Challenges and Successes in the Local Health Department Workforce - - PowerPoint PPT Presentation

Webinar: Recruitment and Retention Challenges and Successes in the Local Health Department Workforce

October 24, 2013

Funded by the Robert Wood Johnson Foundation

Research Team

University of Illinois at Chicago, School of Public Health - (publichealth.uic.edu) – Julie Darnell PhD, MHSA, PI – Susan B. Cahn MA, MHS – Bernard J. Turnock MD, MPH Center for State and Local Government Excellence - (slge.org) – Joshua Franzel PhD, Co-PI – Christine Becker MPA – Danielle Miller Wagner MS

The research team gratefully acknowledges the support of the Robert Wood Johnson Foundation, Public Health Services and Systems Research Program

Agenda

Part 1: Recruitment and Retention

• Joshua Franzel, Vice President of Research, SLGE,

presentation of data and case study findings

• Reaction by Aaron Kissler, Administrator, Florida Department of

Health, Gadsden County

• Audience Q&A

Part 2: Succession Planning

• Julie Darnell, Assistant Professor, UIC, presentation of data and

case study findings

• Reaction by Angela Smith, Commissioner, Morrow County

Health Department

• Audience Q&A

Part 3: Future Outlook

• Bernard Turnock, Clinical Professor, UIC, discussion of

research findings and future outlook

• Audience Q&A

Recruitment and Retention

Joshua M. Franzel, PhD Center for State and Local Government Excellence The findings presented in the following slides are from the UIC / SLGE research team: Cahn, Darnell, Turnock (UIC) and Becker, Franzel, Miller Wagner (SLGE)

The Local Public Health Workforce

• Data Analysis: The Workforce
• Survey Results: Current recruitment

and retention challenges in LHDs

• Case Studies: Recruitment and

retention lessons learned

Local Government Healthcare Workforce

– The two healthcare-related major groups of the BLS Occupation Profiles are: (1) Healthcare Practitioners and Technical Occupations and (2) Healthcare Support Occupations. – Healthcare Practitioners and Technical Occupations decreased by 2% between 2004 and 2010. – Healthcare Support Occupations decreased by 13% between 2004 and 2010.

.

Source: Research team analysis of U.S. BLS (1) Occupational Employment Statistics (2) Employment Projections

Local Government Healthcare Workforce

– BLS projections for 2020:

• 13% growth in Healthcare Practitioner and Technical

Occupations; 10% growth in Healthcare Support Occupations

• Some of the core local health department positions with the

largest growth projections:

– Home Health Aid positions – Epidemiologists – Substance abuse, behavioral disorder, and mental health counselors and health care, mental health, and substance abuse social workers – Health educators, nurses, dietitians and nutritionists, medical and clinical laboratory technologists, and dentists – Most physician positions – Medical and clinical laboratory technicians

Source: Research team analysis of U.S. BLS (1) Occupational Employment Statistics (2) Employment Projections

Local Public Health Positions: % of LHDs that lost FTEs between 2005 and 2010, by jurisdiction size

Source: NACCHO - The National Profile of Local Health Departments Study Series (2005 - 2010)

37% 48% 52% 55% 55% 69% 55% 0% 10% 20% 30% 40% 50% 60% 70% 80%

Local Public Health Positions

– Staff reductions increased between 2008- 2010. – According to the 2010 NACCHO Profile Study, personnel reductions were achieved through attrition, layoffs, reduced hours, and mandatory furloughs. – The use of layoffs and attrition generally grew by jurisdiction size.

Source: Research team analysis of NACCHO National Profile of Local Health Departments

Current Recruitment and Retention Environment

• Reductions in existing defined benefit

pension plans do not offset lower salaries as much as they once did.

• The implementation of the Affordable

Care Act may alter demand for clinical services…how will this affect the personnel needs of LHDs?

• Continued private sector competition for

talent.

Recruitment and Retention Challenges: LHD executives’ level

• f concern about…

Source: UIC/SLGE Local Health Department Survey (2012)

36% 36% 30% 23% 26% 40% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Finding well-qualified individuals Retaining well-qualified individuals Retaining currently-funded positions

Not at all Slightly Moderately Very Extremely

Recruitment and Retention Challenges: ‘Very or Extremely’ Difficult to Fill Open Positions

Source: UIC/SLGE Local Health Department Survey (2012)

0% 10% 20% 30% 40% 50% 60%

Workforce Recruitment Efforts…

Source: UIC/SLGE Local Health Department Survey (2012)

0% 10% 20% 30% 40% 50% 60% 70% 80%

Workforce Retention Efforts…

0% 20% 40% 60% 80% 100% Supplemental pay Formal rotational training program Matching salary offers Formal mentoring Job sharing Telecommuting Rehire retirees Competitive pay Tuition assistance Promotions Post for internal candidates only Flex-time/flexible hours Unpaid recognition/awards Reassignments/job changes Informal mentoring Pay for CE/CME Pay for training Retirement benefits Pay for conferences

Source: UIC/SLGE Local Health Department Survey (2012)

Recruitment and Retention Challenges

Survey results indicate that :

• Practitioner concerns about retaining funded

positions are currently trumping recruitment and retention concerns.

• LHD executives find it difficult to reward and

promote valued employees under rigid human resource rules / procedures.

• Lack of opportunities for advancement

challenge LHD’s ability to retain well-qualified employees.

Source: UIC/SLGE Local Health Department Survey (2012)

Recruitment and Retention Case Studies – Lessons Learned

• Create a motivating work environment.
• Focus on knowledge and expertise

retention.

• Support robust professional

development and leadership training programs to motivate employees and serve as valuable retention tools.

Source: UIC/SLGE local health department case studies (2013)

Recruitment and Retention Case Studies – Lessons Learned

• Be a public service / public health

advocate.

• Plan early for workforce needs…and

use data for planning and decision making.

Source: UIC/SLGE local health department case studies (2013)

Local Health Department Perspective

Aaron Kissler, MPH Florida Department of Health, Gadsden County

Local and State Health Departments:

• State of Florida, Hillsborough County
• State of Florida, Broward County
• State of Louisiana
• Jefferson County, Colorado
• Clear Creek County, Colorado
• State of Florida, Gadsden County

Major Challenges

• Salary Range
• Productivity Increase
• Funding Sustainability
• Public Health Loyalty
• Retiring Workforce

Opportunities

• Defining who we are
• Schools of Public Health and Technical

Schools

• Individual Development Plans
• Standards and Measures
• Generalist Shift
• Regional Resources

Two Challenging Positions for Retainment and Recruitment

• Nurses
• Health Officers

Public Health Nurses

• Clinical Rotations
• Regional Resources
• Benefits of being a public health nurse

Health Officers

• Survive and Thrive
• Leadership Series
• Local Leadership Groups
• Mentorship
• Business classes for Health Officers

Big Decisions

• Public Health Professionals
• Professionals that conduct Public Health
• Training in Both

Succession Planning

Julie Darnell, PhD, MHSA University of Illinois at Chicago The findings presented in the following slides are from the UIC / SLGE research team: Cahn, Darnell, Turnock (UIC) and Becker, Franzel, Miller Wagner (SLGE)

What is succession planning?

We define succession planning as: “intentionally identifying, developing and retaining individuals for future management and leadership roles”

Types of succession planning

• Formal:

– Health department has a written document that specifies a formal process for intentionally identifying, developing, and retaining staff for future management and leadership positions.

• Informal:

– Health department uses an informal process for identifying, developing, and retaining staff for future management and leadership positions but there is no written document or formal process.

Why did we focus on succession planning in LHDs?

• Limited research
• Long-standing, sustained interest among

private companies and increasing interest among public agencies

• Pertinent

Methods

• Survey of Recruitment and Retention

Activities in Local Health Departments

– 225 local health departments responded – 22 items on survey focused on succession planning

• 6 Case Studies of Promising Practices in

Local Health Departments

– 3 recruitment & retention – 3 succession planning

What is the need for succession planning?

• 1.3 years: median number of years since LHD

filled its last key leadership/management position

• 56% filled a key position in the past 18 months
• 59% of LHDs reported being “very” or “extremely”

concerned about finding well-qualified individuals to fill open positions

• 62% of LHDs reported being “very” or

“extremely” concerned about retaining well- qualified employees in jobs.

Source: UIC/SLGE Local Health Department Survey (2012)

10 20 30 40 50 60 70 80 90 100 Total

All health departments

n=149 n=53 10 20 30 40 50 60 70 80 90 100

By jurisdiction size

10 20 30 40 50 60 70 80 90 100 Local State/Shared

By governance type

Percent

10 20 30 40 50 60 70 80 90 100

No clinical services Home health only Other services

By type of services

Percent

= informal = none = formal n=16

No statistically significant differences were found Percent Percent

Frequency of Succession Planning

Source: UIC/SLGE Local Health Department Survey (2012)

Belief in Need for “Ready Now” Top Executive vs. Grooming

Strength of Belief that Top Executive Needs to be “Ready Now”

10 20 30 40 50 60 70 80 90 100

75%

Grooming Specific Individuals to Succeed Top Executive

37 10 20 30 40 50 60 70 80 90 100 Percent Percent

Source: UIC/SLGE Local Health Department Survey (2012)

Succession Planning Activities: Formal vs. Informal

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Not at all In select programs or divisions Department

• wide

F I F I F I F = Formal I = Informal

Source: UIC/SLGE Local Health Department Survey (2012)

Succession Plans in Place by Occupational Category

10 20 30 40 50 60 70 80 90 100

Percent

Note: Denominator includes only those LHDs that actually have the position.

Source: UIC/SLGE Local Health Department Survey (2012)

Timing of Succession Planning

10 20 30 40 50 60 70 80 90 100 Done AFTER leader announced leaving Done BEFORE leader announced leaving but not

• ngoing

Done BEFORE leader announced leaving and

• ngoing

Don't Know

Percent Source: UIC/SLGE Local Health Department Survey (2012)

Self-Rating of Succession Planning

10 20 30 40 50 60 70 80 90 100 Extremely poor Poor Average Very good Extremely good

Percent Source: UIC/SLGE Local Health Department Survey (2012)

Case Studies-Succession Planning

Site Focus Region Pop. Size # FTEs Tenure

• f Top

Exec. (years) Govrn. Clinical Services Type of SP Self- Rating

• f SP

1 R & R Midwest 75,000 29 8 Local No Formal Average 2 R & R West 2.3 million 719 10 Local No Formal Average 3 R & R West 10 million 4,232 15 Local Yes Formal Average 4 SP South 181,000 130 14 State Yes Informal Extremely Good 5 SP Midwest 60,000 25 8 Local Yes Formal Extremely Good 6 SP Midwest 77,000 93 8 Local Yes Informal Very Good KEY Pop. = Population R & R = Recruitment & Retention Exec. = Executive SP = Succession Planning Govrn = Governance

Source: UIC/SLGE local health department case studies (2013)

The Challenge

“We recognize the challenge…how do you take people—nurses, sanitarians, science- based people, professionally-degreed people—and turn them into management? …How do you make [them] shift their gears and become someone in management?”

• Midwestern County Health Commissioner

Source: UIC/SLGE local health department case studies (2013)

Case Study Findings

• Public health (not agency) orientation

“We’re always trying to develop a pool that is not only capable of moving into a position here, but capable of assuming a position in another department.”

–Midwestern County Health Commissioner

“We need to be the best in the world at developing public health leaders.” -Southeastern County Health Director “We are grooming employees who we believe will make great public health officers, either here or somewhere

• else. Public health [in the state] would be losing out if

these people aren’t eventually health officers.”

• Midwestern County Health Department

Source: UIC/SLGE local health department case studies (2013)

Case Study Findings – Role of Top Executive

• Drives succession planning, creates a

culture of high performance, emphasizes a high degree of open communication

• Manages from a behavioral competency

framework

– Nine Box Grid – Emotional Intelligence – Management by Objective (MBO) – Myers-Briggs

• Possesses exemplary interview skills

Source: UIC/SLGE local health department case studies (2013)

Case Study Findings – Culture of Succession Planning

• Create a culture of staff development and

recognize who doesn’t fit

– “There is an informal, but well-understood, principle amongst our senior leadership around development of

• staff. Part of it is [that] our culture is very, very

committed to staff development and succession planning is an off-shoot, the identification of people, who either have leadership potential or raw talent.”

• Southeastern County Health Director

– “I had to have 5 or 6 people I could absolutely count on.”

• Midwestern County Health Commissioner

Source: UIC/SLGE local health department case studies (2013)

Case Study Findings- Grooming

• Groomed candidates, who often lack technical

degrees, respond to coaching and critical feedback to become capable managers

• Kinds of projects that foster development:

– Stretch projects – Cross-training/orientation – Coaching – External management training (e.g., MPH degree) – Structured leadership curriculum

Source: UIC/SLGE local health department case studies (2013)

Case Study Findings- Succession Planning

Similarities

• Public health orientation
• Strong org. culture of staff

development championed by Top Executive who manages from behavioral competency framework

• Assessed vacancy risk
• Willingness to take risks
• Support from Board of Health
• Performance evaluation process

supports professional development

Differences

• Formal or informal approaches
• Targeted or comprehensive
• Need for new positions
• Kinds of projects

Source: UIC/SLGE local health department case studies (2013)

Overcoming Challenges to Succession Planning

• “We do not groom individuals for jobs. But when there is an opening,

we know there will be internal candidates who are well-qualified….”

• Western County Health Department
• “A fundamental principle of the department’s leadership framework is

that all employees have the potential to be leaders and to function in leadership roles. ….this broad-inclusion principle is essential for succession planning to ensure that efforts reach deep to draw and develop leaders from the front lines….” –Western County Health Dept.

• “I think that…having an informal [succession plan] from an employee

perspective makes it…a little bit easier for employees to not see it black and white.” –Director of Community Health, Midwestern LHD

Source: UIC/SLGE local health department case studies (2013)

Benefits of Succession Planning

• A strong and deep employee bench
• Internal talent is there when vacancies
• ccur
• Increased commitment to the agency
• Strong programs

Case Study Findings- Benefits of Succession Planning

• “If I had never received any of that [feedback], then…it’s like…

I’m putting all this effort in and all this [additional work] and on the other end of the scale there’s nothing so why would I stay here, but obviously that’s not the case. So I think succession planning is definitely a big piece of keeping people here.”

• Leadership Candidate Being Groomed, Midwestern County LHD
• “We need to be the best in the world at developing supervisors

and particularly public health leaders. If we’re best at that then all those other things, programs, are going to reflect that.”

• Southeastern County Health Director
• “Anything like the national health care act or anything else that

will come our way, we are ready, we are ready to tackle it because we have this wise approach.”

• Midwestern County Health Commissioner

Source: UIC/SLGE local health department case studies (2013)

Local Health Department Perspective

Angela J. Smith, MPH Morrow County Health Department

Competitive Disadvantages

• No corporate training program - new hires
• No executive training program -

management

• Organizational structure in small and mid

size LHDs is flat

• No specialized HR department
• Less compensation
• Smaller budgets for professional

development

Competitive Advantages

• Attractive mission
• Work environment
• Benefits
• Stability (not true of last 5 years)
• Opportunity for skill development

Approach to Succession Planning

• Employee recruitment & selection is

critical

• Employee retention is important
• Performance evaluation
• Identification of talent
• Mentoring at all levels
• Investment in professional development
• Formalize the process

Challenges & Failed Experiments

• Selection of the least bad candidate
• Mentoring requires time commitment
• Mentoring only successful with secure/

mature mentor

• Government structure does not lend

itself to investment in professional development

What We Did Well

• Identified talent
• Took the long view
• Took measured risks
• Modeled after best business practices
• Used CQI projects & key programs as

training tools

• Mentored effectively
• Invested in our people
• Created culture of honesty

Perspective and Outlook

Bernard J. (Barney) Turnock MD, MPH Clinical Professor of Community Health Sciences UIC School of Pubic Health

My role on today’s panel

• So, what’s new here?
• So what?
• So, what’s next?

So, what’s new here?

• Info and insights into recruitment and

retention activities of local public health agencies

• First detailed look at succession planning

in local public health agencies

• Offers knowledge and practice base to

share; case studies are particularly illuminating

So, what’s new here?

• Benchmarks the high level of concern over

recruitment and retention challenges

• Raises questions as to how well high levels of

concern match with the activities undertaken (use of best practices, overcoming HR

• bstacles)
• Focuses on the long overlooked public health

workforce development strategy: workplace management

So what?

• Over-emphasis on pipeline thinking has

led to distortion of the data, incomplete definition of the problem, and inadequate strategies

– Public health workforce shrinking! – Massive retirements will further erode workforce! – Public health workers not prepared! – Capacity today less than in the past!

So what?

• Evidence indicates

– More individuals trained in public health than ever – FTE workers in health agencies of local government increased through 2008, declined only slightly through 2010 (effects of ARRA?) but not rebounding post- recession (economic and political climate at state/local level) – NACCHO Profile surveys reflect increase through 2008 and little change 2008-2010 (suspect 2013 will show decline) – Health department retirement rates not unusual for public or private sector organizations and retirements have both positive & negative impacts – Productivity gains have been substantial over recent decades

Year Federal FT State FTE Local FTE State / Local FTE Federal, State, Local FTE 1995 125,048 160,031 208,588 368,619 493,667 2000 120,362 172,678 236,496 409,174 529,536 2005 125,163 178,465 246,300 424,765 549,918 2008 140,026 185,667 260,404 446,071 586,097 2009 141,713 184,424 257,725 442,149 583,862 2010 147,165 193,456 250,184 443,640 590,805 2011 152,347 196,424 244,339 440,763 593,110

Government Employment Census Data: Full Time Equivalent (FTE) Workers

• f Governmental Health Agencies,

Selected Years, 1995-2011

Source: Data from U.S. Bureau of the Census, Federal, State, and Local Governments, Public Employment and Payroll Data. Available at www.census.gov/govs/apes

So what?

• Evidence indicates that more (not less)

public health work is being done today

• Gap exists, but between what can be

done today and what is expected today

• Local public health work itself needs to

be put into perspective

Dimensions of public health work- doing

PH Work Organization PH Work PH Trained

Public health workforce

PH Work Organization PH Work PH Trained

1 2 3 4 5

Trained Do PH work In PH org Not trained Don’t do PH work In PH org Not trained Do PH work In PH org Trained Do PH work Not in PH org Not trained Do PH work Not in PH org

6

Trained Don’t do PH work Not in PH org

7

Trained Don’t do PH Work In PH org

So, what’s next?

• Consider the local PH agency workforce within the larger

context of public health work-doing

• Balance pipeline thinking and strategies with Sutton’s Law

approach – Build the public health workforce where we find it via strategic workforce management in the workplace (starting with gov’t PH agencies makes good sense!)

• Improve recruitment, retention, succession planning in

public health agencies – We’re learning what is being done – Next steps: what works and why?

So, what’s next?

• NACCHO, ASTHO, NALBOH, APHA,

PHF, CDC

• RWJ, SLGE et. al.
• Public health systems researchers
• PBRNs (PH Practice-Based Research

Networks), PH Institutes

Questions and Conversation

Briefing Report Coming Soon….

Local Health Department Workforce Recruitment and Retention: Challenges and Opportunities, A Practitioner Briefing

Expected publication date: end of November Report will be sent out to webinar participants and will be available at SLGE.org

For more information

Joshua Franzel Center for State and Local Government Excellence www.slge.org jfranzel@slge.org Julie Darnell University of Illinois at Chicago http://publichealth.uic.edu/ jdarnell@uic.edu