Almost all of the roughly 200 supervisors and managers employed in the City of San Antonio, Texas Metropolitan Health District — or Metro Health, for short — now know what PH WINS means. They know how the survey was conducted, who it represents, and that the acronym stands for the 2021 Public Health Workforce Interests and Needs Survey. Thanks to a four-part monthly learning series, they now also know how the demographics and job functions of their city health department’s 800 or so employees break down. Perhaps most importantly, they know how Metro Health employees feel about their work, their training opportunities, and plans to stay in their jobs over the next year. They’ve visualized how these data compare to those of other large city health departments across the U.S., and in a few weeks, they’ll tune into a session that will give them the tools and resources to apply these insights to their own diverse teams.  

This is all thanks to the “Winning Your Team With PH WINS” monthly virtual learning series that Patricia Kittle, Metro Health’s workforce development administrator, and her team have built to ensure PH WINS doesn’t become “just another survey.”

“A lot of people collect surveys all day long, but then they don’t really act on it,” Kittle said. “We didn’t want to just collect the data without doing something.” 

Morale amid mayhem 

Numbers don’t lie. Morale steadily kept going up and up. We knew that was not an accident.

Patricia Kittle, San Antonio Metropolitan Health District

As Metro Health’s workforce development administrator, Kittle’s role touches everything from workforce pipeline planning to internships, professional development training, coaching, mentoring, support system development, employee engagement, staff retention, and all that’s in between. On a national scale, it’s no secret that these areas — particularly staff retention and engagement — have posed a challenge for public health departments coming out of the COVID-19 pandemic. Indeed, as PH WINS 2021 revealed, nearly a third of the nation’s public health workforce said they were planning on leaving their organization in the next year, and more than 40 percent of those planning to leave blamed burnout.  

But within Metro Health, fewer than a quarter of employees said they planned on leaving their organization — a percentage that actually marked an improvement from PH WINS 2017.  

“From 2020 until last year, staff morale went up, not down,” Kittle said. ” I was expecting it to plummet during COVID. We were exhausted. We were emotionally fatigued. It was 16-hour work days, all hands on deck. We were in tears. But collectively, morale went up when it should’ve been going down.” 

To be sure, Kittle recognized that on an individual level, countless Metro Health employees have struggled with morale. And the data show the department still has quite a bit of room for improvement; she’s not saying they’ve had it easy. But on an overall scale, the data collected through PH WINS showed Metro Health actually performed better than comparable big city health departments in terms of employees’ intent to leave. And the internal surveys Kittle conducts showed the staff feels consistently supported and engaged.  

“Numbers don’t lie,” she said. “Morale steadily kept going up and up. We knew that was not an accident.” 

So what’s been Metro Health’s secret? Kittle, who has a background in behavioral sciences and psychology, credits much of the workforce’s morale to their culture of compassion, which is the sum of many small moments of support, employee appreciation, and recognition. Recently, the whole health department got permission from city officials to shut down activities for half a day to hold “Metro Health Day,” for employees to decompress, rest, and have some fun with colleagues. “We even took an aerial shot of everybody in the department with a drone,” Kittle said.  

From data points to learning opportunities 

Another key factor behind Metro Health’s strong morale has been transparency, especially surrounding the workforce’s needs and the action required to address those needs. Kittle has spent much of the past year building and implementing a way to ensure that some 200 supervisors and managers across diverse teams and functions understand and internalize the findings from PH WINS, including who, exactly, makes up the Metro Health workforce; what job functions they perform; how engaged they feel with their work; and where they feel they could use more training.  

Kittle recognized that the insights collected through PH WINS would have limited impact if only a few people on her team read, analyzed, and understood them. Instead, the findings needed to reach the whole of Metro Health, and each supervisor would need actionable tools and resources to use these findings to support and improve their own teams.  

This was the catalyst behind the monthly “Winning Your Team With PH WINS” learning series. After drafting a proposal in October 2022 and receiving prompt approval, she and her team began advertising the series to managers and supervisors in newsletters and town halls to stir up interest.  Launched in February 2023, the sessions are designed to help team leaders understand what the data mean for their teams and the entire Metro Health workforce and, in turn, to help create a learning tool to support these employees in the long term.   

The learning series has been optional but highly encouraged, and turnout and engagement have been very high. (Kittle has had enough experience with mandatory trainings to know voluntary opportunities are usually more effective.) . The series is interactive, sprinkled with question breaks and opportunities to engage with the findings. For instance, Kittle will pause her presentation to ask attendees what surprised them most about the PH WINS data, or have them guess how Metro Health performed in a certain area before revealing the results. The time commitment required to attend the series is deliberately manageable, too: just one hour per month. The goal, Kittle said, was to keep attendees as engaged as possible.  

“In most cases, I’ve heard people saying they’re pleasantly surprised by the findings on a topic,” she said. “Which means that in their minds, things were possibly worse.” Kittle’s goal isn’t to gloat. “I am not saying, ‘Oh, we’re better than other health departments’. I just want them to see that something we’re doing here is working.”  

Each session is recorded so that those who cannot attend or would like to watch it again can access it on the internal Metro Health site. In the first installment, Kittle introduced attendees to PH WINS, including how the survey was conducted and how it works, and then dug into demographic and workforce characteristics findings. In the second session, she covered findings surrounding health department employees’ intent to stay or leave their organizations as well as their training needs. In the third session, she presented findings on workforce engagement, satisfaction, and well-being. Across each of these areas, Kittle has made a point to show the Metro Health-specific findings against the backdrop of not only the national findings, but also the big city health departments, which she sees as a more meaningful way to consider Metro Health’s workforce alongside comparable government health organizations.  

Finally, the fourth session gave Metro Health supervisors and managers the tools, ideas, and resources they need to apply these findings to their day-to-day jobs.  

“I’m going to package resources and say things like, ‘OK, if you’re concerned about staff retention with your team, here are some resources that may help with that,'” Kittle explained in spring 2023, acknowledging that each team might require a different course of action or set of tools to most effectively apply the PH WINS findings.  

Measuring impact 

Looking ahead, Kittle wants to tangibly assess how the PH WINS learning series has affected various teams within Metro Health.  

“One thing that’s always been a pet peeve of mine as a field trainer is giving trainings for the sake of giving trainings,” she said. “I’m really big on supplementing whatever the training or workshop session is with some consistent follow-up as part of the learning journey. It’s our responsibility to ensure there’s an ongoing discussion so that it doesn’t get lost.” 

This is part of why Kittle and her team spread out the series over four months rather than dumping all of it in a single session. She also plans to develop another survey six months after the final training concludes to probe how the opportunity affected Metro Health employees’ teams.  

“We want to find out, ‘was this series effective enough that supervisors and managers acted on it? Why did they act on it? What did they act on? How are they using it and applying it?'” When November or December 2023 rolls around, she’ll collect that qualitative and quantitative data. Contingent on what that survey reveals, Kittle said she might even reintroduce the PH WINS learning series in 2024 or hold another session to share additional resources.  

For now, she’s looking forward to holding the final session, and is grateful for the buy-in from Metro Health when it came to creating this series.  

“Doing this work can be very challenging when there are not enough hours in the day to accomplish what needs to get done,” she said. “But I have an amazing workforce development team and so much support … that kind of support and buy-in is key to an effort like this.”  

Highlights from the PH WINS National Office

Looking to create your own PH WINS learning series like Patricia Kittle? Here are some ways to get started. 

  • Offer the series as an optional, but highly encouraged learning opportunity for supervisors and managers.  
  • Make the time commitment manageable. Metro Health’s series was held once per month for just one hour with a total of four sessions.  
  • Deconstruct the survey and results strategically. Metro Health’s series was designed as follows:
    • Session 1 reviewed the methods behind PH WINS and the findings about demographics and workforce characteristics. 
    • Session 2 covered findings surrounding intent to leave or stay and training needs.  
    • Session 3 presented findings on workforce engagement, satisfaction, and well-being.  
    • Session 4 focused on resources, tools, and ideas to apply these findings.  
  • Compare results to national-level results or a setting or region that would provide meaningful context around the findings.  
  • Highlight needs and gaps alongside strengths and opportunities. 

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