Qualitative Insights From Governmental Public Health Employees About Experiences Serving During the COVID-19 Pandemic, PH WINS 2021.

OBJECTIVE: The purpose of the current study was to examine governmental public health employee experiences during the COVID-19 pandemic. DESIGN AND SETTING: A total of 5169 responses to a PH WINS 2021 open-ended question were qualitatively coded. The question asked employees to share their experiences during the COVID-19 response. The 15 most common themes are discussed. PARTICIPANTS: Responses from governmental public health employees in state health agencies (SHAs), big cities (Big City Health Coalition or BCHC agencies), and local health departments (LHDs) across all 50 states were included. RESULTS: The most frequently identified theme was pride in public health work and/or the mission of public health (20.8%), followed by leadership (17.2%), burnout or feeling overwhelmed (14%), communication (11.7%), and overtime/extra work (9.7%). Among the top 15 themes identified, comments about pride in public health work and/or the mission of public health (95.9%), teamwork (81.5%), and telework (61%) were predominantly positive. Co-occurring themes for responses that expressed pride in public health work and/or the mission of public health were often countered with explanations of why respondents remain frustrated, including feeling burned out or overwhelmed , disappointment with the community's sense of responsibility or trust in science , and feeling unappreciated either by the community or their agency. All of these co-occurring themes were predominantly negative. CONCLUSIONS: Employees are proud to work in public health and value teamwork but often felt overworked and unappreciated during the COVID-19 pandemic. Reviewing existing emergency preparedness protocols in the context of lessons learned during the COVID-19 pandemic and listening to employees' experiences with teleworking and task sharing may better prepare agencies for future challenges. Creating channels for clear communication during a period of changing information and guidelines may help employees feel more prepared and valued during an emergency response.

Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health.

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 State of the US Public Health Workforce: Ongoing Challenges and Future Directions.

Between the 2009 Great Recession and the onset of the COVID-19 pandemic, the US state and local governmental public health workforce lost 40,000 jobs. Tens of thousands of workers also left during the pandemic and continue to leave. As governmental health departments are now receiving multimillion-dollar, temporary federal investments to replenish their workforce, this review synthesizes the evidence regarding major challenges that preceded the pandemic and remain now. These include the lack of the field's ability to readily enumerate and define the governmental public health workforce as well as challenges with the recruitment and retention of public health workers. This review finds that many workforce-related challenges identified more than 20 years ago persist in the field today. Thus, it is critical that we look back to be able to then move forward to successfully rebuild the workforce and assure adequate capacity to protect the public's health and respond to public health emergencies.

Estimating Public Health Workforce Efforts Toward Foundational Public Health Services.

CONTEXT: The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed. OBJECTIVE: This study assessed the potential use of an FPHS calculator to assess health department workforce needs. DESIGN AND SETTING: Qualitative interviews were conducted via Zoom in December 2020-January 2021. PARTICIPANTS: Seventeen state and local public health leaders. MAIN OUTCOME MEASURES: Qualitative insights into the potential use of an FPHS calculator. RESULTS: Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed. CONCLUSIONS: The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.

The Politicization of Public Health and the Impact on Health Officials and theWorkforce: Charting a Path Forward

[...]in many instances, state or local health officials have become the scapegoats for many of the COVID-19 restrictions society has experienced.3 The distaste for mask requirements and stay-at-home orders as well as other limits on individual liberty have been used as reasons to threaten health officials with violence, attack them on social media, and stage protests at their homes and workplaces. The authors reviewed and cataloged media reports of the harassment of US public health officials and linked these data with health official turnover records. Recent Health Resources and Services Administration guidance for the Regional Public Health Training Center Program requires that each training region have a leadership institute, which may eventually provide similar trainings and networking among local health officials.

Funding Public Health: Achievements and Challenges in Public Health Financing Since the Institute of Medicine's 2012 Report.

OBJECTIVE: The purpose of this study was to review changes in public health finance since the 2012 Institute of Medicine (IOM) report "For the Public's Health: Investing in a Healthier Future." DESIGN: Qualitative study involving key informant interviews. SETTING AND PARTICIPANTS: Purposive sample of US public health practitioners, leaders, and academics expected to be knowledgeable about the report recommendations, public health practice, and changes in public health finance since the report. MAIN OUTCOME MEASURES: Qualitative feedback about changes to public health finance since the report. RESULTS: Thirty-two interviews were conducted between April and May 2019. The greatest momentum toward the report recommendations has occurred predominantly at the state and local levels, with recommendations requiring federal action making less progress. In addition, much of the progress identified is consensus building and preparation for change rather than clear changes. Overall, progress toward the recommendations has been slow. CONCLUSIONS: Many of the achievements reported by respondents were characterized as increased dialogue and individual state or local progress rather than widespread, identifiable policy or practice changes. Participants suggested that public health as a field needs to achieve further consensus and a uniform voice in order to advocate for changes at a federal level. IMPLICATIONS FOR POLICY AND PRACTICE: Slow progress in achieving 2012 IOM Finance Report recommendations and lack of a cohesive voice pose threats to the public's health, as can be seen in the context of COVID-19 emergency response activities. The pandemic and the nation's inadequate response have highlighted deficiencies in our current system and emphasize the need for coordinated and sustained core public health infrastructure funding at the federal level.

Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals' Challenges with Data Exchange.

Policy Points Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges. Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues. Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies. CONTEXT: The novel coronavirus 2019 (COVID-19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management. METHODS: This study uses cross-sectional data of acute-care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology-organization-environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges. FINDINGS: Our findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge. CONCLUSIONS: Our findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.