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Succession Planning in Local Health Departments

Results From a National Survey

Darnell, Julie S. PhD, MHSA; Campbell, Richard T. PhD

Journal of Public Health Management and Practice: March/April 2015 - Volume 21 - Issue 2 - p 141–150
doi: 10.1097/PHH.0000000000000120
Original Articles

Context: Succession planning has received scant attention in the public health sector, despite its potential to generate operational efficiencies in a sector facing chronic budgetary pressures and an aging workforce.

Objectives: We examined the extent to which local health departments (LHDs) are engaged in succession planning and assessed the factors associated with having a succession plan.

Design: We conducted a national cross-sectional Web-based survey of workforce recruitment and retention activities in a sample of LHDs responding to the National Association of County & City Health Officials' 2010 Profile Study and then linked these data sets to fit a multivariable logistic regression model to explain why some LHDs have succession plans and others do not.

Setting and Participants: Top executives in a national sample of LHDs.

Main Outcome Measure: Presence or absence of succession planning.

Results: Two hundred twenty-five LHDs responded to the survey, yielding a 43.3% response rate, but no statistically significant differences between respondents and nonrespondents were detected. Only 39.5% reported having a succession plan. Performance evaluation activities are more common in LHDs with a succession plan than in LHDs without a plan. In adjusted analyses, the largest LHDs were 7 times more likely to have a succession plan than the smallest. Compared with state-governed LHDs, locally governed LHDs were 3.5 times more likely, and shared governance LHDs were 6 times more likely, to have a succession plan. Every additional year of experience by the top executive was associated with a 5% increase in the odds of having a succession plan. Local health departments that report high levels of concern about retaining staff (vs low concern) had 2.5 times higher adjusted odds of having a succession plan.

Conclusions: This study provides the first national data on succession planning in LHDs and sheds light on LHDs' readiness to meet the workforce-related accreditation standards.

This study provides a national baseline of the scope of succession planning activities in local health departments and a first glimpse into the reasons for the variation in the use of succession plans.

School of Public Health, University of Illinois at Chicago (Drs Darnell and Campbell).

Correspondence: Julie S. Darnell, PhD, MHSA, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, Room 758, Chicago, IL 60612 (

This project was supported by a grant from the Robert Wood Johnson Foundation. The authors would like to thank UIC colleagues Susan Cahn, DrPH candidate, for her help in developing and administering the survey, Clinical Professor Barney Turnock, MD, for advice on the project and for reviewing multiple drafts of the manuscript, and Yuanbo Song, PhD candidate, for generating the sample. They thank Joshua Franzel and his team at the Center for State and Local Government Excellence for feedback on the survey and early drafts of survey findings. They wish to thank the National Association of County and City Health Officials, especially Carolyn Leep, for detailed comments on the survey. David Jemielity edited the manuscript. Finally, the authors are grateful to the local health department officials who filled out and returned the survey.

The authors declare no conflicts of interest.

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