Texas Leverages ASTHO Program to Advance Workforce Strategy

September 17, 2024 | Kristin Sullivan, Melissa Touma

The strength and sustainability of a public health workforce are critical to delivering impactful services and achieving long-term goals to improve community health. At the Texas Department of State Health Services (DSHS), an agency comprised of 3,500 employees spread across 193 counties and a complex structure of 12 divisions and eight public health regions, the task of developing a cohesive and effective workforce strategy is both challenging and essential. For many years, the agency experienced an ad-hoc approach to workforce efforts and the absence of a clear vision for a desired state.

Along with the agency leadership’s strong commitment to enhancing the workforce, the Public Health Infrastructure Grant (PHIG) provided a critical resource for DSHS to invest in modernizing its workforce efforts, enabling the agency to hire a new workforce director and create a groundbreaking strategy for workforce transformation. The agency first established a clear vision for its modernization effort: to become “a state agency where employees are drawn to the mission and remain for the positive work experience, resulting in a sustainable and effective public health workforce” capable of meeting the diverse needs of Texas's 30 million inhabitants. To build a roadmap to achieve this vision, and key to any effective strategic plan, the Texas team embarked on a comprehensive assessment of the agency’s current state and organizational capacity for workforce development.

In addition to direct funding, CDC’s investment in public health infrastructure also provides recipients with opportunities to request and receive technical assistance across several technical assistance providers—including ASTHO—to help meet their workforce, foundational capabilities, and data modernization goals. With these new resources and leadership support, DSHS searched for technical assistance opportunities that aligned to their needs and could be leveraged to develop and advance a new approach to support its workforce.

During the 2023 PHIG recipient meeting, DSHS learned of ASTHO’s Peer Assessment Program, a technical assistance program designed for state and island area jurisdictions. It is one of several services available to health agencies through a new State and Territorial Administrative Readiness (STAR) Center. The program is structured to assess public health agencies against a set of evidence-informed indicators through a process facilitated by public health leaders from across the country with extensive experience working in or with governmental public health agencies. By engaging a team of external peers to assess capacity, health agencies benefit from fresh perspectives, valuable insight, and an objective assessment, free from internal biases. Agencies are encouraged to include internal and external partners to consider challenges, opportunities, and solutions for improving organizational and administrative capacity, processes, and policies. A three-month planning period with the agency includes specific data and information collection and sharing related to capacity indicators in up to three focus areas and culminates in a site visit for interviews with key internal and external partners, and a report and presentation of findings and recommendations.

DSHS became the first jurisdiction to utilize ASTHO’s Peer Assessment Program as a beta test site. These additional resources allowed DSHS to spend significant time in discovery mode gaining a deeper understanding of workforce needs, challenges, and opportunities. The program also enabled the agency to engage staff on a meaningful level, empowering them through the change management process and demonstrating that their voices are valued and respected. Findings from the peer assessment process and stakeholder interviews are now supporting action on a new and innovative Texas DSHS workforce strategy that addresses related areas of talent management, learning and development, performance management, total compensation, workforce strategy, talent acquisition, and human resource operations and infrastructure.

As part of the peer assessment process, DSHS executive leaders conducted an initial Strengths, Weaknesses, Opportunities and Threats analysis in three of 10 key administrative and organizational capacity areas that intersect with their workforce strategy. These include Workforce Development, Learning Organization Efforts and Innovation, and Human Resource Management.

In analyzing strengths, DSHS team members examined the processes in which they engage efficiently and there is infrastructure already in place to intake and deploy funds. In analyzing weaknesses, DSHS team members examined the areas in which improvement was needed and processes that hinder their ability to quickly respond to crises. Opportunities were assessed by looking at what is happening at the state or federal level that supports the agency’s ability to be prepared with administrative functions. Threats were assessed by looking at the extent to which external barriers to spending down resources effectively and efficiently existed. A core team of DSHS staff then compiled data and information relevant to the priority area capacity indicators to share with the peer review team. In its entirety, this package of information served as conversation starters for the peer review team to dive deeper into each priority area during the site visit.

On April 16 – 19, 2024, a peer review team comprised of four subject matter experts with extensive experience in governmental public health practice conducted a site visit in Austin at the DSHS. A kickoff meeting to present the capacity assessment goals, process, and intended outcomes was held on the morning of the first day. This was followed by two days of group interviews with stakeholders that represented all levels of the agency, regional, and local public health, and university partners across the state. The interviews generated rich discussions that allowed the peer review team and DSHS to develop a deeper understanding of current capacity, opportunities, and needs for the organization in the areas of focus. Following the interviews, the peer review team analyzed the information gathered and reviewed key documents provided by DSHS to identify strengths and challenges, and to provide recommendations for improving administrative and organizational capacity for workforce development.

Three months post-site visit, ASTHO interviewed DSHS lead staff for peer assessment program impact and to learn more about DSHS’s next steps. To date, the agency leadership team has reviewed and discussed the findings and recommendations, and the DSHS workforce team has applied the findings to complete the analysis of their comprehensive workforce strategy. The team shared several other key takeaways:

• The peer assessment process validated the current state and provided credibility to findings by an independent third party. Leadership recognized the value in this.
• The findings provided the primary input for and put weight around the analysis of their workforce strategy, helped identify gaps, and prioritize areas of focus.
• Recommendations provided an easier way to approach conversations for change, resources, or other infrastructure needs.
• Peer reviewers, with their extensive experience, provided a valuable benchmark for leaders and staff including helpful context for many workforce challenges experienced across jurisdictions.
• The Peer Assessment Program can be enhanced by developing common language for workforce development, improving descriptions of the capacity indicators, and ensuring that agencies understand the range of time and effort to complete the program.
• Future actions include considering and discussing specific recommendations and building a roadmap to implement priorities of their workforce strategy.

These outcomes are promising for agencies who may consider independent assessments to support or identify strategies to build organizational and administrative capacity. ASTHO is evaluating program feedback from the DSHS team and peer reviewers to update and streamline program processes that were part of this initial beta test. With additional program participants, ASTHO looks forward to collecting and sharing best practices to advance organizational and administrative capacity across public health agencies.

For more information on ASTHO’s Peer Assessment Program or to discuss how you can leverage this assistance to support development of foundational capabilities and meet your PHIG goals, contact starpeerassessment@astho.org.