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      Transforming Health Professionals into Population Health Change Agents

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          Abstract

          Background

          With the recognition that professional education has not kept pace with the challenges facing the health and human service system, there has been a move to transformative education and learning professional development designed to expand the number of enlightened and empowered change agents with the competence to implement changes at an individual, organisation and systems level.

          Design and Methods

          Since 2010, the Department of Health and Human Services in Victoria, Australia, in collaboration with The University of Melbourne’s School of Population and Global Health, has delivered seven population health short courses aimed to catalyse participants’ transformation into population health change agents. This paper presents key learnings from a combination of evaluation data from six population health short courses using a transformative learning framework from a 2010 independent international commission for health professionals that was designed to support the goals of transformative and interdependent health professionals. Participatory realist evaluation approaches and qualitative methods were used.

          Results

          Evaluation findings reveal that there were mixed outcomes in facilitating participants’ implementation of population health approaches, and their transformation into population health agents upon their return to their workplaces. Core enablers, barriers and requirements, at individual, organisational and system levels influence the capability of participants to implement population health approaches. The iterative and systemic evolution of the population health short courses, from a one off event to a program of inter-dependent modules, demonstrates sustained commitment by the short course developers and organisers to the promotion of transformative population health learning outcomes.

          Conclusions

          To leverage this commitment, recognising that professional development is not an event but part of an ongoing transformative process, suggestions to further align recognition of population health professional development programs are presented.

          Significance for public health

          With decreasing health and wellbeing of whole populations, increasing inequities among specific population groups, health professional educators are increasingly turning their attention to population health. This has implications for implementing evidence into practice. Professional development short courses are being conducted to equip participants (health service managers, health promotion managers and coordinators, health planners, population health planners and senior executives) with knowledge, skills and tools to implement population health approaches and transform them into population health change agents. The findings of this study indicate there were mixed outcomes in facilitating participants’ implementation of population health approaches and their transformation into population health agents upon their return to their workplaces. The study findings informed the evolution of the short courses, from a one off event to a program of interdependent modules, and further reveal that professional development is not an event but part of an on-going transformative process,suggestions to further align recognition of population health professional development programs are presented.

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          Most cited references6

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          Enabling the implementation of evidence based practice: a conceptual framework.

          The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical effectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper offers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staff to assess what they need to do to successfully implement research into practice.
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            Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review

            Background In knowledge translation, complex interventions may be implemented in the attempt to improve uptake of research-based knowledge in practice. Traditional evaluation efforts that focus on aggregate effectiveness represent an oversimplification of both the environment and the interventions themselves. However, theory-based approaches to evaluation, such as realist evaluation (RE), may be better-suited to examination of complex knowledge translation interventions with a view to understanding what works, for whom, and under what conditions. It is the aim of the present state-of-the-art review to examine current literature with regard to the use of RE in the assessment of knowledge translation interventions implemented within healthcare environments. Methods Multiple online databases were searched from 1997 through June 2013. Primary studies examining the application or implementation of knowledge translation interventions within healthcare settings and using RE were selected for inclusion. Varying applications of RE across studies were examined in terms of a) reporting of core elements of RE, and b) potential feasibility of this evaluation method. Results A total of 14 studies (6 study protocols), published between 2007 and 2013, were identified for inclusion. Projects were initiated in a variety of healthcare settings and represented a range of interventions. While a majority of authors mentioned context (C), mechanism (M) and outcome (O), a minority reported the development of C-M-O configurations or testable hypotheses based on these configurations. Four completed studies reported results that included refinement of proposed C-M-O configurations and offered explanations within the RE framework. In the few studies offering insight regarding challenges associated with the use of RE, difficulties were expressed regarding the definition of both mechanisms and contextual factors. Overall, RE was perceived as time-consuming and resource intensive. Conclusions The use of RE in knowledge translation is relatively new; however, theory-building approaches to the examination of complex interventions in this area may be increasing as researchers attempt to identify what works, for whom and under what circumstances. Completion of the RE cycle may be challenging, particularly in the development of C-M-O configurations; however, as researchers approach challenges and explore innovations in its application, rich and detailed accounts may improve feasibility.
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              Competency development in public health leadership.

              The professional development of public health leaders requires competency-based instruction to increase their ability to address complex and changing demands for critical services. This article reviews the development of the Leadership Competency Framework by the National Public Health Leadership Development Network and discusses its significance. After reviewing pertinent literature and existing practice-based competency frameworks, network members developed the framework through sequential use of workgroup assignments and nominal group process. The framework is being used by network members to develop and refine program competency lists and content; to compare programs; to develop needs assessments, baseline measures, and performance standards; and to evaluate educational outcomes. It is a working document, to be continually refined and evaluated to ensure its continued relevance to performance in practice. Understanding both the applications and the limits of competency frameworks is important in individual, program, and organizational assessment. Benefits of using defined competencies in designing leadership programs include the integrated and sustained development of leadership capacity and the use of technology for increased access and quality control.
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                Author and article information

                Journal
                J Public Health Res
                J Public Health Res
                JPHR
                Journal of Public Health Research
                PAGEPress Publications, Pavia, Italy
                2279-9028
                2279-9036
                26 April 2016
                26 April 2016
                : 5
                : 1
                : 643
                Affiliations
                [1 ]Health Systems and Workforce Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne , Australia
                [2 ]Eastern and Southern Metropolitan Health, Victorian Department of Health and Human Services, The University of Melbourne , Australia
                [3 ]Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne , Australia
                Author notes
                Health Systems and Workforce Unit, Centre for Health Policy, Melbourne School of population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Parkville VIC 3053, Australia. +61.3.83444535. l.naccarella@ 123456unimelb.edu.au

                Conflict of interest: the authors declare no potential conflict of interest.

                Article
                10.4081/jphr.2016.643
                4856865
                27190973
                2f47beab-1846-4f45-a118-a9e54421288c
                ©Copyright L. Naccarella et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 November 2015
                : 27 January 2016
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 29, Pages: 6
                Categories
                Article

                professional development,population health,change agents,evaluation,health professional education

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