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Public Health Financial Management Competencies Public Health Financial Management Competencies Peggy A. Honor´e and Julia F. Costich rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr he absence of appropriate financial management tion, utilization, and management of resources for competencies has impeded progress in advancing the the delivery of public health functions and the im- pact of those resources on population health and the field of public health finance. It also inhibits the ability to T public health system.”3(p90) The multidisciplinary ef- professionalize this sector of the workforce. Financial managers forts of researchers and practitioners have contributed should play a critical role by providing information relevant to to this movement by increasing literature on public decision making. The lack of fundamental financial management health finance, creating venues for structured dialogue, and contributing to evidence-based decision making knowledge and skills is a barrier to fulfilling this role. A national through research. Stimulated by this movement has expert committee was convened to examine this issue. The been the realization that standard financial analysis committee reviewed standards related to financial and business techniques are absent in public health and that an ade- management practices within public health and closely related quately skilled workforce is needed to implement such practices.4,5 As an example, questions proliferate about areas. Alignments were made with national standards such as the variation of public health funding among jurisdic- those established for government chief financial officers. On the tions and the value of public health services. But ex- basis of this analysis, a comprehensive set of public health aminations are stymied by the lack of reliable financial financial management competencies was identified and data and the inability to perform financial analysis that is routinely conducted by skilled financial managers in examined further by a review panel. At a minimum, the hospitals, community health centers, and other related competencies can be used to define job descriptions, assess job organizations. performance, identify critical gaps in financial analysis, create career paths, and design educational programs. ● KEY WORDS: competency, management, public health Workforce Competencies competencies, public health finance, workforce Recent critical examinations of the public health work- force have resulted in a considerable amount of atten- tion to competencies.4,6–9 The Association of Schools of The cornerstone of a profession is an ade- Public Health (ASPH) and Council on Linkages Be- quately skilled workforce. The alignment of work- tween Academia and Public Health Practice (Council force competencies with professional responsibilities on Linkages) have been diligent in addressing these is- is a strategy associated with increasing organizational sues. The ASPH and Council on Linkages have identi- 1 effectiveness. A competency can be defined as a set of fied competencies for master of public health students knowledge, skills, and abilities needed to accomplish a specified task.2 A deficiency in public health is the lack of adequately documented competencies for the public health financial management workforce.3,4 Corresponding Author: Peggy A. Honor´e, DHA, University of Southern Mississippi, 118 College Dr, PO Box 10075, Hattiesburg, MS 39406 (peggy. The movement to develop a field of study in pub- [email protected]). lic health finance has progressed in recent years. The qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq field is defined as one that “examines the acquisi- Peggy A. Honor´e, DHA, is Associate Professor, Department of Community Health Sciences, College of Health, University of Southern Mississippi, Hattiesburg. J Public Health Management Practice, 2009, 15(4), 311–318 Julia F. Costich, JD, PhD, is an Associate Professor and Chair, Department of Health Copyright C 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Services Management, College of Public Health, University of Kentucky, Lexington. 311 312 ❘ Journal of Public Health Management and Practice ● ● TABLEqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq 1 ASPH discipline-specific competencies TABLE 2 ASPH interdisciplinary/crosscutting domains and competencies related to finance Domain: health policy and management qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq Domain: Communication and informatics Competencies: Upon graduation, a student with an MPH should be able Use information technology to access, evaluate, and interpret public to... health data Identify the main components and issues of the organization, Domain: Program planning financing, and delivery of health services and public health systems In collaboration with others, prioritize individual, organizational, in the United Statesa community concerns, and resources for public health programs Describe the legal and ethical bases of public health and health Prepare a program budget with justification services Domain: Systems thinking Explain methods of ensuring community health safety and Analyze efforts of political, social, and economic policies on public health preparedness systems at the local, state, national, and international levels Discuss the policy process for improving the health status of populations Apply the principles of program planning, development, budgeting, petencies to guide position responsibility or job perfor- management, and evaluation in organizational and community mance assessments of the public health financial man- initiativesa agement workforce. Apply principles of strategic planning and marketing to public health Apply quality and performance improvement concepts to address ● organizational performance issues Competency Identification Methodology Apply “systems thinking” for resolving organizational problems Communicate health policy and management issues using appropriate Recognizing this gap, a public health finance ex- channels and technologiesa pert committee was organized to provide authorita- Demonstrate leadership skills for building partnerships tive input for the identification of competencies ap- propriate for the public health financial management a Finance-related competency. workforce. The project was part of a Robert Wood Johnson Foundation–funded initiative to advance the and the broadly defined public health workforce.10,11 field of public health finance. Both practice and aca- The ASPH competencies include two distinct cate- demic organizations were represented. Committee gories of competencies—discipline-specific and interdis- members were finance, business, budgetary, and ad- ciplinary/crosscutting. Three of the 10 competencies un- ministrative experts from public health, healthcare, der the discipline-specific domain of Health Policy and academia, and federal, state, and local government Management focus on financing, budgeting, and man- (Table 4). Members of the committee served as key in- agement (Table 1).10 Of the 60 interdisciplinary/cross- formants and were selected by the lead author on the cutting competencies categorized into six domains, basis of their extensive professional knowledge of pub- four relate directly or indirectly to finance (Table 2). lic health, leadership roles, and responsibilities within Core competencies for public health professionals de- their organizations, knowledge of governmental work- veloped in 2001 by the Council on Linkages identified force competencies, or academic and work experiences Financial Planning and Management Skills as one of eight in finance, accounting, or business. Work of the group domains (Table 3),11 but competencies under that do- culminated in the identification of a comprehensive set main focus primarily on the budgeting process. In eco- nomic and financial terms, budgeting is not consid- TABLE 3 ● Council on linkages core competencies for ered a function for building assets but rather one for publicqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq health professionals forecasting and itemizing funds. In contrast, financial and economic analyses are important tools for compre- Domain: Financial planning and management skills hensive examinations of financial performance. Such Develops and presents a budget knowledge is invaluable to generate new and diversify Manages programs within budget constraints the existing revenue streams and for building organi- Applies budget processes zational monetary value (asset generation). The Coun- Develops strategies for budget priorities cil on Linkages 2008 list of draft competencies remains Monitors program performance heavily focused on the budgeting function.12 The ASPH Prepares proposals for external funding and Council on Linkages competencies are of signifi- Applies human relation skills to program management cant value to public health. However, since they were Manages information systems not developed to be discipline specific, a major gap Negotiates and develops contracts for services remains in the availability of sufficiently detailed com- Conducts cost analyses for effectiveness, benefit, and utility Public Health Financial Management Competencies ❘ 313 TABLE 4 ● Organizations represented on the public health small size and expert knowledge of the committee. In financeqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq competencies expert committee and review panel addition, participation in the calls was never less than 9 of the 10 members. Expert committee A strategy was built into the competency
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