Advisory on the Use of Competency Frameworks in Public Health

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Many countries have developed competency frameworks to support workers faced with the growing complexity of public health practices. To better understand the utilization of these frameworks in Québec, identify courses of action for optimizing their use, and ascertain updating requirements, the Direction générale de la santé publique of the Ministère de la Santé et des Services sociaux du Québec tasked the Institut national de santé publique du Québec with preparing an advisory to that effect.

Main observations and courses of action based on a competency-based approach

Competency frameworks are usually viewed as tools associated with a competency-based approach in the workplace. Therefore, their use depends on contextual factors, such as the extent to which managers and other staff, human resource departments and labour unions understand and adopt this type of approach. Despite the fact that a competency-based approach is promising, there is legitimate resistance to its adoption:

The concept of competency is, in essence, complex and abstract, which hampers our understanding of it together with its perceived usefulness and makes it more difficult to operationalize.
It can be hard to assess competencies because it is sometimes difficult to measure them.
Staff members may have a somewhat ambivalent reaction to such assessments, because they are torn between a desire for recognition and the fear of being judged or sanctioned.

Therefore, to gradually implement or to strengthen a competency-based approach, it is suggested to:

initiate a reflection process involving representatives of all groups concerned (managers, human resource departments, labour unions, staff members with various professional roles, etc.);
conduct case studies with units or teams in the health network that have already adopted a competency-based approach;
explore the relevance and feasibility of pilot projects on the incorporation of different aspects of the competency-based approach at different organizational levels.

Such initiatives would be very useful for optimizing framework use. On the other hand, it should be noted that frameworks already help to promote the competency-based approach to some extent. Therefore, it is still appropriate to base courses of action on the use of frameworks themselves.

Main observations and framework-based courses of action

First of all, it is important to point out that characterizing the different types of framework use and their impacts strengthens the relevance of these tools. Furthermore, although the people we interviewed were generally satisfied with the content and precision of the competency frameworks under study, it should be mentioned that certain factors could help to increase the use of frameworks and promote their development. These factors concern structural levers (public health organizations, funding, influence, university programs, etc.), organizational resources, time allocated, as well as the different mechanisms and tools designed to support framework use. In fact, the results of the present study could be useful for developing mechanisms, such as training on the potential impact of framework use with the help of case studies.

The following courses of action are proposed to optimize the use of frameworks (see Chapter 7 for the complete list):

Use frameworks as guidelines for professional development, rather than as a list of specific criteria that have to be met, in order to gain more insight into the issues associated with competency assessment.
Disseminate frameworks widely and make them readily accessible on the Web.
Explore the idea of preparing training sessions on frameworks, the different ways in which they can be used, their impacts, and “good use practices.”
Develop a Web interface and digital tools to facilitate self-assessment of competencies in order to address the issue of the length and complexity of frameworks.
Update certain “external resources” such as plans and guides that have been republished.
Explore the idea of developing a general public health framework that could include important but little-discussed issues, in particular consideration of social inequities in health and public policy analysis.

The need for empirical studies in Québec

The literature review did not identify very many studies on competency frameworks. Empirical data are needed to better understand the use of these tools. For example, a survey of managers and other staff, as well as human resource departments in Québec’s public health network could be carried out, perhaps in conjunction with interviews or focus groups. If the amount of data collected is not sufficient, benchmarking with organizations outside the health network could also be considered.