Proposal for Quality Improvement of Public Health Services in Kentucky through the Integration of Competency-Based Hiring for Local Health Department Directors

This presentation utilizes results of original research to investigate the relationship between certain local health department director (LHD) characteristics and public health system performance, to argue for and propose novel ways to integrate public health core competencies into the required educational training of LHD directors in Kentucky. We suggest implementing these as part of LHD director hiring standards to enhance the development of Kentucky's public health workforce, which will improve the quality of LHD services throughout the state. Utilizing data from the 2005 National Association of City and County Health Officials (NACCHO), we conclude there may be a deficit in training of LHD directors in Kentucky (80.5% and 89.0% of LHD directors in the US and Kentucky, respectively, were identified as having a lack in formal public health training). Analysis using NPHPSP survey v.1.0 and corresponding NACCHO data suggests significant differences exist in certain performance sub-indicators between systems agencies with formally trained directors and those without. We propose an incrementally implemented scheme (a seven- to ten-year window) that should be voluntary and competency-based, with many options for credentialing, to include in the standardization of hiring credentials to necessitate formal training in public health. Options may include competency certification in the Five Core Areas of public health, a Master of Public Health or Doctor of Public Health degree, and may include a combination of reimbursement for on-the-job training, grandfathering and other career advancement incentives, through partnering with several state and local academic partners for better access to resources to achieve this.