies for Plus mtg attendee Health Directorates. that will influence the cultural competencies organisations organisations from funders, service users, and Competencies for Public Health ‘for expenses @ Ministry - Both above will need practiced by different ‘for Pacific by Pacific’ workloads. other providers that because staff identify as Public Health ‘for Pacific by Pacific’ rate to identify other key providers. A further difference is the mix of Pacific they will automatically be culturally Pacific by Pacific’ providers. stakeholders for this Pacific Islands born and New Zealand born Pacific competent. This places significant pressure on providers to guide priority action. people. However it is suggested that having a individual Pacific staff and collectively on the them in the generic set of Pacific Cultural Competencies for organisation to develop, implement and support development of Public Health ‘for Pacific by Pacific’ should staff to develop these skills. Cultural Competencies provide a helpful starting place from which appropriate for their individual providers can amend and tailor the organisations. generic set to be appropriate for their service.

Priority Action C.2: - ‘Publish’ a generic set Estimated 200 hrs @ - Ministry of Health - As above the multiple ethnic groups that - Pacific health status. - A number of ‘for Pacific by Pacific’ providers - Develop a generic set of $150/hr = $30,000 Pacific Health & Public comprise the collective Pacific group, and the - Individual and report that there is expectation put on their of Pacific Cultural Pacific Cultural Plus mtg attendee Health Directorates. differences within ethnic groups, especially organisations organisations from funders, service users, and Competencies and a Competencies and a expenses @ Ministry - Both above will need between the needs of Pacific Islands born and workloads. other providers that because staff identify as Cultural Audit tool for Cultural Audit tool for rate to identify other key New Zealand Pacific born people presents a wide Pacific they will automatically be culturally Mainstream Public mainstream Public stakeholders for this range of expectations. However it is suggested competent. This places significant pressure on Health providers. Health providers. priority action. that having a generic set of Pacific Cultural individual Pacific staff and collectively if there is Competencies and Cultural Audit tools for a group of Pacific staff, plus knowingly or mainstream Public Health services should unknowingly non Pacific staff may release provide a helpful starting place from which themselves from practicing and enhancing their individual providers can amend and tailor the cultural competence. generic set to be appropriate for their service.

Priority Action C.3: - Refer to Priority - Refer to projects - Refer to projects - Refer to projects listed in box two of this row - Refer to projects - As per the two boxes immediately above and in - Provide opportunities Projects: D, E, F.1, F.2, listed in box two of this listed in box two of this listed in box two of this addition Pacific Health Professionals frequently for Pacific health F.3, G, H, I, & J row row row have their workloads further increased due to professionals as demand for them to represent Pacific on a range described by other of local, regional, and national health Priority Projects in this committees. Further within Pacific communities report. health professionals are highly respected and elected onto many committees / into leadership roles.

Priority Action C.4: - Increased numbers of - Refer to Projects F.3 - Refer to Projects F.3 - Refer to Projects F.3 & Project D. - Refer to Projects F.3 - As per the above boxes. - Increase the numbers Pacific taking up & Project D. & Project D. & Project D. of qualified and second chance experienced Pacific education ?? whether course fees health professionals: opportunities to obtain or the like would be As per Priority Project health professional paid to assist F.3 below encourage qualifications. Community Health and support Pacific Workers as so often Community Health their wages are critical Workers to qualify in for their families basic that role and as per survival Priority Project D encourage and support

12 Pacific to step onto the ‘National Training & Qualifications Framework.

Possible Future Pacific Public Health Workforce: Increased numbers of qualified and experienced Pacific Public Health professionals at all levels and influencing all parts of the health, education, social services, and other related sectors

13 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT D: NATIONAL TRAINING & QUALIFICATIONS FRAMEWORK

Priority Project D: National Training & Qualifications Framework – a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action D.1: - A feasibility study is Estimated 650 hrs - Chaired by Ministry of - It will be critical to learn from developments In place requirements - Once Priority Actions completed. @$150/hr = $97,500 Health already happening & planned across the Health will influence the scope E, F.1, F.2, F.3, & G are Plus mtg attendee - Professional & Education sectors within New Zealand and and direction of this completed (near expenses @ Ministry Organisations abroad particular to establishing recognition of Project, in particular: completion) it will be rate - Tertiary Education prior learning processes (e.g.: NZQA processes in - Health Practitioner timely to compare and Commission Polytechnics for crediting prior training & Competency Assurance contrast the ‘scope of - DHBNZ Workforce qualifications toward postgraduate level course Act, 2003 (HPCA Act). practice’ of each of Development Project requirements) and establishing multidisciplinary - Professional those roles along-with - Current University & common learning opportunities (e.g.: Auckland Organisation ongoing the current health Polytechnic Training University already has in place some lectures & competency processes. professions within Providers field work in common for Medical, Nursing, and - Employer indemnity / Public Health (i.e.: - Clinical Training Pharmacy students; Southhamton University, UK scope of practice / doctors, nurses, Agency (CTA) of and others have established ‘Learning clinical governance dieticians) and identify Ministry of Health Escalators’ across some occupational groups – processes (e.g.: the training subjects in - NZ Qualifications their experiences establishing and developing Credentialing for common, the levels of Authority (NZQA) these models will be a valuable informant for Doctors, Levelling for same required to meet - Employer Priority Action D). Nurses, Collective the qualification Representatives Employment requirements per - Employee Agreement linked profession and Representatives (i.e.: competency processes investigate the Unions, & Professional for Dieticians; Ministry feasibility of Group Reps from PH of Health Designation developing a ‘PH Providers). process for Health Training & Qualification Protection Officers). Escalator’.1 Priority Action D.2: - Establish the Project - Unable to be costed - The Project Charter - This will be a very complex Project with many - As above plus Public - Based on the Charter and Project until Priority Action D.1 and Project Plan will overlapping action points and potential conflicts Health Bill feasibility study output Plan with very clear reports its findings. require input from all of interest that will need to be allowed to surface immediately above, milestones, the the above and others and be worked through. It will be critical to the continuation of this necessary sequence of that will be identified identify these steps in the Project Plan and allow Priority Action can be the milestones, and by the feasibility study. realistic time to manage these processes determined. If the decision making thoroughly to enable the required sequence of feasibility study process and authority - The feasibility study approvals / authorities to happen. recommends per milestone. will need to identify the establishment of a ‘PH key decision making Training & Qualification stages and who the Escalator’ the project key decision makers for this development will need to be. will need to be scoped and milestones established based on the feasibility study findings.

Priority Action D.3: - Establish a ‘PH - Unable to be costed - All the above will - All the above will inform this plus robust Project - All above - Confirm the Project Training & until Priority Action D.2 inform the membership Management ability and experience should be a Steering Group , it’s Qualifications is underway. of the Project Steering pre-requisite for leading the respective Project Terms of Reference Escalator’. Group, and the Component parts.

1 PH Training & Qualification Escalator’ being the explicit pre-requisite learning / qualifications to enter points along a training pathway and qualifications that can be attained at the various exit points along a training pathway

14 and commission the recommended leads component parts of the per Project component. Project Plan in the recommended sequence. Priority Action D.4: Staged implementation - Unable to be costed All the above will All the above will inform this plus robust and - All above - Pilot steps of the ‘PH of the ‘PH Training & until all above Priority inform the key external evaluation will be critical at each Pilot Training & Qualifications Actions have reported participants required stage. Qualifications Escalator’. their findings / actions. per Project team for Escalator’ . the range of Project Components.

15 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT E: PUBLIC HEALTH LEADERSHIP DEVELOPMENT

Priority Project E: Public Health Leadership Development - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action E.1: - Nationally agreed Estimated 400 hrs @ Project Managed to - New Zealand Public Health Core Competencies - The pending NZ - 1998 Ministry of Health commissioned - Determine the ‘Public Health $150/hr = $60,000 ensure consultation will provide a foundation on which to build ‘Public Public Health Bill will ‘Organisational Development Toolkit for Public Leadership & Leadership & with: Health Leadership & Management have direct influence Health Managers and Team Leaders’ this could Management Management Plus mtg attendee - All Public Health Units Competencies’. on ‘Public Health provide useful content. knowledge & skills (ie: Competencies’ . expenses @ Ministry - All Ministry of Health, Leadership & competencies) rate DHB & MAPO - ‘Public Health Leadership & Management Management - LAMP (Leadership & Management Training required of individuals Contracted Public Competencies’ developed by New Zealand Public Competencies,’ Programme) could be a valuable informant for in formal leadership & Health Providers . Health employers can inform this project (NB: it especially with regard development of the ‘Public Health Leadership & management positions is not clear which if any providers have to the statutory powers Management Competencies’. in PH (NB: as distinct developed such a resource so a stocktake will be of the Public Health from all PH workers necessary as part of the action proposed for Unit in the future - Numerous international resources are available responsibilities to Priority Action E.1). rather than statutory to guide and inform development of ‘Public champion PH goals and powers vested in Health Leadership & Management objectives). particular individuals. Competencies’, a literature search will be critical as part of developing the Competencies. It is recommended that the literature search be done by the organisation that drafts the Competencies because detailed synthesis of the literature will be required to inform competency development.

Priority Action E.2: - Standardised national Estimated 200 hrs @ At the table: - Alignment with developments across Health - Emergency Response - Determine the pathway for attainment $150/hr = $30,000 - Chaired By Ministry of Leadership & Management will be essential to Capacity, especially training pathway for of ‘Public Health Health. ensure expectations on Public Health leaders and Pandemic Response attainment of the Leadership & Plus mtg attendee - All current trainers managers are in synch with other specialty areas Readiness will require Public Health Management expenses @ Ministry (ie: University, within the health sector. Close liaison with PH Leaders & Leadership & Competencies’. rate Polytechnics, LAMP DHBNZ Workforce Development Project will be Managers to have Management etc). critical. particular and honed Competencies (ie: on- - DHB representatives people and process the-job training (?? DHBNZ Workforce - It will be critical to ensure the bar is set skill sets – especially in modules / courses; a Project). appropriately in relation to the Masters Business the context of the stream / papers within - PH Leadership & Mgt Administration (MBA) Health Management pending PH Bill as per established Health Reps to include large requirements. The standardised national the section Management urban and small pathway for attainment of ‘Public Health immediately above. Qualifications; a provincial: PH Units; Leadership & Management Competencies’ stream / papers within Maori & Pacific PH cannot be set as high as the MBA standard for the Masters Public providers; other NGO obvious reasons. Health. providers.

Possible Future Public Health Leadership Workforce: A pool of qualified, experienced and successful Public Health managers not just in the Public Health sector but at all levels across the health sector inclusive of leading DHB’s and PHO’s.

16 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT F.1: DEVELOP HEALTH PROTECTION OFFICER AS A PROFESSION

Priority Project F.1: Develop Health Protection Officer (HPO) as a Profession - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action F.1.1: - HPO role is clearly Estimated 650 hrs @ - Ministry of Health - Since the late 1980’s and in the absence of a -The pending Public The key question is: What is the core HPO - Analyse the findings defined with clear $150/hr = $97,500 Public Health national professional body the qualification and Health Bill will be key role? from the 01.05.06 – memoranda Directorate & ‘Drafters career pathway, and the legislative framework to determining the - Work done under NZ Food Safety Authority 30.11.06 Ministry of understanding or Plus mtg attendee of Public Health Bill’ for HPOs work has been continually altered and future HPO scope of [NZFSA] contracts does not count toward the Health pilot of the stronger across and expenses @ Ministry - 4 Pilot Public Health arguably eroded. Consequently few people are practice. Piloted HPO Ongoing Designation. This is a major ‘Competencies for between the respective rate Units (i.e: Auckland, entering the profession and largely the HPO - If the Bill results in a departure from traditional HPO role where ‘Food’ Ongoing Designation agencies that contract Taranaki, Bay of workforce feels vulnerable & significantly neutral change from aspects were a core component of the HPO role. as an HPO’ and use work according to Plenty, Canterbury) dispondent. current state for the - Designation by the Director General of Health these to urgently separate legislation / - All other Public Health - Changes to legislation, for example: HPO role it is requires a high level of knowledge, address the medium regulation (ie: clear Units Biosecurity, Drinking Water, Food and Hazardous suggested this is a understanding and competency to effect the term pending critical role for Ministry of - PSA Union for HPOs Substances require additional specialist crisis waiting to public health requirements within various pieces inability of Director Health to take - NZ Food Safety qualifications. The consequence is Public health happen. of legislation and regulation. Some General to provide a leadership in making Authority (NZFSA) Units and their employees, especially HPOs, are - If the Bill aims to commentators have suggested HPO and Health consistently competent this happen and - Ministry of Agriculture increasingly faced with evermore specialised strengthen the HPO Promotion roles could be merged, this author 24/7 public health monitoring it & Fisheries (MAF) demands from the independent agencies role the core suggests this would be folly and would negatively response capacity. thereafter). - Ministry of Education contracting per legislation, and at times infrastructure proposed affect development and delivery of those (MoE) conflicting demands from agencies acting in on this page will need respective skill sets, and public health outcomes. - Occupational Safety isolation. to be put in place - The unclear qualifications and career pathway & Health (OSH) - Agencies responsible for individual pieces of ahead of the Bill to has resulted in negligible inflow to the HPO - Ministry of Justice legislation as separate from the overview of effect that potential. It profession. The medium term outlook is a major where their piece of legislation fits into the is suggested putting crisis point for the Director General of Health ‘whole Public Health picture’ are increasingly this infrastructure in with insufficient ‘designated officers’ to uphold contracting additional demands on Public Health place could avert the the 24/7 obligations of the Health Act 1956 / Units. Public Health Units are/will increasingly suggested crisis (i.e. Public Health Act (pending) as the current HPO finding/find their 24/7 public health response National Professional workforce retires / moves into the less stressful capacity is correspondingly marginalised due to Body, HPO defined specialist roles outside of Public Health (made the reduced generalist capacity of its HPO scope of practice, possible by the legislation changes). Many if not workforce directly due to the reality of the registering HPO under all of these external roles provide higher pay and specialised workloads required from individual the HPCA Act) . better terms of employment , they are attractive pieces of legislation. to a disenfranchised workforce.

Priority Action F.1.2: - Mandated & Estimated 500 hrs @ - PSA Union (the PSA - Standardise the pathway for an HPO - Establish a national resourced national $150/hr = $75,000 should lead this qualification (i.e: specialist option moved from professional body professional body process with support undergraduate qualification to post graduate responsible for addresses the critical Plus mtg attendee from Ministry of option as per other health professions) leadership and HPO workforce issues, expenses @ Ministry Health) - Confirm / amend and confirm October 2002 development of the see dependencies box. rate - HPOs Ministry of Health draft process for Initial HPO profession. - Public Health Units Designation of HPOs - Confirm Competencies for ‘Ongoing Designation as an HPO’. Register HPO under Health Practitioner Competency Assurance Act (HPCA Act)

Possible Future HPO Workforce: A legitimate health profession that has a clear qualification and career pathway. It is an attractive career option for school leavers and/or Bachelor Health Sciences Graduates looking for the area they want to specialise in. Leadership of Public Health as a ‘Senior Statutory Officer’ (Working title re PH Bill) will be an option once the HPO Profession is registered under the Health Practitioner Competency Assurance Act (HPCA Act) and if an individual HPO achieves the required postgraduate Public Health qualifications

17 18 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT F.2: DEVELOP HEALTH PROMOTION AS A PROFESSION

Priority Project F.2: Develop Health Promotion as a Profession - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action F.2.1: - Nationally Agreed Estimated 650 hrs @ - Project Managed to - New Zealand Public Health Core Competencies - The Public Service - May 2000 Health Promotion Forum (HPF) - Determine Core Health Promoter $150/hr = $97,500 ensure consultation will provide a foundation on which to build Health Association (PSA) Competencies are for a Health Promotion Competencies A Health Competencies (should with: Promotion competencies. recent Multi Employer Workforce and Health Promotion Forum caution Promoter Requires. be achievable within Plus mtg attendee - All Public Health Units Collective Employment these should not be translated for individual (NB: as distinct from 18mths of commencing expenses @ Ministry - All Ministry of Health, - Health Promotion Competencies developed by Agreement (MECA) has Health Promoters, also that they are overdue for the competencies the project). rate DHB & MAPO New Zealand Health Promotion employers can established one salary review. required by a Health Contracted Providers of inform this project. scale for Health - June 2002 MidCentral Health used the HPF Promotion Workforce – Health Promotion Promoters who are Competencies to inform their Health Promotion refer to notes column.) - All current providers - The Auckland Regional Public Health Service degree qualified and Adviser Competencies. of health promotion (ARPHS) and Auckland based Primary Health those without a degree - June 2003 Community & Public Health training Care Organisations (PHOs) pilot of the Australian now fit on the Canterbury used the above to inform their QIPPS (Quality Improvement Programme Community Health Workforce Development Competencies. Planning System) Health Promotion planning and Worker Salary Scale. - 2005 / 2006 Auckland Regional Public Health evaluation database and its supporting training Increased Service (ARPHS) used a variety of international course and competency development framework professionalism of the sources & all the above to inform development can inform this project . Health Promotion of their pending Health Promotion Practitioner workforce will drive up Competencies. costs for employers, - 01.07.06 Counties Manukau Let’s Beat Diabetes this could result in Project as per ARPHS used all the above to fewer more highly inform development of its Health Promotion & qualified Health Health Education Competencies (NB: these Promoters being competencies are for Health Promoters, and for employed. Community Health Workers & Health Professionals whose roles within Let’s Beat Diabetes largely focus on Health Education). Priority Action F.2.2: - Standardised national Estimated 500 hrs @ At the table: - Critical to understand the Tertiary Education - See Priority Action - This will need to be tightly Project Managed to - Facilitate joint qualification pathway $150/hr = $75,000 - Chaired By Ministry of Commission / Sector ‘rules’ particular to ‘levels’ F.2.1 section ensure it actually delivers on the output and discussions between all for Health Promotion Health of qualifications and regarding recent changes to immediately above. doesn’t become sidetracked by competing current Health (possibly take 2 – 3 yrs Plus mtg attendee - All current trainers Polytechnics ability to run national courses. interests to deliver the eventual training courses. Promotion training from start of expenses @ Ministry - DHB representatives - Clinical Training Authority (CTA) maybe able to providers to establish discussions to actually rate (?? DHBNZ Workforce provide guidance. training levels and have a confirmed Project) - Priority Action F.2.3 below could happen standards per level. national qualification - Tertiary Education concurrently with this Priority Action F.2.2 but pathway ready for Commission the momentum created by the above Priority delivery). - Employer Reps Action F.2.1 should be harnessed by moving - Health Promotion straight into Priority action F.2.2 and not waiting Reps (maybe ‘voted’ for Priority Action F.2.3 to be completed. during above proposed action E.2. 1) Priority Action F.2.3: - Establish a National Estimated 300 hrs @ At the table: - Understand the scope and nature of the work - There will be - This will need to be tightly Project Managed to - Establish Health Professional Body For $150/hr = $45,000 - Led by Ministry of existing National Professional Bodies with a significant learning ensure robust and sustainable processes and Promotion as a Health Promotion (to Health similar sized workforce as Health Promotion about establishing systems are established that will actually build legitimate Health take responsibility for Plus mtg attendee - DHB representatives undertake (eg: Dieticians Board, Chiropodists scopes of practice and professionalism of Health Promotion as a Profession – Step 1. leadership and expenses @ Ministry (?? DHBNZ Workforce Board, Acupuncture Guild etc) then compare and ongoing competency legitimate Health Profession and to build real development of the rate Project) contrast this with the scope and nature of the accreditation etc to be career pathways within the Profession. profession- akin to NZ - Employer Reps larger bodies (eg: NZ Medical Council, and NZ learned from the Medical Council/ - Health Promotion Nursing Council) National Professional Nursing Council etc). Reps (maybe ‘selected’ - Based on these findings determine whether to bodies already during above proposed go to a Request For Proposal Process or a registered under the Priority Action F.2.1) ‘shoulder tapping’ process. HPCA Act 2003.

19 Priority Action F.2.4: - Health Promotion is Estimated 300 hrs @ Led by the Health - The HPCA Act 2003 application process will - The pending Public - Establish Health registered and listed as $150/hr = $45,000 Promotion National guide and direct this action. Health Bill will set a Promotion as a a legitimate Health Professional Body platform for the range legitimate Health Profession under the Plus mtg attendee Involving: of Public Health Profession – Step 2. Health Practitioner expenses @ Ministry - Their membership Professionals with Competency Assurance rate - Employer Reps appropriate Public Act, 2003 (HPCA Act, - Ministry of Health Health tertiary 2003). - DHBNZ qualifications to be - Tertiary Training appointed and Providers designated into the new statutory roles. Possible Future Health Promotion Workforce: A legitimate health profession that has a clear qualification and career pathway and the role is recognised, understood and utilised across the health sector

20 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT F.3: DEVELOP A COMMUNITY HEALTH WORKER CAREER PATHWAY

Priority Project F.3: Develop a Community Health Worker Career Pathway - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action F.3.1: - Confirm a Public Estimated 650 hrs @ - Ministry of Health - Critical to understand the Tertiary Education - Establishing a ‘scope - Whiteraia Polytechnic has a long established - Compare and Health Community $150/hr = $97,500 Public Health Commission / Sector ‘rules’ particular to ‘levels’ of practice’ and an Community Health Worker training course. contrast the course Health Worker Scope Directorate of qualifications and regarding recent changes to NZQA Unit Standard is - Auckland University School of Population Health intent and content; of Practice Plus mtg attendee - Whiteraia Polytechnic Polytechnics ability to run national courses. likely to result in recently ‘gifted’ to Manukau Institute of and evaluation findings - Based on the Scope expenses @ Ministry - MIT - DHBNZ Workforce Strategy Group released for increased pay rates for Technology (MIT) the course it developed for of the three known of Practice develop and rate - DHBNZ Non comment on 19.05.06 their draft paper ‘The Non this workforce, it is training Pacific Community Health Workers. The Community Health register on NZ Regulated Workforce Regulated Workforce in the Health and Disability suggested that should ‘gifting’ of the course includes some provisos for Worker Training Qualifications Strategy Group Sector’. This report largely focuses on the non not be a reason to course access, content, and delivery. Courses: Whiteraia Framework (NZQA) a Representative regulated workforce that undertakes personal avoid upskilling and - Counties Manukau DHB Let’s Beat Diabetes Polytechnic, Manukau Public Health - Community Health health care (e.g. Care Givers, Home Based mentoring this Project has purchased and worked with MIT to Institute of Technology Community Health Worker Support Workers etc) but clearly Public Health workforce. develop a Generic Community Health Worker (MIT) Pacific Worker Unit Standard. Representatives Community Health Workers are part of the Non - It is possible that Training Course, the first intake is scheduled for Community Health - PSA Union for Public Regulated Workforce hence DHBNZ need to be a some ‘qualified’ October 2006. The course is designed to cover Workers Course & the It is recommended that Health Community key participant in this project. Community Health the generic Community Health Worker role with pending Generic these two outputs be Health Workers - Establishing an NZQA Unit Standard enables Workers will be the future view that optional extra modules will Community Health done in unison because - Employer education providers across the country to deliver enabled through their be available to cover specific populations / Worker Course (latter given the disparate Representatives, the course, yet their delivery is monitored for personal achievement subject areas etc specific to Community Health scheduled to nature of the inclusive of: Public quality and consistency with the Unit Standard with this second Worker work (eg: Maori Health; Child Health; commence in October Community Health Health Units, Non Govt requirements. chance education (i.e. Chronic Illnesses – Diabetes / Coronary Heart 2006). Worker role across NZ Organisations (NGOs) many did not succeed Disease etc; Mental Health; etc). From the above the risk is too high for especially Maori & as adolescents in the - The 01.07.06 Counties Manukau Let’s Beat analysis Draft a Public misalignment of Pacific education system) to Diabetes Project Health Promotion & Health Health Community training and practice if progress onto Education Competencies described in Priority Health Worker ‘Scope the above processes achieving a tertiary Action F.2.1 above align with the pending MIT of Practice’ and consult are done level health Generic Community Health Training Course the Public Health independently. qualification (N.B. content. Community Health anecdotal evidence Worker Workforce identifies this already across NZ, their happens so potential employers, and the exists for Community training providers. Health Worker qualifications and experience to be a supply line of candidates for entry onto health professions training pathways).

Priority Action F.3.2: - Publish National Estimated 650 hrs @ As per Priority Action While not a pre-requisite for registering a NZQA The cost to train - Discussion is occurring within Let’s Beat - Review the current Standards for ‘Public $150/hr = $97,500 F.3.1 section Unit Standard it would be preferable for Community Health Diabetes Project toward development of a Public Health Health Community immediately above. Community Health Workers to have a national Workers and / or the programme to train Primary Care and NGO Community Health Health Worker Ongoing Plus mtg attendee body that takes leadership and provides support time away from their Managers of Community Health Workers how to Worker Competencies Competency’. expenses @ Ministry for the ‘professionalism’ of Community Health work may deter some supervise & mentor ongoing competency with (NB: it seems there rate Workers (i.e. for example leads the ongoing employers, (especially their Community Health Workers workforce. This may not be any apart development and monitoring of the National smaller NGOs with will be useful work to inform Priority Action F.3.2 from the pending ?? whether course fees Standards for ‘Public Health Community Health minimal discretionary Counties Manukau DHB or the like would be Worker Ongoing Competency’) – Refer to Priority budget available for Health Promotion & paid to assist Project G below. training) from releasing Health Education Community Health their Community Competencies). Workers as so often Health Workers to

21 their wages are critical train. for their families basic survival

Possible Future Public Health Community Health Worker Workforce: A skilled workforce that has a clear ‘scope of practice’ for the safety of their clients, their employers and most importantly for themselves

22 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT G: MULTIDISCLIPLINARY PROFESSIONAL ORGANISATION

Priority Project G: Develop a Public Health Multidisciplinary Professional Organisation - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action G.1: - A feasibility study is Estimated 400 hrs @ Refer to Projects F.1.2 - NZ based health practitioners operate in an - Discussion with the - Concurrently with completed $150/hr = $60,000 & F.2.2 environment of increasing compliance and drafters of the Public Priority Actions F.1.2 & regulation. For example the Health Practitioner Health Bill suggests F.2.2 determine Plus mtg attendee Competency Assurance Act (HPCA Act) 2003, the that the working titles whether the Public expenses @ Ministry Health & Disability Act, ACC legislation, Health & ‘senior statutory Health Professional rate Safety in Employment Act to name but a few; the officer’ and ‘statutory Groups that currently role of the Health & Disability Commissioner, and officer’ are not do not have a national professional accountability developments in synonymous with a professional general across most professional groups (i.e. generic Public Health organisation actually Enron case in USA has impacted beyond Worker. Rather these require separate Accountants Profession). The effect has been describe two specific entities or a joint entity explicit definition of ‘scopes of practice’ and ‘scopes of practice’ processes developed to monitor competency. that require specific ‘Scopes of practice’ define authorities thus professional demarcations between professional groups are qualifications and explicit. History demonstrates that the margins experience to be of what a ‘scope of practice’ ‘can and can’t do designated with the and how to do it will continually shift and ‘lower powers of one or other level’ professional groups will continue to move of these delegated into the ‘exited gaps.’ However it is suggested authorities. that in an environment of increasing compliance and regulation ‘scopes of practice’ will not merge to the point where one or more professional groups will morph into a combined / single entity. Some commentators suggest that a generic Public Health Worker role is imminent; this author considers given the above facts the demarcations between the current professional groups in the Public Health sector will be strengthened not diluted.

23 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT H: BUILD PUBLIC HEALTH CAPACITY IN PRIMARY HEALTH

Priority Project H: Build Public Health Capacity of the Primary Care Workforce - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action H.1: - Agree standardised Estimated 200 hrs @ - Ministry of Health The NZ Core Public Health Competencies Ministry of Health Documents authored in 2003 - Get past the debate NZ ‘definition’ of what $150/hr = $30,000 Public Health & described by Priority Project A above should be a by Dr Marion Poore will be valuable for informing of what is and what comprises Public Primary Care key informant for Priority Action H.1. this debate, namely: isn’t public health care Health Care in the Plus mtg attendee Directorates - ‘A Birds Eye View of Public Health’ (2003) in the primary care Primary Care setting in expenses @ Ministry - DHBNZ Workforce -‘Public Health in a Primary Care Setting’ (2003) setting and enable all the context of the rate Development Project - & numerous other documents on parties to focus energy stages on the - National Reps from www.moh.govt.nz on strengthening the ‘Continuum of Care. Primary Care approach for the workforces (e.g. Royal benefit of the primary College of GP’s; care ‘registered’ Practice, Plunket, & populations. Public Health Nurses etc) - PHO representatives - NGO representatives - Training Provider Reps both undergraduate & postgraduate re primary care

Priority Action H.2: - Resources that coach Estimated 200 hrs @ - Ministry of Health - It will be critical to determine: Workforce shortages & The collaborative project undertaken by Doone - Provide practical and guide practical, $150/hr = $30,000 - Royal College of GPs  what format of resources is most useful workloads in Primary Wynard and Cheryl Hamilton for the Ministry of resources, relevant to realistic, and - Practice Nurses for the respective primary care Care are high and Health and the three Auckland based DHB’s has the respective Primary achievable Plus mtg attendee National Group workforces, and increasing; some parts identified a well respected resource used by Care workforces, to implementation of expenses @ Ministry - Other primary care  whether any resources currently under of NZ are experiencing primary care in the UK. Their findings could illustrate ‘what public public health actions at rate workforce development / recently developed would this more than others, speed this project health in the primary the primary care representatives be a good vehicle for this proposed especially rural NZ To care setting is’ and coalface. Plus resource costs - PHO representatives resource or whether it should be a stand be effective the how to achieve / estimated @ $50,000 - NGO representatives alone resource suggested resources strengthen the need to be user paradigm shift. friendly.

Priority Action H.3: Training programmes Estimated 100 hrs @ - Ministry of Health Priority Action H.1 will need to precede Priority Influence the aligned with the $150/hr = $15,000 - Ministry of Education Action H.3. curriculum for: ‘standardised - Clinical Training undergraduate, post definition’ described in Plus mtg attendee Agency (CTA) graduate training Priority Action H.1 expenses @ Ministry - Training Providers regarding public health above. rate in the primary care setting.

Possible Future Primary Care Workforce Delivery of Public Health: A common understanding is agreed and published to make explicit the points on the ‘Continuum of Care’ that public health is practiced.

24 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT I: DEVELOP PUBLIC HEALTH WORKFORCE PLANNING TOOLS

Priority Project I: Develop Public Health Workforce Planning Tools - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Priority Action I.1: - Analysis report - Cannot be costed - Ministry of Health -Project I cannot undertake robust analysis until - Priority Actions of all - Determine whether until all other Priority - DHBNZ Priority Actions F.1.2, F.2.4 & F.3.2 are fully previous Priority the logic of the model/s Projects nearing - Public Health Units completed. Projects being developed / used completion - NGOs by DHBNZ Workforce - PHOs Development Project can be applied to Public Health Workforce planning.

Priority Action I..2: - Develop the Public - Cannot be costed - As above plus - This will need to be tightly Project Managed to - Priority Actions of all - Dependent on the Health Workforce until Priority Action I.1 software companies ensure it actually delivers on the output and previous Priority findings from Priority Planning Methodology. is completed doesn’t become sidetracked by competing Projects Action I.1: interests Either: Build a Public health Workforce planning methodology off the DHBNZ model’s

Or: Build a stand alone Public Health Workforce planning methodology .

Priority Action I.3: - Project Managed - Cannot be costed - As per all above - Unlikely to be - Commission implementation. until Priority Action I.1 effected before the five implementation of the is completed year timeframe of this Public Health Report Workforce Planning Methodology and the System that effects it.

25 PUBLIC HEALTH WORKFORCE DEVELOPMENT PLAN PRIORITY PROJECT J: ENCOURAGE LEARNING ORGANISATIONS

Priority Project J: Encourage Public Health Organisations as Learning Organisations - a view of how to progress the required action, current at 26.05.06 Proposed Actions Potential Output Per Indicative Costs Key Participants Dependencies Influencers & Future Notes In Priority Order Priority Action (ballpark figures only) (key integration points with other activities internal Implications (1 = happen first, and external to Ministry of Health Public Health 10 = happen last) Workforce Development Project) $ (GST excl) Assess the ‘Learning A guide for Estimated 400 hrs @ - Ministry of Health Developing a ‘Learning Organisation’ is a top ‘Learning The theory and practice of ‘Learning Organisations’ theory implementing $150/hr = $60,000 - DHBNZ down approach, for it to be successful it is Organisations’ theory Organisations’ is already being used, albeit to and practice actually ‘Learning - Public Health Units critical for Public Health Leaders and Managers and practice if varying degrees and with varying success by being used in Public Organisations’ theory - NGOs to be coached in this methodology implemented well can some Public Health providers. Health Organisations and practice in New - PHOs be a strong staff across New Zealand Zealand Public Health Coaching about ‘Learning Organisations’ and retention and Services how to use the implementation guide can be succession planning built into Priority Project E ‘model’

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