FNHM Needs Assessment and Situational Analysis

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FNHM Needs Assessment and Situational Analysis

• Findings from FNHM focus groups

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• As part of the FNHMs Needs Assessment and
  Situational Analysis project, 10 regional focus
  groups were held with FNHMs.
• A focus group is typically a group of between 7
  and 10 interacting individuals who have common
  characteristics or experiences related to the
  subject of the research.
• Moderated by a facilitator, a group is engaged in
  discussion in a comfortable and safe environment,
  which allows participants to share ideas,
  experiences and attitudes regarding the topic(s).
  
• Afterwards, analysis of the discussions looks for
  themes, patterns and other important information.

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• The process for selecting focus group
  participants was
• FNC project team was directed to contact regional
  National First Nations Health Technicians Network
  (NFNHTN) reps regarding the focus groups
• NFNHTN regional reps were provided with
  information on the project and suggested
  dates/locations for focus groups in their region
• NFNHTN regional reps identified potential FNHMs
  from their region to participate in the focus
  groups
• Once provided with names, FNC staff contacted
  potential participants to confirm attendance and
  arrange travel and accommodation
• Participants were reimbursed for all travel
  expenses and per diems

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• BC 4
• AB 4
• Yukon 8
• NWT 8
• SK 5
• Total participants 50

• MB 5
• ON 5
• QC 7
• NS 1
• NB 3

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Focus group questions

• What initially attracted you to the job of HD/HM?
• Were there any aspects of your job that you did
  not expect, or did not feel prepared for?
• Based on your experience, what are the most
  essential skills for a FNHM, and why?
• What has helped you to improve/enhance your
  skills/effectiveness as a health director?
• What kinds of things would support/enhance your
  job performance?
• How could a national network for FNHMs support
  you in your job?

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Analysis

• Recordings were transcribed, resulting in 192
  pages of information.
• For analysis of the data, major topics and themes
  were pre-determined by the focus group questions.
  Further analysis for themes and repeating
  patterns, as well as for unique perceptions and
  descriptive phrases, was also done.
• Data from focus groups in not usually analyzed by
  quantitative means in other words, you do not
  normally attempt to count or measure the number
  of responses.

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1. What initially attracted you to the job of
HD/HM?

• The FNHMs who participated in these focus groups
  have a
• passion for health and a desire to have a
  positive impact on
• the health of their communities
• Im First Nation and want to help my people.
• Im very passionate about my peopletheir needs
  need to be recognizedand being able to give a
  voice to that I can sit at a table and lend
  credibility to what I am saying because of my
  education and experience... this is so
  significant for me.
• My Mom was in health and she was a real role
  model for me. I looked at all sorts of health
  career options and thought the Director position
  was the one that would have the most overall
  impact on the health of the community.

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Background/education

• Ten participants had a nursing background.
• Twelve other individuals had worked in other
  front line and administrative positions in the
  health field, (e.g., clerical, CHR, day care
  worker etc.).
• Seven individuals reported having a social
  service background (e.g., social work).
• Only 4 participants had returned to school to
  obtain formal Health Administration training.

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• Some participants sought out their current jobs
  by applying
• for a vacant position, while a larger number were
• encouraged to accept the position
• I would have never applied had I seen a
  postingI was asked to step in to clean up the
  organizationthis position is so elusive, the
  whole thing is so different than I thought it
  would be.
• I started in one position and it evolved into
  being the Health Directorthis was put on your
  desk and that was put on your desk and then the
  next thing you know youre doing the Health
  Directors job.

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Were there any aspects of your job that you did
not expect, or did not feel prepared for?

• Broad scope of healthcare needs and services
• Health as a service is huge, and there are
  broad expectations
• to address all health-related needs of a
  community
• We really have to be everything for everybody
  for example mould is a health issue but the
  responsibility for mould in houses belongs to the
  band housing department, but we still need to
  work and sometimes fight with them to get the
  problem fixed.
• Some identified as a surprise, or perhaps as a
  challenge, the
• depth and complexity of health issues in the
  communities.

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• Orientation to the Job
• Participants said that orientations to the job,
  the
• organization and to the funding body expectations
  were
• lacking or negligible.
• It appears that most Health Directors learn to
  perform their
• duties on the job with little (if any) support
  or training
• My orientation included giving me the key to the
  centre and to my office.

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• Workload and Expectations
• In general, participants agreed and highlighted
  that the
• Health Director position is more than a 9-5
  job
• this is a 24/7 thing and your home phone
  number is public.
• Many felt that the workload and high expectations
  (from the
• funding body, the community/clients, leadership
  etc.) can
• produce significant stress as one participant
  said,
• Im just happy to keep my head above water.

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• The reporting requirements (primarily to Health
  Canada),
• and the fact that these requirements are
  constantly changing, is
• an issue that was not anticipated by many
  participants. Some
• identified an issue with short turn around
  demands and/or
• notification in relation to attending meetings,
  conferences or
• submitting proposals
• I didnt expect all the demands...what struck
  me... is Health Canada and how much writing,
  reading, the work plans, the activity reports
  measured again the work plan and even the budget
  stuff.
• There is a great emphasis on reporting and
  budgeting rather than on medical/health
  coordination
• Its almost like the system is set up for
  failurewe lack so many resources and its like
  they government are sending us off on the
  little rat races to keep us busy and confused.

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• Human Resources
• Some participants identified a general lack of
  human resources (and
• thus money) to deliver services
• When there is a new initiative, they i.e.
  Health Canada get a new person for the
  position. So they have all these people that are
  directing you, but you have 17,000 other
  files...you end up just adding it to your desk.
• One participant highlighted nursing as an
  issue, especially the Monday
• to Friday rotation On weekends we have no
  medical, if anything
• happens we medivac out our patients.
• Some noted that they were not prepared to deal
  with all of the human
• resource issues, including such issues as
  grievances, liability, union
• negotiations and staff turnover.

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• Finance
• Insufficient financial resources was a challenge
  identified by
• some of the participants. Depending on the type
  of agreement
• with the funding body, some identified that there
  was a constant
• chasing of dollars through proposal writing.
• Some did not feel prepared to handle all aspects
  of the budgets,
• variance reports and cash flow statements, while
  others
• indicated that they worked well with numbers or
  had the
• infrastructure (at the organization or band
  level) where a skilled
• technician (accountant) does most of the finance
  work.

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• Some participants mentioned positive surprises
  
• people that I have met who are champions in
  health.
• the way the community comes together when things
  happenthis is positive thing.
• Another positive perception, likely related to
  the increased
• autonomy afforded by Transfer agreements, was
  that
• we can be more creative with our programming and
  this better suits the community needs.

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3. Based on your experience, what are the most
essential skills for a FNHM, and why?

• Many emphasized the qualities that are
  essential for FNHMs,
• such as
• Being a good role model and living a good,
  healthy lifestyle
• Being up-front, honest, trustworthy and reliable
• Being a mentor, a leader and an advocate for the
  community and the clients
• Developing a positive working relationship with
  the community, building trust and being a people
  person
• Being flexible, open-minded, accessible to
  everyone, non-judgemental, and having compassion
  and patience

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• Being creative and able to adapt to each
  situation
• Having common sense
• Being a big picture thinker and having a world
  view being visionary and anticipating needs
• Being able to multi-task and able to change
  tracks quickly
• Understanding the politics
• Building on the traditional values of the
  community and finding the happy medium between
  Western and traditional ways and values
• Having a positive attitude and using a
  strengths-based approach
• Being a jazz musician rather than a concert
  pianist
• Being always willing to learn, value everybodys
  input and encourage creativity
• Participate, network and share with others

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• In almost all the regions, at least 1 participant
  indicated that
• having a connection to the community, its culture
  and values are
• essential. The importance of speaking the local
  language was
• also identified.
• Some suggested that understanding First Nations
  history, the
• impact of residential schools and colonization is
  important. It is
• especially important for non-Aboriginal health
  managers and
• practitioners to understand the correlation
  between our history
• and current health status.
• Some identified that they must have the skills to
  fill in for their
• staff (e.g., drive the van and be on-call in
  emergencies). Finally,
• some suggested that an essential skill is the
  ability to manage
• crisis in the community.

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• In general, participants agreed that the
  following are
• essential job skills for a Health Director
• Finance
• Communication
• Human Resources
• Planning
• Knowledge of Health Status and Systems
• Information Management

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4. What has helped you to improve/enhance your
skills/effectiveness as a health director?

• Some participants identified their academic
  background
• (e.g., nursing, psychology, management, health
• administration, etc.) as being good grounding for
  their
• current positions.
• More often, participants pointed to their own
  devices,
• qualities that they possess as a manager, as well
  as
• learning by doing as methods that have enhanced
  their
• effectiveness as a Health Director.
• There is no one course that will help you be a
  Health Directoryou have to be everything so its
  hard to point to one course or program.

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• Workshops and courses were mentioned by a few
  participants
• (e.g., university courses on Conflict Management,
  Executive
• Coaching, Community Health Planning training,
  Proposal Writing
• etc.).
• Some identified traditional ways and learning
  as assisting
• them in being effective. Some found their own
  mentors to assist
• them in keeping grounded.
• Another participant identified a process in which
  the community
• and Health Canada have arranged for a one year
  job
• shadowing process for the Health Director
  position.
• Some mentioned volunteering on committees and
  Boards, as
• well as networking/collaborating with other
  health programs in
• their area as being the most effective for their
  development as a
• Health Manager.

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• One participant expressed concern that this study
  would
• result in the development of a national
  educational
• standard for FNHMs
• If you required a 4 year degree or even a 2 year
  diploma in our area, there would be no health
  directors in ¾ of our communities. Education is
  important, but there needs to be a re-think about
  how this is delivered, especially in those areas
  with only long-distance access to learning
  centres e.g., northern and isolated
  communities.
• This participant suggested that the training that
  was used
• for the on-reserve Aboriginal Head Start program
  could be
• a model for FNHM training (that is, in-class
  instruction
• during the summer months and course credits for
  practicums
• during the remaining months of the year).

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5. Whats missing? What kinds of things
would support/enhance your job performance?

• In almost all regions, at least 1 participant
  identified that adequate financial and human
  resources would enhance their job performance.
• One participant thought a clone would be
  helpful while another thought robots would be
  useful.
• Inadequate organizational and community
  infrastructure were mentioned by some, including
  the need for office space, staff housing, all
  season roads and technology (computers).

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• Some identified specific training needs,
  including
• Financial management
• Orientation for health directors
• Communication skills
• Power point training and computer training
• Research skills and information management
• Crisis management and stress management
• Understanding audit requirements
• Human resource management skills
• Information regarding FASD

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• Recognized or nationally accredited training for
  Health Directors was suggested. Taking credit
  courses over time towards a degree or diploma
  seems the most realistic approach, given busy
  schedules and multiple demands.
• Distance education was mentioned frequently.
• One half of the regions indicated that a
  networking forum for Health Directors at a local
  or regional level would be most useful. One
  group described a peer driven support network so
  we dont have to struggle alone.

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How could a national network for FNHMs support
you in your job?

• There was broad support among participants for a
  national FNHM support network.
• Some participants emphasized that activities
  should occur at a regional level, given that
  face-to-face networking and idea-sharing is more
  relevant when conducted in smaller groups which
  reflect the local or regional context.
• Consideration is needed to ensure that needs are
  met through peer and regional processes, while
  not precluding the concept of national
  conferences and/or forums.

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Small Group Discussions

• What has helped you to improve/enhance your
  skills/effectiveness as a FNHM?
• What kinds of things would support/enhance your
  job performance as a FNHM?