Integrated Planning for the Air Force Senior Leader Workforce: Background and Methods

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Monitors the effectiveness of programs through inspection, observation, report review or analysis. Develops and recommends policy that is consistent with the guidance of the Adjutant General. Resolves difficult and sensitive mission oriented problems identified through audits, inspections, complaints or investigations. Translates policies of the Adjutant General into written policy statements assuring that affected officials are fully acquainted with the same.

Follows up on those matters requiring action and ensures timely completion. Authorizes and signs policy, procedures and correspondence on behalf of the Adjutant General or his designated representative. Serves as the state executive responsible for the development of state long-range plans that correlate with USAF and ANG integrated planning processes. Responsibilities include team approaches to planning using a wide range of resources and people from varied weapon systems and disciplines within the ANG.

Developed plans serve as the long-range guide for the Adjutant General, Assistant Adjutant and civilian officials in determining future needs and requirements for the State Air National Guard. Serves on national committees and advisory groups for long-range planning, special initiative studies and integrated planning. Supervises state headquarters full-time staff. Ensures operational units are provided with adequate guidance, manpower, resources and facilities to support both federal wartime and state domestic missions.

Develops state programs and initiatives necessary for implementation of ANG unit reengineering efforts. Monitors subordinate ANG units to ascertain that their programs and activities are conducted within parameters established by higher headquarters, applicable directives, regulations and public law. Develops and prepares analysis and recommendations requested by legislative and other public officials. Coordinates news releases and other media events on items of interest to the Air National Guard members and the community.

Serves as the ANG coordinator for the State Partnership Program and maintains liaison with military officials and representatives of the respective partnership nation. Develops initiatives and programs to resolve difficult and complex problems with respect to public and community relations. Maintains liaison with high level and senior officials in the private and public sector to foster a civilian employment environment that supports the ANG mission. Responsibilities include determining state recruitment and retention goals to meet mission requirements. Develops and implements the recruitment programs for pilots, navigators, and officers including the acquisition of military school allocations.

Directs the efforts of the State Recruiting and Retention Superintendent and Military Personnel Management Officer MPMO to ensure recruiting and retention funds are properly expended to meet strength management requirements. Utilizes senior level expertise to serve on national and inter-state boards, committees and advisory groups. Researches and recommends command actions on medical waivers. Acts as focal point for all environmental issues and compliance matters within the State ANG. Formulates policies and procedures that ensure units are representative of the diverse populations that are represented in communities and demographic areas.

Meets with representatives and officials of minority organizations in order to foster a positive recruitment and retention arena. Directs the activities of the state human resources advisor to ensure units are representative of diverse groups.

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Reviews, evaluates and analyzes diversity policies and programs to determine impact on mission capability and readiness. Meets with senior military officers and civilians in regard to statewide activities and projects. Directs changes as required.

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Reviews correspondence prepared with and for local and higher headquarters. Conducts staff assistance visits to subordinate units on a regular basis. Reviews and approves state headquarters travel. Interviews prospective federal and state employees of the State Headquarters. Approves personnel actions, counsels and evaluates subordinate employees. Assures compliance with published civilian and military personnel management policies.

Round 2 and 3 questionnaires were a reflection of the data collected in Round 1 and were developed into quantitative questionnaires.

Survey for Senior Leadership

Pre-testing of the questionnaires was conducted, in all rounds. The participants who were selected to pretest the tool comprised a purposive sample of nurse leaders senior management level positions whose role included participation in the policy development process.

These individuals were excluded from the main study. The participants indicated that they found: the questions clear; language acceptable; topic relevant to nursing and related to health policy development; and the instrument user friendly.

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Delphi surveys mainly are concerned with face validity and content validity. Face validity was achieved by pre-testing the tool for exhibiting: clarity of content, being reflective of the topic studied, clarity of language, being unambiguous and readable [ 45 ]. Content validity was enhanced in three respects. Second, all three questionnaires were pre-tested with a representative sample of nurse leaders, to ensure that the concepts included in the study were actually related to health policy development process.

Third, the purposive study sample was comprised of a panel of experts who participate in the health policy development process.


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The qualitative data from the open ended questions in the Round 1 questionnaire were transcribed verbatim into Word documents; the documents were read for relationships and patterns. Similarities and differences were identified; words and phrases were grouped by cutting and pasting the Word document into clusters of similar ideas and concepts and by highlighting in different colours. This procedure aided in grouping similar ideas together and identifying the most commonly occurring attributes and concepts.

The analysis of this phase was undertaken independently by the researcher and an assistant; individual notes were compared to validate the concepts that occurred. The concepts that most commonly occurred were then developed by the researcher into questions for questionnaire. The areas that deferred were noted and reevaluated by the researcher and assistant. These questionnaires utilized a Likert scale with numerical values attached to the scale range: one 1 indicated strongly agree and five 5 indicated strongly disagree.

Data were analyzed utilizing descriptive statistics. Data reported in this paper are mainly frequency distributions that include summaries of categories, percentage agreement, mean and standard deviation. In this study, consensus was built over three rounds. The first round generated unstructured data that are presented in the first column as labeled in the tables.

Categories that did not achieve convergence in the second round were omitted from the third round; these have been left blank and highlighted in the tables. Approvals were secured from the National Councils concerned with research clearance in Kenya, Uganda and Tanzania. Right to autonomy was respected and informed consent attained by explaining the benefits, rights and risks involved in the research study in writing. Consent to participate was assumed by the return of the questionnaire.

Once the questionnaires were returned they were stored securely. The information collected was presented anonymously as group views. This meant that the data presented in aggregate form, representing the collective views of the expert panel members [ 47 ]. A database of expert panelists was created through networking with relevant offices because a database with the current information pertaining to the nurse leaders was unavailable.

This database formed the basis for developing the sampling framework. The questionnaires were delivered to all the 78 nurse leaders incorporated in the study via email, and printed copies were hand delivered and also sent to their postal addresses with self-addressed envelopes to facilitate return of the questionnaire.

Follow up reminders were made via email and by telephone. The data collection process was conducted between September and May , for the three rounds. The demographic data indicated that the participants were representative of the target population identified as having had opportunity to be part of the policy making arena. A majority, 16 Participants were mainly from urban settings. A majority of the participants were from the Ministry of Health 17; This demographic may suggest that nurse leaders do not remain in health policy positions for long periods and that by the time they secure policy related positions they are older and nearer retirement.

As such, nursing might be losing nurse leaders with experience and expertise in health policy to retirement.

The concepts identified are shown in the first column of the tables. The second and third rounds built consensus on the most critical and important elements of these concepts and are shown in the second and third columns of the tables. A high degree of consensus was achieved about facilitators identified to enhance participation in health policy activity. These facilitators included: being involved; being knowledgeable and skilled, being supported; positive image of nursing; enabling structures and available resources. There was consensus in Rounds 2 and 3 among the expert panelists on the facilitators related to involvement in the policy development process.

Positive image of nursing was identified as another facilitator.

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There was consensus among the expert panelists on the facilitators related to the image of nursing. There was consensus in rounds 2 and 3 among the expert panelists that resources are required for participation in health policy development activities. The categories identified in the first round were: lack of involvement; lack of knowledge and skills; negative image of nursing; lack of enabling structures and lack of resources. There were a number of areas that were identified as barriers in Round 1, however, that did not achieve consensus in Round 2.

These areas were omitted from Round 3 as indicated by the blank areas in the tables. There was consensus Rounds 2 and 3 among the expert panelists on two barriers related to lack of opportunity to become involved in health policy development. The remainder of the barriers related to lack of involvement did not attain strong consensus as required for this study and were omitted from Round 3. This indicated a divergence in opinions that was interpreted as disagreement and lack of consensus. These barriers were therefore omitted from the next round. This study include a higher number of males compared to the national average which might have influenced this percentage average.

These include not possessing resources and being able to mobilize these for policy making activity. Facilitators included: being involved; possessing knowledge and skills; being supported; positive image of nursing; enabling structures; and having resources. Barriers included: lack of involvement; negative image of nursing; lack of structures; and resources. The facilitators and barriers were largely interconnected.

The concept of support was a facilitator but did not appear to be a strong barrier. Whilst most concepts identified as barriers to participation attained consensus in Rounds 2 and 3, there were some barriers that did not attain consensus in Round, and were omitted from Round 3 of the study. These findings concur with Rains and Carroll [ 48 ] findings that indicated that being educated on health policy led to increased self-perceived competence in knowledge, skills, and understanding within the context of health policy activity.

Furthermore studies by Byrd et al. Furthermore, knowledge and skills can be enhanced if nurse Leaders enjoy access to supportive mentorship and role modeling from leaders who have been actively involved in policy development activities. However it is not clear whether these nurses had learned about policy development and issues pertaining to political activity.

The current study extends current knowledge, derived from studies in other contexts, and provides evidence that this facilitator is relevant in the East African context. The results also indicate that being involved in policy development activity was a facilitator for participation in policy development.

A recent study by Taylor, Fair and Nikodem [ 51 ], conducted in South Africa, with health professionals to examine their suggestions towards improving HIV-related maternal care, confirmed that nurses would like to be involved in health policy decision making. Other studies also are consistent with current study findings [ 13 , 26 , 37 ]. Furthermore, current study findings support the importance of providing nurse leaders with opportunity to gain experience and competence in participating effectively in policy development to having their voices heard and honored.

A positive public image of nursing dictates how society will value nurses and their input in health policy decision making and further will dictate whether or not nurses will actually be part of the process. Similarly, other studies indicate that nurses are not able to influence health policy development as they are not present in large enough numbers and therefore need to increase their numbers in policy activities [ 24 , 53 ]. Influencing policy development and the course of the health policy is largely about securing resources for health care; and the work of participating in policy development activity also is in itself resource intensive.

These include: lack of involvement; negative image of nursing; lack of structures; and resources.


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  4. However, not all barriers identified in Round 1 were retained by the expert panelists as the iterative rounds progressed and as the expert panelists re-evaluated their ideas in relation to the group summaries and statistics. Elimination of certain barriers suggests that the barriers were not altogether applicable to the entire group of expert panelists. Furthermore, this study set a high level of consensus as the threshold for convergence.

    The barriers that did not attain universally strong consensus were all barriers related to knowledge and skills, some barriers related to involvement, and a few barriers related to structures and resources. The findings of the current study indicate that whilst the expert panelists believe that knowledge, skills, and education are necessary for participation in health policy, lack of these are not a barrier to their participation. They lack opportunity to be part of the whole process; instead, they tend to be called upon on an ad hoc basis, which results in an inadequate representation and preparation for and hence in participation in policy forums.

    Opportunity to be involved would engender experience, confidence and competence; hence, lack of opportunity may lead to deficiency in involvement. Their potential contribution to this process is not recognized as significant and they are not included in it by policy makers. Furthermore, Dollinger [ 25 ] concluded that nurses in the USA, exhibited little ability to influence policy due to the lack of status of the nursing profession and the dominance of the medical profession in government. In addition, structures exclude national nurse leaders from the policy development process.

    These structures confine nurse leaders to occupying relatively junior positions, recruitment policy for national nurse leadership being unclear and health policies are developed at national level. The majority of policy development appointments are given to doctors and other health professionals who then represent nursing issues at the health policy development forums.

    The top-down approach toward policy development is not novel: numerous authors cite this problem [ 41 , 54 , 55 ] and all cite top down management at government level, with the government setting the priorities and nurses being the implementers. Opportunity to be involved would engender experience; hence, lack of opportunity leads to a deficiency of experience. There was divergence of opinion with regards to most policy making positions are given to male leaders and nursing leadership positions are political positions. Of interest is that in this study did include a higher number of males These barriers, whilst fewer than the facilitators, appear to be formidable as they exclude a significant portion of these leaders from participation in the policy development process.

    These facilitators f and barriers b were interconnected and there seem to be push and pull factors that included: being involved f and lack of involvement b , being knowledgeable and skilled f and lack of knowledge and skills b , enabling structures f and lack of enabling structures b , positive image of nursing f and negative image of nursing b , and availability of resources f and lack of resources b.

    Although the concept of support was a facilitator but did not appear to be a strong barrier. This spiral further prevents nurses from gaining experience and exposure and being involved in policy processes. Some of these facilitators appear to be available to a portion of the nurse leaders who are able to be part of the health policy development process, although there is a significant proportion that is excluded from the policy development process.

    Nurse leaders appear to want to be part of the health policy development process. There is opportunity for their participation to be enhanced in terms of involving higher numbers of nurse leaders at policy development level; and those who already occupy national positions the process must be more inclusive and open to ideas, suggestions and input from nurse leaders who are, and will be, part of the process.

    However, this can only occur if barriers to participation in the policy development process are overcome. The health policy development process needs to be pluralistic and inclusive of all nurse leaders practicing in positions related to policy development. Additionally, nurse Leaders need to proactively reexamine their own roles with regards to health policy development and strive to formalize these roles with job descriptions that include participation in health policy development. Furthermore, there is need for development of competencies by leaders that would foster inclusion in the process.

    Nurse leaders, through their professional organizations and their positions, need to lobby and create an enabling environment that will engender greater involvement of nurses in this arena, proactively. Nursing education as a whole needs to engender health policy development as a core area of nursing practice and relate clinical practice, education, research and leadership content to broader health policy implications. The nursing curriculum needs to reflect health policy education as a significant component of the educational process. Nurse educators need to take an active role in health policy development activity and provide exposure for nurses as well as being role models and mentors in this area of practice.

    Furthermore nursing books and literature at basic level need to reflect this vision clearly as part of the nursing role. Furthermore, there is the need to explore barriers that did not attain high degree of consensus as these may indicate differences within the sample, and hierarchy.

    A number of study limitations need to be acknowledged. This threshold was intended to ensure that only critical issues were retained in the study in the second round and that in the third round, important issues were not lost. This might have led to elimination of some significant issues. Several areas where there was lack of consensus emerged, and this might constitute a limitation of this study. Lack of consensus may be related to the proportion of the expert panelists from various sectors which might have affected the retention of certain issues such as gender related ones.

    Perceptions of the different sub-groups might be different from the perceptions of the group as a whole. These need to be noted and considered when interpreting the research findings. Other countries in East Africa were omitted. Therefore, the findings are applicable only to the countries where the study was conducted. A disadvantage of the Delphi survey method is that expert panelists may change their minds during the course of the study.

    This might have been the case in this study where a number of barriers were cited by the expert panelists in the first round; however during the iterative rounds several barriers were eliminated. This may have resulted in some relevant nurse leaders being excluded. And as Polit and Beck [ 45 ] caution, it is likely that a segment of the population will be systematically underrepresented; therefore, interpretation of the findings must be made with caution.

    The findings of the study indicate that both facilitators and barriers to policy involvement exist. The former include: being involved in health policy development, having knowledge and skills, being supported, enhancing the image of nursing and enabling structures and processes.

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    The latter include: lack of involvement, the poor image of nursing and structures and processes which exclude them. There appears to be a window of opportunity as there are more facilitators than barriers; therefore, there is presently greater prospect for enhancing their participation in health policy development. Citations of law and regulation are provided. Also included are miscellaneous non-Title 5 authorities. Veterans Employment Opportunity Authority - Veterans Guide VetGuide information about the Veterans Employment Opportunities Act of that allows eligible veterans to apply for positions announced under merit promotion procedures when the agency is recruiting outside of its own workforce.

    Veterans Recruitment Appointment Authority - VetGuide information about a special authority allowing agencies to appoint eligible veterans without competition to positions at any grade level through General Schedule GS 11 or equivalent.

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