Background:

In the aftermath of the COVID-19 pandemic, public health agencies continue to be subjected to public scrutiny, polarization, and pushback against public health protections. This has contributed to retention challenges, with higher turnover begetting a cycle of additional worker burden, burnout, and upheaval. Prioritizing, developing, and investing in tools to support public health workers, with a particular emphasis on worker well-being, recruitment, and retention, is essential to ensuring that public health agencies can sustain a strong workforce that is prepared to effectively respond to challenges.

Methods:

We conducted qualitative interviews with health departments in the United States that have prioritized workforce recruitment and well-being to discuss their aims, efforts, and challenges to revise, innovate, and advance workforce recruitment and retention in their agencies. Additionally, we worked with public health agencies to pilot test an annotated discussion guide aimed at fostering open dialogue among public health agency leadership and staff for collaborative identification of employee needs and exploration of opportunities to advance a culture of worker well-being, retention, and diverse recruitment.

Results:

We will share findings and offer policy recommendations based on the interviews and discussion guide pilot test, honing in on key performance outcomes including innovative strategies to address worker needs and improve recruitment, retention, and the overall well-being of health department staff.

Conclusions:

Advancing knowledge and understanding of public health agency recruitment and retention challenges and successes is crucial to ensure sustained capacity building and improved organizational structures and processes to advance a culture of worker well-being and increase recruitment and retention of a diverse workforce that represents the populations served.

The Staffing Up Calculator (“Calculator”) is a web-based application that allows individual governmental health agencies to develop planning-level estimates of staffing needed to fully implement the Foundational Public Health Services (FPHS). The Calculator was developed by multiple academic institutions and funded by the de Beaumont Foundation and the PHAB Center for Innovation as the culmination of a years-long effort to identify the staffing needed nationwide for full implementation of FPHS. The Calculator takes in an agency’s current staffing allocated to FPHS Foundational Capabilities (FCs) and Foundational Areas (FAs), along with the need relative to other agencies for each FC/FA and the jurisdiction’s population, and exports the staffing purportedly needed for that agency to fully implement FPHS.

In the 2022 fielding of NACCHO Profile, a subset of respondents completed an exercise that asked what staffing they believed was needed for their agency to fully implement FPHS. This presentation will analyze how the Calculator outputs (developed using pre-COVID data) compared to self-reported estimates captured in 2022. We found that agencies systematically reported that they needed more staff than estimated by the Calculator outputs for their agencies. We also discuss how these findings relate to the new public health paradigms that are emerging in the wake of the pandemic and consider opportunities for building on the successes of the Calculator to develop increasingly accurate and precise tools for public health workforce planning and development.

Public health departments at the federal, state, and local levels play a vital role in promoting population health, yet historically, they have often focused more on clinical functions rather than Foundational Public Health Services (FPHS). To assist these departments in shifting towards broader population health improvement, we will discuss occupations that prioritize skills crucial to FPHS and delineate the essential skills needed for effective FPHS implementation.

Using data from the Public Health Workforce Interests and Needs Survey, we analyzed eight key public health occupations: program evaluators, community health workers (CHWs), health educators, epidemiologists, policy analysts, population health specialists (PHS), public health informatics specialists, and data analysts. For these occupations, we tabulated descriptive statistics to examine the self-reported importance of skills in three domains that are central to FPHS: 1) effective communication, 2) data-based decision-making, and 3) justice, equity, and diversity (JEDI). We then estimated the relationship between occupations, perceived importance of strategic skills in core domains, and worker characteristics.

While there was some overlap in the domains reported as critical, occupations prioritized skills in different domains. For example, CHWs, health educators, policy analysts, and PHSs prioritized skills essential to effective communication - 95% of respondents in these occupations affirmed communication skills being central to their job. Skills in the data-based decision-making domain were highly valued by PHSs, epidemiologists, and health educators.

As HDs shift towards providing population health services, our results may enable them to identify occupations that employ and prioritize skill domains essential to successfully transform their agency to deliver comprehensive FPHS.

Context: As individuals leave the public health workforce due to retirement and attrition, and are given challenges in recruitment and retention due to lower compensation, slower hiring processes, and funding limitations, career ladders provide potential strategies for sustaining a viable workforce. Career ladders offer a structured pathway for employees to advance from entry-level to leadership positions, providing formal steps that include education, certification, and performance requirements. Succession planning identifies critical leadership roles and develops staff to fill them, ensuring continuity and institutional knowledge preservation.
Objective: This study explores the importance of career ladders in the context of governmental public health workforce management, with a focus on recruitment, retention, and increasing workforce diversity. This study draws on interviews with representatives from 10 health departments across 7 states, shedding light on the evolving role of career ladders in post-COVID workforce administration. These strategies, usually new, address historical challenges such as lower wages and limited specialized applicant pools.
Participants: Public Health department leaders were identified by mention of career ladders or succession plans in their Public Health Accreditation Board (PHAB) workforce plans.
Results: Public Health departments have begun to utilize career ladders and succession planning in a variety of ways for professional development and maintenance of critical health department roles.
Main Outcome: The interviews reveal that while career ladders are better suited for retention, they have limited impact on recruitment and increasing staff diversity. Challenges include Civil Service requirements, funding limitations, and complex recruitment processes that might exclude diverse candidates.