Addressing Urgent Public Health Workforce Needs: Building Informatics Competency and Strengthening Management and Leadership Skills

The First Nationally Representative Benchmark of the Local Governmental Public Health Workforce: Findings From the 2017 Public Health Workforce Interests and Needs Survey

Context:

A changing public health landscape requires local governmental health departments (LHDs) to have a workforce prepared to meet complex challenges. While previous assessments looked at organizational data on the LHD workforce, the Public Health Workforce Interests and Needs Survey (PH WINS) is the first nationally representative survey to examine individual perceptions of training needs, workplace environment, job satisfaction, and awareness of emerging concepts in public health.

Objectives:

Characterize key interests and needs of the local governmental public health workforce.

Design:

Survey invitations were sent to individual LHD employees on the basis of a stratified sampling approach. The LHDs had to employ a minimum of 25 staff and serve a population of 25 000 or greater to be eligible for inclusion.

Setting:

399 LHDs across the United States.

Participants:

A total of 26 533 LHD employees completed the survey (59% response rate).

Results:

The majority of local public health workers are female (81%, 95% confidence interval [CI]: 78%-84%) and white non-Hispanic (68%, 95% CI: 64%-72%). Of the nearly quarter of workers who declared an intent to leave within the next year excluding retirement (22%, 95% CI: 19%-25%), the most common reasons included pay (46%, 95% CI: 42%-50%), lack of opportunities for advancement (40%, 95% CI: 38%-50%), and workplace environment (30%, 95% CI: 27%-32%). Across jurisdiction size and supervisory level, skills gaps were noted in budget and financial management, systems and strategic thinking, developing a vision for a healthy community, and change management.

Conclusions:

As the first nationally representative sample of the local governmental public health workforce, these data create a national benchmark against which LHDs can measure their workforce. Given the similarities found across LHDs serving different jurisdiction sizes, a unified approach to workforce development should be employed across all LHDs. The LHD leadership should address retention, reward creativity and innovation, improve communication between leadership and employees, and provide opportunities for advancement.

Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States: a qualitative case study

BACKGROUND

Public health agencies are responsible for implementing effective, evidence-based public health programs and policies to reduce the burden of chronic diseases. Evidence-based public health can be facilitated by modifiable administrative evidence-based practices (A-EBPs) (e.g., workforce development, organizational climate), yet little is known about how practitioners view A-EBPs. Thus, the purpose of this qualitative study was to understand state health department practitioners' perceptions about how A-EBPs are implemented and what facilitators and barriers exist to using A-EBPs.

METHODS

Chronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors were recruited to participate in telephone interviews using a snowball sampling technique. Interviews were transcribed verbatim, and transcripts were analyzed using a common codebook and the a priori method in NVivo.

RESULTS

Twenty seven interviews were conducted with practitioners in four states (5-8 interviews per state). All practitioners felt that their work unit culture is positive and that leadership encouraged and expected staff to use evidence-based processes. Participants discussed the provision of trainings and technical assistance as key to workforce development and how leaders communicate their expectations. Access to evidence, partnerships, and funding restrictions were the most commonly discussed barriers to the use of A-EBPs and EBDM.

CONCLUSIONS

Results of this study highlight practitioners' perspectives on promoting evidence-based public health in their departments. Findings can inform the development and refinement of resources to improve A-EBP use and organizational and leadership capacity of state health departments.

Lessons Learned in Promoting Evidence-Based Public Health: Perspectives from Managers in State Public Health Departments

Evidence-based public health (EBPH) practice, also called evidence-informed public health, can improve population health and reduce disease burden in populations. Organizational structures and processes can facilitate capacity-building for EBPH in public health agencies. This study involved 51 structured interviews with leaders and program managers in 12 state health department chronic disease prevention units to identify factors that facilitate the implementation of EBPH. Verbatim transcripts of the de-identified interviews were consensus coded in NVIVO qualitative software. Content analyses of coded texts were used to identify themes and illustrative quotes. Facilitator themes included leadership support within the chronic disease prevention unit and division, unit processes to enhance information sharing across program areas and recruitment and retention of qualified personnel, training and technical assistance to build skills, and the ability to provide support to external partners. Chronic disease prevention leaders’ role modeling of EBPH processes and expectations for staff to justify proposed plans and approaches were key aspects of leadership support. Leaders protected staff time in order to identify and digest evidence to address the common barrier of lack of time for EBPH. Funding uncertainties or budget cuts, lack of political will for EBPH, and staff turnover remained challenges. In conclusion, leadership support is a key facilitator of EBPH capacity building and practice. Section and division leaders in public health agencies with authority and skills can institute management practices to help staff learn and apply EBPH processes and spread EBPH with partners.

Succession Planning and Management Practice in Washington State Local Public Health Agencies

CONTEXT

Turnover of top local public health officials is expected to be great, with 23% being 60 years of age or older, and another 42% being 50 to 59 years of age. Yet, we know little about the use of succession planning in public health agencies.

OBJECTIVE

Describe succession planning practices in local public health agencies.

DESIGN

We conducted a Web-based, cross-sectional survey of succession planning practices and followed the career paths of public health officials for 40 months.

SETTING AND PARTICIPANTS

The top local public health officials from Washington State's 35 local governmental public health agencies.

MAIN OUTCOME MEASURES

Twenty-five succession planning best practices.

RESULTS

All 35 agencies responded, resulting in a 100% response rate. Our study found evidence of succession planning practices in Washington State local public health agencies: 85% of agencies selected high-performing high potential employees for development, 76% sent them to formal technical and management/leadership training, 70% used cross-functional team projects, and 67% used stretch assignments to develop their employees. Impetuses to implement succession planning were discovering that large percentages of employees were able to retire soon and that national accreditation requires workforce development plans. Barriers to implementing succession planning included other competing demands for time, belief that the agency's workforce was too small for a formal program, and concerns that there would be union barriers. In 2012, 50% of the officials surveyed said that it would be at least possible that they would leave their current jobs within 5 years. Forty months later, 12 (34%) had left their positions.

CONCLUSIONS

We were encouraged by the level of succession planning in Washington State and recommend creating a greater sense of urgency by focusing on agency retirement profiles and emphasizing the need for workforce development plans for accreditation. Developing the public health leaders of tomorrow is too important to be left to chance.

Assessing Skills and Capacity for Informatics: Activities Most Commonly Performed by or for Local Health Departments

OBJECTIVE

To describe the informatics activities performed by and for local health departments.

DESIGN

Analysis of data from the 2015 Informatics Capacity and Needs Assessment Survey of local health departments conducted by the Jiann-Ping Hsu College of Public Health at Georgia Southern University in collaboration with the National Association of County & City Health Officials.

PARTICIPANTS

324 local health departments.

MAIN OUTCOME MEASURE(S)

Informatics activities performed at or for local health departments in use and analysis of data, system design, and routine use of information systems.

RESULTS

A majority of local health departments extract data from information systems (69.5%) and use and interpret quantitative (66.4%) and qualitative (55.1%) data. Almost half use geographic information systems (45.0%) or statistical or other analytical software (39.7%). Local health departments were less likely to perform project management (35.8%), business process analysis and redesign (24.0%), and developing requirements for informatics system development (19.7%). Local health departments were most likely to maintain or modify content of a Web site (72.1%). A third of local health departments (35.8%) reported acting as "super users" for their information systems. A significantly higher proportion of local health departments serving larger jurisdictions (500 000+) and those with shared governance reported conducting informatics activities.

CONCLUSION

Most local health department informatics activities are completed by local health department staff within each department or a central department, but many state health departments also contribute to informatics at the local level. Larger local health departments and those with shared governance were more likely to perform informatics activities. Local health departments need effective leadership, a skilled workforce, strong partnerships, and policies that foster implementation of health information systems to successfully engage in informatics. Local health departments also face important training needs, including data analytics, project management, and geographical information systems, so they can adapt to the increasing availability of electronic data and changes in technology.

Workforce Competencies in Syndromic Surveillance Practice at Local Health Departments

Supplemental Digital Content is Available in the Text.

This study provides an assessment of self-reported knowledge and skills in syndromic surveillance tasks to effectively target technical assistance to different levels of local health department need.

As the science and practice of syndromic surveillance (SyS) evolve, it has increasing utility for public health surveillance at the local level. Local health departments (LHDs) require specific organizational and workforce capabilities to use SyS data. In 2013, more than half of the LHDs reported using SyS, although little has been reported about LHD workforce capabilities in SyS.

Public Health Staff Development Needs in Informatics: Findings From a National Survey of Local Health Departments

CONTEXT

Public health practice is information-intensive and information-driven. Public health informatics is a nascent discipline, and most public health practitioners lack necessary skills in this area.

OBJECTIVE

To describe the staff development needs of local health departments (LHDs) related to informatics.

DESIGN

Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County & City Health Officials.

PARTICIPANTS

A total of 324 LHDs from all 50 states completed the survey (response rate: 50%).

MAIN OUTCOME MEASURE(S)

Outcome measures included LHDs' specific staff development needs related to informatics. Predictors of interest included jurisdiction size and governance type.

RESULTS

Areas of workforce development and improvement in informatics staff of LHDs included using and interpreting quantitative data, designing and running reports from information systems, using and interpreting qualitative data, using statistical or other analytical software, project management, and using geographical information systems. Significant variation in informatics training needs exists depending on the size of the LHD population and governance type.

CONCLUSION

Substantial training needs exist for LHDs across many areas of informatics ranging from very basic to specialized skills and are related to the size of LHD population and governance type.