Time to Reflect and Plan for the Future: COVID-19 Response Lessons from the Public Health Workforce
This blog summarizes key actionable insights from the qualitative responses shared by the public health workforce in the 2021 Public Health Workforce Interests and Needs Survey (PH WINS).
The beginning of a new year provides public health leaders with the opportunity to reflect on the challenges and successes of the past. As with the COVID-19 pandemic, governmental public health agencies and their workforces will continue be on the frontlines of future outbreak responses. Although the nation is technically still responding to COVID-19, as a field, we can use this time to reflect on protracted emergency response efforts while memories are still fresh. Thanks to the public health workers who shared their experiences in the 2021 Public Health Workforce Interests and Needs Survey (PH WINS 2021), we have the data necessary to process and consider the lessons learned and what preparations we should consider for the future.
The recent supplement of the Journal of Public Health Management and Practice focused on PH WINS 2021 provides valuable insight about the response and the current workforce. In our qualitative study “Qualitative Insights from Governmental Public Health Employees About Experiences Serving During the COVID-19 Pandemic, PH WINS 2021” we summarize responses to an open-ended question asking public health workers to share their thoughts and experiences about serving in their health department during COVID-19 pandemic. We coded a total of 5,169 or 41% of the responses to this question.
The paper presents the top 15 most common themes identified in responses and examines the disposition of the comment (positive, negative, or neutral) and co-occurring themes. 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%).
Something about human nature lends itself to sharing negative experiences over positive ones. Consider that customers who have had a negative experience are 2 to 3 times more likely to leave a review than customers with positive experiences. However, the workforce’s responses indicated that despite comments about what went wrong or what does not work, they have things to celebrate. For example, the most common theme identified, pride in public health work and its mission, was predominantly positive (95.9%). Similarly, 81.5% of the comments about teamwork and 61.0% of those about telework were positive. On the other hand, 12 of the 15 most common themes were predominantly negative or, as we like to think about it, examples of what can be improved.
Leaders Set the Direction of Change
While not every theme identified a problem that individual public health agencies can directly change (e.g., the politicization of public health), there are a few issues that leaders can start on right away. For example, comments within the leadership theme indicate that the workforce perceived inequity in assigned response roles and expected overtime effort, inequity in who could telework, a lack of communication from leadership, and a sense of not being appreciated by leadership.
Communication, the fourth most common theme, included comments that highlighted a lack of internal communication resulting in inconsistent procedures among employees and inconsistent messaging to the community. The rapidly changing evidence about COVID-19 certainly complicated communication, which may be true in future outbreaks as well. Revising or developing new protocols for disseminating information internally and training and preparing for how to communicate with the public should be top priorities.
Employee wellness is another theme leaders can make a priority right now as they plan for future protracted emergencies. While some of the burnout and stress may be unavoidable during a public health emergency, comments about not feeling appreciated or employee well-being not being prioritized can inform intentional changes for leaders moving forward. The literature offers leaders in health care and public health numerous ideas for supporting employee well-being.
Teamwork was a theme that often occurred alongside burnout, but it was referenced as something that helped to offset the sense of burnout. Fostering a workplace culture that values teamwork may contribute to a mindset of shared responsibility and counter the perceptions of inequity during response events. Lastly, given that overtime pay was often a co-occurring theme with burnout, developing plans or reserve funds for being able to provide overtime compensation for future emergency response events should be a leadership priority now.
We recognize that given the extreme stress and exhaustion enacted by COVID-19 response on all members of the public health workforce, and especially agency leaders, revisiting what went wrong is likely the last thing people want to do right now. However, doing so may protect employees, prepare agencies to support their staff differently during the next emergency, and help the workforce to heal. Given that recruiting and retaining the public health workforce is one of the biggest issues public health agencies face right now, anything that can be done to create environments to support teamwork, improved communication, and employee well-being would go a long way.
Read the full study in the Journal of Public Health Management and Practice:
- Qualitative Insights from Governmental Public Health Employees About Experiences Serving During the COVID-19 Pandemic, PH WINS 2021
- The Opportunity Cost of COVID for Public Health Practice: COVID-19 Pandemic Response Work and Lost Foundational Areas of Public Health Work McCullough, J. Mac; Robins, Moriah. Journal of Public Health Management and Practice. 29(Supplement 1):S64-S72, January/February 2023.
- Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize? Balio, Casey P.; Galler, Nicole; Meit, Michael; Hale, Nathan; Beatty, Kate E.. Journal of Public Health Management and Practice. 29(Supplement 1):S107-S115, January/February 2023.
- Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health Leider, Jonathon P.; Shah, Gulzar H.; Yeager, Valerie A.; Yin, Jingjing; Madamala, Kusuma Journal of Public Health Management and Practice. 29(Supplement 1):S54-S63, January/February 2023.
- Pandemic-Related Workplace Violence and Its Impact on Public Health Officials, March 2020‒January 2021. Ward JA, Stone EM, Mui P, Resnick B. Am J Public Health. 2022 May;112(5):736-746.
- Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Søvold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, Münter L. Front Public Health. 2021 May 7;9:679397.
- Hare Bork, R.; Robins M.; Schaffer K.; Leider J.P.; Castrucci B.C. Workplace Perceptions and Experiences Related to COVID-19 Response Efforts Among Public Health Workers – Public Health Workforce Interests and Needs Survey, United States, September 2021 – January 2022. MMWR Morb Mortal Wkly Rep 2022;71:920-924.
Valerie Yeager is a Professor at the Indiana University Richard M. Fairbanks School of Public Health in Indianapolis. As a researcher focused on public health systems and services (PHSSR), Dr. Yeager studies the recruitment and retention of the public health workforce and organizational strategies for system improvement.
Kay Schaffer is a Senior Research Associate at the de Beaumont Foundation. Her focus is on the Public Health Workforce Interests and Needs Survey (PH WINS) – working on all aspects from administration through dissemination. Kay earned her MPH in Maternal and Child Health from the UNC Chapel Hill Gillings School of Global Public Health and BA in Human Rights from Bard College.