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II. Standards and Suggested Practices

B. Staffing, training, and communication

Obtaining high-quality data requires the coordinated efforts of many persons, including service provider staff (e.g., HIV counselors and supervisors) and health department personnel (e.g., data entry staff, data managers, data analysts, and CTR program managers). Although not every staff person needs to be a data expert, everyone should understand the programmatic advantage of, and work toward, ensuring high-quality CTR data. One way to communicate this information is through training in data QA upon initial employment and during ongoing staff development activities that focus on improving data quality.

Health department CTR staff should communicate regularly with service providers about data issues, emphasizing that obtaining high-quality data is an integral part of their work. To communicate this value, health department staff should demonstrate to service providers the programmatic uses of data, including how data are used to document CTR service needs in a community and how data facilitate adequate program funding to address those needs. Health department staff should appreciate the challenges that service providers face and help build implementation capacity by routinely providing technical assistance in data QA. Health department staff can build their own capacity by encouraging regular communication between CTR program and data staff and with other health department teams.

Standard B1. Health departments should assign appropriate staff, with clearly defined roles and responsibilities, to perform CTR data QA activities

Health department staff and service providers are the backbone of CTR programs and data QA. Employing a sufficient number of staff members with the appropriate qualifications and skills is essential. Managers should identify what roles are needed to perform data QA activities, how many staff members are needed to fill the positions, and what the minimum qualifications should be to succeed. Because not all health departments have the resources to employ dedicated data QA staff, it is critical to develop a thorough job description that includes the appropriate data QA responsibilities for every position. Clearly defined roles and responsibilities are a first step toward ensuring that despite understaffing or temporary vacancies, the range of CTR data QA activities is covered.

Examples of data QA roles and responsibilities

  • Provide regular staff training in policies and procedures, including the security and confidentiality of HIV/AIDS data.
  • Update and distribute the protocol regularly.
  • Periodically supervise counselor-client interactions to assess the need for additional training in eliciting or documenting client data.
  • Communicate with service providers and health department staff about needs for technical assistance.
  • Follow up with service providers about clients who test HIV-positive to ensure that linkages to care and treatment services are provided and that these linkages are properly documented and reported.
  • Establish, update, and communicate clear data-transfer requirements to service providers.
  • Monitor the transfer and receipt of CTR data from service providers.
  • Verify and correct data errors regularly, communicating with service providers as needed.
  • Screen data to identify aggregate- and record-level data errors in CTR database.
  • Implement data-cleaning procedures to resolve errors.
  • Maintain and review a log of the records submitted to CDC and the records that require follow-up.

When the roles and responsibilities for a position are clear, it is easier to reassign tasks during staff absences. Also, when staff members are assigned additional duties for an extended period or when additional responsibilities become a significant part of the scope of work, job descriptions should be updated to reflect the added duties. When data QA activities are written explicitly into job descriptions, CTR staff members know exactly what is expected for each position, and the health department can provide the necessary training for these assigned activities. Ultimately, employees who understand the importance of their data QA roles are more likely to invest their time and energy in producing high-quality data.

Despite concerted planning, gaps in staffing occur. In instances of high staff turnover, it is easier to fill vacancies when related job responsibilities can be clearly and easily communicated. Whether an organization needs to replace staff members who have retired or moved to another position or needs to cover common employee absences (e.g., vacation or maternity leave), it is essential to have a backup staffing plan to ensure that necessary data QA tasks are completed correctly and in a timely manner during the interim. For example, organizations with a backup staffing plan can easily and quickly reassign essential tasks to other staff members, without compromising the quality of their data until regular staff members have returned or vacancies have been filled.

Resource

  1. Sample position descriptions (Ohio)

    Includes examples of position descriptions for an epidemiology supervisor, an epidemiologist, and a data entry operator.

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Standard B2: Training in QA policies and procedures should be provided to health department staff soon after they are hired and as part of staff development activities.

Health department staff should provide training in QA policies and procedures to new CTR staff soon after they are hired. This initial training provides CTR staff with the foundation necessary to support the production and management of high-quality data. Also, health departments should provide periodic staff development activities for both health department staff and service providers to enhance their data QA practices and to communicate changes in policies and procedures. Even in an environment of limited resources, an effort should be made to integrate content from data QA policies and procedures into training and staff development activities. Basic training in data QA practices can preclude common errors and other problems and thus contribute to more efficient use of staff time and resources.

Initial training

Health departments should incorporate data QA training into a more comprehensive initial training or orientation. This integrated training should be mandatory within 60 days after employment to ensure that new staff members promptly receive the information they need to implement data QA practices. Adding a data QA module to a standard initial training or orientation is critical to introduce the value of high-quality data and help staff members overcome fears of data or of program evaluation. This module should cover the essential concepts of data quality, such as the importance of having high-quality data, the CTR data life cycle (see Figure 1),  gathering a complete set of CTR variables, regularly checking the accuracy of data, and processing data in a timely manner. This information can help new staff understand how data are processed in the system and how the absence of careful data QA practices can compromise data quality throughout the stages of the life cycle.

A data quality module should also include information about health department data QA policies and procedures, including HIV/AIDS data security and client confidentiality. Presentations with graphs, charts, and tables of data submitted by service providers can effectively demonstrate what CTR data look like, what the numbers mean, and how high-quality data collected during CTR sessions contribute to information vital for understanding trends, program improvement, and decision making. The training module offers an opportunity to communicate to service providers the ways they can use high-quality data (e.g., helping to get more funding).

The data quality module should also explain the risks of producing and using poor-quality data. For example, decisions based on poor-quality data may lead to inaccurately refocusing prevention efforts on another population or to underfunding venues that have identified large numbers of HIV-positive clients. Health departments should also incorporate QA of data collection, entry and management into their current training for CTR service providers and should provide training materials such as templates, manuals, and slides.

Possible training topics for service providers

  • Importance of data quality and how data can be used to help improve local CTR programs
  • Guidance in CDC-required CTR data variablesAccurate collection of complex and sensitive data without interfering with a client-centered session
  • File and chart management which ensures compliance with security and confidentiality policies and procedures
  • Correct entry and submission of required CTR data
  • Prevention and resolution of common errors in data collection and entry
  • Implementation and monitoring of CTR data QA procedures at sites, including monitoring data for completion and accuracy

Staff development

Staff training should not be a one-time event. After the initial training of new employees, all health department staff should participate in in-service training and other staff development and information-sharing activities. One way to foster the development and adoption of a “culture of high-quality data” is to provide opportunities for staff development in the QA of CTR data both to health department staff and service providers. Staff development is a dynamic process of creating and providing regular opportunities for staff to maintain and improve their professional skills and increase their effectiveness. Often staff members identify their own training and development needs. Managers and supervisors can encourage or schedule additional activities.

Examples of staff development activities

  • Training
  • Attendance at meetings and conferences
  • Partnering with an experienced colleague for a time to learn by example and experience
  • Being shadowed by an experienced colleague so that needs for training or technical assistance can be identified
  • Supervisor observation of staff members during performance of their work duties to ensure completion of training and mastery of new skills

Staff training may be conducted by various providers and through different approaches. For example, in some jurisdictions, training is provided, at least in part, by the health department’s surveillance staff. Training can be provided (in person) at the health department, through field assignments, or by using computer-based training modules. Regardless of the venue or type of activity, the schedule of staff development activities should be regular (e.g., quarterly or semiannually) and based on the extent of staff turnover and changes in how CTR data are processed. All staff development activities should be documented in each employee’s file. A log or a database can be used to track employees’ participation in staff development activities.

Performance review

Supervisors should periodically review staff members’ performance of data QA practices. The review should include documentation of employee achievements, challenges, and recommendations for improvement related to data QA tasks. This review should not be a negative or punitive practice, but a constructive part of the overall performance review conducted regularly by supervisory staff. Once areas for improvement have been identified, specific staff development activities should be offered to staff to help them adhere to the health department’s data QA practices

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Standard B3: Health department staff should communicate with service providers regularly and provide them with continuing technical assistance to build their data QA capacity.

Health department staff should communicate regularly with service providers to better understand the challenges related to collecting and processing high-quality CTR data. Service providers should also understand the value of implementing data QA practices at their site, what happens to their data after collection and entry, and how they can help with the feedback process. For example, health department staff might gain an appreciation for how easy it is to make errors during the data collection process, and service provider staff might learn how CTR data can be used to inform decisions about funding, allocating, and advocating for resources for HIV prevention services at the jurisdiction level. To accomplish this mutual understanding and buy-in, health departments and service providers should build collaborative relationships through technical assistance sessions, monthly data calls, annual meetings, and regular e-mail communication. Health department staff can use these types of communication to share information about their expectations regarding data quality (before problems occur) and to provide feedback focused on improvement of data QA.

Resources that can be provided through a Web site

  • Data collection forms
  • Lists of-required CTR variables
  • 2009 QA Standards
  • Templates for a procedures manual
  • Master code lists (e.g., agency identifications, site identifications, and site types)

Identifying an advocate for high-quality data among service provider staff is another strategy that health departments can use to facilitate communication about their expectations. Data advocates can work with health departments to identify challenges and communicate responsive guidance to their staff.

Another way health departments can identify QA issues early in the process is by maintaining a log or database of information about a CTR service provider’s data (e.g., when data were submitted, data completeness, common errors in the data). By routinely monitoring CTR data activities and communicating regularly with service providers, health departments can identify specific challenges that service providers face and provide the appropriate training, technical assistance, or resources. Technical assistance may be provided to service providers through phone calls, e-mails, face-to-face meetings, site visits, or narrative reports and can be provided by CTR or other health department staff as well as external training or technical assistance providers. Technical assistance meetings for providers who are experiencing challenges with certain aspects of their program (e.g., use of data for program evaluation) can help build capacity and facilitate more frequent local use of data. These technical assistance meetings can be tailored for the site to maximize their time together and provide specific and relevant assistance.

A Web site can be a very efficient and effective mechanism for disseminating information and materials from the health department to CTR service providers. A health department can update its CTR Web site regularly with relevant information, users can easily access tools and templates through links, and users can tailor the electronic tools and templates to fit their needs

Strategies for providing effective data QA technical assistance

  • Communicate regularly with service providers.
  • Identify a data advocate among the service provider staff.
  • Maintain a log of CTR service providers’ data-processing reports.
  • Provide, as needed, specific technical assistance to service providers.
  • Post resources on a Web site.

Resources

  1. AIRS [AIDS Institute Reporting system] software basic training guide (for data entry)

    Detailed example of a health department’s training manual designed for data-entry personnel; provides step-by-step instructions and screenshots for entering data into a local software system.

  2. Memo on training on new HIV test form (Louisiana)

    Excellent example of clear communication between the health department and testing sites about the provision of follow-up training on the data collection guidelines for new HIV test forms.

  3. Training and technical assistance log

    Document to help health department CTR staff track annual training and technical assistance for service providers to enhance quality assurance of CTR data.

  4. Web site with information on agency forms and materials (San Francisco)

    This Web site features complete, updated list of CTR templates, forms, policies and procedures, and other materials that service providers need to fulfill their data requirements: a model of the kind of easy-to-access and easy-to-use information that health departments can make available to service providers via a Web site.

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Standard B4: Health department CTR staff should communicate regularly with other departmental staff.

In health departments, CTR program and data staff members can be focused in two very different ways. Program staff members typically concentrate on coordinating service provision, training CTR counselors and supervisors, and improving CTR services. Data staff members typically work with the numbers and information resulting from CTR programs. Both perform functions that are critical to an effective and efficient CTR system. Health departments should hold regular joint staff meetings for CTR program and data staff. For example, data analysts should share CTR data reports that CTR managers can use in planning training and technical assistance for service providers, and program staff should explain the kind of information needed to make decisions and improve programs so that data staff members understand which reports are most useful. Another way for health departments to improve communication and support within CTR departments is to assign someone with both a program and a data background to serve as a liaison between the teams. This person can provide a program perspective during data discussions and explain complex data reports and findings to program staff.

Also, CTR staff should participate in regular interdepartmental meetings with other HIV prevention groups, such as surveillance staff, information technology (IT) staff, and even community planning groups. Frequent communication provides staff with up-to-date information about changing needs and practices and creates an opportunity to find solutions. For example, if IT staff members are responsible for setting up, maintaining, and troubleshooting hardware and software applications for CTR programs or for storing data and administering rights and passwords, regular communication is essential to ensure smooth operations. Improved internal communication also allows staff from different programs to have a common understanding of needs and available resources, address issues raised by other staff, convey consistent messages to external stakeholders, and acknowledge team improvements and collaboration.

Finally, health department staff should communicate often with those at higher levels in the organization to obtain buy-in on data QA practices. The information in this document can help provide departmental leadership with a rationale for supporting QA practices and infrastructure.

Strategies for effective internal communications

  • Conduct regular joint staff meetings
  • Share information and data needs in a timely manner so that teams can support each other
  • Assign a staff member with a background in program and data to serve as a liaison between teams
  • Meet regularly with other HIV prevention teams, such as IT and surveillance staff and community planning groups
  • Communicate with supervisors and decision makers

Special considerations for staffing, training, and communication in clinical settings

Clinical staff may be less familiar with the programmatic advantages of collecting testing data, consider it time-consuming, or view it as outside their typical job responsibilities. Training in the rationale for collecting and reporting testing data to CDC and completing the tailored data collection forms and/or systems developed for clinical HIV testing initiatives is recommended for all clinical testing staff. This training should cover basic data QA activities and also emphasize the usefulness of testing data to increase buy-in from clinical staff and improve data quality. All staff should be trained when a testing program is being expanded, and new staff should be trained shortly after they are hired.

Health department CTR staff should communicate regularly with clinical staff about data issues and emphasize the importance of high-quality data. Health departments should identify a data advocate in each clinical setting—a person who can assist with communications about testing data and also help health department staff appreciate the challenges and limitations that clinicians face. Finally, health department staff should expect to provide continuing training and technical assistance to clinical staff.

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Resources will be made available in the future

 

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