Q&A with Dr. Kathy Wibberly, Director, Division of Primary Care and Rural Health, Office of Minority Health and Health Equity, Virginia Department of Health

In November 2010, Virginia was the only state awarded a $1.93 million State Health Workforce Development Implementation grant from HRSA, under funding authorized by the Affordable Care Act. This month, HWIC had the opportunity to interview program director Kathy Wibberly about Virginia’s health workforce efforts and accomplishments. Dr. Wibberly directs the Division of Primary Care and Rural Health within the Virginia Department of Health’s Office of Minority Health and Health Equity, managing the state’s Primary Care Office, State Office of Rural Health, and State Health Access Program grants.

While 25 states received workforce planning grants, Virginia was the only state to receive funding to implement a plan. Could you tell us about the groundwork that went into establishing the Virginia Health Workforce Development Authority (VHWDA) and how that factored into your state competing successfully for implementation funding?

During the development of Virginia’s State Rural Health Plan in 2008, the fragmentation and lack of coordination of the health workforce pipeline was identified as a key barrier to Virginia’s ability to more effectively recruit and retain health professionals in rural and other medically underserved areas. On top of that, the Area Health Education Center (AHEC) program in Virginia lost its State funding in 2008 largely due to its lack of strong leadership, unified vision, and integration into broader statewide health care workforce efforts. One of our Delegates introduced a bill during the 2009 General Assembly Session to create an infrastructure that would bring high-level decision makers together to facilitate changes/improvements in the coordination and development of the broad spectrum of health care workforce programs. My Office, within the Virginia Department of Health was asked to develop a legislative study report with recommendations to the bill language prior to the next General Assembly session.

We met with groups of stakeholders, conducted key informant interviews, and developed a blog site where the consolidated draft recommendations from the stakeholder input process was made available for public comment. Reaching consensus on a mission statement and a set of nine core functions when you have a group of over 70 individuals representing over 50 agencies and organizations was not easy, but we did it! Our legislative study report led to the language which established the Virginia Health Workforce Development Authority. Due to the economic realities within Virginia (and most other states in the nation at the time), State Appropriations were not requested. The enabling legislation was unanimously passed by both House and Senate and was signed by the Governor and enacted on July 1, 2010. Hence, the birth of the Virginia Health Workforce Development Authority. All that was lacking at that point was money!

I believe all of the groundwork that led to this shared vision was what uniquely prepared Virginia to apply for and be the first and only state in the nation to be awarded a State Health Workforce Implementation Grant.

What are some of the challenges the Virginia Health Workforce Development Authority was started to address?

The mission of the VHWDA as stated in the Code of Virginia is “to facilitate the development of a statewide health professions pipeline that identifies, educates, recruits, and retains a diverse, appropriately geographically distributed and culturally competent quality workforce.”

In practical terms, we accomplish this by addressing nine core functions, also stated in the Code of Virginia. The VHWDA assesses health workforce needs in Virginia; sets priorities for the AHEC program; informs the development of relevant health care workforce policy; promotes strategies for health workforce pipeline development; supports collaborations between communities, businesses, and social organizations to facilitate recruitment and retention efforts; advocates reducing the student debt load of health professionals; identifies High Priority Target Areas (HPTAs) within each region of the Commonwealth; and aims to create innovative health workforce development models.

How did you get all of the organizations with health workforce interests to reach consensus and work together?
Our first step was to inventory all of the health workforce efforts and initiatives that had taken place within Virginia over the last 15 – 20 years and to bring that information together with health workforce data to help us highlight not only the challenges of the existing infrastructure, but to then identify what might be needed to bring about workable solutions.

Consensus building was developed from a framework of inclusion. A vision was cast early on that the health workforce was to be inclusive of all health professions (not just nurses and physicians) and that the health workforce pipeline was to span the full spectrum of activities (both supply and demand side, and beginning at the primary and secondary school level and ranging all the way up through recruitment and retention in underserved areas). We held multiple meetings and included all stakeholders we could think to include.

These meetings with stakeholders focused less on wordsmithing and more on concept development. After establishing the core concepts, we used a blog site to make the drafting process completely transparent. All changes were made incrementally and were visible to the general public. I believe we were able to reach consensus because we were committed to listening. We took the stance right from the beginning that a win-win was going to be possible. Therefore, whenever a concern was raised, the concern was posted and a “fix” or solution was immediately proposed. I don’t think that consensus would have been possible without this type of transparency.

Who are some of the key partners involved in the implementation grant?
The key partners involved in our implementation grant — those with an actual role, responsibility, or funding commitment –include a number of state-level departments, offices, and organizations. In addition to the VHWDA, these are the Department of Health Office of Minority Health and Health Equity, the Department of Health Professions, AHECs, the Virginia Workforce Council, the Virginia Health Care Foundation, the Virginia Community Health Care Association, the Virginia Academy of Family Physicians, and the Virginia Rural Health Association.

One of the goals for your implementation grant is to set up the infrastructure needed to inform health workforce planning in the state. Could you tell us about the activities underway to better understand Virginia’s health workforce needs?
Our first task was to stand up the VHWDA. To date, the Board for the VHWDA has been appointed by the Governor, two Board meetings have been held (with a third scheduled for later in July), the by-laws have been drafted, and Committees have been established. The VHWDA is presently recruiting its first Executive Director; we are hopeful to have someone selected by the end of the month. Immediately following that, we will be hiring an Administrative/Fiscal Assistant and a Director of Development. We think the Director of Development will be a key player in the development of a business model and sustainability plan.

Our second task for infrastructure building, the Virginia Health Careers Student Registry, is just about ready to be launched. The purpose of the registry is to support pipeline development through “Growing Your Own”. The registry is intended to capture all individuals from Virginia, beginning at secondary school, who have an interest in a health career and to then link these students to programs, schools, and community based initiatives that can foster their development and interests. For example, the registry will target all the high school students who volunteer at their local hospitals or EMS agencies. Our AHECs will identify students and connect them to efforts and initiatives within their respective regions.

A third task is the expansion of our “Choose Virginia” conference. Developed initially for medical students, this year’s conference will be expanded to include residents. It’s one way to help highlight Virginia’s diverse regions and to expose future physicians to opportunities to practice in medically underserved areas in Virginia.

Another goal of your grant focuses on supporting regional partnerships. Could you talk about what’s being done around Virginia and how the different regions are approaching their health workforce efforts?

To support regional efforts, there are several major activities either already underway or about to be underway.

We are starting to develop our web-based “Health Chart Book” application, which will help Virginians identify health care, economic, and social conditions important for local and regional development efforts. We want the application to allow users to define “regions” in any way they choose, including the ability to group non-adjacent areas. We want planners to use this application to identify areas throughout the state that may have similar profiles and needs and to collaborate to meet those needs. The Health Chart Book will be built upon the existing infrastructure of the Virginia Rural Health Data Portal.

We will be making funds available for regional planning and implementation grants. This will pretty much emulate the way HRSA has made funds available to states. Provided the Health Chart Book application works as it is intended, we will be allowing a very broad definition of “region”. Proposals can come in as traditional “regions” or as user-defined regions based on similarities in needs.

As a state, we have historically had a hard time keeping track of model programs and best practices. I can’t even tell you the number of times we’ve heard great presentations about some amazing effort going on somewhere in the State, and a year or two later, no one can recall what the program was called or who to contact to replicate it. We are hoping to avoid that problem by using PhotoVoice to document how regions are transformed by their planning and implementation efforts.

PhotoVoice was developed In the early 1990s by Dr. Caroline Wang , a professor and researcher with the University of Michigan, School of Public Health. This method capitalizes on the power of photographs as a tool to influence public policy. Using the PhotoVoice methodology, photography will be used at the beginning of the regional efforts to document barriers to access to health care and the health workforce development pipeline and again, toward the end of the regional initiative, to capture outcomes and impacts. The images, processes and regional stories resulting from this PhotoVoice project will be made available to other Virginians and nationally through a website similar to the one developed by Kaiser Permanente for their Community Health Initiative.

What have you learned from your health workforce efforts? Were there unanticipated problems or unexpected early wins?

We are still early on in our learning process, but the biggest challenge we’ve encountered thus far pertains to standing up the Authority. This was the age old “chicken or the egg” issue. In order for the VHWDA to do the work on the implementation grant, they needed staff. In order to hire staff, they needed funds. In order for us to provide the VHWDA funds through the grant, they needed to establish a tax id, bank account, etc. In order to do this, they needed staff. To hire staff, they needed funds…you get the picture! This took way too much time to resolve, but it has been resolved. The solution that we ended up with was to have the VHWDA Board approve a short term contract for administrative and fiscal support services through an existing entity (in our case, the Virginia Rural Health Association). Phew!

What types of outcomes will you measure for this project?

We are aiming to increase the FTEs of primary care health care workforce by ten to twenty-five percent over ten years, improve the geographical distribution and diversity of the health workforce, and reduce hospital admissions for certain conditions within regional High Priority Target Areas (HPTAs) in order to ultimately improve the disability-adjusted life years for Virginians residing in those areas. These are all very long-term outcomes, but we are looking forward to our PhotoVoice project being able to show some of the short term outcomes. This might include students from particular regions registering in the Virginia Health Careers Student Registry, promotion efforts by the region at the annual Choose Virginia Conference, utilization of and satisfaction with the Health Chart Book, the amount of funds leveraged toward targeted regional HPTAs, new or expanded regional health care workforce planning and implementation efforts that emerge and/or policy and/or procedural changes that emerge.

What advice do you have for other states that are looking to implement health workforce initiatives?

Keep at it! Believe that a win-win is possible. Start with a vision and build from there. Be careful, you might just get what you ask for!

What’s next for Virginia’s health workforce efforts?

In the best of all worlds, the VHWDA will become effective and self-sustaining by the time our grant funds are expended. We are building a lot of things – including the Health Careers Student Registry – that we hope will lead to bigger and better efforts in the near future.

Kathy Wibberly can be reached at Kathy.Wibberly@vdh.virginia.gov or 804-864-7426.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.