Retaining Public Health Professionals

State: GA Type: Promising Practice Year: 2021

Description of department: For the past 100 years, Cobb & Douglas Public Health (CDPH) has been dedicated to promoting and protecting the health and safety of our community. CDPH was the first PHAB-accredited health department in the state of Georgia. We are committed to improving quality of life by tracking and preventing the spread of disease, promoting health and safety through education, providing prevention services and ensuring our community is prepared for emergencies. 

CDPH serves both Cobb and Douglas counties. Cobb County spans 340 miles and includes the municipalities of Acworth, Austell, Kennesaw, Marietta, Powder Springs, and Smyrna. Douglas County is one of the smallest counties in the state with just under 200 miles and includes the city of Douglasville.

CDPH protects the health and safety of the 906,484 residents of Cobb (760,141) and Douglas (146,343) counties. To accomplish this, CDPH employs 300 people across 30 programs that support services delivered in 7 locations.

Race and ethnicity demographics within District 3-1 vary. According to 2019 U.S. Census, 29% of Cobb residents were African-American, 62% were white and 13% were Hispanic. By contrast 45% of Douglas were white, 50% were African-American, and 10% were Hispanic. 

CDPH is one of the largest health departments in Georgia and is made up of eight functional centers, including Administration (includes Emergency Preparedness), Community Health, Clinical Services, Environmental Health, Workforce Administration, Communications, Quality Management and Epidemiology/Infectious Disease. 

Description of issue:  According to the 2018 Forces of Change survey conducted by NACCHO, one-third of local health departments reported job losses in 2017. Over the past decade, public health departments have been challenged to "do more, with less" amid dwindling resources (including people). Recognizing our employees are our greatest resource, CDPH determined it would take a deliberate approach to strengthening the workforce. The employees provide the services which promote, protect, and improve the health of our residents. We embrace the philosophy of building a "learning culture" and are concerned with the impact of jobs lost due to attrition and retirements.  It is important we develop, train, and retain our current employees for future vacancies. 

Goals and objectives:  CDPH's workforce development initiative is led by a multidisciplinary "Workforce Development (WFD) Committee". The initiative is one of five strategic initiatives tied to the agency strategic plan. Goals/objectives for this initiative were selected based on results of the core competency gap analysis, employee satisfaction survey and strategic planning process.  The committee plans and manages the execution of the Workforce Development Plan projects and initiatives as identified in PHAB Domain 8; monitors progress on the objectives and metrics supported; stays current on environmental scanning data; identifies strategic issues that require attention; makes recommendations to leadership and develops new approaches to talent development; ensures execution of the WFD objectives and initiatives, and strategically responds to factors affecting talent development. 2019/2020 WFD goals included the following:

1. Create a merit-based pay plan

2. Develop succession plan

3. Implement cultural competency training

4. Establish a shared governance council

5. Create a young professionals retention strategy

6. Establish a management development strategy

Activities implemented: 

1. Created a plan for merit-based pay aimed at decreasing turnover to include an educational reimbursement policy (adding hourly staff and paying for CEUs), Career Ladders for several job codes and a template for the remaining job codes.

2. Developed a succession plan for key positions in the agency in an effort to increase internal promotion by 10%.

3. Created a nursing shared governance council who completes two quality improvement projects per year in order to reduce turnover in nursing staff by 10%.

4. Created a management development strategy to include "Stepping Up to Supervisor" and "Supervisor Development" to improve employee satisfaction with supervisors by 5% and decrease turnover due to supervision by 10%.

5. Created a strategy in an effort to reduce turnover in young professionals by 10%.

Results/Outcomes: Upon implementation of the merit-based pay plan, the Merit-Based Pay committee was established. One outcome includes updating the education reimbursement policy that allows employees $1,500 per year to pursue CEUs, licensure, certifications and college-level courses. Another outcome is in addition to the career ladders already in place for customer service representatives, nurses, and environmental health, the committee developed career ladders for epidemiologist and accountants to support the goals of decreasing turnover and increasing internal promotion rates. We continue to work towards establishing prescribed career ladders for all other job codes. Furthermore, development of the succession plan increased internal promotion rates by 50% in 2020 and creation of the young professional's retention strategy reduced turnover in Generation Z staff by 231% in 2020, far exceeding the goals. Although realizing the full impact of the newly created management development strategy and nursing shared governance council will take time, the council has already resulted in a 6% decreased turnover, retaining staff who are difficult to replace during the COVID-19 pandemic.

Factors to success: Buy-in from our Health Director and Leadership was critical. The Director budgeted funding and staff time for our projects, supported our Training & Development Coordinator position which is imperative for these strategies to work. Also, feedback from the cross-functional members on the various committees were imperative for success. Program Managers' support was also critical. Many managers spent considerable time creating ladders and supporting staff to acquire skills necessary to progress.

Impact: The increased staff retention resulting from these initiatives, positively impacts public health by reducing disruptions in service delivery caused by inadequate/undertrained staff and hiring/training demands caused by turnover. The increased expertise through tenure and improved job satisfaction improve our ability to deliver high quality services.

Health inequities: CDPH has a separate initiative dedicated to health equity and previously developed an internal, cross-departmental Health Equity Committee.  This committee was charged with developing a Health Equity Strategy that reduced inequities among our staff and better prepared staff to reduce inequities through our programs delivered to the community . The committee has launched mandatory, agency-wide training on health equity, social determinants of health and most recently a cultural competency course. 



Target population: The target population for our interventions aimed at improving staff retention was our entire workforce of nearly 300 employees with a wide variety of backgrounds, including clinical providers, such as physicians, nurse practitioners, and registered nurses, epidemiologists, environmental health specialists, health educators, program managers and other subject matter experts. We also have support staff in administration, facilities, medical records, information technology and customer service. Among these employees, approximately 91% are females and 9% are males; 50% are Caucasian, 29% are African American, 12% are Hispanic, 5% are Asian and 2% are more than one race. Our ages are broken down as follows: 16% are between ages 18-29; 21% are between ages 30-39; the majority - 24% are between ages 40-49; 23% are between ages 50-59 and the remainder over age 60. We employee 196 full-time employees and 86 part-time. Our goals/objectives were for all employees.

Past efforts to address the problem: CDPH has tried to actively improve employee retention since 2012 when it was first identified as a strategic initiative in the agency's first Strategic Plan. Between 2012 and 2016, a few strategies that worked well included working with the University of Georgia Carl Vinson Institute of Government to provide our staff with Management Development Training, updated our job classification system, increased internal communications, implemented an employee recognition program called the "WoW" program, renovated our buildings to increase employee workspace and morale,, and worked on moving salaries toward market average. 

Activities to address health equities: CDPH has developed a strategic initiative to develop and execute classes/trainings and programs focused specifically on providing agency staff with an understanding of health equity and related concepts as well as the ability to serve all populations with cultural humility. We created a cross-functional Health Equity Committee to work on the objectives of this initiative. The objectives we created were to provide educational opportunities to our employees related to health disparities and health equity through the implementation of online training modules. This was completed by all employees and is now a part of our new employee orientation. Our second goal was to offer an annual cultural competency and diversity training for all employees. We sent two employees to a train-the-trainer course. They have taught three classes thus far. Our third goal was to offer an annual social determinants of health training to employees. All employees have taken this training and it is part of our new employee orientation as well as our annual update training.

New to field of public health: Our current approach to workforce retention is more innovative and deliberate. It has garnered much better results with the staff. A few novelties include:

1. While over the years, health departments have employed various methods of retention, the Workforce Development Committee has proactively employed strategies designed to develop a culture where employees want to grow. For example, the young professionals' strategy and nursing shared governance are things other local health departments have not done.

2. This strategy is unique in that while previous programs were developed and administered by the leadership team (top down), these current initiatives are workforce driven since the Workforce Development Committee is championed by staff from within each division/program.

3. CDPH monitors implementation and collects data as evidence of the workforce development strategy's success.

Creative tool used: CDPH is using many tools to assist in retention. We created the "Working with Young Professionals" guide, the succession plan/evaluation tool, and a nursing shared governance council, and are working on three different types of management development courses.

The CDPH Workforce Development (WFD) Committee created a strategic initiative action plan for workforce development. The objectives of the initiative are as follows:

1. Develop a plan for merit-based pay in a staged approach to decrease turnover due to salary.

2. Develop a succession plan for key positions to increase internal promotion rates.

3. Create a nursing shared governance council to reduce turnover rates in nursing.

4. Create a management development strategy to improve employee satisfaction with supervisors.

5. Create a strategy to reduce employee turnover in our younger generation staff.

Steps taken to achieve goals:

In FY2020, our WFD Committee, comprised of a cross-functional group of employees, developed a "Strategies for Working with Young Professionals" document. The document outlines the following best practices/strategies:

1. Use strong technology skills to your benefit

2. Ensure collaboration through group work

3. Embrace diversity/flexibility

4. Give frequent feedback

5. Provide opportunities for additional learning and development

6. Encourage short-term growth in entry-level roles

7. Complete stay interviews

8. Maintain a healthy work/life balance

9. Avoid making performance judgements based on age or appearance

10. Recognize the big accomplishments

11. Focus on agency culture

12. Identify opportunities for new employees to build connections

CDPH also has a Succession Planning Committee, comprised of a cross-functional group of employees, who developed a succession plan for key positions in FY2020 to increase internal promotion rates. The primary goal of the succession plan is to facilitate leadership transition in the event of retirement, resignation or unexpected tragedy. The plan reflects our values by ensuring the continued success of the agency remains a high priority. The Succession Planning Committee meets to discuss job descriptions and desired knowledge, skills, and attributes (KSAs) of the job and compiled a list of management-related tasks and possible training solutions.  The committee then meets with retirees to review and finalize the SKAs and the list of management-related tasks and training solutions Upon completion of these efforts, the committee discusses potential internal candidates and rates them on their strengths and weaknesses using a prescribed guide.  The committee next interviews each suggested candidate to gauge interest in becoming a potential candidate. Once interested, high-potential candidates are identified, CDPH matches them with a mentor and creates individual development plans to provide them with development opportunities. The mentors also delegate management tasks to the candidates so they can gain practical experience with different workplace responsibilities and put their management training to work. This process better prepares the internal candidates for the position, increasing their chances of getting the job.

In FY2020, CDPH's Center for Clinical Services and the Center for Quality Management created a Nursing Shared Governance Council. The council is comprised of nurses from several departments to including Clinical Services as well as Community Health. The nursing shared governance council helps promote professional practice environments, integrates our core values and beliefs, and empowers nurses to help make decisions affecting themselves, their colleagues and their patients. This group works on at least two quality improvement projects per year.

CDPH also created a Merit-Based Pay Committee in FY2020. This committee is comprised of our District Health Director, Deputy District Health Director, Director of Clinical Services, Director of Quality Improvement, Director of Workforce Administration and Director of Administration. So far, the committee has created an education reimbursement policy to allow employees $1,500 per year to pursue CEUs, licensure, certifications and college-level courses and developed career ladders for epidemiologists and accountant job codes that align with the customer service representatives, nurses and environmental health specialist ladders we already had in place. We continue to work towards developing a prescribed career ladder for all other job codes as well.  This group has also worked to provide COVID-19-related hazard and other one-time payments to employees during FY2021 in recognition of their tireless efforts towards fighting the COVID-19 pandemic. 




Our Leadership Team has an annual retreat where we determine what strategic initiatives our agency will prioritize for the following fiscal year.  One of our strategic initiatives is workforce development and we have developed objectives to meet the goals of this initiative.  The objectives and evaluation data are las follows:

1 Objective: Create a plan for merit-based pay in a staged approach to decrease staff turnover due to salary by 5%. Evaluation of the data: The Director of Workforce Administration attempts to meet one-on-one with each employee leaving the agency to complete an exit survey and ask follow-up questions. Unfortunately, during FY2020, turnover due to low salaries was still an issue.

2 Objective: Develop a succession plan for key positions in an effort to increase internal promotion rates by 10% Evaluation of Data: We created a Succession Plan Committee to prepare and implement the succession plan.  The results were great!  Workforce Administration managed and evaluated the data using our Munis database.  The results indicated that during FY2020, internal promotions increased by 50% from the previous fiscal year, demonstrating the success of this initiative.

3 Objective: Create a nursing shared governance council to reduce turnover rates in nursing staff by 10% Evaluation of data:  We started with nurse focus groups and used the results of these focus groups to identify a cross-functional group of nurses interested in serving on the council. Workforce Administration managed and evaluated nurse turnover data using our MUNIS database. The results indicated that during FY2020, we decreased nursing turnover by 6%. Although we didn't quite reach our target of 10%, the nursing governance council has been a positive initiative for our nursing staff, and we are excited to continue it.

4 Objective: Create a management development strategy to improve employee satisfaction with supervisors by 5% and decrease turnover due to poor supervision by 10%. Evaluation of data: Unfortunately, we were unable to complete this objective due to turnover in our agency's Training & Development Specialist position. We have a new person in this role who is working hard to begin implementing this strategy in FY2021.

5 - Objective: Create a strategy to reduce employee turnover in young professionals by 10%. Evaluation of data: Our Workforce Development Committee created the plan, and it was approved by the leadership team and implemented. Based on data provided by Workforce Administration staff, turnover in Generation Z employees was reduced by 231% after implementation of this strategy, highlighting the impact of this strategy.  

We are committed to sustaining the workforce development and retention plans and strategies highlighted above. These objectives have been integrated into our department of Workforce Administration where continuous quality improvement will be used to optimize the effectiveness of these initiatives, keep,our staff engaged and maintain leadership buy-in. We are fortunate to have a leadership team that is very committed and engaged in our goals and objectives. Additionally, they provide the financial backing needed to ensure the long-term sustainability of these efforts. We believe retaining our workforce is key to continuing to deliver high-quality essential public health programs to the communities we serve.  We will continue to strive to keep our employees motivated and to stay with us for the long haul.