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Karnik H, Zemmel DJ, Kulik PKG, Power LE, Leider JP. Strategic Workforce Analysis: Identifying Skills and Gaps Among Frontline Public Health Workers Amidst Transformation. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00290. [PMID: 39072417 DOI: 10.1097/phh.0000000000002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Recent shifts in public health (PH) include consistent budget cuts, workforce attrition, and loss of vital skills and institutional knowledge followed by heightened pandemic-driven attention, new responsibilities, and renewed funding. This study investigates whether frontline employees working in different types of public health departments have different educational characteristics and whether these characteristics are associated with differentials in skill gaps toward informing targeted interventions to nurture a competitive workforce. METHODS Utilizing 2021 Public Health Workforce Interests and Needs Survey (PH WINS) data, we document variations in educational qualifications, skill gaps, and workforce characteristics among frontline workers in different sizes of health departments and examine attributes associated with skill gaps: level and field of education, years of experience, program areas, and job classifications using a negative binomial model. RESULTS Skill gaps in resource management, systems and strategic thinking, and change management persist across all local health departments (LHDs), but the extent of these gaps is greater in small LHDs. Small LHDs also have few employees with graduate and public health degrees. Additionally, whereas public health degrees were not associated with fewer skill gaps, tenure in public health was, suggesting people learn on the job. CONCLUSION The results highlight the role regional training centers can play in emphasizing the need for strategic skills and foundational public health concepts, as well as customizing training content by agency size and educational levels to improve accessibility, particularly for small LHDs with resource constraints.
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Affiliation(s)
- Harshada Karnik
- Author Affiliations: Region V Public Health Training Center, University of Michigan-School of Public Health, Ann Arbor, Michigan (Mss Zemmel and Kulik and Drs Karnik, Power, and Leider); Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor, Michigan (Mss Zemmel and Kulik and Dr Power); and Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Karnik and Leider)
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Bather JR, Furr-Holden D, Burke EM, Plepys CM, Gilbert KL, Goodman MS. Racial and Ethnic Composition of Departments of Health Policy & Management and Health Education & Behavioral Sciences. HEALTH EDUCATION & BEHAVIOR 2024:10901981241255611. [PMID: 38785389 DOI: 10.1177/10901981241255611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
The diversity of racial/ethnic representation in the health services and policy research (HSPR) workforce plays a crucial role in addressing the health needs of underserved populations. We assessed changes (between 2012 and 2022) in the racial/ethnic composition of students and faculty from departments of Health Policy & Management (HPM) and Health Education & Behavioral Sciences (HEBS) among the Association of Schools and Programs of Public Health member institutions. We analyzed annual data from over 40 institutions that reported student and faculty data in 2012 and 2022 within each department. Racial/ethnic populations included American Indian/Alaska Native (AI/AN), Asian, Hispanic, Native Hawaiian/Pacific Islander (NH/PI), Black, White, Unknown, and Multiracial. We conducted analyses by department and examined racial/ethnic composition by student status, degree level, faculty rank, and tenure status. We found statistically significant increases in Black assistant professors (HPM and HEBS) and tenured faculty (HPM), Hispanic graduates and tenure-track faculty (HPM), Asian professors (HPM: full and tenured, HEBS: associate and tenured), and Multiracial students and graduates (HPM and HEBS). Statistically significant decreases were observed in White professors (HPM: assistant and full, HEBS: all ranks) and tenure-track faculty (HPM and HEBS), AI/AN associate professors and tenured faculty (HEBS), Hispanic associate professors (HPM), Asian assistant professors (HEBS), and NH/PI students (HPM and HEBS). Our findings highlight the importance of increasing racial/ethnic representation. Strategies to achieve this include facilitating workshops to raise awareness about the structural barriers encountered by Hispanic faculty, providing research support, evaluating promotion processes, establishing more pathway programs, and fostering interdisciplinary academic environments studying AI/AN or NH/PI populations.
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Affiliation(s)
- Jemar R Bather
- New York University School of Global Public Health, New York, NY, USA
| | - Debra Furr-Holden
- New York University School of Global Public Health, New York, NY, USA
| | - Emily M Burke
- Association of Schools and Programs of Public Health, Washington, DC, USA
| | - Christine M Plepys
- Association of Schools and Programs of Public Health, Washington, DC, USA
| | - Keon L Gilbert
- Saint Louis University, St. Louis, MO, USA
- The Brookings Institution, Washington, DC, USA
| | - Melody S Goodman
- New York University School of Global Public Health, New York, NY, USA
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Kirkland C, Dill JS, Karnik H. Retention of Community Health Workers in the Public Health Workforce: Public Health Workforce Interests and Needs Survey, 2017 and 2021. Am J Public Health 2024; 114:44-47. [PMID: 38033282 PMCID: PMC10726946 DOI: 10.2105/ajph.2023.307462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Objectives. To investigate the organizational factors contributing to the intent of community health workers (CHWs) to quit their jobs in local and state health departments in the United States. Methods. We used the 2017 (n = 844) and 2021 (n = 1014) Public Health Workforce Interests and Needs Survey data sets to predict CHWs' intent to leave with Stata 17 balanced repeated replication survey estimations. Results. CHWs dissatisfied with organizational support, pay, or job security had high probabilities of reporting an intent to leave (50%, P < .01; 39%, P < .01; and 42%, P < .01, respectively) relative to satisfied or neutral workers (24%, P < .01; 21%, P < .01; and 26%, P < .01, respectively). Conclusions. Improving organizational support, pay satisfaction, and job security satisfaction in public health agencies can significantly improve CHW retention, potentially lowering overall organizational costs, enhancing organizational morale, and promoting community health. Public Health Implications. Our findings shed light on actionable ways to improve CHW retention, including assessing training needs; prioritizing diversity, equity, and inclusion; and improving communication between management and workers. (Am J Public Health. 2024;114(1):44-47. https://doi.org/10.2105/AJPH.2023.307462).
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Affiliation(s)
- Chelsey Kirkland
- The authors are with the Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis
| | - Janette S Dill
- The authors are with the Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis
| | - Harshada Karnik
- The authors are with the Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis
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Morabia A. Public Health Workforce: Retention, Enumeration, and Safety. Am J Public Health 2024; 114:42-43. [PMID: 38091562 PMCID: PMC10726925 DOI: 10.2105/ajph.2023.307524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/18/2023]
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Eldridge L, Kujath AS. Subspecialty Clinic Scheduling for Emergency Room Follow-ups: A Focus on Provider Satisfaction. Orthop Nurs 2023; 42:346-353. [PMID: 37989154 DOI: 10.1097/nor.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Inaccurate patient scheduling disrupts the continuity of care between patient and provider, diminishing satisfaction. One clinic had 19% of patients scheduled incorrectly after follow-up from emergency room visits. The purpose of this project was to reduce the number of incorrectly scheduled patients following up from emergency room visits that required orthopaedic consultations from advanced practice providers (APPs) and monitor the impact the change process had on APP job satisfaction. The design was nonexperimental, did not have a control group for comparison, and used standardized electronic health record documentation. A pretest and posttest design was used for the job satisfaction survey. Postimplementation data showed patients were correctly scheduled 97% of the time. Provider satisfaction improved from 2.375 to 3.125 on a 0- to 5-point scale as it pertains to clinic scheduling. Organizations can benefit from the use of standardized communication documentation to ensure proper follow-up for patients, improve continuity of care, and positively impact provider satisfaction.
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Affiliation(s)
- Leigha Eldridge
- Leigha Eldridge, DNP, CPNP, AC/PC, Pediatric Orthopedic Nurse Practitioner for UT Southwestern Medical Center, Dallas, TX; Doctor of Nursing Practice in Transformational Leadership: Systems, College of Nursing, Rush University Medical Center, Chicago, IL
- Amber S. Kujath, PhD, RN, ONC, Director and Professor of Nursing, College of Nursing, Rush University Medical Center, Chicago, IL
| | - Amber S Kujath
- Leigha Eldridge, DNP, CPNP, AC/PC, Pediatric Orthopedic Nurse Practitioner for UT Southwestern Medical Center, Dallas, TX; Doctor of Nursing Practice in Transformational Leadership: Systems, College of Nursing, Rush University Medical Center, Chicago, IL
- Amber S. Kujath, PhD, RN, ONC, Director and Professor of Nursing, College of Nursing, Rush University Medical Center, Chicago, IL
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Voluntary Separations and COVID-19: A Snapshot of Turnover Intention in the Federal Workforce in the First Year of the Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:442-445. [PMID: 36693625 DOI: 10.1097/phh.0000000000001720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Voluntary separations can exact heavy tolls on organizations that affect their efficiency or effectiveness. This historical retrospective investigates how the COVID-19 pandemic may have influenced federal employees' intention to leave for reasons other than retirement. We examined the 2020 Federal Employee Viewpoint Survey (FEVS) with a particular focus on agencies likely heavily impacted by the pandemic, including the Departments of Agriculture (USDA), Health and Human Services (HHS), Homeland Security (DHS) and the US Environmental Protection Agency (EPA). We used inferential statistics and a logistic model to identify correlations for intent to leave, considering changes related to the pandemic. Intentions to leave notably increased after the pandemic for most respondents, and overall intentions to leave were lower for USDA, HHS, and EPA staff than for all federal employees. Reasons included perceived unavailability of protections from COVID-19 exposure, disruptions to work by the pandemic, and increased work demands due to the pandemic.
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Balio CP, Galler N, Meit M, Hale N, Beatty KE. Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize? JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:S107-S115. [PMID: 36223506 PMCID: PMC10573113 DOI: 10.1097/phh.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study uses findings from the most recent iterations of the Public Health Workforce Interest and Needs Survey (PH WINS) to describe importance, skill level, and gaps of key public health competencies as well as characteristics associated with gaps. DESIGN Repeated cross-sectional analysis of the 2017 and 2021 PH WINS data. SETTING State and local health departments. PARTICIPANTS Nationally representative population of state and local governmental public health workers. MAIN OUTCOME MEASURES Gaps of key public health competencies related to data, evidence-based approaches, health equity and social justice, factors that affect public health, cross-sectoral partnerships, and community health assessments and improvement plans. Gaps reflect areas of high importance and low skill level. Differences in gaps among the traditional public health workforce and those hired specifically for COVID-19 response. RESULTS For most competency areas, more than 20% of the public health workforce perceived a gap. Gaps related to environmental factors that affect public health, social determinants of health and cross-sector partnerships, and community health assessments and improvement plans were the largest. Tenure in public health practice, highest level of education, and having formal public health training were associated with lower odds of gaps in most areas. In a secondary analysis of traditional public health workforce compared with those hired specifically for COVID-19 response, those hired for COVID-19 response reported significantly fewer gaps for all but one competency considered. CONCLUSIONS A substantial proportion of the public health workforce perceives gaps in competency areas that are of high importance to the evolving role of public health. As public health continues to adjust and modernize in response to the COVID-19 pandemic and other historic changes, understanding and addressing training needs of the workforce will be instrumental to public health's ability to respond to the needs of the public.
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Affiliation(s)
- Casey P. Balio
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Nicole Galler
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Michael Meit
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Nathan Hale
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Kate E. Beatty
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
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Owens-Young JL, Leider JP, Bell CN. Public Health Workforce Perceptions About Organizational Commitment to Diversity, Equity, and Inclusion: Results From PH WINS 2021. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:S98-S106. [PMID: 36223514 PMCID: PMC10573085 DOI: 10.1097/phh.0000000000001633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In response to calls to achieve racial equity, racism has been declared as a public health crisis. Diversity, equity, and inclusion (DEI) is an approach public health organizations are pursuing to address racial inequities in health. However, public health workforce perceptions about organizational commitment to DEI have not yet been assessed. Using a nationally representative survey of public health practitioners, we examine how perceptions about supervisors' and managers' commitment to DEI and their ability to support a diverse workforce relate to perceptions of organizational culture around DEI. METHODS Data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) to examine the relationship between public health employees' perceptions about their organization's commitment to DEI and factors related to those perceptions. PH WINS received 44 732 responses (35% response rate). We calculated descriptive statistics and constructed a logistic regression model to assess these relationships. RESULTS Findings show that most public health employees perceive that their organizations are committed to DEI; however, perceptions about commitment to DEI vary by race, ethnicity, gender identity, and organizational setting. Across all settings, White respondents were more likely to agree with the statement, "My organization prioritizes diversity, equity, and inclusion" (range, 70%-75%), than Black/African American (range, 55%-65%) and Hispanic/Latino respondents (range, 62.5%-72.5%). Perception that supervisors worked well with individuals with diverse backgrounds had an adjusted odds ratio (AOR) of 5.37 ( P < .001); organizational satisfaction had an AOR of 4.45 ( P < .001). Compared with White staff, all other racial and ethnic groups had lower AOR of reporting their organizations prioritized DEI, with Black/African American staff being the lowest (AOR = 0.55), followed by Hispanic/Latino staff (AOR = 0.71) and all other staff (AOR = 0.82). CONCLUSIONS These differences suggest that there are opportunities for organizational DEI commitment to marginalized public health staff to further support DEI and racial equity efforts. Building a diverse public health workforce pipeline will not be sufficient to achieve health equity if staff perceive that their organization does not prioritize DEI.
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Affiliation(s)
- Jessica L. Owens-Young
- Department of Health Studies, American University, Washington, District of Columbia (Dr Owens-Young); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, Louisiana (Dr Bell)
| | - Jonathon P. Leider
- Department of Health Studies, American University, Washington, District of Columbia (Dr Owens-Young); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, Louisiana (Dr Bell)
| | - Caryn N. Bell
- Department of Health Studies, American University, Washington, District of Columbia (Dr Owens-Young); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, Louisiana (Dr Bell)
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Kirkland C, Oldfield-Tabbert K, Karnik H, Orr J, Martin S, Leider JP. Public Health Workforce Gaps, Impacts, and Improvement Strategies from COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13084. [PMID: 36293664 PMCID: PMC9603116 DOI: 10.3390/ijerph192013084] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/09/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
The public health workforce has been instrumental in protecting residents against population health threats. The COVID-19 pandemic has highlighted the importance of the public health workforce and exposed gaps in the workforce. Public health practitioners nationwide are still coming to understand these gaps, impacts, and lessons learned from the pandemic. This study aimed to explore Minnesota's local public health practitioners' perceptions of public health workforce gaps, the impacts of these workforce gaps, and the lessons learned in light of the COVID-19 pandemic. We conducted seven concurrent focus groups with members of the Local Public Health Association of Minnesota (LPHA; n = 55) using a semi-structured focus group guide and a survey of the local agencies (n = 70/72 respondents, 97% response rate). Focus group recordings were transcribed verbatim and analyzed using deductive and inductive coding (in vivo coding, descriptive coding), followed by thematic analysis. The quantitative data were analyzed using descriptive analyses and were integrated with the qualitative data. Participants indicated experiencing many workforce gaps, workforce gaps impacts, and described improvement strategies. Overall, many of the workforce gaps and impacts resulting from COVID-19 discussed by practitioners in Minnesota are observed in other areas across the nation, making the findings relevant to public health workforce nationally.
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Affiliation(s)
- Chelsey Kirkland
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Harshada Karnik
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jason Orr
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Skky Martin
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jonathon P. Leider
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
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Examining Factors Associated With Minority Turnover Intention in State and Local Public Health Organizations: The Moderating Role of Race in the Relationship Among Supervisory Support, Job Satisfaction, and Turnover Intention. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E768-E777. [PMID: 35867516 DOI: 10.1097/phh.0000000000001571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
CONTEXT There is a need to understand minority governmental public health workforce turnover to ensure the retention of public health minority workers, capitalize on diversity benefits, and enhance public health's capacity to serve diverse populations. OBJECTIVE This study assesses the moderating effect of minority health workers' race on (1) the relationship between the workforce environment, particularly employees' perceptions of their pay and supervisory support on job satisfaction, and (2) the relationship between job satisfaction and turnover intentions. DESIGN Using the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), a cross-sectional survey of the public health workforce, a hierarchical logistic regression modeling technique was used to assess the moderating role of race on the relationship between supervisory support, pay and job satisfaction, and turnover intentions. SETTING AND PARTICIPANTS The PH WINS survey data from state and local health department employees. MAIN OUTCOME MEASURE Job satisfaction, pay, supervisory support, and turnover intention. RESULTS Job satisfaction was found to mediate the relationship between the work environment factors of pay satisfaction and supervisory support and turnover. Our findings also suggest that while race moderates the influence of compensation and supervisory support on job satisfaction, race has no moderating effect on the job satisfaction-turnover intentions relationship. CONCLUSIONS A focus on boosting job satisfaction, particularly through pay equity and perceived support, may reduce turnover among minority public health personnel.
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Training the MCH workforce: the Time for Change is now. Matern Child Health J 2022; 26:60-68. [PMID: 35980498 PMCID: PMC9386196 DOI: 10.1007/s10995-022-03438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 03/07/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022]
Abstract
Introduction Maternal and child health (MCH) services are critical for vulnerable populations. Workforce shortages, poor retention, and gaps in necessary trainings impede the capacity of public health systems to address needs. This manuscript characterizes the current MCH workforce, MCH program applicants and graduates, and describe findings within a national context to devise elements of a recruitment and retention strategy. Methods Data were obtained for public health program applicants, first-destination employment outcomes, and worker perceptions and demographics. Data were stratified according to the MCH and total public health workforce and by local, state, and national totals. Data were characterized by degree type, discipline, demographics, and employment outcomes. Results MCH staff constitute 11% of the state and local governmental public health workforce. MCH staff are approximately as diverse, have higher educational attainment, and are more likely to hold nursing degrees than the rest of the public health workforce. Yet, just 14% of MCH staff hold any type of public health degree. The MCH pipeline from academia appears modestly sized, with approximately 5% of applicants between 2017 and 2021 applying to a MCH master’s degree. Discussion The MCH workforce has a lower proportion of formal training or degrees in public health, though trends seem to indicate improvements. However, it is critical that a multi-faceted recruitment and retention strategy be coordinated by a broad range of stakeholders. These efforts will serve to improve the capability and capacity of the public health system to address critical needs of increasingly diverse MCH populations. Significance In order to modernize and reimagine the academic-public health pipeline, it is critical to better understand how many applicants and graduates exist within Maternal and Child Health programs across the US, and their characteristics. This manuscript connects that information with the most recently available public health workforce information on demographics, workplace perceptions, and intent to leave among staff at state and local health departments. Data presented in this paper allow the most comprehensive characterization of the MCH academia->practice pipeline to-date, identifies a fundamental disconnect in those career pathways, and offers options to repair that break.
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Yeager VA, Balio CP, Chudgar RB, Hare Bork R, Beitsch LM. Estimating Public Health Workforce Efforts Toward Foundational Public Health Services. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:393-398. [PMID: 34939602 DOI: 10.1097/phh.0000000000001452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed. OBJECTIVE This study assessed the potential use of an FPHS calculator to assess health department workforce needs. DESIGN AND SETTING Qualitative interviews were conducted via Zoom in December 2020-January 2021. PARTICIPANTS Seventeen state and local public health leaders. MAIN OUTCOME MEASURES Qualitative insights into the potential use of an FPHS calculator. RESULTS Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed. CONCLUSIONS The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.
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Affiliation(s)
- Valerie A Yeager
- Department of Health Policy and Management, IU Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Center for Rural Health Research, East Tennessee State University College of Public Health, Johnson City, Tennessee (Dr Balio); Public Health National Center Innovation, Public Health Accreditation Board, Alexandria, Virginia (Ms Chudgar); de Beaumont Foundation, Bethesda, Maryland (Dr Hare Bork); and Florida State University College of Medicine, Tallahassee, Florida (Dr Beitsch)
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Yassine BB, Rojewski JW, Ransom MM. Gender Inequity in the Public Health Workforce. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E390-E396. [PMID: 34016906 DOI: 10.1097/phh.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Public health is a gendered field. Although a majority of the public health workforce, women encounter an imbalance of power and experience disparate opportunities within the profession. ANALYSIS This article offers a multidimensional critique of gender inequity within the public health workforce through an examination of the literature. RESULTS There are three existing disparities between men and women in public health: unequal representation in leadership positions; persistence of wage discrimination; and disparities in scholarly publication and citations. Disparities are often more pronounced among women with intersectional identities (eg, race/ethnicity or other identities). DISCUSSION Gender inequity is structural, and solutions must address micro-, interactional, and macro-levels. The changing workforce and practitioners' skills in addressing upstream issues provide the opportunity to address this issue.
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Affiliation(s)
- Brianne Bostian Yassine
- Department of Career and Information Studies, University of Georgia, Athens, Georgia (Drs Yassine and Rojewski); National Network of Public Health Institutes, Washington, District of Columbia (Dr Ransom); and College of Health and Health Sciences, Walden University, Minneapolis, Minnesota (Dr Ransom)
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Leider JP, Sellers K, Bogaert K, Liss-Levinson R, Castrucci BC. Voluntary Separations and Workforce Planning: How Intent to Leave Public Health Agencies Manifests in Actual Departure in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:38-45. [PMID: 32769420 PMCID: PMC7690638 DOI: 10.1097/phh.0000000000001172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To ascertain levels of turnover in public health staff between 2014 and 2017 due to retirement or quitting and to project levels of turnover for the whole of the state and local governmental public health in the United States nationally. DESIGN Turnover outcomes were analyzed for 15 128 staff from public health agencies between 2014 and 2017. Determinants of turnover were assessed using a logit model, associated with actually leaving one's organization. A microsimulation model was used to project expected turnover onto the broader workforce. RESULTS Between 2014 and 2017, 33% of staff left their agency. Half of the staff who indicated they were considering leaving in 2014 had done so by 2017, as did a quarter of the staff who had said they were not considering leaving. Staff younger than 30 years constituted 6% of the workforce but 13% of those who left (P < .001). CONCLUSIONS Public health agencies are expected to experience turnover in 60 000 of 200 000 staff positions between 2017 and 2020. IMPLICATIONS As much as one-third of the US public health workforce is expected to leave in the coming years. Retention efforts, especially around younger staff, must be a priority. Succession planning for those retiring is also a significant concern.
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Affiliation(s)
- Jonathon P. Leider
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
| | - Katie Sellers
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
| | - Kyle Bogaert
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
| | - Rivka Liss-Levinson
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
| | - Brian C. Castrucci
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
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Leider JP, Coronado F, Bogaert K, Sellers K. A Multilevel Workforce Study on Drivers of Turnover and Training Needs in State Health Departments: Do Leadership and Staff Agree? JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:30-37. [PMID: 32000170 PMCID: PMC7690639 DOI: 10.1097/phh.0000000000001082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterize agreement between senior governmental public health staff and their subordinates concerning drivers for staff turnover, and skill importance and ability. DESIGN Data were combined from 2 national surveys conducted in 2017; one was a nationally representative, individual-level survey of public health workers, and one was an individual-level survey of their leadership. SETTING State health agencies. PARTICIPANTS Respondents who held scientific, nonsupervisory positions at state health agency central offices (n = 3606) were matched with leadership (n = 193) who provided programmatic area oversight. MAIN OUTCOME MEASURES Drivers of turnover and training needs are the primary outcomes examined in this article. RESULTS Leaders and their staff agreed on the main 2 drivers of turnover (low salary and lack of opportunities for advancement), but discordance was observed for other major drivers of turnover. Substantial discordance was observed between leaders and their staff in terms of perceived staff proficiency with selected skills. CONCLUSIONS This multilevel assessment of workplace perceptions offers evidence around training needs and drivers of turnover in state health agencies. Although staff and leaders agree on some major drivers of turnover, other potential reasons for leaving cited by staff, and the difference in perceptions of skills, can help target job satisfaction, training, and retention efforts in state health agencies.
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Affiliation(s)
- Jonathon P. Leider
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Coronado); Association of State and Territorial Health Officials, Washington, District of Columbia (Ms Bogaert); and de Beaumont Foundation, Washington, District of Columbia (Dr Sellers)
| | - Fátima Coronado
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Coronado); Association of State and Territorial Health Officials, Washington, District of Columbia (Ms Bogaert); and de Beaumont Foundation, Washington, District of Columbia (Dr Sellers)
| | - Kyle Bogaert
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Coronado); Association of State and Territorial Health Officials, Washington, District of Columbia (Ms Bogaert); and de Beaumont Foundation, Washington, District of Columbia (Dr Sellers)
| | - Katie Sellers
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Coronado); Association of State and Territorial Health Officials, Washington, District of Columbia (Ms Bogaert); and de Beaumont Foundation, Washington, District of Columbia (Dr Sellers)
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Tripković K, Šantrić-Milićević M, Vasić M, Živković-Šulović M, Odalović M, Mijatović-Jovanović V, Bukumirić Z. Factors Associated with Intention of Serbian Public Health Workers to Leave the Job: A Cross-Sectional, Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010652. [PMID: 34682398 PMCID: PMC8535250 DOI: 10.3390/ijerph182010652] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/28/2023]
Abstract
Recruitment and retention of public health workers (PHWs) is crucial for the optimal functioning of the public health system at a time of budget cuts and the threat of a pandemic. Individual and job-related variables were examined by univariate and multivariate logistic regression to identify predictors of the intention to leave a job during the COVID-19 outbreak among Serbian PHWs in 25 institutes of public health (n = 1663 respondents, of which 73.1% were female). A total of 20.3% of PHWs intended to leave their current job within the next five years. Males and persons aged younger than 55 years who had additional practice were more likely to report an intention to leave their job than females, those older than 54 years and those without additional work. While uncertainty and fear of infection during the COVID-19 pandemic were almost perceived as job attractiveness, other job-related characteristics were identified as significant barriers to maintaining the sufficient capacity of qualified PHWs in the future. Authorities need to address these factors, including the following: the feeling of tension, stress or pressure, and unavailability of information during the COVID-19 pandemic, as well as dissatisfaction with respect, valuation, and the job in general.
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Affiliation(s)
- Katica Tripković
- Department for Analysis, Planning and Organization of Health Care, City Institute of Public Health Belgrade, 11000 Belgrade, Serbia
- Correspondence:
| | - Milena Šantrić-Milićević
- Centre–School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Faculty of Medicine, Institute of Social Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milena Vasić
- Faculty of Dentistry Pancevo, University Business Academy in Novi Sad, 26000 Pancevo, Serbia;
- Institute of Public Health of Serbia “Dr Milan Jovanović Batut”, 11000 Belgrade, Serbia;
| | | | - Marina Odalović
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia;
| | - Vesna Mijatović-Jovanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
| | - Zoran Bukumirić
- Faculty of Medicine, Institute of Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia;
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Leider JP, Sellers K, Owens-Young J, Guerrero-Ramirez G, Bogaert K, Gendelman M, Castrucci BC. Determinants of workplace perceptions among federal, state, and local public health staff in the US, 2014 to 2017. BMC Public Health 2021; 21:1654. [PMID: 34507578 PMCID: PMC8431955 DOI: 10.1186/s12889-021-11703-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background The governmental public health workforce in the United States comprises almost 300,000 staff at federal, state, and local levels. The workforce is poised for generational change, experiencing significant levels of retirement. However, intent to leave for other reasons is also substantial, and diversity is lacking in the workforce. Methods Workforce perception data from 76,000 staff from Health and Human Services (HHS) including 14,000 from the Centers for Disease Control and Prevention were analyzed across 2014 and 2017. Additionally, data from 32,000 state and local health department staff in 46 agencies reporting in both years. Estimates were constructed accounting for survey design and non-response. Results In 2017, women made up 43% of the total US government workforce and 33% of supervisors or higher, compared to 73 and 68% generally in State Health Agencies (p < .0001); and 62% vs 52% in HHS (p < .0001). Among state staff, intent to leave increased from 22 to 31% (p < .0001), but fell in 2017 from 33 to 28% for HHS (p < .0001). Correlates of intent to leave included low job satisfaction, pay satisfaction, and agency type. Federal entities saw the highest proportion respondents that indicated they would recommend their organization as a good place to work. Conclusions While intent to leave fell at federal agencies from 2014 to 2017, it increased among staff in state and local health departments. Additionally, while public health is more diverse than the US government overall, significant underrepresentation is observed in supervisory positions for staff of color, especially women. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11703-x.
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Affiliation(s)
- Jonathon P Leider
- University of Minnesota School of Public Health, D312 Mayo Building, MMC 729, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
| | - Katie Sellers
- de Beaumont Foundation, 7501 Wisconsin Avenue, Suite 1310e, Bethesda, MD, 20814, USA
| | - Jessica Owens-Young
- American University, 4400 Massachusetts Avenue NW, Washington DC, 20016, USA
| | | | - Kyle Bogaert
- Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA, 22202, USA
| | - Moriah Gendelman
- de Beaumont Foundation, 7501 Wisconsin Avenue, Suite 1310e, Bethesda, MD, 20814, USA
| | - Brian C Castrucci
- de Beaumont Foundation, 7501 Wisconsin Avenue, Suite 1310e, Bethesda, MD, 20814, USA
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18
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Chen Z, Zhang Y, Luo H, Zhang D, Rajbhandari-Thapa J, Wang Y, Wang R, Bagwell-Adams G. Narrowing but persisting gender pay gap among employees of the US Department of Health and Human Services during 2010-2018. HUMAN RESOURCES FOR HEALTH 2021; 19:65. [PMID: 33985512 PMCID: PMC8120826 DOI: 10.1186/s12960-021-00608-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The gender pay gap in the United States (US) has narrowed over the last several decades, with the female/male earnings ratio in the US increased from about 60% before the 1980s to about 79% by 2014. However, the gender pay gap among the healthcare workforce persists. The objective of this study is to estimate the gender pay gap in the US federal governmental public health workforce during 2010-2018. METHODS We used an administrative dataset including annual pay rates and job characteristics of employees of the US Department of Health and Human Services. Employees' gender was classified based on first names. Regression analyses were used to estimate the gender pay gap using the predicted gender. RESULTS Female employees of the DHHS earned about 13% less than men in 2010, and 9.2% less in 2018. Occupation, pay plan, and location explained more than half of the gender pay gap. Controlling for job grade further reduces the gap. The unexplained portion of the gender pay gap in 2018 was between 1.0 and 3.5%. Female employees had a slight advantage in terms of pay increase over the study period. CONCLUSIONS While the gender pay gap has narrowed within the last two decades, the pay gap between female and male employees in the federal governmental public health workforce persists and warrants continuing attention and research. Continued efforts should be implemented to reduce the gender pay gap among the health workforce.
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Affiliation(s)
- Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, 305B Wright Hall, Athens, GA, 30602, United States of America.
- School of Economics, Faculty of Humanities and Social Science, University of Nottingham Ningbo China, Ningbo, China.
| | - Yihong Zhang
- School of Economics, Faculty of Humanities and Social Science, University of Nottingham Ningbo China, Ningbo, China
| | - Huabin Luo
- Department of Public Health, East Carolina University, Greenville, NC, United States of America
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, 305B Wright Hall, Athens, GA, 30602, United States of America
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, 305B Wright Hall, Athens, GA, 30602, United States of America
| | - Yuheng Wang
- Charles River Associates, Boston, MA, United States of America
| | - Ruoxi Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Grace Bagwell-Adams
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, 305B Wright Hall, Athens, GA, 30602, United States of America
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Niswaty R, Wirawan H, Akib H, Saggaf MS, Daraba D. Investigating the effect of authentic leadership and employees' psychological capital on work engagement: evidence from Indonesia. Heliyon 2021; 7:e06992. [PMID: 34027188 PMCID: PMC8129939 DOI: 10.1016/j.heliyon.2021.e06992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/05/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
This study aims at investigating the positive effect of Authentic Leadership on Work Engagement and the mediating role of Psychological Capital (PsyCap). This study employed the Jobs Demands Resource (JD-R) model theory to explain the contribution of Authentic Leadership and PsyCap on Work Engagement. Also, the direct effect of Authentic Leadership on employees' PsyCap was examined. This study randomly selected participants from 1,120 employees in one of the largest public service offices in Indonesia. 192 employees (male = 120 or 62.5%) fully participated in a three-wave data collection. By using a Structural Equation Modeling (SEM) technique, this study confirmed that the proposed theoretical model (χ2/df = 2, p < .05, RMSEA = .07, SRMR = .07, CFI = .95) showed a better fit than the alternative model (χ 2/df = 3, p < .05, RMSEA = .09, SRMR = .09, CFI = .85). The results also confirmed that Authentic Leadership and PsyCap directly predicted Work Engagement. Furthermore, the indirect effect of Authentic Leadership on Work Engagement was positively mediated by employees' PsyCap. Authentic Leadership in Indonesian public organizations may provide a tremendous impact on employees' PsyCap and Work Engagement. This study has provided new insight into the application of the JD-R model in Indonesian public organizations. Discussion, implications, limitations, and future research directions are included.
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Affiliation(s)
- Risma Niswaty
- The Department of Administrative Sciences, Faculty of Social Sciences, Universitas Negeri Makassar, Makassar, Sulawesi Selatan, Indonesia
| | - Hillman Wirawan
- The Department of Psychology, Faculty of Medicine, Universitas Hasanuddin, Makassar, Sulawesi Selatan, Indonesia
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Haedar Akib
- The Department of Administrative Sciences, Faculty of Social Sciences, Universitas Negeri Makassar, Makassar, Sulawesi Selatan, Indonesia
| | - M. Said Saggaf
- The Department of Public Administration, Universitas Islam Makassar, Makassar, Indonesia
| | - Dahyar Daraba
- The Economic Development and Community Empowerment Study Program, Faculty of Government Politics, Institut Pemerintahan Dalam Negeri (IPDN), Jatinangor, Indonesia
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Taylor YJ, Scott VC, Danielle Connor C. Perceptions, Experiences, and Outcomes of Lactation Support in the Workplace: A Systematic Literature Review. J Hum Lact 2020; 36:657-672. [PMID: 32530352 DOI: 10.1177/0890334420930696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite legislation requiring break time and a private space to express milk, variations exist in accommodations for breastfeeding employees in the United States. RESEARCH AIMS We aimed to describe employee and employer perceptions of and experiences with workplace lactation support in the United States and to identify research needed to inform workplace lactation support programs. METHODS We searched Academic Search Complete, Business Search Complete, CINAHL, MEDLINE, PubMed, and PsycInfo for peer-reviewed articles published from 2009 to 2019 (n = 1638). We included 27 articles. Studies were categorized into four non-exclusive themes: (a) employee perceptions of and experiences with workplace lactation support; (b) employer reports of workplace lactation support; (c) association between workplace lactation support and business outcomes; and (d) association between workplace lactation support and breastfeeding outcomes. RESULTS Analyses of associations between lactation support at work and employee breastfeeding outcomes (n = 14, 52%), and employee perceptions of and experiences with lactation support at work (n = 14, 52%) were most common, followed by employer reports of lactation support (n = 3, 11%) and associations between lactation support at work and job satisfaction (n = 3, 11%). Results indicated that workplace lactation support varied by employer, and that employee perceptions of and experiences with workplace lactation support varied by demographic and employment characteristics. The use of cross-sectional designs, unvalidated instruments, and limited representation from women with low incomes and minorities were common study limitations. CONCLUSIONS More research is needed to learn about experiences of employers and low-income and minority women with workplace lactation support and associations with business-relevant outcomes.
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Affiliation(s)
- Yhenneko J Taylor
- 2351 Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, USA
| | - Victoria C Scott
- 124546 Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, USA
| | - C Danielle Connor
- 2351 Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, USA
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"The hardest job you will ever love": Nurse recruitment, retention, and turnover in the Nurse-Family Partnership program in British Columbia, Canada. PLoS One 2020; 15:e0237028. [PMID: 32898142 PMCID: PMC7478534 DOI: 10.1371/journal.pone.0237028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background Nurse turnover is a significant issue and complex challenge for all healthcare sectors and is exacerbated by a global nursing shortage. Nurse-Family Partnership is a community health program for first-time pregnant and parenting girls and young women living in situations of social and economic disadvantage. In Canada, this program is delivered exclusively by public health nurses and only within a research context. The aim of this article is to explore and describe factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada between 2013 and 2018. Methods Interpretive description was used to guide sampling, data collection and analytic decisions in this qualitative component drawn from the British Columbia Healthy Connections Project mixed methods process evaluation. Semi-structured, individual interviews were conducted with 28 public health nurses who practiced in and then exited Nurse-Family Partnership. Results Nurses were motivated to join this program because they wanted to deliver an evidence-based program for vulnerable young mothers that fit with their personal and professional philosophies and offered nurse autonomy. Access to program resources attracted nursing staff, while delivering a program that prioritizes maintaining relationships and emphasizes client successes was a positive work experience. Opportunities for ongoing professional development/ education, strong team connections, and working at full-scope of nursing practice were significant reasons for nurses to remain in Nurse-Family Partnership. Personal circumstances (retirement, family/health needs, relocation, career advancement) were the most frequently cited reasons leading to turnover. Other factors included: involuntary reasons, organizational and program factors, and geographical factors. Conclusions Public health organizations that deliver Nurse-Family Partnership may find aspects of job embeddedness theory useful for developing strategies for supporting recruitment and retention and reducing nurse turnover. Hiring nurses who are the right fit for this type of program may be a useful approach to increasing nurse retention. Fostering a culture of connectivity through team development along with supportive and communicative supervision are important factors associated with retention and may decrease turnover. Many involuntary/external factors were specific to being in a study environment. Program, organizational, and geographical factors affecting nurse turnover are modifiable.
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Gwon SH, Cho YI, Paek S, Ke W. Public health nurses' workforce factors and population health outcomes in the United States. Public Health Nurs 2020; 37:829-836. [PMID: 32869359 DOI: 10.1111/phn.12793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES (a) To examine associations between public health nurse (PHN) workforce factors (PHNs' highest education and PHNs' mean years of employment) and health-risk behaviors (smoking and physical inactivity rates), and (b) to investigate the associations between PHN workforce factors and premature mortality rates across all counties of the United States. DESIGN Secondary analysis. SAMPLE A total of 5,705 PHNs from the 2015 National Nursing Workforce Survey and 2,977 U.S. counties from the 2016 County Health Rankings & Roadmaps data were included. METHODS Multilevel linear regression was used. RESULTS Bachelor's, and master's or doctorate-prepared PHNs accounted for 41.5% and 17.0%, respectively. The mean year of employment among PHNs was 17.3. The percentages of PHNs with bachelor's, master's, and doctoral degrees were significantly associated with decreased physical inactivity rates. The PHNs' mean year of employment was significantly associated with decreased physical inactivity rates and reduced premature age-adjusted mortality rates. CONCLUSIONS The findings indicated that PHNs with higher levels of education and more years of employment were important in improving health outcomes (health-risk behavior and premature mortality). Policymakers need to consider strategies to encourage more PHNs to obtain advanced degrees and to retain PHNs longer in the public health field.
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Affiliation(s)
- Seok Hyun Gwon
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Young Ik Cho
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Soonhwa Paek
- Department of Educational Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Weiming Ke
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Changes in the State Governmental Public Health Workforce: Demographics and Perceptions, 2014-2017. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017:S58-S66. [PMID: 30720618 PMCID: PMC6519782 DOI: 10.1097/phh.0000000000000933] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Context: Workforce is a critical cog in the governmental public health enterprise in the United States. Until 2014, workforce research was largely conducted at the organizational level. However, the fieldings of the Public Health Workforce Interests and Needs Survey allow for nationally representative comparisons with individual respondents. Objective: Using data from agencies that participated in 2014 and 2017, we conducted multi–cross-sectional comparisons of the Public Health Workforce Interests and Needs Survey data. Design: The Public Health Workforce Interests and Needs Survey participants at the State Health Agency Central Offices were surveyed using a Web-based platform. Balanced repeated replication weights were used to account for differential designs between 2014 and 2017. Setting: Thirty-three state health agency central offices that participated in both 2014 and 2017. Participants: Permanently employed governmental public health staff. Main Outcome Measures: We examined changes in perceptions of the workplace environment, job and pay satisfaction, intent to leave, awareness of emerging concepts in public health, and demographic/worker characteristics. Pearson and Rao-Scott–adjusted χ2 analyses were used to compare changes between 2014 and 2017. Results: The percentage of staff who are people of color increased from 29% (95% confidence interval, 28%-30%) to 37% (95% confidence interval, 36%-38%) from 2014 to 2017 across 33 states. Approximately 26% of staff were younger than 40 years in 2014 compared with 29% in 2017 (P < .001). Job satisfaction increased in 17 states overall (P < .05, n = 5) and decreased in 16 states (P < .05, n = 5) but did not change in aggregate. Overall, the percentage of staff considering leaving the organization in the next year or retiring within 5 years is up from 44% to 48% (P < .001). Conclusions: Global measures of satisfaction are relatively high and consistent between 2014 and 2017. Demographics are shifting toward a marginally younger workforce as many retire, and a significant portion of staff indicates that they are considering leaving their organization or planning to retire.
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Considering Leaving, But Deciding to Stay: A Longitudinal Analysis of Intent to Leave in Public Health. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017:S78-S86. [PMID: 30720620 PMCID: PMC6586295 DOI: 10.1097/phh.0000000000000928] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Context: Public health has been hit by the first wave of the “silver tsunami”—baby boomers retiring en masse. However, thousands of staff members say they are considering voluntarily leaving for other reasons as well. Objective: To identify characteristics of staff who said they were planning on leaving in 2014 but stayed at their organizations through 2017. Design: Data from the 2014 and 2017 Public Health Workforce Interests and Needs Survey (PH WINS) were linked by respondent, and characteristics associated with intent to leave were analyzed. Longitudinal logistic models were fit to examine correlates of intent to leave, with job and pay satisfaction, demographic variables, and workplace engagement perceptions as independent variables. Setting and Participants: Respondents from state health agency–central offices and local health departments that participated in the PH WINS in 2014 and 2017. Main Outcome Measures: Intent to leave (excluding retirement), demographic measures, and changes in the perceptions of workplace engagement. Results: Among all staff members responding in 2014 and 2017, 15% said they were considering leaving in 2014, excluding retirement, compared with 26% in 2017 (P < .001). Overall, 21% of those who were not considering leaving in 2014 indicated they were doing so in 2017. Comparatively, 57% of those considering leaving in 2014 said they were still considering it in 2017. The regressions showed those who were somewhat or very satisfied were significantly more likely to indicate they were not (or were no longer) considering leaving. Conclusions: Among staff members who have been considering leaving but have not yet left their organization, improvements to workplace engagement perceptions and job satisfaction were highly associated with not considering leaving their job.
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Unleashing the Creativity and Innovation of Our Greatest Resource-The Governmental Public Health Workforce. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017:S96-S102. [PMID: 30720622 PMCID: PMC6519881 DOI: 10.1097/phh.0000000000000973] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Context: Creativity and innovation in the governmental public health workforce will be required to generate new ideas to solve complex problems that extend beyond traditional public health functions such as disease surveillance and monitoring. Creativity and innovation can promote and advance necessary organizational transformation as well as improve organizational culture and workplace environment by motivating employees intrinsically. However, there is little empirical evidence on how rewarding creativity and innovation in governmental public health departments is associated with organizational culture and workplace environments. Objective: This study describes (1) the degree to which creativity and innovation are rewarded in governmental public health agencies and (2) associations between rewarding creativity and innovation and worker satisfaction, intent to leave, and workplace characteristics. Design: The cross-sectional Public Health Workforce Interests and Needs Survey (PH WINS) was administered using a Web-based platform in fall 2017. Settings and Participants: Data used for these analyses were drawn from the 2017 PH WINS of governmental health department employees. This included state health agency and local health department staff. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. PH WINS excludes local health departments with fewer than 25 staff or serving fewer than 25 000 people. Results: Fewer than half of all workers, regardless of demographic group and work setting, reported that creativity and innovation were rewarded in their workplace. Most measures of worker satisfaction and workplace environment were significantly more positive for those who reported that creativity and innovation were rewarded in their workplace. Conclusion: This research suggests that promoting creativity and innovation in governmental public health agencies not only could help lead the transformation of governmental public health agencies but could also improve worker satisfaction and the workplace environment in governmental public health agencies.
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Allen P, Jacob RR, Parks RG, Mazzucca S, Hu H, Robinson M, Dobbins M, Dekker D, Padek M, Brownson RC. Perspectives on program mis-implementation among U.S. local public health departments. BMC Health Serv Res 2020; 20:258. [PMID: 32228688 PMCID: PMC7106610 DOI: 10.1186/s12913-020-05141-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health resources are limited and best used for effective programs. This study explores associations of mis-implementation in public health (ending effective programs or continuing ineffective programs) with organizational supports for evidence-based decision making among U.S. local health departments. METHODS The national U.S. sample for this cross-sectional study was stratified by local health department jurisdiction population size. One person was invited from each randomly selected local health department: the leader in chronic disease, or the director. Of 600 selected, 579 had valid email addresses; 376 completed the survey (64.9% response). Survey items assessed frequency of and reasons for mis-implementation. Participants indicated agreement with statements on organizational supports for evidence-based decision making (7-point Likert). RESULTS Thirty percent (30.0%) reported programs often or always ended that should have continued (inappropriate termination); organizational supports for evidence-based decision making were not associated with the frequency of programs ending. The main reason given for inappropriate termination was grant funding ended (86.0%). Fewer (16.4%) reported programs often or always continued that should have ended (inappropriate continuation). Higher perceived organizational supports for evidence-based decision making were associated with less frequent inappropriate continuation (odds ratio = 0.86, 95% confidence interval 0.79, 0.94). All organizational support factors were negatively associated with inappropriate continuation. Top reasons were sustained funding (55.6%) and support from policymakers (34.0%). CONCLUSIONS Organizational supports for evidence-based decision making may help local health departments avoid continuing programs that should end. Creative mechanisms of support are needed to avoid inappropriate termination. Understanding what influences mis-implementation can help identify supports for de-implementation of ineffective programs so resources can go towards evidence-based programs.
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Affiliation(s)
- Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA.
| | - Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Renee G Parks
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Hengrui Hu
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Mackenzie Robinson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, Ontario, L8P 0A1, Canada
| | - Debra Dekker
- National Association of County and City Health Officials (NACCHO), 1201 Eye Street, NW, 4th Floor, Washington, DC, 20005, USA
| | - Margaret Padek
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, 4921 Parkview Place, St. Louis, MO, 63110, USA
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Ryu S. Turnover Intention among Field Epidemiologists in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030949. [PMID: 32033019 PMCID: PMC7037969 DOI: 10.3390/ijerph17030949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/18/2020] [Accepted: 02/02/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to explore the level of occupational stress, job satisfaction, and turnover intention among Korean field epidemiologists, and to identify the factors that contribute to their turnover intention. We surveyed the Korean field epidemiologists in the cohort from 2016 to 2018 using the Occupational Stress Inventory, revised edition, and questionnaires developed from the Public Health Workforce Interest and Needs Survey. Fisher's exact test was used to identify the association between sociodemographic characteristics, occupational stress, job satisfaction, and turnover intention. Overall, 17 Korean field epidemiologists participated in this study (response rate: 74%). More than half of field epidemiologists had turnover intention (53%), and it was less likely to be present in the field epidemiologists recruited from the civilian sector than those recruited from the military (adjusted odds ratio, 0.59; 95% confidence interval, 0.39-0.88). Furthermore, about two-thirds of field epidemiologists had a burden of occupational stress on Role Ambiguity (65%), and only one respondent expressed satisfaction with the job. There was no significant relation among the levels of occupational stress, job satisfaction, and turnover intention. In this study, the field epidemiologists recruited from the military were more likely to have turnover intention. Additional studies to identify possible ways to reduce turnover intention among the public health workforce are warranted.
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Affiliation(s)
- Sukhyun Ryu
- Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon 35365, Korea
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Succession Planning in State Health Agencies in the United States: A Brief Report. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:473-478. [PMID: 29112036 DOI: 10.1097/phh.0000000000000700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Approximately 25% of the public health workforce plans to retire by 2020. Succession planning is a core capability of the governmental public health enterprise; however, limited data are available regarding these efforts in state health agencies (SHAs). METHODS We analyzed 2016 Workforce Gaps Survey data regarding succession planning in SHAs using the US Office of Personnel Management's (OPM's) succession planning model, including 6 domains and 27 activities. Descriptive statistics were calculated for all 41 responding SHAs. RESULTS On average, SHAs self-reported adequately addressing 11 of 27 succession planning activities, with 93% of SHAs adequately addressing 1 or more activities and 61% adequately addressing 1 or more activities in each domain. CONCLUSIONS The majority of OPM-recommended succession planning activities are not being addressed, and limited succession planning occurs across SHAs. Greater activity in the OPM-identified succession planning domains may help SHAs contend with significant turnover and better preserve institutional knowledge.
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Lessons Learned in Promoting Evidence-Based Public Health: Perspectives from Managers in State Public Health Departments. J Community Health 2019; 43:856-863. [PMID: 29500725 PMCID: PMC6119481 DOI: 10.1007/s10900-018-0494-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Sellers K, Leider JP, Gould E, Castrucci BC, Beck A, Bogaert K, Coronado F, Shah G, Yeager V, Beitsch LM, Erwin PC. The State of the US Governmental Public Health Workforce, 2014-2017. Am J Public Health 2019; 109:674-680. [PMID: 30896986 PMCID: PMC6459653 DOI: 10.2105/ajph.2019.305011] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/04/2022]
Abstract
Public health workforce development efforts during the past 50 years have evolved from a focus on enumerating workers to comprehensive strategies that address workforce size and composition, training, recruitment and retention, effectiveness, and expected competencies in public health practice. We provide new perspectives on the public health workforce, using data from the Public Health Workforce Interests and Needs Survey, the largest nationally representative survey of the governmental public health workforce in the United States. Five major thematic areas are explored: workforce diversity in a changing demographic environment; challenges of an aging workforce, including impending retirements and the need for succession planning; workers' salaries and challenges of recruiting new staff; the growth of undergraduate public health education and what this means for the future public health workforce; and workers' awareness and perceptions of national trends in the field. We discussed implications for policy and practice.
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Affiliation(s)
- Katie Sellers
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Jonathon P Leider
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Elizabeth Gould
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Brian C Castrucci
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Angela Beck
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Kyle Bogaert
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Fátima Coronado
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Gulzar Shah
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Valerie Yeager
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Leslie M Beitsch
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
| | - Paul C Erwin
- Katie Sellers and Brian C. Castrucci are with the de Beaumont Foundation, Bethesda, MD. Jonathon P. Leider is with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. Elizabeth Gould and Kyle Bogaert are with the Association of State and Territorial Health Officials, Arlington, VA. Angela Beck is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. Fátima Coronado is with the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Gulzar Shah is with the Jiann-Ping Hsu College of Public Health, Health Policy and Management, Georgia Southern University, Statesboro. Valerie Yeager is with the Richard M. Fairbanks School of Public Health, Health Policy and Management, Indiana University, Indianapolis. Leslie M. Beitsch is with the Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee. Paul C. Erwin is with the University of Alabama Birmingham School of Public Health
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Public Health Workforce Development Needs: A National Assessment of Executives' Perspectives. Am J Prev Med 2019; 56:e153-e161. [PMID: 30885521 PMCID: PMC8135090 DOI: 10.1016/j.amepre.2018.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Workforce development is one of the ten essential public health services. Recent studies have better characterized individual worker perceptions regarding workforce interests and needs, but gaps remain around workforce needs from program managers' perspectives. This study characterized management perspectives regarding subordinate's abilities and training needs and perceived challenges to recruitment and retention. METHODS In 2017, the Directors Assessment of Workforce Needs Survey was sent to 574 managers at state health agencies across the U.S. Respondents were invited based on the positions they held (i.e., to be included, respondents had to be employed as managers and oversee specific program areas). In 2018, descriptive statistics were calculated, including Fisher's exact for inferential comparisons and Tukey's test for multiple comparisons, as appropriate. RESULTS Response rate was 49% after accounting for undeliverable e-mails; 226 respondents met the inclusion criteria. The largest perceived barriers to staff recruitment were wages or salaries (74%) and private sector competition (56%). Similarly, wages or salaries were identified as the main cause of turnover by 70% of respondents, followed by lack of opportunities for advancement (68%), and opportunities outside the agency (67%). CONCLUSIONS The Directors Assessment of Workforce Needs Survey fills important knowledge gaps and complements previously identified evidence to guide refinement of workforce development efforts. Although competition from the private sector remains challenging, these findings indicate that recruitment and retention must be top priorities in state health agencies nationwide. Prioritizing individual state health agency workforce gaps and committing to provide specific local-level interventions to those priorities is crucial for individual health agencies.
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Jacob RR, Duggan K, Allen P, Erwin PC, Aisaka K, Yang SC, Brownson RC. Preparing Public Health Professionals to Make Evidence-Based Decisions: A Comparison of Training Delivery Methods in the United States. Front Public Health 2018; 6:257. [PMID: 30271767 PMCID: PMC6146213 DOI: 10.3389/fpubh.2018.00257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/20/2018] [Indexed: 01/25/2023] Open
Abstract
Background: Evidence-based decision making (EBDM) in health programs and policies can reduce population disease burden. Training in EBDM for the public health workforce is necessary to continue capacity building efforts. While in-person training for EBDM is established and effective, gaps in skills for practicing EBDM remain. Distance and blended learning (a combination of distance and in-person) have the potential to increase reach and reduce costs for training in EBDM. However, evaluations to-date have focused primarily on in-person training. Here we examine effectiveness of in-person trainings compared to distance and blended learning. Methods: A quasi-experimental pre-post design was used to compare gaps in skills for EBDM among public health practitioners who received in-person training, distance and blended learning, and controls. Nine training sites agreed to replicate a course in EBDM with public health professionals in their state or region. Courses were conducted either in-person (n = 6) or via distance or blended learning (n = 3). All training participants, along with controls, were asked to complete a survey before the training and 6 months post-training. Paired surveys were used in linear mixed models to compare effectiveness of training compared to controls. Results: Response rates for pre and post-surveys were 63.9 and 48.8% for controls and 81.6 and 62.0% for training groups. Participants who completed both pre and post-surveys (n = 272; 84 in-person, 67 distance or blended, and 121 controls) were mostly female (89.0%) and about two-thirds (65.3%) were from local health departments. In comparison to controls, overall gaps in skills for EBDM were reduced for participants of both in-person training (β = −0.55, SE = 0.27, p = 0.041) and distance or blended training (β = −0.64, SE = 0.29, p = 0.026). Conclusions: This study highlights the importance of using diverse methods of learning (including distance or blended in-person approaches) for scaling up capacity building in EBDM. Further exploration into effective implementation strategies for EBDM trainings specific to course delivery type and understanding delivery preferences are important next steps.
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Affiliation(s)
- Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | | | - Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Paul C Erwin
- School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Samuel C Yang
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States.,Division of Public Health Sciences, Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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Leider JP, Coronado F, Beck AJ, Harper E. Reconciling Supply and Demand for State and Local Public Health Staff in an Era of Retiring Baby Boomers. Am J Prev Med 2018; 54:334-340. [PMID: 29336862 PMCID: PMC6944191 DOI: 10.1016/j.amepre.2017.10.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/09/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The purpose of this study is to reconcile public health workforce supply and demand data to understand whether the expected influx of public health graduates can meet turnover events. METHODS Four large public health workforce data sources were analyzed to establish measures of workforce demand, voluntary separations, and workforce employees likely to retire at state and local health departments. Data were collected in 2014-2016 and analyzed in 2016 and 2017. Potential workforce supply (i.e., candidates with formal public health training) was assessed by analyzing data on public health graduates. Supply and demand data were reconciled to identify potential gaps in the public health workforce. RESULTS At the state and local level, ≅197,000 staff are employed in health departments. This is down more than 50,000 from 2008. In total, ≥65,000 staff will leave their organizations during fiscal years 2016-2020, with ≤100,000 staff leaving if all planned retirements occur by 2020. During 2000-2015, more than 223,000 people received a formal public health degree at some level. More than 25,000 students will receive a public health degree at some level in each year through 2020. CONCLUSIONS Demands for public health staff could possibly be met by the influx of graduates from schools and programs of public health. However, substantial implications exist for transferal of institutional knowledge and ability to recruit and retain the best staff to sufficiently meet demand.
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Affiliation(s)
- Jonathon P Leider
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Fatima Coronado
- Center for Surveillance Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela J Beck
- University of Michigan Center of Excellence in Public Health Workforce Studies, Ann Arbor, Michigan
| | - Elizabeth Harper
- Association of State and Territorial Health Officials, Arlington, Virginia
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Brownson RC, Allen P, Jacob RR, deRuyter A, Lakshman M, Reis RS, Yan Y. Controlling Chronic Diseases Through Evidence-Based Decision Making: A Group-Randomized Trial. Prev Chronic Dis 2017; 14:E121. [PMID: 29191262 PMCID: PMC5716810 DOI: 10.5888/pcd14.170326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Although practitioners in state health departments are ideally positioned to implement evidence-based interventions, few studies have examined how to build their capacity to do so. The objective of this study was to explore how to increase the use of evidence-based decision-making processes at both the individual and organization levels. Methods We conducted a 2-arm, group-randomized trial with baseline data collection and follow-up at 18 to 24 months. Twelve state health departments were paired and randomly assigned to intervention or control condition. In the 6 intervention states, a multiday training on evidence-based decision making was conducted from March 2014 through March 2015 along with a set of supplemental capacity-building activities. Individual-level outcomes were evidence-based decision making skills of public health practitioners; organization-level outcomes were access to research evidence and participatory decision making. Mixed analysis of covariance models was used to evaluate the intervention effect by accounting for the cluster randomized trial design. Analysis was performed from March through May 2017. Results Participation 18 to 24 months after initial training was 73.5%. In mixed models adjusted for participant and state characteristics, the intervention group improved significantly in the overall skill gap (P = .01) and in 6 skill areas. Among the 4 organizational variables, only access to evidence and skilled staff showed an intervention effect (P = .04). Conclusion Tailored and active strategies are needed to build capacity at the individual and organization levels for evidence-based decision making. Our study suggests several dissemination interventions for consideration by leaders seeking to improve public health practice.
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Affiliation(s)
- Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Dr, Campus Box 1196, St. Louis, MO 63130. .,Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Anna deRuyter
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Meenakshi Lakshman
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Rodrigo S Reis
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Yan Yan
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri.,Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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Beck AJ, Leider JP, Coronado F, Harper E. State Health Agency and Local Health Department Workforce: Identifying Top Development Needs. Am J Public Health 2017; 107:1418-1424. [PMID: 28727537 DOI: 10.2105/ajph.2017.303875] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify occupations with high-priority workforce development needs at public health departments in the United States. METHODS We surveyed 46 state health agencies (SHAs) and 112 local health departments (LHDs). We asked respondents to prioritize workforce needs for 29 occupations and identify whether more positions, more qualified candidates, more competitive salaries for recruitment or retention, or new or different staff skills were needed. RESULTS Forty-one SHAs (89%) and 36 LHDs (32%) participated. The SHAs reported having high-priority workforce needs for epidemiologists and laboratory workers; LHDs for disease intervention specialists, nurses, and administrative support, management, and leadership positions. Overall, the most frequently reported SHA workforce needs were more qualified candidates and more competitive salaries. The LHDs most frequently reported a need for more positions across occupations and more competitive salaries. Workforce priorities for respondents included strengthening epidemiology workforce capacity, adding administrative positions, and improving compensation to recruit and retain qualified employees. CONCLUSIONS Strategies for addressing workforce development concerns of health agencies include providing additional training and workforce development resources, and identifying best practices for recruitment and retention of qualified candidates.
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Affiliation(s)
- Angela J Beck
- Angela J. Beck is with the Center of Excellence in Public Health Workforce Studies, University of Michigan School of Public Health, Ann Arbor. Jonathon P. Leider is with JP Leider Research and Consulting, Minneapolis, MN. Fatima Coronado is with Center for Surveillance Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Elizabeth Harper is with Association of State and Territorial Health Officials, Arlington, VA
| | - Jonathon P Leider
- Angela J. Beck is with the Center of Excellence in Public Health Workforce Studies, University of Michigan School of Public Health, Ann Arbor. Jonathon P. Leider is with JP Leider Research and Consulting, Minneapolis, MN. Fatima Coronado is with Center for Surveillance Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Elizabeth Harper is with Association of State and Territorial Health Officials, Arlington, VA
| | - Fatima Coronado
- Angela J. Beck is with the Center of Excellence in Public Health Workforce Studies, University of Michigan School of Public Health, Ann Arbor. Jonathon P. Leider is with JP Leider Research and Consulting, Minneapolis, MN. Fatima Coronado is with Center for Surveillance Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Elizabeth Harper is with Association of State and Territorial Health Officials, Arlington, VA
| | - Elizabeth Harper
- Angela J. Beck is with the Center of Excellence in Public Health Workforce Studies, University of Michigan School of Public Health, Ann Arbor. Jonathon P. Leider is with JP Leider Research and Consulting, Minneapolis, MN. Fatima Coronado is with Center for Surveillance Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. Elizabeth Harper is with Association of State and Territorial Health Officials, Arlington, VA
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