Faces of Public Health: Daniel Barnett, MD

Oct 24, 2014, 1:59 PM

Faces of Public Health with Daniel Barnett, MD

News today that a fourth case of Ebola has been diagnosed in the United States underscores the urgent need to have health workers not just ready, but also willing to treat patients with the illness. Next Wednesday, the National Coordinating Center on Public Health Systems and Services Research (PHSSR) will be hosting a webinar on legal protections to help facilitate health worker willingness. Daniel Barnett, MD, an Associate Professor in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, will be the main presenter. Barnett and three Bloomberg colleagues, Leonie Ratko, JD, PhD, MPH, Jon S. Enrick, JD, MPH Carol B. Thompson, MS, MBA received funding from the Robert Wood Johnson Foundation and PHSSR to study the issue. PHSSR's Center is funded by RWJF and based at the University of Kentucky.

NewPublicHealth recently spoke with Barnett.

NewPublicHealth: What are the concerns with respect to health workers being prepared to take some risks in order to protect the public?

Daniel Barnett: There’s been a longstanding tacit dysfunction about preparedness trainings: That if you train someone in knowledge and skills in terms of how to respond, that will necessarily translate into a willingness to do so. But our work has shown that “training to knowledge equals training to willingness” is a false assumption. In other words, I can teach someone how to recognize anthrax or some other infectious disease agent under a microscope, but that in no way ensures that that individual will be willing to come to work to look at anthrax or another infectious disease agent under a microscope, and by analogy, any other type of frontline public health or health care response.

That’s been, frankly, a missing piece in public health preparedness training nationally and internationally, and I think that we need to really rethink paradigms of preparedness training and education to take a more holistic approach. In other words, an approach that recognizes that frontline healthcare workers and public health workers have fears and concerns attached to a whole variety of aspects of the events at hand.

Even before our grant began, my colleagues and I had looked at, since 2005, issues surrounding willingness of public health hospital providers and EMS providers and even medical reserve corps volunteers’ willingness to come to work in a variety of public health emergency scenarios. These have included, for example, pandemic influenza and radiological/dirty bomb terrorism events. We found that there are really two factors that are particularly important when understanding health care workers’ willingness to respond. One is this concept called self-efficacy — that individuals who feel confident that they can perform a given task, even in an uncertain or risky environment, are more apt to actually do so in real life. For example for a study we did among workers at a large urban hospital, individuals who had high self-efficacy were over 12 times more likely than individuals who didn’t to be willing to respond.

The other part is what we call response efficacy, and by us I mean there’s a whole body of communication research that describes this concept of response efficacy, which basically translates loosely into “I perceive that I matter if I show up.” In other words, trainings not only need to build a sense of confidence in performing one’s role-specific expectations, but they also need to instill a sense that in each responder, that he or she makes a meaningful difference in participating in response to an infectious disease outbreak.

NPH: What are other key findings of your work that shed light on helping responders to report for duty?

Barnett: Concerns about safety at work. One of the consistent barriers to willingness to respond that we found in all of our prior research is if healthcare workers and public health workers do not feel safe in their work environment in the course of response, they would be much less likely to be willing to respond. Now, that may seem obvious and seem intuitive. But public health emergency laws can, and in many cases do, speak to these issues of safety at work, of mental health resources and other protections such as liability protections that are relevant to response willingness.

Work by researchers at the University of Michigan has found that there’s a disconnect that seems to exist between laws that are on the books and public health and health care employees’ awareness that those laws exist. So a law can be very protective in its scope and impact, but if employees aren’t aware of its existence or don’t understand how it applies to them, it’s like a tree falling in the forest in terms of their own behaviors and their own willingness.

This speaks to the importance of not just having laws that protect health care and public health workers, but teaching them about what those laws are in the course of preparedness trainings and explaining how those laws pertain to them. And, in turn, giving them a sense of confidence that they’re going to be optimally protected in their work environment in the course of a public health emergency response.

NPH: Who should participate in the webinar, and what do you hope they will get out of it?

Barnett: I’m hoping that attendees will include policymakers; senior public health administrators at all levels; and health care workers and public health workers in particular. It’s important for these individuals and cohorts to understand how laws are or are not in many cases understood by those who are the boots on the ground in the response and who represent the boots on the ground in response. I hope that by having a broad range of participants in this webinar, that we’ll be able to bridge or partly eliminate the current disconnect that appears to exist between protected laws and responders’ awareness of them.

NPH: What else do you think needs to happen that would give greater confidence to public health workers when it comes to the current Ebola crisis in particular?

Barnett: What I’d like to see happen is frankly at the senior policy level, and even legislative level, for lawmakers and policymakers to really revisit current public health emergency preparedness laws and perhaps consider adapting or revising them to reflect the research that is clearly indicating the fears and concerns of frontline health care workers. I think that research can and needs to inform policy in general.

This is a teachable moment in the context of Ebola where we can modify or add laws if they don’t currently exist in certain jurisdictions to address employees’ fears about personal safety in performing their duties during the Ebola outbreak, or during other infectious disease responses down the line. And I also believe that it’s important that trainings in preparedness explicitly include employee awareness of legal protections that do exist so that we can avoid this tree falling in the forest phenomenon of laws that may be on the books and may be very well written and may indeed by very protective, but employees’ lack of awareness of their existence rendering them less impactful because employees are afraid to come to work.

This commentary originally appeared on the RWJF New Public Health blog.