Thinking beyond the silos: emerging priorities in workforce development for state and local government public health agencies

Enhancing Leadership and Management Skills in Public Health: Insights from the Public Health Management and Leadership Training Program in Uttar Pradesh, India

Background

In many Indian states, public health programs are led by clinicians without formal training in leadership and management, limiting their effectiveness. To tackle this, Uttar Pradesh's Department of Medical, Health, and Family Welfare initiated a Public Health Management and Leadership (PHML) training program for the Level 4 (mid-career) medical officers. This program aims to enhance the leadership and management skills necessary for these officers to support them transitioning to administrative roles.

Methods

The training focused on essential competencies such as leadership, communication, team building, fiscal management, and public health problem-solving. It included in-person sessions and mentored practicum, utilizing experiential learning and problem-solving group projects. Kirkpatrick's model was used to evaluate participants' reactions, learning outcomes, and behavior change. Feedback was analyzed using descriptive statistics across 12 training domains, while pre- and post-training test scores were compared using paired t-tests in Stata 18 to measure learning improvements. Participant interviews provided additional insights.

Results

Participants reported high satisfaction with the learning environment and methods but faced challenges in applying management concepts, citing limited contextual input and faculty interaction. Learning outcomes showed moderate improvement, with average test scores rising from 53.3 to 59.6 (p = 0.003). They successfully applied a structured problem-solving framework in practicum projects and created action plans for public health challenges. Participants recommended adding topics on financing, procurement, human resources, and hospital management to support them in performing their core functions. Barriers to applying learned concepts included human resource constraints, limited autonomy, gender stereotypes, and lack of recognition.

Conclusion

Emphasizing leadership competencies, experiential learning, and mentored practicum holds promise. However, customizing the curriculum to UP's specific context, ensuring sufficient training time, focusing on core management functions, and addressing organizational barriers are vital. Integrating these recommendations into blended training that enhances core managerial skills and leadership development can strengthen workforce capabilities.

Student reflections on an interdisciplinary pandemics course utilising systems thinking

ISSUE ADDRESSED

The complexity and uncertainty of the COVID-19 pandemic highlights the need to change training of public health professionals in higher education by shifting from siloed specialisations to interdisciplinary collaboration. At the end of 2020 and 2021, public health professionals collaboratively designed and delivered, a week-long intensive course-Public Health in Pandemics. The aim of this research study was to understand whether the use of systems thinking in the design and delivery of the course enabled students to grasp the interdisciplinary nature of contemporary health promotion and public health practice.

RESEARCH METHODS

Two focus group interviews (n = 5 and 3/47) and a course opinion survey (n = 11/47) were utilised to gather information from students regarding experiences and perceptions of course design and delivery, and to determine if students felt better able to understand the complex nature of pandemics and pandemic responses.

MAJOR FINDINGS

Students provided positive feedback on the course and believed that the course design and delivery assisted in understanding the complex nature of health problems and the ways in which health promotion and public health practitioners need to work across sectors with diverse disciplines for pandemic responses.

CONCLUSIONS

The use of an integrated interdisciplinary approach to course design and delivery enabled students used systems thinking to understand the complexity in preparing for and responding to a pandemic. This approach may have utility in preparing an agile, iterative and adaptive health promotion and public health workforce more capable of facing the challenges and complexity in public health.

Health Educators in State/Local Public Health Departments: Training Needs and Awareness of Emerging Areas of Public Health Practice

Although great progress has been made to define the field of health education and provide a voluntary certification system for professionals, research about the governmental health educator and health education specialist workforce is limited. The 2017 PH WINS (Public Health Workforce Interests and Needs Survey) provides valuable data on understanding the workforce demographics, attitudes, and training needs of governmental public health workers, including health educators, and informs future investments in workforce development efforts nationally. The purpose of this article is to examine demographics, job engagement and satisfaction, training needs, certification, and other characteristics of health educators and certified health education specialists (CHES®) from PH WINS. We analyzed the data to describe the health educator workforce and compared it with the national governmental workforce across a range of variables. Compared with the national 2017 PH WINS sample, health educators were relatively younger, more ethnically diverse, more likely to be educated with an advanced degree, and were predominately employed in local versus state public health agencies. Health educators sampled were significantly more knowledgeable of all public health concepts compared with the national 2017 PH WINS respondent workforce. Comparison of CHES® versus non-CHES® professionals is also provided, along with practice and policy implications based on the data. This is the first detailed analyses of health educators in state and local health departments, with important findings and implications related to workforce composition, satisfaction, retention, and training. Further cross-sectional workforce research is needed to understand the current strengths and gaps in the health education workforce.

Leadership academy for excellence in disability services: evaluation of outcomes for state employees

As the United States' first disability-specific leadership academy in state government, the Leadership Academy for Excellence in Disability Services is a year-long competency-based training experience designed for employees who manage programs that impact the lives of Tennesseans with intellectual and developmental disabilities and their families. The Tennessee Department of Human Resources, in collaboration with the Tennessee Council on Developmental Disabilities, began implementing this program in 2017. The lasting impact of such a training experience on the practices of state employees once they complete the program is not known; this was the aim of the study. A follow-up survey examining graduate perceptions and outcomes was sent to 71 graduates; 48 completed the measure. The results reveal an increase in knowledge of disability service systems and a perceived ability to lead and advocate for others. Leadership competencies deemed most important to graduates' current efforts in state government included developing direct reports, managing diversity, organizational agility, and innovation management. Graduates' written comments cited the variety of subject matter experts, networking opportunities, and small group projects as fundamental in breaking down barriers to cross-agency collaboration in their disability work. The impact of this experience continues to be seen years after completing the leadership academy.

Epidemic Intelligence Service Alumni in Public Health Leadership Roles

Since 1951, the Epidemic Intelligence Service (EIS) of the U.S. Centers for Disease Control and Prevention (CDC) has trained physicians, nurses, scientists, veterinarians, and other allied health professionals in applied epidemiology. To understand the program's effect on graduates' leadership outcomes, we examined the EIS alumni representation in five select leadership positions. These positions were staffed by 353 individuals, of which 185 (52%) were EIS alumni. Among 12 CDC directors, four (33%) were EIS alumni. EIS alumni accounted for 29 (58%) of the 50 CDC center directors, 61 (35%) of the 175 state epidemiologists, 27 (56%) of the 48 Field Epidemiology Training Program resident advisors, and 70 (90%) of the 78 Career Epidemiology Field Officers. Of the 185 EIS alumni in leadership positions, 136 (74%) were physicians, 22 (12%) were scientists, 21 (11%) were veterinarians, 6 (3%) were nurses, and 94 (51%) were assigned to a state or local health department. Among the 61 EIS alumni who served as state epidemiologists, 40 (66%) of them were assigned to a state or local health department during EIS. Our evaluation suggests that epidemiology training programs can serve as a vital resource for the public health workforce, particularly given the capacity strains brought to light by the COVID-19 pandemic.

Results From a National Mixed-Methods Study Exploring Community Health Improvement Implementation: An Opportunity to Strengthen Public Health Systems Through Collective Action

CONTEXT

There are multiple calls for public health agency role and workforce transformation to increase capacity to orchestrate cross-sectoral partnerships that set and implement strategies addressing the structural and social determinants of health. Mobilizing for Action through Planning and Partnerships (MAPP) may be one tool for collective action to improve population health and equity. However, little is known about the Action Cycle in MAPP and implementation of resulting community health improvement plans.

OBJECTIVE

To explore the characteristics of MAPP users who completed the MAPP Action Cycle and factors that facilitated or inhibited implementation activities during this phase.

METHODS

We used a sequential participatory mixed-methods design involving 2 phases of data collection. The first data collection phase included a Web-based survey using Qualtrics. The second data collection phase included qualitative key-informant interviews and focus groups. A national public health and health care advisory group informed the evaluation throughout the entire process to ground the process in practice and experience.

RESULTS

This study showed that some MAPP participants do not conduct implementation activities as defined by the MAPP Action Cycle and of those who do, implementation activity varies by participant experiences conducting MAPP and accreditation status. The MAPP users who completed 3 or more rounds of MAPP were more likely to align and integrate MAPP within their agencies as well as organize a collaborative implementation process with partners. More resources and skills in planning that facilitate long-range partnerships were noted as key to implementation.

CONCLUSIONS

Opportunity remains to improve implementation in MAPP. National leaders should explore and build capacity and infrastructure within public health agencies and with their partners to create a system of readiness and an infrastructure that support implementation over time.

Developing State Leadership in Maternal and Child Health: Process Evaluation Findings from a Work-Based Learning Model for Leadership Development

Objectives

Since 2013 the MCH Bureau has supported the National MCH Workforce Development Center to strengthen the Title V MCH workforce. This article describes the Center’s Cohort Program and lessons learned about work-based learning, instruction, and coaching.

Description

The Cohort Program is a leadership development program that enrolls state-level teams for skill development and work-based learning to address a self-identified challenge in their state. Teams attend a Learning Institute that teaches concepts, skills, and practical tools in systems integration; change management and adaptive leadership; and evidence-based decision-making and implementation. Teams then work back home on their challenges, aided by coaching. The Program’s goals are for teams to expand and use their skills to address their challenge, and that teams would strengthen programs, organizations, and policies, use their skills to address other challenges, and ultimately improve MCH outcomes.

Methods

This process evaluation is based on evaluation forms completed by attendees at the three-day Learning Institute; six-month follow-up interviews with team leaders; and a modified focus group with staff.

Results

Participants and staff believe the Cohort Program effectively merges a practical skill-based curriculum, work-based learning in teams, and coaching. The Learning Institute provides a foundation of skills and tools, strengthens the team’s relationship with their coach, and builds the team. The work-based learning period provides structure, accountability, and a “practice space” for teams to apply the Cohort Program’s skills and tools to address their challenge. In this period, teams deepen collaborations and often add partners. The coach provides accessible and tailored guidance in teamwork and skill application. These dimensions helped teams in develop skills and address state-level MCH challenges.

Conclusions for Practice

Continuing professional development programs can help leaders learn to address complex state-level MCH challenges through integrated classroom-based skills development, work-based learning on state challenges, and tailored coaching.

Building Collective Efficacy to Support Public Health Workforce Development

CONTEXT

Leaders in public health have made great advances in workforce development over the past 30 years, while shifting from an emphasis based in training on individual, technical skills to a more holistic development approach, which boosts crosscutting skills. Efforts to increase public health workforce capabilities remain focused on workers as individuals, rather than the workforce as a collective unit.

PROGRAM

Research has shown that a strategic adult learning approach can improve both individual capabilities and the collective performance of the workforce, which can be explained using social cognitive theory and the concept of collective efficacy, or the collective belief of workers in the ability of the group to succeed. We explain how a prior training program pushed us to explore this approach.

IMPLEMENTATION

The proposed approach covers proposed implementation strategies to build collective efficacy as part of existing workforce development initiatives, with a focus on 5 key steps.

EVALUATION

Experience in fields as diverse as sports psychology and organizational development has shown that it is possible to evaluate changes in collective efficacy using measures that can be adopted in public health.

DISCUSSION

Adjusting existing public health workforce development initiatives to build collective efficacy can help link workforce self-confidence to performance. More actionable data are needed to determine the best methods for achieving those goals in the field of public health.

Core Competency Gaps Among Governmental Public Health Employees With and Without a Formal Public Health Degree

OBJECTIVES

To examine the role of a formal public health degree as it relates to core competency needs among governmental public health employees.

DESIGN

This cross-sectional study utilizes the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate relationships were analyzed by conducting χ tests of respondents' supervisory level and reported skill gaps. Multivariate logistic regressions of reported skill gaps were performed holding gender, age, race/ethnicity, highest degree attained, current employer, role type, tenure in current agency, and public health certificate attainment constant.

SETTING

Nationally representative sample of government public health employees.

PARTICIPANTS

A total of 30 276 governmental public health employees.

MAIN OUTCOME MEASURE

Self-reported competency skills gaps.

RESULTS

Among nonsupervisors, those with a public health degree had significantly lower odds of reporting a competency gap for 8 of the 21 skills assessed. Among supervisors/managers, those who had a formal public health degree had significantly lower odds of reporting a competency gap in 3 of the 22 skills assessed. Having a degree in public health was not significantly related to an executive's likelihood of reporting a skill gap across any of the 22 skills assessed. Regardless of supervisory level, having a public health degree was not associated with a reduced likelihood of reporting skill gaps in effective communication, budgeting and financial management, or change management competency domains.

CONCLUSIONS

Possessing a formal public health degree appears to have greater value for skills required at the nonsupervisor and supervisor/manager levels than for skills needed at the executive level. Future work should focus on longitudinal evaluations of skill gaps reported among the public health workforce as changes in public health curricula may shift over time in response to newly revised accreditation standards. In addition, public health education should increase emphasis on communication, budgeting, systems thinking, and other management skills among their graduates.

Evaluation of Training Gaps Among Public Health Practitioners in Washington State

CONTEXT

Identifying training gaps in public health competencies and skills is a first step in developing priorities for advancing the workforce.

OBJECTIVE

Our purpose was to identify training gaps in competencies and skills among local, state, and nonjurisdictional public health employees in Washington State. Our secondary aim was to determine whether training gaps differed by employees' work-related and demographic characteristics.

DESIGN

We used data from our training needs assessment of the public health workforce, conducted as an online cross-sectional survey in Spring/Summer of 2016.

RESPONDENTS AND SETTING

Employees from governmental local, state, and nonjurisdictional public health departments in Washington State.

MAIN OUTCOME MEASURES

Training gaps were calculated for 8 public health competencies and 8 skills, using a composite score of respondents' ratings of their "training confidence" and "training need." For each domain and skill area, we calculated the percentage of associated items, where respondents rated their training needs as high and their confidence as low to create scores ranging from 0% to 100%.

RESULTS

The largest training gaps in public health competencies were in the Financial Planning and Policy Development domains. For skills, Quality Improvement and Developing Effective Communication Campaigns had the largest training gaps. In adjusted models, female employees or employees working in local health departments in select Washington State regions had higher training gaps in Financial Planning, Policy Development, and Quality Improvement, relative to male or state health department employees. Employees who worked in specialized programs, such as Communicable Disease Control, and Maternal, Child, and Family Health, had higher training gaps in Financial Planning and Developing Effective Communication Campaigns than those who worked in Administrative and Support Services.

CONCLUSIONS

We identified important training gaps in several competency domains and skills. Findings are informing decisions about tailoring training opportunities for public health practitioners in Washington and other states.

The Methods of PH WINS 2017: Approaches to Refreshing Nationally Representative State-Level Estimates and Creating Nationally Representative Local-Level Estimates of Public Health Workforce Interests and Needs

Supplemental Digital Content is Available in the Text.

Context:

The Public Health Workforce Interests and Needs Survey (PH WINS) was first fielded in 2014 and is the largest public health workforce survey in the nation. This article elucidates the methods used for the 2017 PH WINS fielding.

Program or Policy:

PH WINS was fielded to a nationally representative sample of State Health Agency Central Office (SHA-CO) staff, as well as local health department (LHD) staff. The instrument largely mirrored 2014, though the training needs section was revised, and a validated item measuring burnout in staff was added.

Implementation:

Staff lists were collected directly from all participating state and local agencies. Forty-seven state health agencies (SHAs), 26 large LHDs, and 71 midsize LHDs participated. All SHAs were surveyed using a census approach. The nationally representative SHA-CO frame is representative of all central office staff members. The nationally representative local frame was a complex survey design, wherein staff from LHDs were randomly sampled across 20 strata, based on agency size and geographic region. Staff were also contributed with certainty from large LHDs in nondecentralized states. The frame is representative of staff at LHDs serving more than 25 000 people and with 25 or more staff members. Other LHDs are excluded, and so PH WINS is not representative of smaller LHDs. Balanced repeated replication weights were used to adjust variance estimates for the complex design.

Evaluation:

Overall, 47 604 people responded to PH WINS in 2017 across all frames. PH WINS 2017 achieved a response rate of 48%. The design effect for the SHA-CO frame was 1.46 and was 16.42 for the local frame.

Discussion:

PH WINS now offers a nationally representative sample of both SHA-CO and LHD staff across 4 major domains: workplace environment, training needs, emerging concepts in public health, and demographics. Both practice and academia can use PH WINS to better understand the perceptions and needs of staff, address training gaps, and work to recruit and retain quality staff.

Regional Training Needs Assessment: A First Look at High-Priority Training Needs Across the United States by Region

Supplemental Digital Content is Available in the Text.

Context:

Although core scientific skills remain a priority to public health, preventing and responding to today's leading causes of death require the workforce to build additional strategic skills to impact the social, community-based, and economic determinants of health. The 2017 Public Health Workforce Interests and Needs Survey allows novel regional analysis of training needs, both individually and across 8 strategic skill domains.

Objective:

The purpose of this article is to describe the training needs of public health staff nationally, across the 10 Department of Health and Human Services Regions.

Design:

The Public Health Workforce Interests and Needs Survey was a Web-based survey fielded to 100 000 staff nationwide across 2 major frames: state health agency-central office and local health department. State-based respondents were fielded on a census approach, with locals participating in a more complex sampling design. Balanced repeated replication weights were used to address nonresponse and sampling.

Setting:

State and local health departments.

Participants:

Respondents from state and local health departments.

Main Outcome Measures:

This article draws from the training needs portion of Public Health Workforce Interests and Needs Survey. Descriptive statistics are generated, showing training needs gaps. Inferential analyses pertain to gaps across Region and supervisory status, using Pearson χ² test and Rao-Scott design–adjusted χ² test.

Results:

Training needs varied across regions and work setting. Certain strategic skills tended to see larger, consistent gaps regardless of Region or setting, including Budgeting & Finance, Change Management, Systems Thinking, and Developing a Vision for a Healthy Community.

Conclusions:

Overall, the data suggest substantial interregional variation in training needs. Until now, this picture has been incomplete; disparate assessments across health departments, Regions, and disciplines could not be combined into a national picture. Regionally focused training centers are well situated to address Region-specific needs while supporting the broader building of capacity in strategic skills nationwide.

Top Training Needs of the Governmental Public Health Workforce

Context:

Workforce development in governmental public health has historically focused on discipline-specific skills. However, as the field of public health has evolved, crosscutting skills have become critical. The 2017 fielding of the Public Health Workforce Interests and Needs Survey (PH WINS) provides a national benchmark for gaps in crosscutting skills in state and local health departments.

Objective:

The purpose of this article is to identify top areas of training needs in the governmental public health workforce using data from PH WINS 2017.

Design:

PH WINS participants in state and local health departments were surveyed in fall 2017 using a Web-based platform. Balanced repeated replication weights were used to account for complex sample design.

Setting:

Forty-seven state health agencies, 26 large city health departments, and a nationally representative sample of mid-to-large local health departments.

Participants:

Permanently employed governmental public health staff.

Main Outcome Measures:

Training needs were determined by combining self-reported skill importance and proficiency. Skills reported to be of high importance, and low levels of proficiency were coded as training needs. Focus area gaps were defined as having a training need in at least one skill in the focus area.

Results:

The largest area of training need, regardless of supervisory status, was in budgeting and financial management (55%; 95% confidence interval [CI], 53-56), with a large gap also identified in systems and strategic thinking (49%; 95% CI, 47-50). There was some variation by supervisory status, with training needs for nonsupervisors in change management and in developing a vision for a healthy community for management.

Conclusions:

The PH WINS training needs assessment provides the first nationally representative data on training needs for the state and local health department workforce. Across state and local health departments, there are common critical training needs essential for the current and future practice of public health.

Strategies and Tools for Public Health Workforce Training Needs Assessments in Diverse and Changing Population Health Contexts

CONTEXT

A key component of the improvement of public health infrastructure in the United States revolves around public health workforce development and training. Workforce challenges faced by the public health system have long been recognized, but there are additional challenges facing any region-wide or cross-jurisdictional effort to accurately assess priority workforce training needs and develop training resources to address those needs. These challenges include structural variability of public health organizations; diverse population health contexts; capturing both topic-specific skill sets and foundational competencies among public health workers; and reaching/representing the target population despite suspicion, disinterest, and/or assessment "fatigue" among employees asked to participate in workforce development surveys.

OBJECTIVE

The purpose of this article is to describe the challenges, strategies to meet those challenges, and lessons learned conducting public health workforce training needs assessments by academic and practice partners of the Region 2 Public Health Training Center (R2/PHTC).

SETTING AND PARTICIPANTS

The R2/PHTC is hosted by the Mailman School of Public Health at Columbia University and serves New York, New Jersey, Puerto Rico, and the US Virgin Islands within its jurisdiction.

RESULTS

Strategies for responding to diverse organizational structures and population health contexts across the region; defining training priorities that address both foundational competencies for public health professionals and content-specific training to address local public health needs; reaching/representing target populations of public health workers; and analysis and report writing to encourage rapid response to identified needs and comprehensive workforce development planning are discussed. Lessons learned are likely instructive to other workforce training needs assessments in complex and ever-changing public health environments.

Chronic disease prevention evaluation in Ontario's public health system: a qualitative needs assessment

OBJECTIVES

Building evaluation capacity for chronic disease prevention (CDP) is a critical step in ensuring the effectiveness of CDP programming over time. In this article, we highlight the findings of the qualitative arm of a mixed-methods needs assessment designed to assess the gaps and areas of strength within Ontario's public health system with respect to CDP evaluation.

METHODS

We conducted 29 interviews and focus groups with representatives from 25 public health units (PHUs) and analyzed the data using thematic analysis. We sought to understand what gaps and challenges exist in the Ontario public health system around CDP evaluation.

RESULTS

Challenges facing Ontario's PHUs in CDP evaluation include variation and centralization of capacity to evaluate, as well as competing priorities limiting the development of evaluative thinking. Participating PHUs identified the need for evaluation capacity building (ECB) strategies grounded in an understanding of the unique contexts in which they work and a desire for guidance in conducting a complex and thoughtful evaluation. Moving forward, PHUs noted a desire for a strong system of knowledge sharing and consultation across the public health system, including through strengthening existing partnerships with community collaborators.

CONCLUSION

These results support the case for ECB strategies that are adaptive and context-sensitive and equip PHUs with the skills required to evaluate complex CDP programming.

Public Health Workforce Self-Identified Training Needs by Jurisdiction and Job Type

CONTEXT

Ensuring adequate and appropriate training of the workforce is a crucial priority for governmental public health. This is particularly important, given the diverse backgrounds of the public health workforce; the vast majority (approximately 83%) do not have formal training in public health, and those that do have formal training in public health have limited training in management and other essential organizational skills.

OBJECTIVE

The purpose of this article is to identify training needs among public health workers in specific job types and settings.

DESIGN AND PARTICIPANTS

This cross section study used 2014 data from the Public Health Workforce Interests and Needs Survey. Qualitative analyses were used to code open-ended responses to questions about training needs. Needs are stratified across job types and jurisdiction.

RESULTS

Eight main themes or skill areas were identified with the largest proportion indicating a need for management/leadership skills (28.2%). The second most frequent need was communication skills (21.3%). Across the 9 job types examined, general management skills were either the first or second training need for 7 job types. Among individuals who already have leadership/management positions, budgeting was the most common training need.

CONCLUSIONS

Findings from this study can inform targeted strategies to address training needs for specific types of employees. Such strategies can influence the efficiency and effectiveness of public health efforts and employee satisfaction. As new public health frameworks-like Public Health 3.0 and the Chief Health Strategist-are advanced nationally, it is necessary to ensure that the workforce has the skills and abilities to implement these frameworks.

A systemic approach to achieving population-level impact in injury and violence prevention

The contemporary public health model for injury and violence prevention is a four-step process, which has been difficult to fully actualize in real-world contexts. This difficulty results from challenges in bridging science to practice and developing and applying population-level approaches. Prevention programmes and policies are embedded within and impacted by a range of system-level factors, which must be considered and actively managed when addressing complex public health challenges involving multiple sectors and stakeholders. To address these concerns, a systemic approach to population-level injury and violence prevention is being developed and explored by the Division of Analysis, Research, and Practice Integration in the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. This article makes the case for and provides a high-level overview of this systemic approach, its various components, and how it is being applied in one governmental unit.

Workforce/Population, Economy, Infrastructure, Geography, Hierarchy, and Time (WEIGHT): Reflections on the Plural Dimensions of Disaster Resilience

The concept of resilience and its relevance to disaster risk management has increasingly gained attention in recent years. It is common for risk and resilience studies to model system recovery by analyzing a single or aggregated measure of performance, such as economic output or system functionality. However, the history of past disasters and recent risk literature suggest that a single-dimension view of relevant systems is not only insufficient, but can compromise the ability to manage risk for these systems. In this article, we explore how multiple dimensions influence the ability for complex systems to function and effectively recover after a disaster. In particular, we compile evidence from the many competing resilience perspectives to identify the most critical resilience dimensions across several academic disciplines, applications, and disaster events. The findings demonstrate the need for a conceptual framework that decomposes resilience into six primary dimensions: workforce/population, economy, infrastructure, geography, hierarchy, and time (WEIGHT). These dimensions are not typically addressed holistically in the literature; often they are either modeled independently or in piecemeal combinations. The current research is the first to provide a comprehensive discussion of each resilience dimension and discuss how these dimensions can be integrated into a cohesive framework, suggesting that no single dimension is sufficient for a holistic analysis of a disaster risk management. Through this article, we also aim to spark discussions among researchers and policymakers to develop a multicriteria decision framework for evaluating the efficacy of resilience strategies. Furthermore, the WEIGHT dimensions may also be used to motivate the generation of new approaches for data analytics of resilience-related knowledge bases.

A Review of Public Health Training Needs Assessment Approaches: Opportunities to Move Forward

CONTEXT

Assessing training needs of the public health workforce is crucial for creating professional development opportunities to improve knowledge, competence, and effectiveness of this workforce.

DISSEMINATION

Regional Public Health Training Centers (RPHTCs) assess workforce training needs and deliver training based on identified needs. To determine training priorities, several needs assessment surveys have been administered by RPHTCs and national public health member organizations.

EVALUATION

This study identified the types of training questions being asked to public health practitioners in the various assessment surveys implemented by RPHTCs and national membership organizations. Although the surveys measured similar overarching constructs, multiple approaches with limited consistency were used to measure training needs.

DISCUSSION

Although successful in responding to the needs of their targeted constituents, the limited consistency among survey types makes generalization of findings difficult. Disseminating common metrics and aggregate survey findings would increase efficiency in determining workforce training needs and developing targeted training.

The State of the US Governmental Public Health Workforce, 2014-2017

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.

Preparing Public Health Professionals to Make Evidence-Based Decisions: A Comparison of Training Delivery Methods in the United States

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.

A Multifaceted Approach to Public Health Career and Professional Development Training

The purpose of this article is to describe how a multifaceted approach to career and professional development training, focused on core competencies, student-driven programming, inter and multidisciplinary collaboration, and cultivating a community of insight and support, is being implemented by a university Public Health Career Services office with limited staff and resources and to share these practices for other public health programs to scale this approach to their own students' needs. The design of the career and professional development training program comprised five main approaches: (1) one-on-one career counseling, (2) peer-to-peer learning workshops, (3) community partnerships and experiential opportunities, (4) student-driven programming, and (5) accessible training and digital resources. All programs were tracked to gauge participation and to assess effectiveness. Noteworthy findings from program evaluations include (1) a large increase in student confidence levels in professionalism topics, from all of the school's departments; (2) benefits of student-driven programming and peer-to-peer learning, and (3) importance of employer and alumni engagement. Rather than use an optional participation model, it is recommended that a cohort model or mandatory participation be implemented as the opportunity to build on curriculum is vital.

CDC's "Flexible" Epidemiologist: A Strategy for Enhancing Health Department Infectious Disease Epidemiology Capacity

CONTEXT

CDC's Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement aims to help health departments strengthen core epidemiology capacity needed to respond to a variety of emerging infectious diseases. In fiscal year 2014, $6 million was awarded to 41 health departments for flexible epidemiologists (FEs). FEs were intended to help meet health departments' unique needs and support unanticipated events that could require the diversion of resources to specific emerging or reemerging diseases.

OBJECTIVE

Explore multiple perspectives to characterize how FEs are utilized and to understand the perceived value of this strategy from the health department perspective.

DESIGN, SETTING, AND PARTICIPANTS

We conducted 14 in-depth interviews using a semistructured questionnaire with a heterogeneous sample of 8 state health departments; 2 different instruments were administered to ELC principal investigators (PIs) or supervisors, and FEs. The team produced a codebook consisting of both structural and data-driven codes to prepare for a thematic analysis of the data.

RESULTS

Three major patterns emerged to describe how FEs are being used in health departments; most commonly, FEs were used to support priorities and gaps across a range of infectious diseases, with an emphasis on enteric diseases. Almost all of the health departments utilized FEs to assist in investigating and responding to outbreaks, maintaining and upgrading surveillance systems, and coordinating and collaborating with partners. Both PIs and supervisors highly valued the flexibility it offered to their programs because FEs were cross-trained and could be used to help with situations where additional staff members were needed.

CONCLUSION

ELC enhances epidemiology capacity in health departments by providing flexible personnel that help sustain areas with losses in capacity, addressing programmatic gaps, and supporting unanticipated events. Our findings support the notion that flexible personnel could be an effective model for strengthening epidemiology capacity among health departments.

IMPLICATIONS FOR POLICY & PRACTICE

Our findings have practical implications for addressing the overall decline in the public health workforce, as well as the current context and environment of public health funding at both state and federal levels.

Joint Community Health Needs Assessments as a Path for Coordinating Community-Wide Health Improvement Efforts Between Hospitals and Local Health Departments

OBJECTIVES

To examine the association between hospital-local health department (LHD) collaboration around community health needs assessments (CHNAs) and hospital investment in community health.

METHODS

We combined 2015 National Association of County and City Health Officials (NACCHO) Forces of Change, 2013 NACCHO Profile, and 2014-2015 Area Health Resource File data to identify a sample of LHDs (n = 439) across the United States. We included data on hospitals' community benefit from their 2014 tax filings (Internal Revenue Service Form 990, Schedule H). We used bivariate and multivariate regression analyses to examine LHDs' involvement in hospitals' CHNAs and implementation strategies and the relationship with hospital investment in community health.

RESULTS

The LHDs that collaborated with hospitals around CHNAs were significantly more likely to be involved in joint implementation planning activities than were those that did not. Importantly, LHD involvement in hospitals' implementation strategies was associated with greater hospital investment in community health improvement initiatives.

CONCLUSIONS

Joint CHNAs may improve coordination of community-wide health improvement efforts between hospitals and LHDs and encourage hospital investment in community health improvement activities. Public Health Implications. Policies that strengthen LHD-hospital collaboration around the CHNA may enhance hospital investments in community health.

Reconciling Supply and Demand for State and Local Public Health Staff in an Era of Retiring Baby Boomers

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.

Public health nurses' graduate education decision making processes

INTRODUCTION

A well-educated public health workforce is needed to improve population health. Although nurses constitute the largest number of U.S. public health professionals, those holding graduate degrees remain low. This study describes public health nurses' (PHNs) perspectives on graduate school decision-making processes.

METHODS

Using a qualitative descriptive design, semi-structured, qualitative telephone interviews with PHNs (n=30) were conducted June 2014-January 2015. Study participants included PHNs from 17 states employed in a variety of positions within government health agencies, academe, and business. Interview transcripts were coded and thematically analyzed.

RESULTS

PHNs' pursuit of a graduate degree varied, often depending on work setting and/or availability of degree programs. Many study participants were unaware of the public health nursing graduate degree option, with only 9 of 26 participants obtaining an advanced degree in public health nursing. The MPH degree however, was well-known and particularly valued.

CONCLUSION

Opportunities for graduate public health nursing are limited; as such, marketing of existing programs need to be nationally coordinated and new collaborative efforts between schools of nursing and schools of public health developed. These efforts are required if graduate-prepared public health nurses are to be part of the future workforce, prepared to tackle increasingly complex population health issues.

Setting priorities for EU healthcare workforce IT skills competence improvement

A major challenge for healthcare quality improvement is the lack of IT skills and knowledge of healthcare workforce, as well as their ambivalent attitudes toward IT. This article identifies and prioritizes actions needed to improve the IT skills of healthcare workforce across the EU. A total of 46 experts, representing different fields of expertise in healthcare and geolocations, systematically listed and scored actions that would improve IT skills among healthcare workforce. The Child Health and Nutrition Research Initiative methodology was used for research priority-setting. The participants evaluated the actions using the following criteria: feasibility, effectiveness, deliverability, and maximum impact on IT skills improvement. The leading priority actions were related to appropriate training, integrating eHealth in curricula, involving healthcare workforce in the eHealth solution development, improving awareness of eHealth, and learning arrangement. As the different professionals' needs are prioritized, healthcare workforce should be actively and continuously included in the development of eHealth solutions.

The Methods Behind PH WINS

Supplemental Digital Content is Available in the Text.

This article outlines the conceptualization, development, and implementation of the Public Health Workforce Interests and Needs Survey, as well as considerations and limitations.

The Public Health Workforce Interests and Needs Survey (PH WINS) has yielded the first-ever nationally representative sample of state health agency central office employees. The survey represents a step forward in rigorous, systematic data collection to inform the public health workforce development agenda in the United States. PH WINS is a Web-based survey and was developed with guidance from a panel of public health workforce experts including practitioners and researchers. It draws heavily from existing and validated items and focuses on 4 main areas: workforce perceptions about training needs, workplace environment and job satisfaction, perceptions about national trends, and demographics. This article outlines the conceptualization, development, and implementation of PH WINS, as well as considerations and limitations. It also describes the creation of 2 new data sets that will be available in public use for public health officials and researchers—a nationally representative data set for permanently employed state health agency central office employees comprising over 10 000 responses, and a pilot data set with approximately 12 000 local and regional health department staff responses.

Perception of Workforce Skills Needed Among Public Health Professionals in Local Health Departments: Staff Versus Top Executives

OBJECTIVES

To examine how top executives and staff from local health departments (LHDs) perceive the importance of various types of workforce skills, and to assess the differences in the perception of the importance of these workforce skills between these 2 groups and among LHDs serving different-sized jurisdictions.

DESIGN

Data for this study were drawn from the 2014 Public Health Workforce Interests and Needs Survey (PH WINS) and the 2015 Forces of Change survey. While PH WINS collected data from LHD staff, the Forces of Change survey was administered to LHD top executives. Ratings of perceived importance of workforce skills from LHD staff and top executives were compared.

RESULTS

Overall, LHD workers at all levels believe that core competencies are important for their jobs. The perceived importance of these skills differed somewhat across supervisory level (nonsupervisory staff vs supervisory staff vs top executives). Communication was rated as one of the most important skills by all groups. For top executives, ensuring that programs are managed within budget constraints was the most important skill for their employees. However, this skill was rated much lower among staff. Policy development skills were rated to be of lowest importance by LHD leaders and staff.

CONCLUSIONS

LHD leaders and staff agree on the relative importance of some competencies, although they also show some clear differences in the relative importance that they place on other competencies. It is essential to strengthen the communication between public health leaders and staff regarding the importance of workforce skills. More investigation is needed to assess whether and how gaps in staff competencies are addressed in the workforce development strategies.

Educational Attainment of the Public Health Workforce and Its Implications for Workforce Development

This study ascertains the levels of educational attainment among state health agency employees as well as the correlates of attainment.

Educational attainment is a critical issue in public health workforce development. However, relatively little is known about the actual attainment of staff in state health agencies (SHAs).

Job Satisfaction: A Critical, Understudied Facet of Workforce Development in Public Health

CONTEXT

The field of public health faces multiple challenges in its efforts to recruit and retain a robust workforce. Public health departments offer salaries that are lower than the private sector, and government bureaucracy can be a deterrent for those seeking to make a difference.

OBJECTIVE

The objective of this research was to explore the relationship between general employee satisfaction and specific characteristics of the job and the health agency and to make recommendations regarding what health agencies can do to support recruitment and retention.

DESIGN

This is a cross-sectional study using data collected from the 2014 Public Health Workforce Interests and Needs Survey (PH WINS). A nationally representative sample was constructed from 5 geographic (paired adjacent HHS [US Department of Health and Human Services]) regions and stratified by population and state governance type. Descriptive and inferential statistics were analyzed using the balanced repeated replication method to account for the complex sampling design. A multivariate linear regression was used to examine job satisfaction and factors related to supervisory and organizational support adjusting for relevant covariates.

SETTING AND PARTICIPANTS

PH WINS data were collected from state health agency central office employees using an online survey.

MAIN OUTCOME MEASURE

Level of job satisfaction using the Job in General Scale (abridged).

RESULTS

State health agency central office staff (n = 10,246) participated in the survey (response rate 46%). Characteristics related to supervisory and organizational support were highly associated with increased job satisfaction. Supervisory status, race, organization size, and agency tenure were also associated with job satisfaction.

CONCLUSIONS

Public health leaders aiming to improve levels of job satisfaction should focus on workforce development and training efforts as well as adequate supervisory support, especially for new hires and nonsupervisors.

The Public Health Workforce Interests and Needs Survey: The First National Survey of State Health Agency Employees

This article describes a nationally representative survey of central office employees at state health agencies to characterize key components of the public health workforce.

Public health practitioners, policy makers, and researchers alike have called for more data on individual worker's perceptions about workplace environment, job satisfaction, and training needs for a quarter of a century. The Public Health Workforce Interests and Needs Survey (PH WINS) was created to answer that call.

An Evaluation of a Competency-Based Public Health Training Program for Public Health Professionals in Kansas

CONTEXT

Less than one-third of the US public health workforce has formal training in public health. Academic-public health agency partnerships aimed at addressing the nation's workforce challenges have shown great promise.

OBJECTIVE

To evaluate the effectiveness of a piloted competency-based public health training program formed out of an academic-public health agency partnership.

DESIGN

Mixed-methods design using pre- and postworkshop surveys and quizzes, open-ended questions, and document review.

SETTING

Large, urban local health department located in south central Kansas.

MAIN OUTCOME MEASURES

Participant satisfaction with training, knowledge change, self-report application of new knowledge, and organizational change.

RESULTS

Participants reported high satisfaction with the training program and valued the hands-on, practical approach used. Participation increased knowledge and confidence in public health competency areas covered in the program. At 3-month follow-up, 90% of participants reported applying new knowledge and skills in their primary job duties. At the organizational level, 3 major policy changes aimed at sustaining the program were implemented following its launch.

CONCLUSION

Incorporating tailored, theory-driven approaches to trainings and collaborating with health department leadership to identify policy opportunities that help sustain the training program within the agency is recommended. Findings from this evaluation demonstrate the success of an academic-agency partnership's effort to develop and implement at a large, urban local health department.

Assuring a strong foundation for our nation's public health systems

BACKGROUND

A strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them.

PURPOSE

This article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health.

DISCUSSION

National nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession.

CONCLUSION

We propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.

Loving and Leaving Public Health: Predictors of Intentions to Quit Among State Health Agency Workers

CONTEXT

State health agencies play a critical role in protecting and promoting the health and well-being of the people they serve. To be effective, they must maintain a highly skilled, diverse workforce of sufficient size and with proper training.

OBJECTIVE

The goal of this study was to examine demographics, job and workplace environment characteristics, job satisfaction, and reasons for initially joining the public health workforce as predictors of an employee's intentions to leave an organization within the next year.

DESIGN

This study used a cross-sectional design. Respondents were selected on the basis of a stratified sampling approach, with 5 geographic (paired Health and Human Services [HHS] regions) as the primary strata. Balanced repeated replication was used as a resampling method for variance estimation. A logistic regression model was used to examine the correlates of intentions to leave one's organization within the next year. The independent variables included several measures of satisfaction, perceptions about the workplace environment, initial reasons for joining public health, gender, age, education, salary, supervisory status, program area, and paired HHS region.

SETTING AND PARTICIPANTS

The sample for this study consisted of 10,246 permanently employed state health agency central office employees who responded to the Public Health Workforce Interests and Needs Survey (PH WINS).

MAIN OUTCOME MEASURE

Considering leaving one's organization within the next year.

RESULTS

Being a person of color, living in the West (HHS regions 9 and 10), and shorter tenure in one's current position were all associated with higher odds of intentions to leave an organization within the next year. Conversely, greater employee engagement, organizational support, job satisfaction, organization satisfaction, and pay satisfaction were all significant predictors of lower intentions to leave one's organization within the next year.

CONCLUSIONS

Results from this study suggest several variables related to demographics, job characteristics, workplace environment, and job satisfaction that are predictive of intentions to leave. Future researchers and state health agencies should explore how these findings can be used to help with retention of employees in the state health agency workforce.

Making sense of health care delivery Where does the close to community health care worker fit in? - The case for congestive heart failure

Close to community health care workers (CTC-HCW) is an increasingly used term to describe the emergence of a new partner in health services delivery. In strengthening arguments for this part of the health workforce the authorities, health staffers, supporters, sceptics and perhaps clients will look to the academicians and the evidence base to determine the fate of this group. There is no doubt, CTC-HCW are a vital resource, whose importance is tied to socio-demo-geographic variables. Regardless of what the common perceptions of its importance are, the evolving evidence base could suggest either way. In this short commentary we would like to highlight the importance of a balanced and common sense approach in these arguments. An important example is heart failure where the majority have an associated comorbidity and one in four would also suffer with cognitive or mood disturbances. It is unclear how the CTC-HCW would fare for this devastating syndrome. In moving forward it is important we understand there are: strengths and limitations in the evidence gathering processes; indecision as to the questions; uncertainty of the starting points to gather evidence; and sociodemogeographic biases, which have to be factored before determining the fate of this much needed health care resource.