Accelerating diversity, equity, and inclusion goals: a qualitative assessment from the lens of scientists at the 2020 Clinical Translational Science Awards Annual Meeting.

Participants in the leadership breakout session at the Clinical Translational Science Awards (CTSA) virtual 2020 conference discussed and ranked six recommendations in terms of feasibility, impact, and priority for advancing Diversity, Equity, and Inclusion (DEI) efforts to elevate underrepresented populations to leadership positions in CTSAs and their broader institutions. A thematic analysis of chat and polling data identified challenges and opportunities to achieve DEI goals, with the three most promising recommendations as: cross-institutional Principal Investigator (P.I.) action-learning workgroups, transparent policies for recruiting and promoting underrepresented minorities (URM) leadership, and a clear succession plan to nurture and elevate URM leaders. Suggestions are made to improve DEI in CTSA leadership and allow for greater representation in the translational science field.

Learning to Lead: 3 Models to Support Public Health Leadership Development.

CONTEXT: The current public health system is underresourced and understaffed, which has been exacerbated by the coronavirus pandemic. In addition, there has been a decline in the public health workforce at both state and local levels during the last decade. While workforce numbers dwindle, public health systems have to address increasingly complex challenges-such as climate change, chronic diseases, and health equity-challenges that require skilled, adaptive leaders. This article describes the importance of leadership development and how 3 public health training centers (PHTCs) are building leadership skills in the public health workforce. PROGRAM: To address the need for public health leadership training, the PHTCs in the Health & Human Services (HHS) Regions 4, 7, and 10 all offer public health leadership institutes (PHLIs). IMPLEMENTATION: The 3 PHLIs discussed in this article vary in longevity (3-18 years), cohort length (8-12 months), and format (virtual, in-person, and hybrid); yet, all 3 emphasize adaptive leadership through a health equity lens and intentional opportunities to apply skills in practice. EVALUATION: Each PHLI conducts extensive evaluation based on Kirkpatrick's levels of evaluation and collects common metrics collected by all PHTCs. Data from the PHLIs illustrate high levels of satisfaction with learning, presentation of data, identification of workplace actions, and improvement of subject matter understanding. Each PHLI also has numerous stories of impact. DISCUSSION: With public health leaders leaving the workforce and the complexities of practice increasing, leadership training is critical to the current workforce and succession planning. These PHTCs provide a significant, enduring resource toward the development of our nation's public health leaders, as well as meeting the unique needs of their regions' workforces.

Leadership Development to Advance Health Equity: An Equity-Centered Leadership Framework.

Enduring questions about equity are front and center at this watershed moment in health care and public health. Inequities that became evident in the COVID-19 pandemic in 2020 have highlighted long-standing disparities in health by race and ethnicity. Current crises require examining and reorienting the systems that have, for decades, produced these health inequities; yet, public health and health care leaders are inadequately prepared to respond. The authors offer an equity-centered leadership framework to support the development of visionary leaders for tomorrow. This framework for leadership development programs interweaves traditional leadership and equity, diversity, and inclusion domains in both conceptual knowledge and skills-based teaching for health care and public health leaders, grouping competencies and skills into 4 domains: personal, interpersonal, organizational, and community and systems. A framework such as this will equip leaders with the mindset and skill set to challenge the paradigms that lead to inequity and health disparities.

Advancing Health Equity Through Equity-Centered Leadership Development with Interprofessional Healthcare Teams.

INTRODUCTION: Events of spring 2020-the COVID19 pandemic and re-birth of a social justice movement-have thrown disparities in disease risk, morbidity, and mortality in sharp relief. In response, healthcare organizations have shifted attentions and resources towards equity, diversity, and inclusion (EDI) issues and initiatives like never before. Focused, proven equity-centered skill and mindset development is needed for healthcare professionals to operationalize these pledges and stated aims. AIM: This article highlights program evaluation results for this Clinical Scholars National Leadership Institute (CSNLI) specific to EDI. We will show that CSNLI imparts the valuable and essential skills to health professionals that are needed to realize health equity through organizational and system change. SETTING: Initial cohort of 29 participants in CSNLI, engaging in the program over 3 years through in-person and distance-based learning offerings and activities. PROGRAM DESCRIPTION: The CSNLI is a 3-year, intensive leadership program that centers EDI skill development across personal, interpersonal, organizational, and systems domains through its design, competencies, and curriculum. PROGRAM EVALUATION: A robust evaluation following the Kirkpatrick Model offers analysis of four data collecting activities related to program participants' EDI learning, behavioral change, and results. DISCUSSION: Over the course of the program, participants made significant gains in competencies related to equity, diversity, and inclusion. Furthermore, participants demonstrated growth in behavior change and leadership activities in the areas of organizational and system change. Results demonstrate the need to center both leader and leadership development on equity, diversity, and inclusion curriculum to make real change in the US Healthcare System.

Training "Pivots" from the Pandemic: Lessons Learned Transitioning from In-Person to Virtual Synchronous Training in the Clinical Scholars Leadership Program.

INTRODUCTION: Since the inception of distance-based teaching modalities, a debate has ensued over the quality of online versus in-person instruction. Due to the COVID-19 pandemic, a number of teaching environments-including leadership development trainings for post-graduate learners-have been thrust into exploring the virtual learning environment more thoroughly. One three-year leadership development program for interdisciplinary healthcare professionals transitioned three simultaneous leadership intensives from in-person to online in the spring of 2020. METHODS: Documented changes in overall training length, session length, and session format are described. Further, evaluative data were collected from participants at both retreats via post-session surveys. Ninety-three participants attended the 2019 retreat, and 92 participants attended the 2020 virtual retreat. Quantitative data of three rating questions per session are reported: 1) overall session satisfaction, 2) participants' reported knowledge gain, and 3) participants' reported ability gain. Qualitative data were obtained via two open-ended feedback questions per session. RESULTS: In comparing pre/post scores for knowledge and ability, participants had meaningful (and in some cases higher) self-reported gains in knowledge and ability measures in the online environment, as compared to the in-person environment. Participants reported statistically significant gains in all sessions for both knowledge and ability. Qualitative data of participant feedback identified a number of positive themes similar across the in-person and virtual settings. Negative or constructive feedback of the virtual setting included time constraint issues (eg too much content in one session, a desire for more sessions overall), technical difficulties, and the loss of social connection and networking with fellow participants as compared to in-person trainings. DISCUSSION: While meaningful shifts in knowledge and ability ratings indicate that the transition to successful online learning is possible, several disadvantages remain. The preparation time for both faculty and participants was considerable, there is a need to reduce overall content in each session due to time restraints, and participants indicated feeling the loss of one-on-one connections with their peers in the training. Lessons learned of transitioning leadership training from in-person to an online experience are highlighted.

Creating Customized Workforce Development Plans for Medium-to-Large Public Health Departments.

OBJECTIVES: The objectives of our study were to (1) illustrate a public health workforce assessment process in a medium-sized city or county health department and (2) demonstrate the insights gained by moving from the use of aggregate department-level and competency domain-level training needs results to more granular division-level and skills-level results when creating a workforce development plan. METHODS: We used a 130-question needs assessment to guide the creation of a workforce development plan for the Lincoln Lancaster County Health Department (LLCHD) in Nebraska and its 7 divisions. Using SurveyMonkey, we administered the survey to 128 (of the 129) LLCHD public health staff members in June 2015. Using a Likert scale, respondents indicated (1) the importance of the skill to their work and (2) their capacity to carry out 57 skills in 8 domains of the core competencies for public health professionals. We identified training needs as those for which the percentage of respondents who perceived moderate-to-high importance was at least 15 percentage points higher than the percentage of respondents who perceived moderate-to-high capacity. RESULTS: LLCHD as a department had training needs in only 2 competency domains: financial planning and management (importance-capacity difference, 15 percentage points) and policy development and program planning (importance-capacity difference, 19 percentage points). The Health Promotion and Outreach division had training needs in all 8 domains (importance-capacity difference range, 15-45 percentage points). Of the 57 skills, 41 were identified by at least 1 of the LLCHD divisions as having training needs. In 24 instances, a division did not qualify as having training needs in the overall domain yet did have training needs for specific skills within a domain. CONCLUSIONS: When performing public health workforce assessments, medium-to-large public health departments can obtain detailed workforce training needs results that pertain to individual skills and that are tailored to each of their divisions. These results may help customize and improve workforce development plans, ensuring that the workforce has the necessary skills to do its job.

The EDIC Method: An Engaging and Comprehensive Approach for Creating Health Department Workforce Development Plans.

In 2013, the Nebraska Department of Health & Human Services, Division of Public Health (Nebraska's State Health Department); and the University of Nebraska Medical Center, College of Public Health developed a comprehensive approach to assess workforce training needs. This article outlines the method used to assess the education and training needs of Division staff, and develop comprehensive workforce development plans to address those needs. The EDIC method (Engage, Develop, Identify, and Create) includes the following four phases: (1) Engage Stakeholders, (2) Develop Assessment, (3) Identify Training Needs, and (4) Create Development Plans. The EDIC method provided a process grounded in science and practice, allowed input, and produced buy-in from staff at all levels throughout the Division of Public Health. This type of process provides greater assurance that the most important gaps in skills and competencies will be identified. Although it is a comprehensive approach, it can be replicated at the state or local level across the country.

A model for training public health workers in health policy: the Nebraska Health Policy Academy.

There is growing recognition that health goals are more likely to be achieved and sustained if programs are complemented by appropriate changes in the policies, systems, and environments that shape their communities. However, the knowledge, skills, and abilities needed to create and implement policy are among the major needs identified by practitioners at both the state and local levels. This article describes the structure and content of the Nebraska Health Policy Academy (the Academy), a 9-month program developed to meet the demand for this training. The Academy is a competency-based training program that aims to increase the capacity of Nebraska's state and local public health staff and their community partners to use public health policy and law as a public health tool. Our initiative allows for participation across a large, sparsely populated state; is grounded in adult learning theory; introduces the key principles and practices of policy, systems, and environmental change; and is offered free of charge to the state's public health workforce. Challenges and lessons learned when offering workforce development on public health policy efforts are discussed.

Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality.

Objectives: This study aimed to identify community-level actions to decrease racial disparities in infant mortality (IM). Design: Six urban multidisciplinary teams generated ideas for decreasing racial disparities in IM using a mixed methods concept mapping approach. Participants rated each idea as to its necessity and action potential and grouped ideas by theme. A cluster analysis produced a series of visual representations, showing relationships between the identified actions and the clustering of actions into themes. Multidimensional scaling techniques were used to produce analyses describing the necessity of and action potential for implementing the proposed ideas. Participants identified actions communities could take to decrease racial disparities in IM and suggested applications of the knowledge gained from the mapping process. Results: Participants produced a total of 128 actions, within 11 thematic clusters, for decreasing racial disparities in IM. The thematic clusters contained a range of elements designed to promote knowledge and understanding of the relationship between health and racism; improve educational systems and community opportunities; facilitate community-driven health promotion, marketing, and research; improve health services for women; address physical and social environments that impact community health; prioritize resource allocation of community-based services; institutionalize strategies that promote equity across all systems; and create and support legislation and policies that address social determinants of health. Correlation coefficients of the clusters ranged from 0.17 to 0.90. Average necessity ratings ranged from 2.17 to 3.73; average action potential ratings ranged from 1.64 to 3.61. Conclusion: Findings suggest that thematic clusters with high action potential usually represented ongoing community activities or actions communities could easily initiate. Community size, existing programs, partnerships, policies, and influential advocates were among the factors cited affecting feasibility of implementation. Clusters with lower action potential require broader, longer term, policy, institutional or system-wide changes, and significant resources. High necessity clusters often contained actions perceived as essential for change, but sometimes outside of a community's control. Participants identified a number of practical actions that were considered to hold potential for individual, community, and institutional changes which could result in decreasing racial disparities in IM.

Integrating preconception health into public health practice: a tale of three cities.

In 2006, the national Select Panel on Preconception Care published a set of 10 recommendations on how to improve preconception health and healthcare in the United States. Since then, CDC has been engaged in efforts to ensure that those recommendations are implemented. To help translate the national recommendations into action at the local level, CDC funded CityMatCH, a national maternal and child health organization representing urban health departments, to coordinate a practice collaborative. Beginning in October 2006, multidisciplinary teams from Hartford, Connecticut, Nashville, Tennessee, and Los Angeles County, California, have engaged in the CityMatCH Urban Practice Collaborative on Preconception Health. The CityMatCH practice collaborative process includes team building and leadership development, community assessment, identification of strategies, and action planning around those strategies. The Hartford team's strategies are broad--conducting a scan of preconception health-related activity in Hartford and promoting public policy-and intended for building awareness of preconception health and healthcare among multiple audiences while strengthening the systems necessary to provide women's services. The Nashville team has focused on sickle cell trait as a point of entry into preconception care for women of reproductive age and has developed strategies involving extensive collaboration, a public awareness campaign, and data gathering. The Los Angeles County, California, team is strengthening and more explicitly connecting work related to preconception health that was already being performed in the public sector and the community. This paper describes the collaborative process designed by CityMatCH and highlights the three participating teams' experiences in implementing the national recommendations at the local urban level.