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Prioritizing the Public Health Workforce

Harnessing PH WINS Data in Local Health Departments for Workforce Development

Brown, Jessica N., MPH; Fuchs, Jonathan, MD, MPH; Ristow, Alexa, MPH

Journal of Public Health Management and Practice: March/April 2019 - Volume 25 - Issue - p S183–S184
doi: 10.1097/PHH.0000000000000975
Practice Commentaries: Commentary

Center for Learning & Innovation (Dr Fuchs and Ms Brown), San Francisco Department of Public Health (SFDPH), San Francisco, California; and DuPage County Health Department, DuPage County, Illinois (Ms Ristow).

Correspondence: Jessica N. Brown, MPH, Population Health Division, San Francisco Department of Public Health, 25 Van Ness Ave, Suite 500, San Francisco, CA 94102 (

The authors declare no conflicts of interest.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

The Public Health Workforce Interests and Needs Survey (PH WINS), which was fielded for a second time in 2017, is a national survey of governmental health agency workers. It assesses, at the local and state levels, the workforce's knowledge, skills, and attitudes. Results from PH WINS have been used within agencies and at the federal level to inform workforce investments and priorities. This commentary presents perspectives from local and city health agency staff who are prioritizing the use of data from PH WINS 2017 to inform their agency's workforce development activities. These staff members served as champions for the survey and were critical for its administration; consequently, they play an important role in understanding their agency's unique challenges and taking action to address them. Each account describes how PH WINS 2017 data are being used to shape workforce development programming and effect lasting change in their agencies.

Jessica N. Brown, MPH

Manager of Training and Workforce Development

Jonathan Fuchs, MD, MPH

Director of the Center for Learning & Innovation

Population Health Division, Center for Learning & Innovation

San Francisco Department of Public Health, San Francisco, California

As in 2014, the results of PH WINS in 2017 have informed our department's quality improvement journey. We relied on the data from the first PH WINS to craft the workforce development plan required for public health accreditation. At that time, results reinforced that our workforce was highly mission driven; however, it also revealed the need to enhance staff engagement and focus on succession planning. Since then, the Population Health Division has followed in the footsteps of our integrated clinical delivery system in embracing a Lean improvement methodology. Lean is grounded in humility and respect for people and relies heavily on staff insights to improve the quality of services and to reduce waste. We sought additional Lean training and launched an annual engagement event that featured improvement activities driven by the frontline staff. In addition, to plan for succession, we redoubled efforts to sustain meaningful internships, such as our Summer HIV/AIDS Research Program (, and created new opportunities for high school, undergraduate, and master's level students to attract them to careers in public health.

Three years later, we are gratified to see that our response rate to PH WINS 2017 increased substantially from 2014 (from 37% to 59%). Overall job satisfaction is on par with the national average for the Big Cities Health Coalition health departments, and 81% of staff members are aware of quality improvement concepts, reflecting our organization's continued focus in this area. However, we were struck by the significant portion of respondents (34%) who shared that they intended to leave governmental public health in the next year for reasons other than retirement, with a perceived lack of opportunities for advancement being the most commonly cited reason. We will partner closely with human resources to assess structural barriers posed by our existing civil service processes and take a critical look at supervisors' efforts to promote the professional development of the frontline staff so that they can meet different job qualifications. Given that only half of respondents reported that their training needs were assessed over the past year, and a similar proportion noted that creativity and innovation are being rewarded, we must ensure that we are investing sufficient resources to engage, and ultimately retain, highly qualified staff who can readily find opportunities elsewhere in a highly favorable Bay Area job market.

PH WINS 2017 has provided several actionable data points, and listening sessions with staff will help us formulate our improvement strategies moving forward. Of note, the current survey has a limited assessment of how the public health workforce perceives departmental efforts to advance health equity and operate as a trauma informed system; we call for future iterations of PH WINS to delve more deeply into these areas. The city and county of San Francisco have recently joined the Government Alliance on Race and Equity (GARE), which offers jurisdictions ways to combat structural racism as a root cause of persistent health disparities. PH WINS could be an important tool for our workforce to hold us accountable.

Alexa Ristow, MPH

Quality and Compliance Coordinator

DuPage County Health Department, DuPage County, Illinois

The DuPage County Health Department is a diverse agency with more than 40 programs and about 575 staff members dedicated to providing accessible, quality services for a county population of nearly 1 million. As a large suburban health department with a diverse staff, PH WINS offered a unique opportunity to capture workforce perspectives and identify opportunities for improvement.

Data and data-driven decision making are valued and further supported by our culture of continuous quality improvement, as we are accredited by both the Public Health Accreditation Board and the Joint Commission. The results of PH WINS 2017 enabled our agency to validate the areas of strength, the areas we have already identified and are working hard to improve and shed light on new opportunities. For example, 85% of our staff members responded satisfaction with their job: Next steps will explore the reasons staff find their role to be satisfying through stay interviews. These findings will support workforce development and retention efforts as long-term staff members begin to retire.

Upon receipt of our PH WINS results, the Organizational Development service unit established a workgroup to focus on timely, actionable steps based on the identified areas of opportunity. These areas include advancement opportunities, dissatisfaction with pay and incentives, communication between senior leadership and employees, and specific training needs. Some of these issues were already being addressed at the time of the workgroup's first meeting. For example, our health department had already initiated a third-party salary analysis to review staff pay structures. In addition, our agency had recently rolled out an incentive program in which staff could recognize their coworkers for going above and beyond. Collectively, these initiatives aim to provide our workforce with competitive compensation and gratitude for their commitment to improve the health of DuPage County residents.

The PH WINS results showed that 20% of respondents do not have a college degree. In collaboration with a local community college, our agency began exploring a program for staff without a college degree, allowing them to earn an associate degree upon completing the program. To encourage staff participation, some program courses may take place at the Health Department. Our workgroup has suggested identifying the level of staff interest in this program to hopefully offer this opportunity in the future.

According to our PH WINS results, only 59% of our staff members agree that communication between senior leadership and employees is good. Our workgroup is researching anonymous employee feedback platforms, such as an online-based suggestion box, or through regular pulse surveys to gauge staff satisfaction and encourage feedback at all levels. We will also coordinate all staff communication regarding agency initiatives and projects to be paired with related PH WINS findings so that staff know their voices have been heard. Overall, the interest and needs identified by our staff through PH WINS have allowed our Health Department to focus our efforts and ensure our workforce is prepared to continue leading local public health efforts.

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