employee perspectives on working in public health agencies: a qualitative analysis janna m....

Employee Perspectives on Working in Public Health Agencies:A Qualitative Analysis

JANNA M. WISNIEWSKI, MHA; VALERIE A. YEAGER, DrPHTULANE UNIVERSITY SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE

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Introduction

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Background Public health agencies are experiencing severe and increasing workforce shortages.◦ Recent loss of 46,000 state and local positions due to budget

cuts.1 ◦ 26% of state and local public health workers eligible to retire

as of 2016.1

◦ 200,000 new public health workers will be needed over the next decade.2

1. Association of State and Territorial Health Officials. ASTHO Profile of State Public Health, Volume Three. Washington, D.C. 2014. Available at: http://www.astho.org/Profile/Volume-Three/. Accessed November 3, 2014.

2. Association of Schools of Public Health. Annual Data Report 2011. 2012. Available at: http://depts.Washington.edu/sphnet/wp-content/uploads/2013/06/FINAL_ASPH-Annual-Data-Report-2011.pdf. Accessed November 3, 2014.

http://depts.washington.edu/sphnet/wp-content/uploads/2013/06/FINAL_ASPH-Annual-Data-Report-2011.pdf

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Background A 2008 qualitative study in six communities examined recruitment and retention factors among state and local public health employees.1 ◦ Found a lack of enthusiasm for public health careers.◦ Employees cited limited opportunities for

advancement and additional training.◦ Tuition reimbursement, release time, financial

incentives for obtaining advanced degrees may be of value.

1. Draper DA, Hurley RE, Lauer JR. Public health workforce shortages imperil nation’s health. Research brief. 2008(4):1-8.

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Study Objective Examine the opinions of public health workers with regards to recruitment, workplace experiences, and retention, on a national scale.

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Methods

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Data Set Council on Linkages Between Academia and Public Health Practice’s 2010 Survey of Public Health Workers.

Distributed by email to individuals who had accounts in Public Health Foundation’s online training system.

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Data Set Purpose of the survey was to determine:

◦ Factors that attracted employees to public health◦ Level of job satisfaction◦ Factors that impact employees’ decision to

remain in the field

Survey questions were primarily multiple-choice; however, one open-ended question was included.

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Study Selection Criteria Of the 11,640 respondents, 2,381 (20 percent) provided a substantive response to the open-ended question: “Is there anything else you would like to tell us that we did not ask?”

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Analysis: First Stage1. A team of four coders coded a set of fifty

responses. Each comment was assigned up to two primary codes.

2. The team discussed the analysis, agreed upon a standard set of codes, and individually recoded the fifty responses and discussed to ensure concordance.

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Analysis: First Stage3. Three coders then each coded a separate

set of 200 comments; the fourth coder coded a sub-set of each to assess inter-rater reliability (ranging from 80-95%).

4. Three coders completed the remainder of the comments.

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Analysis: Second Stage5. The comments corresponding to the five

most commonly-occurring primary codes were selected for further analysis.

6. Secondary themes were identified for each of these comments in order to gain more depth.

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Results

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Respondent Characteristics

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n (%)Education High School 243 (10.2%) Associate’s degree 399 (16.8%) Bachelor’s degree 806 (33.9%) Master’s degree 708 (29.7%) Terminal degree 225 (9.4%)Gender Female 1,887 (79.3%) Male 494 (20.7%)Age Group 18-24 24 (1.0%) 25-34 237 (10.0%) 35-44 394 (16.5%) 45-54 818 (34.4%) 55-64 766 (32.2%) 65+ 136 (5.7%)

Table 1. Personal characteristics of respondents (n=2,831)

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>70 percent


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>70 percent


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n (%)Current Role Administrative support staff 346 (14.5%) Administrator/Director/Manager 534 (22.4%) Allied health professional 200 (8.4%) Epidemiologist/Statistician/Data analyst 212 (8.9%) Environmental health specialist 197 (8.3%) Laboratory professional 92 (3.9%) Nurse 716 (30.1%) Physician 61 (2.6%) Other 1,148 (48.2%)Organization Type Academic institution 136 (5.7%) Government 1,931 (81.1%) Healthcare services 581 (24.4%) Nonprofit organization 204 (8.6%) Private industry 53 (2.2%) Self-employed 60 (2.5%) None (not currently employed) 113 (4.7%)Jurisdiction Local 1,339 (56.2%) State 720 (30.2%) National 84 (3.5%) Unspecified 238 (10.0%)

Table 2. Organizational characteristics of respondents (n=2,831

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Table 2. Organizational characteristics of respondents (n=2,831n (%)

Current Role Administrative support staff 346 (14.5%) Administrator/Director/Manager 534 (22.4%) Allied health professional 200 (8.4%) Epidemiologist/Statistician/Data analyst 212 (8.9%) Environmental health specialist 197 (8.3%) Laboratory professional 92 (3.9%) Nurse 716 (30.1%) Physician 61 (2.6%) Other 1,148 (48.2%)Organization Type Academic institution 136 (5.7%) Government 1,931 (81.1%) Healthcare services 581 (24.4%) Nonprofit organization 204 (8.6%) Private industry 53 (2.2%) Self-employed 60 (2.5%) None (not currently employed) 113 (4.7%)Jurisdiction Local 1,339 (56.2%) State 720 (30.2%) National 84 (3.5%) Unspecified 238 (10.0%)

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Table 2. Organizational characteristics of respondents (n=2,831n (%)

Current Role Administrative support staff 346 (14.5%) Administrator/Director/Manager 534 (22.4%) Allied health professional 200 (8.4%) Epidemiologist/Statistician/Data analyst 212 (8.9%) Environmental health specialist 197 (8.3%) Laboratory professional 92 (3.9%) Nurse 716 (30.1%) Physician 61 (2.6%) Other 1,148 (48.2%)Organization Type Academic institution 136 (5.7%) Government 1,931 (81.1%) Healthcare services 581 (24.4%) Nonprofit organization 204 (8.6%) Private industry 53 (2.2%) Self-employed 60 (2.5%) None (not currently employed) 113 (4.7%)Jurisdiction Local 1,339 (56.2%) State 720 (30.2%) National 84 (3.5%) Unspecified 238 (10.0%)

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Primary Themes and Secondary Themes

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Primary Themes1. Salary (20%)2. Job Satisfaction (14%)3. Funding (13%)4. Management (12%)5. Retention (11%)

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1. Salary (20%)a. Discrepanciesb. Low payc. Raises

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“I actually quit the Health Department for 22+ months so that I could pay off outstanding debts. I can actually take home one-half of my Health Department take home working 8 days a month as week-end coverage at a local nursing home.”

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“I am the chief person responsible for infectious disease control for all reportable diseases as well as outbreaks of disease for a county of 380,000+ citizens. However, I do not make enough money to live within this county.”

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“There is little to no upward movement within state entities. I have never received a raise in 10 years of work. It seems irrelevant whether or not my evaluations are excellent, good or bad. Everyone is treated the same.”

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2. Job Satisfaction (14%)a. Intrinsic rewardsb. Job tasksc. Workplace conditions

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“Public Health gives me the opportunity to put on my Superman cape every day and try to save the world.”

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“Working in Public Health is one of the great joys of life, helping to prevent, educate, serve, and support your family, friends and community.”

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“Don't encourage people to work in public health. It's nothing but dealing with penny pinching bosses that won't pay a decent wage while being attacked by the public that wants instant service you can't provide because you're only working three days a week.”

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3. Funding (13%)a. Trainingb. Staffing/Workloadc. Cuts

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“State funds are in short supply… There are no funds to travel out of State to national conference. Because we are so short staffed, there really is no time for professional development.”

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“We are a skeleton crew and are not able to provide all the needs of our county. We used to have 13 nurses, and now only have 4. But it is this way all over the state.”

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“We can no longer do more (or even the same) with fewer resources, and unfunded mandates continue to arrive. We do not have the funds or the knowledge and skills to leverage today's technological advances. The public health infrastructure in this country is crumbling, and no one is paying attention!”

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4. Management (12%)a. Poor performanceb. Unprofessionalismc. Lack of qualification and training

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“Need more support from supervisor and management when issues involving safety, ability to properly do each job correctly, and trouble shooting any problem which may arise.”

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“Politics and nepotism now determine who will succeed, be promoted, trained, supplied with equipment and who will remain in the same position forever, not offered training, and be issued equipment needed to complete tasks.”

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“Clearly I am disappointed with my public health experience. It is related to the fact that I have a supervisor with no public health experience, and no initiative to learn public health other than what affects her directly. This has been my worst healthcare experience in 23 years.”

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5. Retention (11%)a. Competitive salaryb. Mismanagementc. Economic instability

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5. Retention (11%)a. Competitiveness of salariesb. Mismanagementc. Economic instability

“The area of recruitment and retention of the public health workforce is among the most serious issues impacting public health at this time. Our inability to be competitive with salaries and support further education is a major contributing factor to the future direction of public health.”

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“Our current health director has made our work environment much less desirable than the last 21 years I have worked here. It is hard to maintain a high quality of work with this type of management. Everyone is either retiring before they planned to or are finding other jobs. Although I am the most qualified candidate for a promotion I will not apply because of trust issues and incompetency with this director..”

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“There is no such thing as "security" in any position. When we rely on community and levies to fund our small rural organization we are the first to have to reduce services and staffing because our unemployment rate is 15%... Public Health needs a transformation quickly to keep the quality individuals on board now and to recruit other quality individuals in the future.”

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Discussion

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Considerations• Enhance job design in ways that foster employee satisfaction, including:• Opportunities to interact with the community• Performance of a variety of tasks • Regular acquisition of new skills• Ongoing professional growth

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Considerations• Employ strategies to strengthen management• Provide training for managers on ways to improve

organizational culture and create motivating work environments.• Design or highlight career development guides so that

employees understand advancement opportunities.• Support professional development programs to build the

leadership and management skills of employees at all levels.

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Considerations• Mitigate the effects of unfunded mandates on employees’ workload and job satisfaction.

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Study Strengths and Limitations• Largest survey of the public health workforce to date; primarily representing 26 states.• Responses may have been influenced by the topics of the survey questions.• Timing of the survey (during the recession) may have influenced employee perspectives.

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Conclusions This study offers information which can be used to strategize toward filling gaps in the public health workforce, strengthening worker satisfaction, and improving levels of service.

Next steps for research: use recent qualitative data to examine changes in public health employee perspectives as the economy transitions out of recession.

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Investigators

Janna M. Wisniewski, [email protected]

Valerie A. Yeager, [email protected]

AcknowledgementsRon Bialek, PhD & Kathleen Amos, MLIS

Public Health Foundation

Channah Adler, Kathryn Kampa, & Corinne McNicholsTulane School of Public Health and Tropical Medicine

employee perspectives on working in public health agencies: a qualitative analysis janna m....

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