In our previous post, we showed how burnout and moral injury were systemic threats to the institution of public health and the health of the nation. Public health leaders will need to take bold action to address these issues. A shift is needed to create a culture of well-being in public health organizations and across the public health system. Leaders tend to focus on individual well-being programs while overlooking the larger systemic issues that lead to burnout. Adjusting strategies to address burnout at the individual, institutional, and systems levels is important as public health leaders work toward the future vision of public health. PHAB’s 2022 Standards and Measures includes a section devoted to “Building a Supportive Work Environment.” This standard empowers public health institutions to invest in their work environment, focus on wellness, work-life balance, employee recognition, inclusive culture, and using employee feedback to drive institutional change. In this post we lay out six strategies that public health leaders can use to meet these PHAB standards and create a culture of well-being that permeates throughout the public health system.

Strategies and Resources to Develop a Culture of Well-Being in Public Health

Strategies for Team Leaders and Supervisors

1. Employee engagement is the most important factor for employee performance and retention. It includes commitment to and identification with the organization and its mission, as well as job satisfaction and energizing work. While employee engagement and well-being do not correspond perfectly, addressing both the connection and the demand side of engagement can improve well-being. Team leaders and supervisors can use or adapt Gallup’s validated Q¹² Employee Engagement Survey to easily assess employee engagement. They can also use the Employee Engagement Checklist from Harvard Business Review to find opportunities to boost engagement by aligning employee’s work with their passion, easing work processes, and creating sufficient time to focus on work and home life.
2. Professional recognition is another opportunity to improve employee well-being. Recognition is a motivator, creating positive competition and professional commitment. Leadership’s acknowledgement of a team’s or individual’s effort builds employee morale and loyalty and can increase productivity. Recognition can be symbolic, tied to compensation, or through new responsibilities or promotion.
3. Team cohesion occurs when the team has a shared vision and effective collaboration. Cohesive teams accomplish day-to-day operations with efficiency and mastery, adapt to change, and understand how each member of the team fits into the department’s structure. Critical steps to build team cohesion include clearly defining employee roles, creating alignment and promoting transparency. Resources that can help with this include tips on how to write better job descriptions, information about creating team alignment, and suggestions on building trusting teams.

 Strategies for Organizational Leaders

4. Strategic alignment plays a crucial role in promoting well-being by establishing a clear and concise vision for the organization. Strategic alignment occurs when an organization’s structure, resources and activities are aligned with its goals and objectives. Strategic alignment reduces burnout by ensuring there are sufficient resources to meet priorities and by clearing the way so that employees can focus their work on the stated priorities. Public health leaders can improve how they prioritize strategic issues using the framework titled “A Better Way to Set Strategic Priorities” from Harvard Business Review and can create an essentialist culture that maximizes the ability of employees to contribute to priorities.
5. Transparent communication helps to build trust across an organization. Organizations that use transparent communication as a strategy build a workforce that values idea sharing, collaboration and ethical behavior. Communication includes not only broad messaging but also sharing critical metrics tied to strategies, timely and appropriate communication of safety concerns, and recognition of accomplishments. Strategies for transparent communication include sharing key performance indicators monthly, documenting important instructions, conducting one-on-one meetings, using dashboards and project management tools, holding daily stand-up meetings, and creating incentives for transparency. In addition, the institution should have a process for reporting concerns anonymously and/or confidentially that includes a full circle response for incident resolution.

Strategies for Public Health Systems Leaders

6. A research and leadership agenda for well-being in public health could create focus, coordination, and momentum for a culture of well-being across the public health workforce. Burnout and other factors have led to substantial turnover that threatens the effectiveness of the public health system and could harm America’s health. Disciplines like medicine and education have already advanced initiatives to study and implement innovations to enhance well-being for clinicians and teachers, respectively. As the membership organization for America’s public health workers, the American Public Health Association could provide leadership for this issue, similar to programs for physicians from the American Medical Association and American Academy of Family Physicians. In addition, funders like the National Institutes of Health and private foundations could help fund research on this topic. More attention from national public health organizations could advance this issue and give it the gravitas it needs.

Conclusion

Burnout and moral injury are systemic threats to the public health system and the health of all Americans. Public health leaders should take bold action to improve well-being at the individual, team, organization and systems levels. The resources referred to in this post can help public health leaders bring to life PHAB’s workforce well-being standards and create a culture of well-being in their organization. Furthermore, tackling the root causes of burnout and moral injury is essential. Working together, we can all contribute toward building a culture of well-being throughout the public health system.

Important Notice on Burnout and Moral Injury

The authors acknowledge the seriousness of burnout and moral injury and their devastating impacts. If you or someone you know is suffering, timely support is crucial. Here are some vital resources:

1. For Immediate Crisis:
   • 988 Suicide & Crisis Lifeline
   • Website: 988lifeline.org
   • Call or Text: 988
2. Mental Illness Support (National Institutes of Health):
   • Find comprehensive assistance for mental illnesses here (https://www.nimh.nih.gov/health/find-help)
3. APA Well-Being Resources:
   • American Psychiatric Association resources for managing well-being and burnout (https://www.psychiatry.org/psychiatrists/practice/well-being-and-burnout/well-being-resources).

Remember, seeking help is a sign of strength. Your well-being matters.