How Staffing and Workload Can Impact Public Health Agencies

February 10, 2025 | Kelsey Tillema

Public health agencies often face significant challenges managing workforce priorities related to staffing and workload. While these issues are not new, the COVID-19 pandemic underscored the importance of retaining the public health workforce as a critical component of emergency response. A lack of capacity to manage an agency's workload can create a toxic cycle, often negating any impact of positive organizational culture improvements. In turn, productivity diminishes, turnover increases, and the remaining workforce suffers. To combat this pattern of inadequate staffing and attrition, a robust combination of effective recruitment, timely hiring practices, equitable workload policies, pay considerations, and skilled leadership to champion changes are essential.

With one in three public health employees considering leaving their organizations within the next year—citing pay, work overload and burnout, lack of opportunities for advancement, stress, and organization culture as top reasons for leaving—retaining employees in public health has never been more important. As demonstrated during the COVID-19 pandemic, a lack of solid workforce infrastructure and workload imbalance among healthcare professionals and public health employees can have disastrous consequences for the workforce and overall public health. According to an analysis by the de Beaumont Foundation, “state and local health departments need to hire a minimum of 80,000 more full-time equivalent positions (FTEs)—an increase of nearly 80% —to provide adequate infrastructure and a minimum package of public health services.”

As challenges and uncertainties continue to arise in an ever-changing public health landscape, quickly filling open positions and retaining current public health professionals is a key strategy to ensuring a healthy workload balance among teams and programs. Timely recruitment and hiring practices, creative recruitment strategies, broader job requirements and qualifications, as well as conducting capacity and project prioritization assessments can help alleviate stress and burnout that existing employees may experience due to open roles or understaffing. Chronic understaffing and delays in filling positions can contribute to stress, burnout, and higher turnover due to employee dissatisfaction. While an agency can have meaningful organizational culture and well-being initiatives in place, understaffing and workload imbalances can quickly counteract these efforts if not addressed quickly.

Policies such as providing additional pay to employees who are taking on extra duties due to unfilled positions, cross-training or cross-skilling across duties and/or programs, assessing team and individual workloads, as well as providing avenues for staff to work toward promotions when taking on work that isn’t normally part of their role can motivate employees who are asked to take on more than their job description outlines.

One such framework in discussion at North Dakota Department of Health and Human Services is a creative take on a career ladder—called a “career honeycomb.” In contrast to the ladder framework that typically reflects straight upward career growth, the honeycomb is a bi-directional opportunity to look at career development from various angles. The desire is to increase employee retention and satisfaction by providing avenues for staff to receive bonuses or other incentives for taking on extra work, earn “points” toward specific career milestones or promotions, be recognized on various platforms by their colleagues and leadership team, and embed their workforce development plan and mentorship program opportunities into the various “cells” of the honeycomb. This kind of creative thinking is an innovative way to holistically address both the agency’s and individual’s needs and strengthen overall workforce development.

When understanding and implementing effective hiring policies and ensuring equitable workloads across a public health agency, human resource and workforce development/well-being teams are a crucial component. An internal team that is dedicated to assessing employee capacity, hiring and promotion policies, well-being, and overall organizational culture can help mitigate burnout among staff, lower turnover rates, and ensure wise use of resources. By continuously evaluating both the staffing needs and the overall health of the organization, HR and workforce development professionals can foster an environment that attracts and retains top talent, leading to improved job satisfaction and agency performance.

The relationship between staffing, capacity, and workforce culture in public health agencies is undeniable. Ensuring that there are timely and efficient recruitment and hiring practices in place, equitable workload policies, and advancement opportunities can foster a healthy and effective workforce. These efforts must be supported by a dedicated team of workforce development and human resource professionals who regularly focus on assessing and addressing workforce staffing, capacity, well-being, and organizational culture. By prioritizing these internal needs, agencies can break cycles of burnout and turnover to create a resilient and capable workforce that effectively responds to public health challenges.