The COVID-19 pandemic comes as governmental state and local public health agency staff are continually stretched thin in both resources and personnel. As health departments contend with an unprecedented public health crisis, they also face an impending workforce turnover on top of existing shortages, according to the Public Health Workforce Interests and Needs Survey (PH WINS). Public health agencies need to recruit and retain qualified employees to meet current and future challenges.
The Research to Action program was created in response to PH WINS findings that called for a more robust, well-trained, and competent workforce. The original program was designed to foster collaboration and sharing of workforce best practices among state and local health agencies. In the latest Research to Action program, the de Beaumont Foundation, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Big Cities Health Coalition focused on building strategic skills capacity in the workforce to address recruitment and retention challenges in their agencies.
Through the program, health department teams learned how to lead positive, systemic change by participating in a change leadership certification program that focuses on appreciative inquiry. Public health and human resource professionals develop skills in change leadership and systems thinking and apply their learning to improve recruitment or retention at their agency.
Appreciative inquiry is a strengths-based approach to change that focuses on reducing deficits in an organization by building on the most positive attributes. Many of the problems public health professionals try to solve are complex system-level challenges with multiple solutions. The same is true of workforce challenges. When focusing primarily on fixing a problem with a deficit-based mindset, it is possible that the problem will persist or that the fix will result in unintended consequences elsewhere in the system.
A strengths-based approach to change acknowledges that problems exist; it also recognizes that organizations can improve success by imagining a future that replaces the problem. This strategy is useful for addressing seemingly intractable problems such as recruitment and retention of public health workers within a complex labor system, as well as other public health priorities such advancing health equity within political, financial, educational, criminal justice, housing, and health care systems.
Based on our experience with the Research to Action program, we offer the following set of considerations for public health agency leaders who are interested in incorporating aspects of appreciative inquiry to improve recruitment and retention or to help build more resilient organizations:
Start with what is right, not what is wrong. Public health practice is driven by the pursuit of quality improvement. Practitioners look to the root causes of problems and work backward to find solutions. Once root causes are determined, solutions can be identified by first envisioning a desired future state and then looking for existing evidence about how that vision is already being achieved. Building on what is working well is a way to acknowledge and celebrate the creativity and innovation within the existing system. When organizations choose to look, they notice that both exist throughout their agencies.
Set a positive tone. Adopting a positive tone in the workplace is an opportunity to build a resilient workforce, especially in these times of high stress. Creating a positive workplace atmosphere involves encouraging employees to view their work through a lens of opportunity. Help staff envision a desired future and actions they have taken or could take to achieve that desired state. Employees may also be encouraged to share bright spots from their week at the beginning of meetings to foster a positive culture.
Show appreciation. Public health practitioners are primarily focused on the health and well-being of our communities; public health leaders must also be concerned with the health and well-being of their staff. Acknowledging the challenges that staff face and actively appreciating what they do is important. Simply recognizing the specific things staff do on a daily basis can go a long way to build a positive culture and resilient workforce. Beyond this, a positive and resilient culture can be fostered by honoring and encouraging time off, encouraging self-care, and even finding ways to instill humor into long days.
Acknowledge people's unique skill sets. Crises such as the COVID-19 pandemic have highlighted the contributions that all members of a health department bring to the organization, regardless of their titles. For example, the incident command structure is driven by the skills that are most needed for effective response rather than one's education or position in the office structure, meaning that a person with a director title is not necessarily best suited to lead. The appreciative inquiry framework affirms the importance of highlighting people's unique skills and abilities, as well as finding leadership opportunities for staff who do not have formal leadership positions.
Involve people at all levels of decision making. An appreciative inquiry framework encourages management to involve staff at all levels in processes that are typically limited to a handful of people in upper management, such as strategic planning. Bringing more employees to the table also ensures that people who have been historically marginalized or underrepresented, including people of color and LGBTQ individuals, can incorporate their perspectives into decisions that help organizations better serve diverse communities.
Provide and encourage appreciative feedback. Feedback is often framed as a process of dissecting employees' shortcomings. Promoting appreciative feedback, however, provides an opening to increased dialogue about how to support employees in elevating their strengths. When employees request feedback, ask others what they liked or appreciated most about what was shared and how it can be made even more impactful or valuable.
Participants' experiences with Research to Action continue to offer useful lessons for public health agencies. Shifting the organizational approach to what agencies are doing well to address challenges helps employees tap into their creativity, working together toward a shared vision of a desirable workplace. Throughout the pandemic, and in the future, public health agencies will benefit from new ways of approaching their work, including operating from a perspective of affirmation and possibility.