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Succession Planning in State Health Agencies in the United States: A Brief Report

Authors:

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.
Research Brief Report
Succession Planning in State Health Agencies in the
United States: A Brief Report
Elizabeth Harper, DrPH; Jonathon P. Leider, PhD; Fatima Coronado, MD, MPH; Angela J. Beck, PhD, MPH
ABSTRACT
Objective: Approximately 25% of the public health workforce plans to retire by 2020. Succession planning is a core ca-
pability 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 Ofce 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-identied succession planning domains may help
SHAs contend with signicant turnover and better preserve institutional knowledge.
KEY WORDS: public health practice, retirement, state health agencies, succession planning, turnover
Succession planning is dened as a method
used by organizations to address the need for
identifying and developing high-performing
staff to assume leadership positions.1,2 Ideally, this is
part of a comprehensive approach to ensure conti-
nuity of leadership and preservation of institutional
knowledge, even if predecessors and successors have
different backgrounds or skills.1Despite an aging
governmental public health workforce, increased
and impending retirements, and data suggesting that
approximately 25% of the state workforce will be el-
igible to retire by 2020, a lack of succession planning
Author Afliations: Association of State and Territorial Health Ofcials,
Arlington, Virginia (Dr Harper); JP Leider Research & Consulting, Minneapolis,
Minnesota (Dr Leider); Center for Surveillance, Epidemiology and Laboratory
Services, Centers for Disease Control and Prevention, Atlanta, Georgia
(Dr Coronado); and Center of Excellence in Public Health Workforce Studies,
School of Public Health, University of Michigan, Ann Arbor, Michigan
(Dr Beck).
This project was supported by a cooperative agreement from the Centers for
Disease Control and Prevention to the Association of State and Territorial
Health Ofcials (3U38OT000161-03S2).
The ndings and conclusions in this report are those of the author(s) and do
not necessarily represent the ofcial position of the Centers for Disease
Control and Prevention.
The authors declare no conicts of interest.
Correspondence: Jonathon P. Leider, PhD, JP Leider Research & Consulting,
Minneapolis, MN 55414 (leider@gmail.com).
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/PHH.0000000000000700
has only recently been considered a threat to the
public health capabilities.1,3-10
A systems-level study of succession practices in state
public health agencies has not been published; how-
ever, 2 studies have characterized succession planning
efforts at the local health department (LHD) level. In
2015, a nationally representative study of 255 LHD
top executives reported that just 40% of LHDs were
engaged in either formal or informal succession plan-
ning, and these activities tended to target bureaus or
divisions rather than the entire LHD.11 In this same
study, 32% of respondents indicated that they did
not evaluate how leadership positions affected their
LHD’s goals.11 Lack of evaluation can make long-term
planning challenging during turnover periods, given
the link between succession planning and leadership
continuity of operations. In addition, in a 2016 study
of Washington State’s 35 LHDs, only 3 had written
a succession and management plan. Separately, none
of these LHDs reported implementation of an agency-
wide succession planning program.12
Data from the Public Health Workforce Interests
and Needs Survey (PH WINS) indicate that 24%
(mean and median =24%; range, 13%-35%; in-
terquartile range =22%-27%) of state health agency
(SHA) workforce plans to retire by 2020, with an
additional 13% considering leaving their organiza-
tion for nonretirement reasons.4,5 Even if staff delay
retirement or quit at lower rates than expected,13
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00 2017 • Volume 00, Number 00 www.JPHMP.com 1
2Harper, et al • 00(00), 1–6 Succession Planning in State Health Agencies
succession planning alongside recruitment and
retention will remain major challenges for SHA
leaders. To understand succession planning efforts
in SHAs, we assessed the overall scope of succession
planning at SHAs, including whether states with high
proportions of planned retirements have differences
in succession planning implementation. In addition,
we characterized barriers to succession planning.
Methods
The Workforce Gaps Survey (WGS) was conducted
in 2016 to identify public health workforce devel-
opment needs. The study methodology has been
described previously.14 To summarize, an organiza-
tional Web-based survey was elded during 2016 as a
census to SHA senior deputies and human resources
directors in 46 SHAs (4 states were undergoing
leadership transitions at the time of the study and
not included). Overall, 41 SHAs responded to WGS
(89% response rate), including 19 senior deputies, 25
human resources personnel, 3 workforce directors,
and 5 staff members of other types.
Respondents reported agency activities regarding
agency-level succession planning activities using the
US Ofce of Personnel Management’s (OPM’s) suc-
cession planning model.15 While federally oriented,
the policies and procedures OPM sets are inuential
across the public sector and incorporated by national
organizations as guides for succession planning.16 Sur-
vey components were drawn from the OPM model’s
6 domains and 27 subset activities. The domains in-
clude (1) linking strategic and workforce planning
decisions; (2) analyzing gaps; (3) identifying talent
pools; (4) developing succession strategies; (5) imple-
menting succession strategies; and (6) monitoring and
evaluating. For each domain, respondents answered
questions whether subset activities were adequately
addressed as part of their SHA’s succession planning
processes. Respondents were asked to indicate activ-
ity for each item (“select all that apply”). Respon-
dents also identied barriers for succession planning
implementation.
Descriptive statistics were calculated for each do-
main (n =6) and activity (n =27). These statistics
were calculated for all responding SHAs (n =41)
and were stratied by the percentage of the agency’s
staff who are planning to retire by 2020 according to
PH WINS 2014 ndings5(median =25% among n
=33 SHAs responding to PH WINS and WGS). PH
WINS was conducted in 2014, with more than 10 000
SHA respondents in a nationally representative SHA
frame. Respondents were asked whether they were
planning to retire by 2020. Answers were aggregated
by state, and we dichotomized succession planning
activities among SHAs with lower (<25%) and higher
(25%) than the median of planned retirements. For
reference, PH WINS methods have been described
previously in this journal.17 Fisher’s exact test was
used to compare the 2 stratied groups. Data were
managed in Microsoft Excel 2016 (Microsoft Corpo-
ration, Redmond, Washington) and analyzed in Stata
13.1 (StataCorp LP, College Station, Texas). The
Centers for Disease Control and Prevention reviewed
this study for human subjects protection and deemed
it to be not human subjects research.
Results
Overall, 38 of 41 responding SHAs (93%) indicated
that their process adequately addressed 1 or more of
the OPM succession planning activities. Overall, as
displayed in the Table, activity performance varied
substantially (excluding “other”: mean =42%; stan-
dard deviation [SD] =15%; range, 7%-68%). The
most commonly performed activities were as follows:
identifying long-term vision and direction (68%,
domain 1); identifying core competencies and tech-
nical competency requirements of leadership (68%,
domain 2); and identifying development or learning
strategies (65%, domain 4). The least commonly
performed activities included the following: develop-
ing a business plan on the basis of long-term talent
needs, not on position replacement (7%, domain
2), implementing strategies for maintaining senior-
level commitment (17%, domain 5), and tracking
selections from talent pools (20%, domain 6).
Among all respondents, 25 SHAs (61%) reported
that their succession planning processes adequately
addressed at least 1 activity in each of the 6 succes-
sion planning domains. Approximately 78% of SHAs
reported having addressed 5 or more activities, 56%
addressed 10 or more activities, and 27% addressed
15 or more activities. Ten percent of participating
SHAs (4/41) indicated that their succession planning
processes sufciently addressed 20 or more succes-
sion planning activities. No SHAs indicated that their
processes sufciently addressed all 27 activities. On
average, SHAs addressed 11.4 activities (SD =6.9;
maximum =25).
Although substantial nominal differences were ob-
served when comparing the 16 SHAs with higher
planned retirement and the 17 SHAs with lower
planned retirement, statistically signicant differences
were only observed for 1 activity, identifying long-
term vision and direction (domain 1). Approximately
47% of SHAs (8/17) with lower than planned retire-
ment indicated that their process included this activ-
ity compared with 87% of SHAs (14/16) with higher
planned retirements (P=.026).
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00 2017 • Volume 00, Number 00 www.JPHMP.com 3
TA B L E
Succession Planning Activities at SHAs
OPM-Recommended Succession Planning Domains
and Activities
Percentage of SHA Respondents Planning to
Retire by 2020 (From PH WINS 2014) All SHAsa
Domain 1: Link strategic planning & workforce planning
decisions
<25% (n =17 SHAs) 25% (n =16 SHAs) Total (n =41 SHAs)
Identied its long-term vision and directionb8 (47%) 14 (88%) 28 (68%)
Analyzed future requirements for products and services 6 (35%) 8 (50%) 16 (39%)
Used data already collected elsewhere for succession
planning efforts
7 (41%) 6 (38%) 16 (39%)
Connected succession planning to the values of the
organization
7 (41%) 10 (63%) 20 (49%)
Connected succession planning to the needs and
interests of senior leaders
7 (41%) 8 (50%) 18 (44%)
Other related activities 1 (6%) 1 (6%) 4 (10%)
At least 1 activity in domain 1 12 (71%) 15 (94%) 34 (83%)
Domain 2: Analyze gaps <25% (n =17 SHAs) 25% (n =16 SHAs) Total (n =41 SHAs)
Identied core competencies and technical competency
requirements of leadership
10 (59%) 11 (69%) 28 (68%)
Determined current supply and anticipated demand 5 (29%) 6 (38%) 14 (34%)
Determined talents needed for the long term 5 (35%) 5 (31%) 16 (39%)
Identied substantive continuity issues 6 (35%) 6 (38%) 14 (34%)
Developed a business plan on the basis of long-term
talent needs, not on position replacement
1 (6%) 1 (6%) 3 (7%)
Other related activities 0(0%) 3 (19%) 3(7%)
At least 1 activity in domain 2 13 (76%) 14 (88%) 34 (83%)
Domain 3: Identify talent pools <25% (n =17 SHAs) 25% (n =16 SHAs) Total (n =41 SHAs)
Fully utilized internal candidate pool 6 (35%) 7 (44%) 16 (39%)
Frequently identies talent with critical competencies
from multiple levels
6 (35%) 6 (38%) 16 (39%)
Assessed competency and skill levels of current
workforce, by using assessment instrument
5 (29%) 5 (31%) 13 (32%)
Used workforce performance feedback from supervisors
and subordinates for development purposes
9 (53%) 8 (50%) 24 (59%)
Analyzed external sources of talent 3 (18%) 7 (44%) 11 (27%)
Other related activities 1 (6%) 5 (31%) 6 (15%)
At least 1 activity in domain 3 13 (76%) 14 (88%) 34 (83%)
Domain 4: Develop succession strategies <25% (n =17 SHAs) 25% (n =16 SHAs) Total (n =41 SHAs)
Identied recruitment strategies (eg, recruitment and
relocation bonuses)
6 (35%) 12 (75%) 22 (54%)
Identied retention strategies (eg, retention bonuses and
quality of work-life programs)
7 (41%) 10 (63%) 20 (49%)
Identied development or learning strategies (eg, planned
job assignments, formal development, coaching and
mentoring, and assessment and feedback)
11 (65%) 9 (56%) 26 (63%)
Other related activities 0(0%) 2 (13%) 2(5%)
At least 1 activity in domain 4 11 (65%) 15 (94%) 33 (80%)
Domain 5: Implement succession strategies <25% (n =17 SHAs) 25% (n =16 SHAs) Total (n =41 SHAs)
Implemented recruitment strategies (eg, recruitment and
relocation bonuses)
4 (24%) 7 (44%) 15 (37%)
Implemented retention strategies (eg, retention bonuses
and quality of work-life programs)
7 (41%) 6 (38%) 16 (39%)
(continues)
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4Harper, et al • 00(00), 1–6 Succession Planning in State Health Agencies
TA B L E
Succession Planning Activities at SHAs (Continued)
OPM-Recommended Succession Planning Domains
and Activities
Percentage of SHA Respondents Planning to
Retire by 2020 (From PH WINS 2014) All SHAsa
Implemented development/learning strategies (eg,
planned job assignments, formal development,
coaching and mentoring, and assessment and
feedback)
8 (47%) 8 (50%) 21 (51%)
Linked succession planning to HR process (eg,
performance management, compensation, recognition,
recruitment and retention, and workforce planning)
5 (29%) 6 (38%) 13 (32%)
Implemented strategies for maintaining senior-level
commitment
4 (24%) 2 (13%) 7 (17%)
Other related activities 1 (6%) 3 (19%) 4 (10%)
At least 1 activity in domain 5 12 (71%) 14 (88%) 32 (78%)
Domain 6: Monitor and evaluate <25% (n =17 SHAs) 25% (n =16 SHAs) Total (n =41 SHAs)
Track selections from talent pools 3 (18%) 4 (25%) 8 (20%)
Listen to leader feedback on success of internal talent
and internal hires
9 (53%) 10 (63%) 23 (56%)
Analyze satisfaction surveys from customers, employees,
and stakeholders
8 (47%) 10 (63%) 23 (56%)
Assess response to changing requirements and needs 8 (47%) 7 (44%) 21 (51%)
Other related activities 0 (0%) 0 (0%) 0 (0%)
At least 1 activity in domain 6 11 (65%) 12 (75%) 30 (73%)
Abbreviations: HR, human resources; OPM, US Ofce of Personnel Management; PH WINS, Public Health Workforce Interests and Needs Survey; SHA, state health agency;
WGS, Workforce Gaps Survey.
aIncludes all 41 respondents to WGS. Columns 1 and 2 are constrained to only those agencies that also participated in PH WINS 2014 and WGS (n =33).
bDifference between higher and lower planned retirement statistically signicant at P<.05.
The mean number of succession planning activities
reported by SHAs in the lower planned retirement cat-
egory was 10 (SD =7.6) compared with a mean of 12
activities reported by SHAs in the higher planned re-
tirement category (difference was not statistically sig-
nicant at the P=.05 level). Comparisons of results
by SHA size and governance classication found no
statistically signicant differences (data not shown).
Overall, 25 of 41 of SHAs (60%) were active in at
least 1 activity in each domain. There were not differ-
ences by level of planned retirement (10/16, 63% for
higher; 10/17, 59% for lower).
In response to a question concerning barriers to suc-
cession planning, respondents indicated the following:
lack of personnel time to dedicate to succession plan-
ning (34/41; 83%), lack of funding to support succes-
sion planning efforts (27/41; 66%), lack of agreed-
upon strategy for engaging in succession planning
(11/41; 27%), succession planning was not a prior-
ity in the agency (1/41; 2%), and other reasons (8/41;
20%).
Discussion
SHAs across the country are facing unprecedented
levels of retirement eligibility and substantial
workforce turnover, including leadership turnover.13
Despite the relatively recent recognition of succession
planning as a core capability of the governmen-
tal public health enterprise and its importance for
maintaining a competent workforce,18 our ndings
indicate that limited succession planning is occurring
across SHAs. There were not statistically signicant
differences when comparing SHAs with relatively
higher and lower planned retirement rates and that
the majority of the OPM-recommended succession
planning activities are not being addressed.
While the OPM-recommended succession planning
model was initially developed for federal agencies,
it offers a valuable process for other governmental
agencies to follow. Identifying and recruiting employ-
ees, developing their skills and abilities to lead the
workforce to respond to public’s health needs, and
preparing them for advancement into more challeng-
ing roles in the organization should be recognized as
a priority for leaders at all levels of the public health
enterprise.19,20 Succession planning is a proactive
attempt to ensure that leadership in an organization
will be continuous by identifying how these posi-
tions will be lled as both planned and unplanned
departures occur.3Although guidance regarding
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00 2017 • Volume 00, Number 00 www.JPHMP.com 5
succession planning for the general public sector
exists, succession planning has not traditionally been
a leadership priority1,2,15,21,22 and specic guidance for
implementing such efforts within the public health
eld is limited.1Nevertheless, at a minimum, it is
prudent for public health agencies to initiate activities
in each of the OPM-recommended succession plan-
ning domains even if additional evidence is needed
to identify the most important activities within
each domain that can be used for prioritization of
efforts.
Like other capability-focused efforts, insufcient
funding is a main reason for limited support to work-
force development broadly and specically for suc-
cession planning not being formally implemented
in SHAs and other public health agencies. Histori-
cally, exible or discretionary funds have been cru-
cial to workforce development and other health
department–wide activities.23 Discretionary funding
is extremely limited at the state and local levels,24,25
which has translated to limited capacity to spend
staff time on workforce development, including suc-
cession planning. Furthermore, because of the na-
ture of public service, many governments require fully
competitive processes for management and leadership
positions, making appointing a new leader or man-
ager ahead of the hiring process not feasible. Func-
tionally, this means that excellent internal candidates
might be eligible for generalized leadership training
but rarely can be trained for a specic leadership po-
sition. Despite this practice, the high prevalence of hir-
ing restrictions12 highlights the importance of cultivat-
ing talent internally.
When implementing formalized succession plan-
ning practices, a public health agency exhibits com-
mitment to workforce development, with advantages
to the agency and the public health system as a whole.
Succession planning recognizes the need to prepare
employees to step into roles as the public health mis-
sion becomes more complex and the importance of
transferring employees’ knowledge before they leave
the workforce. Experienced and continuous leader-
ship is important for strong responses to public health
crises such as major disease outbreaks and natural
disasters. Having a succession plan in place that iden-
ties how leadership voids are lled can help minimize
risks to populations in an emergency.3Furthermore,
among employees, succession planning efforts boost
self-esteem, desire for career development, and ability
to identify development opportunities needed for ca-
reer progression. Although some public health agen-
cies have not fully introduced succession planning in
their organizations, they might plan informally, for
example, by identifying the strongest potential leaders
in their organization.12 To support implementation
Implications for Policy & Practice
Public health agencies are facing substantial turnover; ap-
proximately 25% of staff members indicate they are planning
to retire by 2020.
Succession planning activities are a crucial aspect of opera-
tions management and planning in health departments.
SHAs self-report adequately addressing an average of 11 of
27 OPM-recommended succession planning activities, which
serves as a base to build upon and guide future work.
To aid succession planning efforts, public health agencies
could engage colleges and universities to build their work-
force pipeline, and their regional Public Health Training Cen-
ters and local ofces to take advantage of management train-
ing and leadership expertise. Leadership institutes or other
midcareer programs might be an appropriate means to begin
addressing this concern. In addition, some resources exist
to aid public organizations in establishing succession plan-
ning processes including organizations such as the Human
Resources Council and Careers in Government. In addition,
universities with ofces and programs of public health prac-
tice are resources for practice-based tools and guides.27-31
OPM offers guidance on succession planning processes,15
and ASTHO is collaborating with state and local public health
agencies to develop resources to aid in succession planning
efforts.26
succession planning activities, key partners including
the Association of State and Territorial Health Of-
cials (ASTHO) and the Big Cities Health Coalition are
developing toolkits to assist public health agencies im-
prove workforce development efforts in areas includ-
ing leadership, communication, change management,
developing a culture of learning, cultural awareness,
and succession planning.26 These toolkits are being
aligned to support OPM priority areas for succession
planning. Actively pursuing succession planning can
ensure that the workforce is constantly being devel-
oped to maintain the transfer of institutional knowl-
edge and keep the mission of public health on track.
Limitations
This study reports on a cross-sectional study of SHAs
in the United States conducted in 2016. Findings are
reective only of SHAs and might not be generaliz-
able to LHDs. Although the response rate was rel-
atively high, responses from the 9 nonparticipating
SHAs might not align with our ndings. In addition,
succession planning activity questions rely on self-
reported data; an outside observer might have a dif-
ferent perspective concerning how adequately an SHA
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
6Harper, et al • 00(00), 1–6 Succession Planning in State Health Agencies
is performing on the basis of OPM’s approach to suc-
cession planning.
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Pract. 2017;23(5):537-542.
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
... The increased unemployment of recent public health doctoral graduates coincides with a time when 25% of the 2005 public health workforce intended to retire by 2020 and another 13% planned to leave for nonretirement reasons. 3 However, governmental public health agencies also have a history of hiring persons with degrees outside public health. A 2015 study revealed that 73.6% of top executives in local health departments did not have a degree in public health. ...
... We have argued frequently in this column for generating science that can help address questions of contemporary relevance, and we have written in previous work about the importance of conducting scholarship of consequence. [1][2][3] This approach moves us to generate data with clear passion and purpose, with the aim of contributing to efforts that improve the population's health. We continue to consider this the highest calling of public health research and were pleased to read articles in this issue of AJPH that do just that, including, for example, the article by Edwards et al. (p. ...
... The authors used stratified random sampling and surveys as part of the methodology of their study. As discussed by Harper, Leider, Coronado and Beck (2018), succession planning is essential in the identification and development of high performing employees to assume leadership roles. They advocated for a comprehensive approach that ensures leadership continuity. ...
... 19 Furthermore, loss of institutional knowledge due to turnovers and inadequate succession planning may pose additional challenges. 20,21 Therefore, incentivizing retention of the existing public health employees remains imperative. Strategies to incentivize retention will have to address the "push factors" (ie, reasons provided for wanting to leave) and promote the "pull factors" (ie, reasons employees report for wanting to stay). ...
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Background and objectives: Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay. Design: Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models. Results: In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees' intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one's supervisor. Conclusions: Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover. Implications: Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries.
... The author further argues that succession planning should take into account previous competencies when recruiting and selecting employees to lead and manage health institutions. Harper, Leider, Coronado, and Beck (2018) suggest that by 2020 more than 25% in the health sector will retire whilst succession planning activities are not being addressed in health institutions. In the US, between 9 and 16 percent of all medical school deans in 2017 were employed in an acting capacity (Bunton, Sass, Sloane, & Grigsby, 2018). ...
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Background: The challenges in the Faculty of Health Sciences in universities are unique and complex. These dynamic faculties require decisive and strong leadership, smooth systems and business processes, succession plans and development opportunities. These challenges in these faculties are exacerbated by the fact that the roles and responsibilities of the Heads of Departments are multifaceted. Those who are heading them are not acclimatising to the responsibilities because of the lack of support to develop and succeed in their positions. This study therefor seeks to determine challenges faced by the HoDs in the Faculty of Health Sciences, and the succession plans, competences and development programmes that are in place to develop future leadership talent in a university in South Africa. Methods: A single case study approach was employed whereby qualitative in-depth interviews were conducted with nine HoDs and a faculty dean as well as the observation and document analysis. The grounded theory as an inductive process was used to categorise and code data where themes and trends emerged from the data. Results: Four major themes emerged from the data:  The university, faculty and departments within the faculty did not have succession plans while the strategic positions were occupied by post-retirees.  The Faculty did not have competent employees who could ascend to academic leadership positions in the faculty.  There was limited growth in the Faculty due to the absence of the developmental programmes.  There was a plethora of challenges including the shortage of office equipment, absence of the mentoring programmes, structural fragmentation and inefficiencies in the Human Resource Department (HRD). Conclusions: A pervasive crisis was observed in this particular Faculty of Health Sciences during the turbulent times in universities. It is crucial for the HoDs to receive quality support from the administrative departments such as HRD in order for them to achieve the departmental objectives. The HoDs’ leadership capabilities and effectiveness can be enhanced by mainstreaming the human resources business systems, development, mentoring and coaching, as well as the implementation of well-coordinated succession plans.
... 8 Recruitment, retention, and succession planning have been identified as major needs by leadership. [9][10][11][12][13][14][15][16][17] While the drivers behind recruitment and retention are well documented in the literature, 12,13,[18][19][20] prior to 2014, there existed no national resources to track these data points. This changed with the inception of the Public Health Workforce Interests and Needs Survey (PH WINS). ...
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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 χ 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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Introduction The public health enterprise has a people problem. An aging workforce coupled with a sustained, strong economy and healthcare sector has made the recruitment and retention of young, educated staff challenging. Approximately one third of public health staff aged 33 years and younger are considering leaving their organization in the next year. Their reasons for leaving, and considerations for staying, are not well characterized within public health. Methods Data were drawn from the Public Health Workforce Interests and Needs Survey, a nationally representative survey of state and local governmental public health employees across the U.S. In 2017, a total of 43,701 staff responded. Descriptive statistics across age groups were examined, and reasons for leaving were characterized. A latent class model and an intent-to-leave logit model were fit in 2019. Results Pay and lack of opportunities for advancement were most frequently selected as reasons for considering leaving. Results of a logit model showed that being somewhat or very dissatisfied (versus somewhat or very satisfied) was associated with higher odds of intending to leave (AOR=4.4, p<0.0001), as was pay dissatisfaction (AOR=2.0, p<0.0001). Scoring higher than the agency median on a construct measuring perceived lack of organizational support (AOR=1.8, p<0.0001) and on a scale measuring burnout (AOR=2.6, p<0.0001) was also associated with higher odds of intending to leave. Conclusions Many factors associated with an increased intent to leave are present among all age groups. However, support is needed for managers as they attempt to develop and implement solutions that seek to retain the younger workforce in particular. Creating paths for promotion, competitive pay practices, organizational support, and engagement are all critical for retention in this group.
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Background: Employee engagement, exemplified by positive perceptions of supervisors, workplace, and job, improves productivity and employee retention. We identified the extent of and barriers to employee engagement at Centers for Disease Control and Prevention’s (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Methods: In 2015, NCHHSTP’s leadership collected baseline data through a centerwide Employee Engagement Pulse Survey (EEPS) from NCHHSTP’s full-time Civil Service employees, U.S. Public Health Service Commissioned Corps officers, and Title 42 service fellows. EEPS included six demographic questions; nine Likert-type scale questions measuring 26 perceptions related to immediate supervisors, the work environment, and job satisfaction; and four open-ended questions soliciting recommendations for improvement. Findings: Among 727 of 1,171 staff (response rate = 62%), positive perceptions of supervisors ranged from a high of 94% (supervisor conducts performance reviews) to a low of 63% (supervisor assists employees with career development). Perceptions of work experience ranged from 98% (respondents were willing to put in extra effort to get a job done) to 68% (respondents’ talents were used well in the workplace). Perceptions of job satisfaction ranged from 87% (support from their coworkers) to 69% (satisfaction with opportunities to learn or grow professionally). Conclusion/Application to Practice: Overall, NCHHSTP staff have positive perceptions of their work, their leaders, and the agency. Other public- and private-sector employers might be able to improve their employees’ engagement and retention by listening to their opinions and needs and frequently recognizing their individual achievements. NCHHSTP’s workforce development initiatives can be used as a model for assessing a baseline of their employees’ engagement.
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Context: More than 80% of Americans live in urban areas. Over the past 20 years, an increasing number of local governmental public health departments, particularly those in big cities, have taken pioneering action to improve population health. This article focuses on members of the Big Cities Health Coalition (BCHC) who participated in the 2017 Public Health Workforce Interest and Needs Survey (PH WINS). If the impact of these health departments is to be sustained, they will require a workforce prepared for the challenges of 21st-century public health practice. Objective: To characterize workforce interests and needs among staff in 26 large, urban health departments who are BCHC members. Design: Administered PH WINS survey to staff in BCHC member health departments to assess perceptions about the workplace environment and job satisfaction; training needs; awareness of national trends; and demographics. Setting: In total, 26 of 30 BCHC member health departments, United States. Participants: In total, 7453 of 17 613 staff members (response rate 43.4%) from participating departments. Results: The workforce consists predominantly of women (75%) and people of color (68%). Staff is satisfied with their job (81%), the organization (71%), and pay (59%), but more than a quarter are considering leaving within the year. The agency's mission drives staff, but it lacks an environment fostering creativity and innovation. Training needs include budgeting/financial management, change management, and strategic thinking. Conclusions: BCHC departments must improve retention, provide opportunities for advancement, enhance communication between leadership and staff, foster creativity and innovation, and align labor allocation with disease burden in local communities. Findings from the second iteration of PH WINS allow a comprehensive, comparable analysis of the workforce across the 26 BCHC member health departments that participated. These data expand upon the ability to assess and monitor improvement in the workforce environment, job satisfaction, awareness of national trends, and training needs.
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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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Context: State health officials (SHOs) serve a critical role as the leaders of state public health systems. Despite their many responsibilities, there is no formal process for preparation to become an SHO, and few requirements influence the selection of an SHO. Furthermore, to date, no studies have examined SHO tenure or their experiences. Objective: This study examines SHO tenure over time and the relationship between SHO tenure and organizational and state attributes. Design: This longitudinal study employed primary data on SHOs and secondary data from the Association of State and Territorial Health Officials on organizational attributes of state public health agencies. Setting: This study examines SHOs within the United States. Participants: SHOs who served in years 1980-2017. Main outcome measures: Annual average SHO tenure; average SHO tenure by state. Results: In the 38 years of this study, 508 individuals served as SHOs in the 50 states and the District of Columbia. The average tenure over this period was 4.1 years, with a median tenure of 2.9 years. During the study period, almost 20% of SHOs served terms of 1 year or less. A total of 32 SHOs (32/508 or 6.3%) served for 10 years or longer. Excluding SHOs who served 10 years or longer (n = 32 SHOs who had a collective 478 years of tenure) reduces the average term in office to 3.5 years. The average number of new SHOs per year is 12.3. SHOs appointed by a board of health averaged more than 8 years in office compared with averages just under 4 years for those appointed by governors or secretaries of state agencies. Conclusions: There are notable differences in SHO tenure across states. Future research is needed to further examine SHO tenure, effectiveness, job satisfaction, transitions, and the relationship between SHOs and state health. It may be valuable to expand on opportunities for new SHOs to learn from peers who have moderate to long tenures as well as SHO alumni. Given that average SHO tenure is approximately 4 years and that an SHO could be thrust into the national spotlight at a moment's notice, governors may want to consider experience over partisanship as they appoint new SHOs.
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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. (Am J Public Health. Published online ahead of print July 20, 2017: e1-e7. doi:10.2105/AJPH.2017.303875).
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Objectives: To use data on the governmental public health workforce to examine demographics and elucidate drivers of job satisfaction and intent to leave one's organization. Methods: Using microdata from the 2014 Federal Employee Viewpoint Survey and 2014 Public Health Workforce Interests and Needs Survey, we drew comparisons between federal, state, and local public health staff. We fitted logistic regressions to examine correlates of both job satisfaction and intent to leave one's organization within the coming year. Results: Correlates of job satisfaction included pay satisfaction, organizational support, and employee involvement. Approximately 40% of federal, state, and local staff said they were either considering leaving their organization in the next year or were planning to retire by 2020. Conclusions: Public health practitioners largely like their jobs, but many are dissatisfied with their pay and are considering working elsewhere. More should be done to understand the determinants of job satisfaction and how to successfully retain high-quality staff. Public health implications: Public health is at a crossroads. Significant turnover is expected in the coming years. Retention efforts should engage staff across all levels of public health. (Am J Public Health. Published online ahead of print August 23, 2016: e1-e7. doi:10.2105/AJPH.2016.303305).
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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.
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Context: 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. Objective: Characterize key components of the public health workforce, including demographics, workplace environment, perceptions about national trends, and perceived training needs. Design: A nationally representative survey of central office employees at state health agencies (SHAs) was conducted in 2014. Approximately 25 000 e-mail invitations to a Web-based survey were sent out to public health staff in 37 states, based on a stratified sampling approach. Balanced repeated replication weights were used to account for the complex sampling design. Setting and participants: A total of 10 246 permanently employed SHA central office employees participated in PH WINS (46% response rate). Main outcome measures: Perceptions about training needs; workplace environment and job satisfaction; national initiatives and trends; and demographics. Results: Although the majority of staff said they were somewhat or very satisfied with their job (79%; 95% confidence interval [CI], 78-80), as well as their organization (65%; 95% CI, 64-66), more than 42% (95% CI, 41-43) were considering leaving their organization in the next year or retiring before 2020; 4% of those were considering leaving for another job elsewhere in governmental public health. The majority of public health staff at SHA central offices are female (72%; 95% CI, 71-73), non-Hispanic white (70%; 95% CI, 69-71), and older than 40 years (73%; 95% CI, 72-74). The greatest training needs include influencing policy development, preparing a budget, and training related to the social determinants of health. Conclusions: PH WINS represents the first nationally representative survey of SHA employees. It holds significant potential to help answer previously unaddressed questions in public health workforce research and provides actionable findings for SHA leaders.
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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.
Article
Context: Turnover of top local public health officials is expected to be great, with 23% being 60 years of age or older, and another 42% being 50 to 59 years of age. Yet, we know little about the use of succession planning in public health agencies. Objective: Describe succession planning practices in local public health agencies. Design: We conducted a Web-based, cross-sectional survey of succession planning practices and followed the career paths of public health officials for 40 months. Setting and participants: The top local public health officials from Washington State's 35 local governmental public health agencies. Main outcome measures: Twenty-five succession planning best practices. Results: All 35 agencies responded, resulting in a 100% response rate. Our study found evidence of succession planning practices in Washington State local public health agencies: 85% of agencies selected high-performing high potential employees for development, 76% sent them to formal technical and management/leadership training, 70% used cross-functional team projects, and 67% used stretch assignments to develop their employees. Impetuses to implement succession planning were discovering that large percentages of employees were able to retire soon and that national accreditation requires workforce development plans. Barriers to implementing succession planning included other competing demands for time, belief that the agency's workforce was too small for a formal program, and concerns that there would be union barriers. In 2012, 50% of the officials surveyed said that it would be at least possible that they would leave their current jobs within 5 years. Forty months later, 12 (34%) had left their positions. Conclusions: We were encouraged by the level of succession planning in Washington State and recommend creating a greater sense of urgency by focusing on agency retirement profiles and emphasizing the need for workforce development plans for accreditation. Developing the public health leaders of tomorrow is too important to be left to chance.
Article
Context: Workforce shortages have been identified as a priority for US public health agencies. Voluntary turnover results in loss of expertise and institutional knowledge as well as high costs to recruit and train replacement workers. Objective: To analyze patterns and predictors of voluntary turnover among public health workers. Design: Descriptive analysis and linear probability regression models. Participants: Employees of state health agencies in the United States who participated in the Public Health Workforce Interests and Needs Survey (PH WINS). Main outcome measures: Intended retirement and voluntary departure; pay satisfaction; job satisfaction. Results: Nearly 25% of workers reported plans to retire before 2020, and an additional 18% reported the intention to leave their current organization within 1 year. Four percent of staff are considering leaving their organization in the next year for a job at a different health department. There was significant heterogeneity by demographic, socioeconomic, and job characteristics. Areas such as administration/management, health education, health services, social services, and epidemiology may be particularly vulnerable to turnover. The strongest predictors of voluntary departure were pay and job satisfaction, which were associated with 9 (P < .001) and 24 (P < .001) percentage-point decreases, respectively, in the probability to report the intention to leave. Our findings suggest that if all workers were satisfied with their job and pay, intended departure would be 7.4%, or less than half the current 18% rate. Controlling for salary levels, higher levels of education and longer work experience were associated with lower pay satisfaction, except for physicians, who were 11 percentage points (P = .02) more likely to be satisfied with their pay than employees with doctoral degrees. Several workplace characteristics related to relationships with supervisors, workplace environment, and employee motivation/morale were significantly associated with job satisfaction. Conclusions: Our findings suggest that public health agencies may face significant pressure from worker retirement and voluntary departures in coming years. Although retirement can be addressed through recruitment efforts, addressing other voluntary departures will require focusing on improving pay and job satisfaction.