Results of the systematic review and meta-synthesis phase
These 12 studies were published over 12 years, from 2005 to 2017. These studies were conducted in 6 developed countries (including the United States, Australia, Canada, Ireland, Spain, and the United Kingdom) (13, 14, 22-30) and one developing country (Iran) (31). The focus of this study was on health working in the health sector. Two studies of the studies focused on global health competencies (22, 26), and 10 of the studies focused on national level (13, 14, 23-25, 27-31).
Due to the results of this phase of the study, seven main themes were obtained. The competencies contained leadership and management (14 sub-themes), analysis, interpretation, and reporting (6 sub-themes), public health knowledge (7 sub-themes), Interpersonal relationships (5 sub-themes), individual competencies (8 sub-themes), Cultural and community competencies (8 sub-themes), and global health competencies (3 sub-themes). Table 2 shows a summary of the information obtained from this phase (see the published article for more information)(15).
Table 2Mapping of competencies across International studies
Themes
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studies
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Number of codes
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Percentage of codes
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Ablah et al (22)
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Akbar et al (23)
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Bornstein et al (24)
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Conejero et al (57)
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Council on Linkages (58)
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Damari et al (31)
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Joqerst et al (26)
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Lamb et al (27)
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Margaret et al (28)
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Rodriques et al (29)
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Whittaker et al (30)
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Wright et al (14)
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Leadership and management
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261
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41.6
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Analysis, interpretation, and reporting
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|
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99
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15.8
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Public health knowledge competencies
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48
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7.6
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Interpersonal relationship competencies
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|
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67
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10.7
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Personality competencies
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45
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7.1
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Cultural and community competencies
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|
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87
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13.1
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International/ global health competencies
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19
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3
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Descriptive results (interview) - Competencies of HHW
To find the competencies of HHW from the experts' point of view, the data were saturated by interviewing twenty-six participants. Three people refused to participate because of their responsibility in health organization during the covid-19 pandemic. All participants had experience in the field of HRH. Finally, six main themes and thirty-four sub-themes were extracted. Most of the duplicate codes related to leadership and management competencies, analysis, interpretation and reporting competencies, and individual competencies, each of which is described below.
First theme: Leadership and management competencies
Leadership competencies in an organization are the effective abilities by which a person can create an inspiring picture of the future, motivate people to follow the organization's vision, and ultimately effectively guide people toward the organization's goals.
- Leadership and related skills
Since the leadership is a key factor to improve the organizational performance, the success or failure of the organization depends on the effectiveness of leadership at all levels. One of the key points about leadership is the ability to motivate other experts.
"The ability of a health headquarters to motivate and persuade subordinate units, that is, to lead, and manage them is very important" (P4).
- Policymaking and related skills
Policy-making in the health system is a combination of economics, sociology, anthropology, political science, public health, and epidemiology that provides a comprehensive picture of how health systems comply with health policies and seek to understand and improve collective health achievement goals.
“we all have no doubt that policy-making is necessarily a headquarter task" (P23).
- Planning and related skills
Planning skills are the best solution for sharing critical and limited resources.
"A health headquarters which plan at the macro level should be able to plan based on international and upstream policies" (P10).
- Organizing and related skills
The organizing is defined as identifying and categorizing required activities, grouping essential activities into achievable goals.
“Headquarters should be familiar with the skill of labor division in a department to avoid interfering and overlapping responsibilities" (P11).
- Financial management and related skills
The lack of financial skills in the HHW of the Ministry of Health will lead to decisions that affect the entire health system.
"Since many of the decisions which have been made in healthcare organizations have important outcomes, especially in the field of finance, the health headquarters should have financial management skills” (P7).
- Control management and related skills
Control is an ongoing process to ensure that actual results are in line with planned schedules.
"What is certain is that control and supervising activities are necessarily the duties of health headquarters, so we should see what skills are needed to monitor and control" (P25).
- Change management and process improvement skills
Change management is a skill used to prepare, equip, and support individuals to successfully adapt to change. “The ability to manage changes, especially in health organizations that face various issues and challenges, and to be able to make the changes made at the system level” (P19).
Time management skill is one of the acquired skills that lead to improving people's working life.
"Sometimes, the small tasks assigned to the experts are so delayed that it becomes a problem" (P4).
- Empowerment and counseling and related skills
In personal productivity, the organization uses the set of potential talents and abilities of the individual to advance the organization. Therefore, effective management of these valuable resources is necessary to achieve the goals of the organization.
"The issue of empowering others to be able to transfer their competencies to other people is very important" (P5).
Second theme: Competencies related to analysis, interpretation, and reporting
The set of the skills of this category to collect, process, analyze, interpret, and reporting data provides significant assistance to HHW. Due to the interviews with their experts, these skills are classified into the following six sub-themes:
A basic acquaintance with statistics is essential for HHW.
"Health headquarters should be familiar with the statistics to some extent (basic for lower levels and advanced for higher levels)" (P22).
In the field of research, familiarity with the methods of conducting quantitative and qualitative research was another important issue for experts.
"The policymaker should be able to conduct qualitative studies and be fully acquainted with them" (P9).
- Topic or subject recognition skills
Understanding the problem and separating it from other similar concepts, and analyzing different types of problems from different points of view is crucial for problem-solving.
"Health headquarters that feed the policymakers and can identify issues in-depth have a very important status, especially in the service sector" (P20).
- The skills of collecting, analyzing, and interpreting data
If information collection is done regularly and correctly, the work of analyzing and concluding the data will be done with good speed and accuracy.
"The health headquarters should be able to collect and process information" (P16).
The analysis is the analyst's mental effort to simplify complex concepts, understand the components of a phenomenon, examine the relationship between the analyzed phenomenon and other phenomena, and predict future developments.
"A very important characteristic which both executive experts and health headquarters should have is analytical skills, that is, to be able to analyze issues well" (P24).
Interpretation is expressed by taking a critical position on a particular event or incident. By in-depth examination, the interpreter presents various and relatively invisible aspects of the event to the audience. “This skill is the ability to reveal hidden layers that are vaguely formed in analyzes and topics and require further explanation” (P13).
- Problem-solving, solution-providing, and decision-making skills
Problem-solving skills and abilities help people to solve problems, which have occurred in their career path.
"They should be able to identify solutions to those problems. Furthermore, they should know how to achieve these solutions" (P14).
Decision-making skills are the process of choosing a course of action from various actions.
"Sometimes, the managers do not allow this skill to be strengthened in experts. That is, managers think that an expert should only have the power to support decisions, but in my opinion, an expert should also have the ability to make decisions" (P3).
- Follow-up analysis and getting feedback on implemented solutions
Feedback is information that people receive due to their performance. This information includes the messages sent by the sender of message to the recipient of message.
"Receiving feedback from the manager, colleagues, and people who are influenced by the decisions, especially in the subordinate units, is very effective in improving an individual's performance" (P11).
- Reporting and related skills
Reporting is the writing of news, information, facts, causes of problems, and their logical and sequential analysis to achieve the correct solution. The report should be concise and clear.
"In many cases, the managers do not know what they want. If the headquarter is a creative one, he/she can create a decision feed for his/her managers" (P8).
Third theme: Competencies related to interpersonal relationships
Carrying out any activity, including planning, organizing, coordinating, leading, and supervising, requires establishing these relationships.
Communication skills refer to the ability to communicate information to others effectively and efficiently.
"If an HHW is unable to communicate with the subordinate units, he/she cannot convey his/her messages and instructions to them" (P1).
Teamwork is one of the skills used to meet the challenges of today's competitive environment as a way to increase organizational flexibility and achieve other benefits.
"Teamwork is not related to levels and status. Thus, all workers should have this ability" (P3).
The skill of building effective and constructive relationships is networking.
"High-level health headquarters should know networking and should be able to identify and use different networks because, at these levels, works cannot be done without networking" (P21).
- Establish effective international communication and related skills
Due to the issue of health is one of the topics for which no boundaries can be imagined, it is necessary to have skills related to communication at the international level.
"Diseases exist all over the world. Therefore, we should be in constant interaction with the whole world and have the ability to communicate to exchange information" (P26).
- Forth theme: Individual competencies
Individual skill is learnable and teachable and is acquired and improved through experience. Sometimes this ability relates to an individual's thoughts and vision and is not physical.
Creative thinking means the power to develop new solutions to problems, and it is other expression outside the framework of thinking.
"The characteristics of this skill is that it helps other skills as well, meaning that the person is not content with just his own experiences and his thoughts are flexible so that he can try to create new things" (P12).
System thinking helps people examine the relation between structures, patterns, and events, and not just pay attention to the observations.
"They should have a holistic and systematic view that is, look at the issue through the entire health system and see their place in the health system” (P8).
Critical thinking means correct thinking in the pursuit of relevant and reliable knowledge about the world.
"One of the most important things is to have the ability to think critically” (P3).
- Skills related to ethics and moral values
The issue of ethics has always considered due to its scientific place in the culture of societies.
"Some competencies, such as ethics, seem to be common to all people working in the health system" (P2).
"Responsibility and accountability are needed at all levels, but accountability is more needed at higher levels. It is something that many people do not have” (P3).
- Skills to develop individual capabilities
Personal development is an effort and investment to develop individual skills. One of the experts said:
"Science is constantly changing. As a result, the health headquarters must be able to use the new sciences "(P9).
- Individual management and related skills
These skills help a person to manage and control himself/herself in a variety of situations. One of these skills is anger management that is, learning to control anger and the skill of maintaining calm and composure. Another skill is stress management. This skill refers to a wide range of techniques and methods designed to control individual stress levels. "It is very important for professionals working at this level to be familiar with stress management skills because they constantly face various pressures” (P11).
In addition, conflict management can increase creativity and promote innovation and change or waste the organization's energy and resources. Another related skill is self-motivation skill. Self-motivation means the ability to motivate oneself to move forward. This issue was also of interest to the experts (P8) (P10).
Fifth theme: Cultural and community competencies
Culture is defined as a complex set of knowledge, beliefs, arts, laws, ethics, habits, and whatever one learns as a community member.
- Familiarity with community health culture
A health culture is a coherent and systematic set of goals, values, beliefs, customs, and norms of a people belonging to a large community, ethnicity, or nation that leads to effective unhealthy and healthy behaviors.
"Familiarity with the overall health culture program, which is a set of values, beliefs, and norms that meet the needs of everyday life, is crucial" (P7).
- Knowledge about the health system
The health system consists of all organizations, institutions, and resources that provide services to maintain and promote the health of individuals.
"The health headquarters should be familiar with the structure of the health system” (P9).
- Advocacy and related skills
Many health programs designed to change behavior are not possible without reforming decision-makers' minds and changing public policy. "They should seek support and advocacy from and interact with other existing social organizations so that they move them in the direction of health goals” (P6).
- Familiarity with the structure of international health
The health systems of each country affected by international organizations involved in the field of health.
"They should follow the news of World Health Organization, and they are aware of the information and news inside the country so that they can update their information" (P10).
Sixth theme: Competencies related to administrative activities in the health sector
Working in the public health environment requires a set of skills, abilities, and knowledge that the lack of any of them can lead to dysfunction of experts.
- Familiarity with the related rules, regulations, and guidelines
Familiarity with the related rules, regulations, and guidelines provides a clear picture of duties and responsibilities.
"Since health headquarters prepare regulations in the organization, so they must be familiar with the legal basis of the creation of these documents; otherwise the organization will face problems" (P6).
- Familiarity with administrative correspondence
Administrative correspondence is the organization's official language, and it could lead to the organization's success and development. "Familiarity with administrative correspondence and knowing the hierarchy of correspondence is of the most important skills" (P4).
- Familiarity with computer science and related software
Every employee, regardless of his/her position, should be familiar with a series of specific skills to use technology practically. One of the experts said in this regard:
"Another important issue is the familiarity of health headquarters with different software" (P10).
The skill of honoring the customer
Proper communication of the experts of public and private organizations with the client and providing services to them through desirable and appropriate methods plays an effective role in improving the quality of services and customer satisfaction and correction of their view toward the relevant organization.
"Being customer-oriented, the customer of here can be experts in other areas, and not just outsiders, so this is also important.” (P10).
Phase 3: Descriptive results of the third stage: designing a proposed model of competence of HHW
Due to the results obtained from the analysis of the results of the previous steps, the competencies extracted for each level of HHW were determined. The summary of results obtained from this stage of the research has shown in Table 3.
Table 3 Competencies that are needed for any level of health headquarter workers based on mini- Delphi phase findings
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Leadership and management
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analysis, interpretation, and reporting
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interpersonal relationships
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Individual competencies
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Cultural and community competencies
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Administrative activities in the health sector
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Knowledge management
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Performance management
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Resource management
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Time management skill
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Empowerment and counseling and related skills
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Control management and related skills
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Change management and process improvement skills
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Financial management and related skills
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Organizing and related skills
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Planning and related skills
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Policymaking and related skills
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Leadership and related skills
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Reporting and related skills
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Follow-up analysis and getting feedback on implemented solutions
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Problem-solving, solution-providing, and decision-making skills
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The skills of collecting, analyzing, and interpreting data
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Topic or subject recognition skills
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Basic analysis skills
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Establish effective international communication
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Networking skills
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Teamwork skills
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Communication skills
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Individual management
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develop individual capabilities
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ethics and moral values
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Critical thinking
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systemic thinking
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Creative thinking skills
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Self-awareness
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Health promotion
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Familiarity with the structure of international health
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Advocacy and related skills
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knowledge about the health system
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Familiarity with community health culture
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Familiarity with administrative correspondence
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The skill of honoring the customer
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Familiarity with computer science and related software
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Familiarity with the related rules, regulations, and guidelines
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Level 3
Headquarters
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Level 2
Headquarters
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Level 1
Headquarters
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Guide: cells that are stained show required competency for each level of health headquarters
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Phase 3: Validation of the proposed model of general competencies of HHW by Delphi method
After sending questionnaires, 15 questionnaires were completed and collected. After analyzing the results obtained from the first round of Delphi, regarding the competencies required by the experts of the third level of HHW, all (100%) of the competencies were approved (average agreement scores above 75%). Regarding the competencies required by the second level of HHW, 29 competencies out of 38 items were approved in the first round of Delphi (65.8% of the competencies). Nine competencies entered the second Delphi stage for this group (average agreement scores below 75%), and finally, seven competencies were approved. Also, two items "Planning and related skills" and "Problem-solving, solution-providing, and decision-making skills" were removed from the set of competencies required for this category (average agreement scores less than 75%). Also, regarding the competencies required by the first level HHW, all 13 categories of competencies were agreed upon by the respondents in the first Delphi round.
Finally, in the third round of Delphi, to determine the level of competencies required by each expert group, three-level questionnaires (high level, medium level, and low level) were designed and sent. Fifteen answers were obtained at this stage. Then, based on each competency's mining score, the level of each competency required by each level of HHW was determined. Fig. 2 shows the final model of the general competencies of the HHW that obtained and confirmed in the Delphi phase.