In public health, we believe in using data to inform and drive decisions and to advance policies. But sometimes, we don't have enough data, sometimes the data aren't current, and sometimes the data are inadequate to give a complete picture of an issue. In workforce development, we've struggled to collect high-quality representative data that give a comprehensive picture of workforce needs across the country. Fortunately, the recently completed Public Health Workforce Interests and Needs Survey (PH WINS) gives participating health agencies the data they need to both assess their workforce and compare their workforce with those at other agencies in the region and the nation. Given the rapidly growing interest in accreditation through the Public Health Accreditation Board, and its requirement that accredited health departments have workforce development plans, PH WINS comes at a critical time in the evolution of the nation's public health system.
This commentary highlights how 3 states responded to their PH WINS data and how they plan to use the data to improve the effectiveness of their efforts to build the best possible public health workforce in their states.
Tennessee: From John Dreyzehner, MD, MPH, FACOEM, Commissioner, Tennessee Department of Health
We are gratified by the data and trends as well as with findings of statistical significance compared with national surveys. Tennessee Department of Health (TDH) employees are significantly more likely to say they are “very satisfied” with their jobs and with their organization. They are significantly more likely to “strongly agree” that they “recommend [TDH] as a good place to work” and that they “know how [their] work relates to the agency's goals and priorities.” Furthermore, they are significantly more engaged (“strongly agree” with “I am determined to give my best effort at work every day”) and are also significantly more likely to “strongly agree” that “creativity and innovation are rewarded.” Our employees are significantly less likely to say they are “very satisfied” with their pay.
This suggests that our deliberate layered approach to fostering innovation, creativity, and leadership at all levels is beginning to have an impact on the critical engagement, drive toward accelerative innovation, and satisfaction of our vital team across our enterprise. The findings also suggest that we must attend to our risk of losing highly talented, motivated, and engaged employees to the often more remunerative employment situations outside state government. Our department is very interested in further use of the data for workforce planning purposes. We undertook the survey chiefly for this opportunity.
Workforce planning is critical in a public sector environment that is experiencing the national swirl of changes in health and health care. Changes in organization, financing, and delivery of health services are challenging the public sector to not only move the public health enterprise forward but also to sometimes help lead change in the health care enterprise. We do so from our typical seats of responsibilities for regulation, surveillance, planning, and some categorical services delivery. The ability of a state health department to continuously feel the “comfort pulse” of its workforce through nationally benchmarked surveys such as this is useful to steer training and staff development and maximize effectiveness in moving key needles.
TDH adopted the Baldrige Performance Excellence framework both to guide internal planning and as a management framework. Workforce is 1 of the 7 Baldrige criteria that the overall department and its program and county operations are led to consider in reviews. PH WINS results will be useful in considering specific areas of satisfaction and improvement. Since TDH had conducted its own department-wide survey in 2010, PH WINS provides an additional data point for comparison of some key concerns. On the whole, TDH is pleased with the PH WINS results and finds the workforce's responses to reinforce the collegial and strategic management approach being employed.
Washington: From John Wiesman, DrPH, MPH, Secretary of Health, Washington State
One of Governor Inslee's priorities is to make Washington State the employer of choice. The PH WINS results have given the Washington Department of Health (WDOH) excellent workforce data to assess our strengths as well as areas for improvement.
We were pleased to see that the department provides significantly more support than our regional and national peers for continuing education and has significantly more employees who are very satisfied with the organization, are satisfied with their salaries, and would recommend the agency as a good place to work. Our employees also find that they get more benefit from hosting practicums than do peers in other health departments, which has helped us both cope with reduced resources and assess and recruit new talent.
We were surprised to learn that a smaller proportion of WDOH staff plan to retire before 2020 than other agencies in the region and the nation. Unfortunately, PH WINS results still show that 23% are considering leaving the organization within a year! This lights a fire for succession-planning efforts and retention efforts, which we had already begun to prioritize.
One perplexing finding, given that Washington has been a leader in public health system improvement initiatives and that the agency is accredited, is that WDOH employees are less likely to report that their day-to-day work will be impacted by evidence-based public health practices than their peers across the nation. WDOH recently joined a pilot project with the National Library of Medicine giving the department ready access to journal articles and evidence-based guidelines for the first time. PH WINS results really validate that decision.
PH WINS data are supplying information and insights into the department that we previously did not have. But what is most helpful is that PH WINS provides regional and national benchmarks, which we could not get by fielding our own workforce survey. Because the data are stratified by supervisory status, role classification, foundational service areas, length of employment, and other demographics, we plan to explore internal differences to focus change improvement efforts and learn from the areas of the agency that seem to be more successful.
Missouri: From Gail Vasterling, JD, Director, Missouri Department of Health and Senior Services
At the Missouri Department of Health and Senior Services, we were excited to participate in this assessment of our workforce. In the past year, we have strengthened our performance management, quality improvement, and employee engagement activities, so we were particularly interested in the data on those topics.
The data validated our perception that our public health employees are satisfied and have a strong commitment to their programs and customers. The data also suggest that our department's workforce is engaged. Employees across supervisory levels are satisfied with their jobs, determined to give their best efforts at work every day, and know how their work relates to the department's goals and priorities. In addition, 73% of employees are satisfied with the department and 73% also would recommend it as a good place to work.
The data also identified areas where the department might improve. For instance, 96% of employees indicated that fostering a culture of quality improvement is somewhat or very important, but only 71% indicated that fostering a culture of quality improvement affects their day-to-day work a fair amount or a great deal.
Some of the most revealing data from the survey are those that indicate the difference between know-how and perceived importance. We will need to determine whether and how training that increases knowledge might increase perceived importance, which could, in turn, change employees' behavior and improve their performance.
Going forward, we plan to use the data to build on the foundation we have already established with performance management, employee engagement, and quality improvement, by identifying and prioritizing workforce issues that impact these topics. Being able to view the data from different perspectives (ie, based on supervisory level, job classification, and tenure) allows us to pinpoint our efforts. Also going forward, we plan to more thoroughly analyze the data and use it to drive and measure strategic planning activities across the department.
State health agency leaders strive to make their agencies the kind of places where talented and committed employees want to work, and make important long-term contributions to the agencies' mission. PH WINS now provides the data to help us learn more about where we have workforce successes and challenges, which should allow us to be more effective in our efforts to reach this goal. To be successful, we will also need readily accessible information about what interventions are likely to improve recruitment, morale, engagement, and retention in the context of governmental public health. We will also need the resources to implement those best workforce practices. The challenge at all levels of government is (to paraphrase the Institute of Medicine) to collectively create the conditions in which workers in public health can be successful. PH WINS is a good step in that process.