Lawrence-Douglas County Public Health, Kansas

Introduction

Public Health Forward: Modernizing the U.S. Public Health System recognizes that the modern public health workforce needs specific abilities to advance health equity. As such, the report recommends that health departments provide professional development opportunities, giving public health workers the skills and knowledge needed to meet modern public health challenges (e.g., change management, data science skills, and cultural and linguistic competencies).

Context

When Lawrence-Douglas County Public Health (LDCPH) in Kansas embraced the vision of Public Health 3.0: A Call to Create a 21st Century Public Health Infrastructure in 2017, a major focus was to build the workforce of the future. LDCPH management team members led discussions among themselves and with staff about how to move toward that vision. In 2018, the health department hosted a Public Health 3.0 presentation to share information and gain staff buy in. In 2019, management team and academic partners developed a strategic workforce development plan to support staff in fulfilling their roles within this context.

Key Actions

Consider a formal partnership with academia.

This can greatly facilitate the development of professional development opportunities.

  • The University of Kansas (KU) is in Lawrence, and the University of Kansas Medical Center (KUMC) is in Kansas City. LDCPH formed a partnership with KU and KUMC called the Academic Health Department to support its Public Health 3.0 professional development activities. This academic-practice collaboration pools assets from both institutions to enhance student experiences and public health practices. Through this partnership, LDCPH, KU, and KUMC offer training opportunities to staff. LDCPH’s employee benefits include resources for tuition reimbursement. Staff from LDCPH have also been invited to complete specific courses related to public health competencies, with tuition costs shared by LDCPH and KU.

LDCPH realized that to effectively implement Public Health 3.0, all staff must have a solid grasp of partnership development, policy development, and community engagement skills. A staff-wide capacity assessment confirmed that most staff needed training in these areas.

  • LDCPH, KUMC, and KU collaboratively developed an eight-month training series for all staff on the competencies needed in a Public Health 3.0 health department. Specifically, the goal is to ensure that staff skills correspond with a health department that fully embodies the chief health strategist role.
  • Examples of applied exercises include the following:
    • Partnership development: At the outset, participants were asked to identify other people and organizations they work with, and how those partners contribute to the work of the health department.
    • Equity: During a required training session, the facilitator asked, “How do issues around equity apply to your work?” A staff member shared that computer access and the cost of the fingerprinting process were barriers for organizations applying for childcare permits through the health department. As a result, the health department temporarily waived permit fees.

Recommendations

Policy

Formally incorporate professional development activities into routine health department operations.

LDCPH’s strategic plan is a “living document” that actively guides the attainment of health department priorities. It currently includes completion of a workforce development plan.

  • In the process of moving to a Public Health 3.0 model, LDCPH realized that incorporating community engagement work into job descriptions meant that some staff would now need to work after usual business hours. As a result, the department is exploring changing their positions from non-exempt to exempt status.
  • In addition, all policies have been reviewed, and policies such as work from home have been adopted to encourage flexibility in where and when work takes place.

Workforce

Take time needed to plan an all-staff training effort.

This body of work is large and potentially daunting, so it is important to be thoughtful about how to engage the staff, accommodate staff schedules, and revise expectations and deadlines as needed for staff to be fully immersed in training activities.

  • LDCPH began by discussing the need for professional development among its management team and gradually expanded to conversations with all staff.
  • The management team was thoughtful about challenges and potential barriers that surfaced in these discussions and intentionally planned around them. For example, clinical and WIC staff noted that trainings held at certain times of the day posed barriers to attendance, so trainings were scheduled at times staff indicated availability and far enough in advance to allow staff to reserve the time on their calendars.
  • Discussions began about two years before the chief health strategist training plan was launched.

Staff training usually focuses on job-specific technical skills. A modern health department, however, requires its staff to understand the “big picture” of public health and have the associated foundational knowledge and skills. This concept is most likely to resonate with staff who join the agency because they are passionate about public health; staff who do not have this viewpoint may not see how these activities are relevant to their work.

Deliberately assign staff with experience in the training topic to each training team or small group discussion so they can share their own insights and experiences with their colleagues. These exchanges enrich the training by making it more directly relevant and can prompt others to share.

Financial

Budget modest amounts of funds.

Budget modest amounts of funds for refreshments and room costs to provide a comfortable space, ensure staff are well-nourished, and otherwise offer an environment conducive to learning.

Anticipated Impacts For Public Health Departments

Partnerships

For example, LDCPH’s Public Health 3.0 efforts led to centering partnerships for completion of community health improvement plan (CHIP) work, in which the Douglas County government and administrator’s office play a key role. That initial partnership was strengthened as LDCPH and Douglas County formed the unified command structure that oversaw pandemic response efforts.

Thanks to foundational public health training sessions, staff thinking about public health problems has evolved to focus more on community conditions than on an individual’s circumstances.
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Potential Challenges To Implementation

Staff Resistance

Staff may feel that they do not need any additional training because the topics do not apply to their job. Providing overall context and using applied exercises, as described above, can be helpful to staff understanding their role as chief health strategist and thus being more amenable to the professional development activities.

Sustainability

Leadership Support

The health director and management team should set expectations among staff, provide encouragement, and ensure conditions for staff to fully participate in professional development activities.

Including professional development activities in operational frameworks helps to institutionalize the practice.

Either though a memorandum of understanding or an informal mechanism, partnering with academia can ensure high-quality and low-cost opportunities for staff to learn and build new skills.

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