Combating Employee Burn-Out by Investing in our People

It is no secret that the pandemic caused high levels of stress and burnout in the public health workforce. Towards the end of 2020, the Larimer County Department of Health and Environment (LCDHE) started to feel the impact of the pandemic. Through the 2020 county-wide employee survey, staff reported increased feelings of burnout, anxiety, and depression, and a decreased feeling of community. Between 2019 and September 2022, our overall separation rate for regular and limited-term employees was 40.7%. By year, this breaks down to 10.4% in 2019, 20.7%% in 2020, 19.6% in 2021, and 15% in 2022 with the total number of separations, during this time at 61. Separations include staff who voluntarily or involuntarily left the organization as well as those who retired.  Although the pandemic was far from over, the department's leadership understood that we couldn't wait any longer to invest in, and best retain staff.

At the beginning of 2021, with the pandemic still looming, our leadership refocused our priorities to help staff avoid burnout. We started by listening to staff and learning about how to support them in achieving and maintaining a healthy work-life balance. We then created a new employee onboarding system so that new staff would feel a sense of belonging. Thirdly, we increased professional development funds to encourage and empower our staff to seek out new training opportunities. 

Throughout all these new projects and processes, we implemented steps to ensure all staff could participate and were learning about equity and inclusion every step of the way. One of the ways we did this was by offering interpretation services for staff during orientation for those who have limited English proficiency. Additionally, in new employee orientation, we dedicate a section to the basic principles of diversity, equity, and inclusion. Although we can't include everything, we want staff to know that equity is one of our values and how these principles are applied to our public health work every day. Our Health Equity Initiatives Coordinator is also working closely with staff to discuss the barriers to providing services to the community and discuss what specific training related to equity would most benefit their work. Teams within the department are then using our training funds to pay for these training sessions.  

Overall, our objectives were to:

1. Increase staff ratings of Work-Life Balance” and Amount of work is reasonable” on the employee survey.

2. 100% of staff attend new employee orientation, this includes existing staff who did not have the opportunity to attend such an offering when they started at LCDHE.

3. Increase staff knowledge of our mission, vision, values, organizational structure, roles and responsibilities, and programs. 

4. Make staff feel valued by investing in their professional development.

5. Significantly reduce staff separation rates.

Achieving these objectives required collaboration across the department and buy-in from all levels of the organization including the Board of Health, which is the body that governs our department. Supervisors hosted informational interviews with all of their staff, staff adjusted their schedules to attend orientation, leadership created budget line items to fund training opportunities, and management created tools and resources to improve bi-directional communication. Additionally, staff was asked to provide feedback and we made adjustments, when possible and when needed, based on relevant feedback. This project required all egos to be set aside and for everyone to commit to our common goal of investing in our people and is something that has been very successful. 

This collaborative and comprehensive effort has led us to be very successful in reaching our objectives. From 2021 to 2022, employees increased their rating of the amount of work is reasonable'' by 5% and work-life balance” by 10%. We have launched and trained all supervisors in our new onboarding process and over 75% of staff have attended the new employee orientation. Through pre and post-orientation surveys, we have learned that staff has increased knowledge of LCDHE's mission, vision, and values and a better understanding of their roles and responsibilities and how they fit into the organization. Staff is increasingly using professional development funds and seeking out innovative training such as learning a new language, improving writing skills, and learning how to better manage conflict. 

With public health agencies being in the spotlight more than ever before, we must have a strong workforce who understand their roles and responsibilities within the community. It is also important that we are spending our time providing the services we offer instead of constantly hiring and onboarding new staff which can cost upwards of $4,000 per staff member hired. LCDHE is committed to continuing these practices in years to come and hopes to continue to increase our employee retention, satisfaction, and well-being. 

Throughout the pandemic, LCDHE had an average of 100 employees and currently employs 115 individuals (not including temporary employees). LCDHE provides a variety of services including, but not limited to, clinical services, chronic disease prevention, communicable disease response, emergency preparedness, maternal services, monitoring air, water, food, and soil, and safety and sanitation. 

According to our employee survey results, between 2019 and 2020 our employee turnover rate increased by 7% from 11% to 18%, respectively. This resulted in having to spend more time hiring staff, and also created a loss in institutional knowledge. In addition to the higher turnover rate, employees were also reporting that their work-life balance had decreased by 9% and only 54% of staff thought that the amount of work they had to complete was reasonable. A huge driver of both of these issues was the amount and type of work that staff was asked to perform during the COVID-19 pandemic, in addition to the required work that continued during the pandemic, and the vast amount of change everyone was enduring. 

This increase in turnover meant that we would be onboarding more new staff than ever before and leadership made it a goal to improve this process and create a new employee orientation. By creating a more structured process, new employees would immediately understand our values and have a chance to get to know each other and the roles and responsibilities of the health department. 

Additionally, we wanted to make sure that new staff members would understand our commitment to health equity and what it means for their work. During orientation, our Health Equity Initiatives Coordinator spends an hour reviewing how public health is rooted in social justice, along with the definitions of equality, equity, and justice. Additionally, we review ways that staff can get involved in our employee resource groups and access training through our health equity calendar, which provides opportunities for staff to attend free health equity training offered in person and online. This year, we have also been working on our Language Access Plan and we are excited to include sections on language justice and plain language in 2023. 

In addition to including health equity training in these processes, we also wanted to make sure that all staff was able to attend orientation in the language of their preference and need, so we offered interpretation services to anyone who needed them. This was beneficial because all staff was fully able to understand the content. In addition, most of our staff have never worked with an interpreter before so this was a good introduction to how that process works.  

Health equity is also at the center of our workforce development planning. This work was initiated by having all staff participate in a Core Competency Assessment in the Spring of 2022. This assessment asked staff to rate themselves on a variety of skills. One of our lowest-scoring competencies was applies principles of ethics, diversity, inclusion, and justice”. With this knowledge, our Health Equity Initiatives Coordinator began working with individual teams to find out more about why this competency scored low. He learned about the specific barriers our customer's face and helped connect teams to training to address these barriers. 

One example of how retention and health equity training have impacted our staff is with our  Consumer Protection Team.  Since 2019, 73% of this team is newly-hired. Additionally, there have been changes in leadership and priorities, one of these being providing more equitable services during restaurant inspections. Through the core competency results, this skill gap was highlighted and our Health Equity Initiative Coordinator has worked with that team to set professional development goals and connect them with cultural humility training tailored to their specific needs. This training is being funded through our training resource fund since it is outside of their team's budget scope of work. 

Before we started working on these dedicated projects, there was very little in place in terms of getting employee feedback on work-life balance, an onboarding process, or dedicated resources for staff's professional development. Although these are not new concepts, they are new to our department. Furthermore, in talking with our County Commissioners and Human Resources Generalist, it is clear that no other department in the County has taken these steps to invest in their staff. 

The goals of our practices were to:

1) Incorporate a system of staff discovery, utilizing a series of question prompts to explore, evaluate, and promote the work-life balance of LCDHE staff. 

2) Create a new employee orientation and onboarding process.

3) Offer ongoing workforce development and secure a budgetary line item for department-wide staff capacity and staff development funding. 

Incorporate a system of staff discovery, utilizing a series of question prompts to explore, evaluate, and promote work-life balance of LCDHE staff. 

Since this approach is focused on investing in staff, we started by creating opportunities for supervisors to listen to their staff and to hear what challenges they are facing when it comes to work-life balance. This was a year-long project that started in January 2021.  Interviews were conducted in September and October, and results were shared with staff in December. Our management team, which is composed of supervisors who support at least two staff members and manage a program budget, was tasked with organizing this effort. In collaboration with the Human Resources Department, they created a set of questions and created training for supervisors on how to effectively conduct an informational interview. The questions asked are provided below: 

1. How would you describe a healthy work-life balance?

2. How would you rank your current work-life balance on a scale of 1 to 5? (1 = Work completely overburdens my personal life. 5 = I have a very healthy and fulfilling balance of work and personal responsibility.)

3. Do you feel pressure, either self-imposed or from others, to work outside of your daily scheduled work hours, or beyond your allotted hours per pay period? What, if any, are the expectations or norms around email/voicemail after-hours for your position?

4. Do you find yourself thinking about work-related things frequently while away from work? Do thoughts about work impact your ability to sleep or relax?

5. Is there any specific resource, such as professional training or access to additional information, tools, or staff/team, that would help to improve your success and efficiency with your workload, and in turn, reduce your after-hours work? 

6. Would your close family/friends likely say that your job is family-friendly” and supportive/conducive to a healthy work-life balance? 

7. Do you feel your work schedule and work environment allow you the ability to accomplish both work-related and personal goals?

8. What ideas do you have for ways that you could create/maintain a healthy balance of work responsibilities and personal life? As your supervisor, how can I support you in moving towards one or more of those throughout this next year?

After the interviews, we also asked staff to fill out an anonymous survey so that they had the opportunity to share their experience as an interviewee and let us know if they had any final thoughts. The management team then read through all of the feedback and determined themes. Additionally, in the survey, staff mentioned how much they appreciated having the time to have these conversations with their supervisors and how it opened the door to future conversations. This feedback was then incorporated into our strategic work plan for 2022. 

Create a new employee orientation and onboarding process

Through this process, our goal has always been to improve employee retention by making them feel included, welcomed, and valued from the moment they walk through the door on their first day. Before we started creating the new employee orientation, we had no structured onboarding process. We wanted to create something that made employees feel engaged and gave them a strong sense of our company culture and values, and a strong understanding of the vast and varied work public health encompasses. 

Our Strategic Plan Initiatives Supervisor worked with the Executive Assistant and began work in December 2021. Our first iteration of the presentation was provided to our Leadership team in January 2022 and our first orientation was delivered in February 2022. One thing that made our orientation unique is that our Leadership Team members agreed to present relevant information during the event. This was an important strategy because it allowed staff to meet the people who were making decisions for the organization. It also allowed leadership to get to know new staff.

The orientation schedule includes: 

Welcome & Introductions

Mission, Vision, Values

Organizational Chart/Roles & Responsibilities

What is Public Health?

Program Scavenger Hunt

Financial Overview

Communication

Strategic Plan Overview & Values

Emergency Preparation & Procedures

Websites & Applications

Starting in February 2022, we held an orientation once a month through October and required all staff to attend, no matter the length of time they worked for the department. We wanted to ensure that everyone was on the same page with understanding our values, the culture we were creating, and how they fit into the organization. Additionally, it added to a sense of community at work. Staff hired during the pandemic had never met anyone outside of their team. This allowed them to mix and mingle and learn about others in the department.  We also collected pre and post-data on the orientation and used that feedback to make appropriate adjustments. 

Teamwork was the main reason we were so successful in delivering this orientation. Since we decided that the members of the Leadership Team would be the main presenters, the Strategic Plan Initiatives Supervisor worked closely with all of them to create the presentation. 

At this point, we then needed to get buy-in from all the supervisors to have them and their staff attend. Since we wanted to reorient all staff to the department we needed the supervisor's permission to have their staff spend a full day of work away from their assigned duties and tasks. All the supervisors immediately opted in and encouraged their staff to attend one of our sessions throughout the year. It was especially complex to plan for staff who had appointments booked out months in advance and for clerical or front desk staff to attend since it required them to move appointments or to find coverage. The ability to coordinate this was made possible by scheduling out orientations through the end of the year to allow staff to plan ahead.  This endeavor was such a success, that we decided to adapt the presentation to create an orientation for new members of our Board of Health. This again required collaboration to develop and update the presentation and involve all relevant team members.

Other than the staff time associated with planning and attending the orientation, the costs were relatively low. We provided lunch and light refreshments for everyone in attendance. This ends up costing us about $20.00/per person. In addition to the orientation, we also created an onboarding checklist for supervisors to use when they hired a new employee. This ensures that all staff receives the same crucial information on their first day and during the first weeks. Both attendance at orientation and the completion of the onboarding checklist were monitored using our learning management system. 

Offering ongoing workforce development and instituting a budget item for department-wide staff capacity and staff development funding. 

The next step in our innovative employee retention journey was to invest in workforce development. Like many health departments, we started with a core competency assessment based on the Core Competencies for Public Health Professionals published by The Council on Linkages. From there, we took a non-traditional and unique approach to help staff use their results and find meaningful professional development opportunities.

We started with setting up two different training funds for staff.  The first was set up so that each employee at LCDHE had $300 to spend on their own professional development. The second fund allowed teams or groups of staff to use funds for group training opportunities. This, again, was a teamwide effort and required cooperation and investment from everyone in the department. Initially, we had to get the budget approved for this fund. In 2022, we had a budget of $38,700. This covered both the $300 individual funds for staff and group-based funds to bring in training for teams.

The process for utilizing these funds came out of our Invest in our People workgroup. This group is made up of staff from across the department and at all levels of the organization who work on specific initiatives and decision-making for staff growth, development, and satisfaction. The group helped to create an application form, formulated a group to review the applications, and assisted in the development of department-wide materials to promote the funds to staff. This fund was launched in April of 2022 and continues today.

In addition to the funding, the Strategic Plan Initiatives Supervisor and Health Equity Initiatives Coordinator are meeting with every team in the department to review their results and help brainstorm and identify training opportunities. We wanted staff to feel empowered to take their professional development into their own hands and find training that interests them to further their career goals. Through this process, we have supported teams in finding cultural humility training, offered verbal judo training to all staff, and saw persons sign up and participate in breastfeeding conferences, writing workshops, Crucial Conversations training, language development opportunities, and other training.

In addition to paying for staff to attend training, we are also implementing a Lunch & Learn series so that staff can bring back what they have learned and share it with their colleagues. This gives staff yet another opportunity to connect and share about their programs and has deeper conversations about how they apply what they learned with their colleagues. 

The evaluation of the practices noted has occurred throughout their implementation and continues to be a focus. Since these practices were implemented to improve staff morale, we rely heavily on staff feedback and are constantly making improvements to best meet the needs of our staff.

Objective 1:  Increase staff ratings of Work-Life Balance” and Amount of work is reasonable” on the employee surveys.

To evaluate this objective, we rely on the Larimer County Employee Survey which is conducted every Fall through our Human Resources department. Staff is asked to rate their  reasonable Work-Life Balance” and amount of work is reasonable” on a scale of one to five with one being the lowest. In 2019, 72% of staff stated that they had a reasonable work-life balance. This decreased by 9% in 2020 and then in 2021 increased by 1%  from the prior year to 64%. In 2022, this metric continued to climb and we surpassed our 2019 results with 74% of staff stating that they have a reasonable work-life balance. 

Our results for the amount of work is reasonable” also continue to increase over time. In 2019 71% of staff agreed with this statement. In 2020 this metric dropped by 17% but in 2021, it increased by 14% to 68%. This metric continued to rise by 5% in 2022 and again surpassed our 2019 results. 

In addition to the qualitative data from the Employee Surveys, we also have all of the qualitative data that we collected during our work-life balance discovery interviews. Our manager team spent a great deal of time reviewing this data and found the following themes: 

- A desire for more time to connect with coworkers through team-building activities

- Improve the hiring process

- Continue allowing remote work and flexible work schedules

- Clear expectations/modeling from supervisors/leadership around work-life balance

These themes have been incorporated into much of our work over the last year. As a health department, we have created more time for all-staff get-togethers including, public health week celebrations, all-staff professional development days, and a holiday party. We have also asked supervisors to talk to their teams about hosting more in-person meetings. Additionally, we clarified and streamlined the hiring process and created a remote work policy to help supervisors determine best practices for their teams. Lastly, management and leadership have discussed what it looks like to model work-life balance. For instance, when someone is on vacation, not contacting them and relying on a person to serve as program contact during the absence, as well as not emailing or calling staff after hours unless it is very urgent. 

Objectives 2 & 3: 

Create a better onboarding experience and have 75% of current staff attend new employee orientation.

Increase staff knowledge of our mission, vision, values, organizational structure, roles and responsibilities, and programs. 

The next two objectives have been evaluated through our pre and post-orientation surveys. Since February 2022, 100 employees have attended our new employee orientation reaching our annual goal of having 75% of staff attend orientation. This was an important step in re-aligning everyone in the department with our mission, vision, and values.

After attending orientation, 100% of staff surveyed said that they understand the mission, vision, and values of LCDHE, the organizational structure, and our role in various emergencies. Across the board, this was an increase of 10%. Additionally, when asked, Do you understand the roles and responsibilities of the Board of Health, Public Health Director, and Leadership/Management Teams?”, affirmative responses increased by 36%. Similar increases occurred when asking staff if they know where to go to find out more information about our policies and procedures (a 33% increase) and if they know where to go to find out more about the various programs LCDHE offers (a 29% increase). 

Finally, we asked staff about which portions of the orientation had provided the most useful and least useful information. We used these responses to adjust the timing and schedule of orientation, and for making content-based adjustments to ensure that the majority of our time was prioritized towards topics that provided the most useful or relevant information. 

Objective 4: Make staff feel valued by investing in their professional development.

The evaluation process for this objective is still in its early phases. So far, we have conducted the Core-Competency Assessment, with a 90% staff participation rate. We have used the results from this assessment to guide our all-staff professional development days, offering Trauma-Informed Care, Conflict Management, and Leadership Development events during 2022. 

Furthermore, our department has been promoting the use of our training funds, which has increased substantially since we introduced them in April of 2022. Thus far, 35 staff members have taken advantage of the fund for a variety of training including, but not limited to, learning a second language, improving oral and written communication, time management, and cultural humility. Moreover, we have introduced a lunch & learn series where staff can prepare a ten-minute presentation to share what they have learned at these training sessions with their colleagues. These were initiated in November of 2022 and will be continuing throughout 2023. Lastly, we plan on conducting the core competency assessment a second time in the summer of 2024 to determine if staff have increased their knowledge in specific areas, as well as guide us in our priority areas in the following years. 

Objective 5: Decrease staff separation rates.

To evaluate staff separation rates, we are relying on data from Human Resources. As previously mentioned, we have seen increases in rates between 2019 and 2021 but in 2022 we are starting to see a decrease. Our separation rates by year are as follows*:

2019 -- Average number of employees was 105.7 and our separation rate was 10.4%

2020 - Average number of employees was 96.4 and our separation rate was 20.7%

2021 - Average number of employees was 91.8 and our separation rate was 19.6%

2022 year to date - Average number of employees is 106.3 and our separation rate is 15%

*It is important to note that these numbers only account for Regular and Limited Term Employees and do not include our temporary employees hired throughout COVID. 

We will continue to monitor these rates in years to come. Additionally, our County just implemented a new off-boarding process that includes a more detailed exit interview for departing employees. We hope to be able to use some of this information to continue to decrease our staff separation rates.

The practices noted in this submission have all been built with sustainability at their core. Coming out of the pandemic, there was huge buy-in across the department to invest in our staff using a variety of strategies and practices. This buy-in has included practices ranging from creating new budget lines to fund these projects to intentionally investing in staff time and providing resources for success. There have been many lessons learned from when we started, which have been instrumental in guiding and making improvements, but the enthusiastic commitment has remained constant and is the biggest reason why these practices will continue in the future. 

Employee feedback has also been a huge driver. We have learned great information and we have been able to make many quick adjustments to meet the changing needs of staff. One of the biggest changes we are looking to make is to our orientation next year. Since most staff have attended the orientation and our retention numbers are increasing, we are in the process of determining the frequency of orientation for years to come. We have learned that one of the most important parts of orientation is the feeling of community that happens by having a full room of colleagues. Thus, we are looking at conducting orientations quarterly and adjusting our onboarding process to make sure that staff is getting all pertinent information in their first week. Even with all these changes, a budget continues to be available to cover all costs of orientation for next year. 

Through the discovery interview process, we quickly realized that our team didn't have the time to commit to creating questions and reviewing all of the data every year. Additionally, a great deal of the feedback we received provided a snapshot in time of how the staff was feeling, but also demonstrated that work-life balance fluctuates throughout the year. Moving forward, we are asking supervisors to have these discussions with staff at their one-on-one a few times a year. Our hope is that these dialogue sessions become commonplace and that staff don't have to wait to have these crucial conversations.

Additionally, our management and leadership teams worked together in November to create a thematic department goal of Breathe, Reconnect, and Restore”. This goal ties together all of the work we have been doing to invest in our people and gives us permission to slow down and ensure that we are using trauma-informed approaches throughout the department and within our decision-making processes. Within this goal, we hope to nurture healthy staff, create a clear singular focus, grow leaders, and build a thriving, unified internal community. 

Lastly, we are continuing to fund the training budget and have increased it to $40,640 for 2023. In the beginning, there was some confusion about what the funds could be used for and how to apply for them. To combat this confusion, we are creating a web page and have made clarifications for ease of the application process. 

In 2023, our strategic planning and health equity teams will work with each program team to help them set professional development goals based on their core competency assessment results. We hope that this will encourage teams to use the training funds available to them, as well as help coordination between teams if there are trends in the types of training required or desired. 

Overall, LCDHE is truly committed to these practices in years to come. Our department is looking forward to making adjustments along the way to best meet the needs of our staff.