Succession Planning in Nebraska’s Local Health Departments

Succession Planning in Nebraska’s Local Health Departments | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Succession Planning in Nebraska’s Local Health Departments Patrina (Trina) White, Dana Verhoeven, Celeste Ehrenberg, Katie Brandert This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5835118/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objectives . To (1) understand the current state of succession planning in Nebraska health departments (HDs) and (2) understand succession planning needs in Nebraska HDs. Study Design. Qualitative interviews with a semi-structured format. Methods . Purposive sampling was used to identify a list of HD leaders. Interviews were conducted in 2024 with twelve HD leaders representing 10 HDs in Nebraska (50% of state-funded HDs in the state). Themes were developed based on the frequency with which different concepts and key terms were mentioned. Results . We found variation in the definitions and utilization of succession planning amongst those interviewed. However, consistent themes included that Nebraska health department leaders believe succession planning is a beneficial public health workforce sustainability strategy and resources and training on succession planning are considered valuable. Conclusions . Variation in utilization of succession planning exists and resources to help health department leaders are sparse. Succession planning is an important workforce sustainability strategy with direct implications for the safety and health of the public. Providing more training and resources to HDs on succession planning can improve workforce sustainability. succession planning health departments public health workforce sustainability Introduction Succession planning is a critical activity to improve organizational efficiency and sustainability and deliver on the mission of protecting and serving the public. However, few United States (U.S.) health departments (HDs) prioritize succession planning. 1 Retirement in governmental health agencies is another key concern in workforce planning and sustainability. 2 While succession planning can make a significant positive impact on retirement transitions, only limited succession planning occurs across U.S. health departments. 3 Staffing shortages and turnover in HDs are also common challenges, escalated by the COVID-19 pandemic. 2 , 4 Gaps in HD staffing, both in front line and leadership roles, can negatively impact public health and safety; it is important to have “a strong local public health infrastructure to respond to disasters and major disease outbreaks”. 5 Succession planning is also a key requirement in achieving and maintaining accreditation. 6 The Public Health Accreditation Board (PHAB) is the accreditation body for health departments. Domain 8 of the PHAB 2022 standards for initial accreditation outlines succession planning requirements including development and retention of staff and goes on to highlight that workforce planning must align with the strategic plan. 6 In the PHAB 2022 reaccreditation standards, leadership succession planning is mentioned in depth. Measure 8.2.1.3, states, “the intent of this requirement is to describe efforts to develop future managers or leaders.” 7 The Public Health Workforce Interests and Needs Survey (PH WINS) shows regions 7 and 8, of which Nebraska is a part, has higher intent to leave in one year (28%) than the national average and that this marker of immediate potential turnover trended up significantly from 2017 to 2021. 8 While succession planning is an important workforce sustainability strategy 1 , the utilization of succession planning in Nebraska HDs was not known. To better understand the use of succession planning as a workforce retention strategy, HD leaders across Nebraska were interviewed to (1) assess the current state of succession planning in Nebraska HDs and (2) evaluate succession planning needs across rural and urban HDs. The information collected was used to develop and deliver education on succession planning for Nebraska HD leaders and was conducted as a quality improvement opportunity rather than a traditional research study. Methods Our study design was qualitative using semi-structured interviews (see Appendix A for the interview questions). Purposive sampling was used to identify a list of HD leaders. Leaders were defined as the agency head (i.e., Health Director). Participating leaders were identified through the University of Nebraska Medical Center Office of Public Health Practice. Participants were contacted via email to participate in a virtual one-hour interview to assess current succession planning practices and succession planning needs for their HD. All ten HDs contacted agreed to participate in the study. Participants were given the option to include additional members from their HD; two health departments included their accreditation coordinators. Ten interview sessions with a total of twelve HD leaders were conducted using a semi-structured format with a list of questions developed to determine succession planning definitions, practices and needs. Thematic saturation was reached after the ten interviews and final themes were presented to HD leaders for further refinement. The lead author (TW) conducted the interviews while the second author (DV) took notes to record interviewee responses. Following each interview, the notetaker cleaned and synthesized the key themes discussed, then the lead author further developed overarching themes based on the frequency with which different concepts and key terms were mentioned. The interviewers reviewed the themes together to ensure accuracy in capturing the key terms and concepts. Results Succession Planning Definition and Attitudes There was variation in the definition of succession planning. Some HDs saw succession planning as continuity of operations during emergencies, some saw it as a tool for workforce planning (e.g. retirement planning) and others saw it as both. In addition, some saw succession planning as a strategy while others saw it as a tactical tool (e.g. job role definition) while some saw it as both. Succession planning themes in Nebraska HDs included (1) succession planning is valuable, and (2) resources and training on succession planning are valuable. Succession Planning Practices We also found variation in the utilization of succession planning. Some HDs were not using succession planning, and some were fully using succession planning. For those using succession planning, there were strong themes of (1) utilizing succession planning for business continuity followed by (2) using succession planning strategies to fill critical positions and finally, (3) tying succession planning into activities like talent development. HDs interviewed viewed all positions as important to consider in succession planning rather than focusing only on leadership positions. There was a difference between rural and urban HDs interviewed. Most urban HDs were not fully utilizing succession planning, including incorporating specific strategies such as cross-training, while most rural HDs interviewed were. This may be because two of the rural locations interviewed were preparing for the retirement of long-term directors and because of the difficulty recruiting to rural areas, factors noted by interviewees in their responses. Succession Planning Needs HDs did not feel there was not a common source on succession planning they could reference at a national, regional, or local level. In discussion of which critical components succession planning resources should include, the following items were mentioned: a methodology for approaching succession planning, a way to evaluate job roles critical to ongoing operations, how to evaluate where talent is in the organization (who are the successors for roles), a methodology for identifying and outlining the critical components of each role (job actions), and finally, supporting retention via talent development strategies such as cross-training. Alignment with accreditation/re-accreditation requirements was not widely mentioned specific to succession planning, but themes around the overall importance of accreditation and re-accreditation were present in the interviews. Key findings are outlined in Table A. Out of Current Scope Several other HD needs arose during our interviews that were out of scope for succession planning but are important to mention in understanding the landscape of HDs. Sourcing and recruitment of employees was a top need identified across the interviewees. Supporting job transitions, including a process and check list with detailed job responsibilities for position handoffs and onboarding of new employees was frequently mentioned. Difficulties recruiting to rural areas was highlighted by rural HDs. Other needs mentioned with less frequency included policy and job description templates, mentoring programs for people new to leadership roles, resources for departments seeking accreditation, education in population health for front-line workers new to public health, and general education on human resources management functions including conducting more impactful performance reviews, hiring interviews and exit interviews, and understanding compensation philosophy. Discussion and Conclusions In our study, we found variation in definitions of and utilization of succession planning, but common themes included HD leaders believe succession planning is valuable and resources and education on succession planning are needed. For those departments utilizing succession planning, the primary utilization of succession planning was for continuity of operations during emergencies, which represents an opportunity for improved utilization of succession planning. A similar state-level study of succession planning practices in Washington state revealed that while many HDs in Washington state utilized succession planning, there was an opportunity to formalize and further leverage succession planning in the state. Through surveying HDs, the authors also found key impediments to formal succession planning included competing priorities for leadership time and a belief that the departments were too small to need structured planning. The researchers went on to recommend the need to create “a greater sense of urgency by focusing on agency retirement profiles and emphasizing the need for workforce development plans for accreditation.” 9 These findings present an opportunity for greater focus on succession planning overall and for continuing education development, especially with the workforce gaps that existed in public health prior to the pandemic and worsened with COVID-19. 2 We utilized these findings to develop succession planning resources and educate Nebraska HD leaders on succession planning. Specific focuses included education on the full spectrum of succession planning including workforce planning and talent development as well as on utilizing specific tools such as successor identification strategies. Several other valuable ideas emerged from our meetings with HDs that were outside of the original intent of our interviews but offer opportunities for insight, future research directions, and development of education and training. While our focus began with succession planning, the needs and ideas outlined are interrelated. Acting on these findings with additional research, resources, education and training will create improved public health workforce sustainability in Nebraska and can serve as a roadmap for other states. Public Health Implications Gaps in the public health workforce have direct, negative impacts to the safety and health of the public. Succession planning is important to public health workforce sustainability. Variation exists in definitions and utilization of succession planning among HDs in Nebraska. Resources on succession planning and overall strategies for workforce sustainability in public health are valued but are viewed as lacking by HD leaders. Providing additional training and resources to HDs on succession planning can improve workforce sustainability. Declarations Funding: Research reported in this publication was supported by the University of Nebraska Medical Center Office of Public Health (OPHP),the Nebraska Department of Health and Human Services (DHHS) and through the Centers for Disease Control (CDC) Cooperative Agreement for Emergency Response: Public Health Crisis Response-2018 Award # 6NU90TP922166-01-04 Financial Disclosures : The authors do not have any additional funding related to this work to disclose. IRB statement: Our research is exempt from IRB review per the UNMC IRB policy because this research is a quality improvement activity, and all data is shown in aggregate without individual identifiers. Informed Consent: Interview subjects gave their informed consent to participate in the study. Separate consent to publish was not obtained because all data is shown in aggregate without individual identifiers. Individual subjects are unidentifiable in the published results. Data availability statement: All data generated or analyzed during this study are included in this published article and its supplementary information files. Conflicts of Interest: The authors do not have any potential conflicts of interest to disclose. Acknowledgements : The authors thank the University of Nebraska Medical Center OPHP, DHHS and CDC for supporting this work and thank the Nebraska Health Department leaders who contributed to this work. Author Contribution Dr. White was the co-lead researcher and lead author including writing the main manuscript text and preparing Table A. Dr. Verhoeven was the co-lead researcher and contributed to the main manuscript text and preparing Table A. Ms. Ehrenberg and Dr. Brandert reviewed the manuscript and Table A and recommended edits. All authors reviewed the manuscript. References Darnell, J. S., & Campbell, R. T. Succession planning in local health departments: results from a national survey. Journal of public health management and practice: JPHMP, 2015; 21(2), 141–150. Leider JP, Castrucci BC, Robins M, et al. The Exodus Of State And Local Public Health Employees: Separations Started Before And Continued Throughout COVID-19. Health Aff (Millwood). 2023;42(3):338–348. doi: 10.1377/hlthaff.2022.01251 Harper, E., Leider, J. P., Coronado, F., & Beck, A. J. Succession Planning in State Health Agencies in the United States: A Brief Report. Journal of public health management and practice: JPHMP, 2018; 24(5), 473–478. Michaels, I., Pirani, S., Fleming, M., Arana, M. M., D'Angelo, E., Dyer-Drobnack, C., DiManno, M., Ravenhall, S., & Gloria, C. T. Enumeration of the Public Health Workforce in New York State: Workforce Changes in the Wake of COVID-19. International journal of environmental research and public health, 2022; 19(20), 13592. Schmalzried, H., & Fallon, L. F., Jr. Succession planning for local health department top executives: reducing risk to communities. Journal of community health, 2007; 32(3), 169–180. The Public Health Accreditation Board (PHAB). Standards & Measures for Initial Accreditation Version 2022 . https://phaboard.org/wp-content/uploads/Standards-Measures-Initial-Accreditation-Version-2022.pdf . Accessed January 10th, 2024. The Public Health Accreditation Board (PHAB). (2022). Standards & Measures for Reaccreditation Version 2022 . https://phaboard.org/wp-content/uploads/Standard-Measures-Version-2022-Reaccreditation.pdf . Accessed January 10th, 2024. The Public Health Workforce Interests and Needs Survey (PH WINS). Explore Staying and Leaving . https://phwins.org/national/dashboard?&type=public&fi=3_7&topic=3&fe=all_employees&c=0_1&ci=OFF&dl=point_estimate&sort=def#void.Accessed May 1st, 2024. Wiesman, J. M., Babich, S. M., Umble, K., & Baker, E. L. (2016). Succession Planning and Management Practice in Washington State Local Public Health Agencies. Journal of public health management and practice: JPHMP , 2016; 22(6), 512–519. https://doi.org/10.1097/PHH.0000000000000397 Tables Table A – Succession Planning Themes and Practice Considerations Succession Planning Aspects Themes Practice Considerations Succession Planning Definitions and Beliefs There is variation in the definition of succession planning Succession planning is viewed as valuable Resources and training on succession planning were viewed as valuable Education and resources can serve to level-set definitions of succession planning, and this may further advance the value equation for using succession planning Succession Planning Practices There is variation in the utilization of succession planning Succession planning was used for (1) business continuity followed by (2) filling critical positions and finally, (3) tying into activities like talent development HD leaders viewed all positions as important to consider in succession planning rather than focusing only on leadership positions Most urban HDs were not fully utilizing succession planning while most rural HDs interviewed were Education and resources should represent the full spectrum of and value of succession planning including examples of succession planning and talent development at all levels of the organization. Further, resources should also include specific strategies for talent development (e.g. cross-training) Succession Planning Needs There was not a common source on succession planning health department leaders felt they could reference at a national, regional or local level Specific needs mentioned included a methodology for approaching succession planning, a way to evaluate job roles critical to ongoing operations, how to evaluate where talent is in the organization (who are the successors for roles), a methodology for identifying and outlining the critical components of each role (job actions), and finally, supporting retention via strategies such as cross-training Accreditation/Reaccreditation Education and resources should include the specific needs outlined by HD leaders and made easily accessible for all HD leaders Leadership development ideas from PHAB include: (1) develop leadership skills by exposing people to more complex initiatives (2) empower people to act in leadership roles on an interim basis, (3) provide opportunities to perform specialized tasks such as conducting a skills assessment and (4) provide training on specific leadership skills such as strategic planning or negotiation. 5 Additional Declarations No competing interests reported. Supplementary Files AppendixA.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 Jul, 2025 Reviews received at journal 13 May, 2025 Reviewers agreed at journal 09 May, 2025 Reviewers agreed at journal 09 May, 2025 Editor assigned by journal 23 Apr, 2025 Reviewers invited by journal 11 Apr, 2025 Submission checks completed at journal 10 Apr, 2025 First submitted to journal 18 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5835118","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":441711693,"identity":"537df2e8-2b6c-4b86-9bc5-e0f978e6dc8c","order_by":0,"name":"Patrina (Trina) White","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYJACZgYDBgZ+KIexgRgNQC0GDJINpGkBWmNwgFgt5uznj0kXFPyRM76Re3TDDwYb2Q0HCGix7Elmk55hYGBsdiMv7WYPQ5oxQS0GB5LZbvMYGCRuu5FjdpuB4XAiYS3nH4O11G+eAdbynwgtNyC2JBhIgLUcIKzFcsZj8988BsaGM868MbvZY5BsPJOQFnP+xMfGPH/k5Pnbc8xu/Kiwk+0j6DC8XGK0jIJRMApGwSjAAgBYDEDk/l0KzQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Patrina","middleName":"(Trina)","lastName":"White","suffix":""},{"id":441711694,"identity":"77e96b1b-229a-4f45-bd54-156d04c23e71","order_by":1,"name":"Dana Verhoeven","email":"","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Dana","middleName":"","lastName":"Verhoeven","suffix":""},{"id":441711695,"identity":"d93593b9-2322-4554-a6f4-31e8b9306a4d","order_by":2,"name":"Celeste Ehrenberg","email":"","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Celeste","middleName":"","lastName":"Ehrenberg","suffix":""},{"id":441711696,"identity":"97b70e08-de84-4417-b71e-9f9d0c4db1cf","order_by":3,"name":"Katie Brandert","email":"","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Katie","middleName":"","lastName":"Brandert","suffix":""}],"badges":[],"createdAt":"2025-01-15 14:08:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5835118/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5835118/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80534762,"identity":"a20d6065-e764-4370-9e40-900450198100","added_by":"auto","created_at":"2025-04-14 11:44:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":457578,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5835118/v1/827e6611-2de9-4f46-ae2f-4e46eef7b211.pdf"},{"id":80533456,"identity":"627e9485-c100-4080-a17a-0f73743ba56a","added_by":"auto","created_at":"2025-04-14 11:28:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17661,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-5835118/v1/5bb87ca0b43710ea9478741f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSuccession Planning in Nebraska’s Local Health Departments\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuccession planning is a critical activity to improve organizational efficiency and sustainability and deliver on the mission of protecting and serving the public. However, few United States (U.S.) health departments (HDs) prioritize succession planning.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Retirement in governmental health agencies is another key concern in workforce planning and sustainability.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e While succession planning can make a significant positive impact on retirement transitions, only limited succession planning occurs across U.S. health departments.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Staffing shortages and turnover in HDs are also common challenges, escalated by the COVID-19 pandemic.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Gaps in HD staffing, both in front line and leadership roles, can negatively impact public health and safety; it is important to have \u0026ldquo;a strong local public health infrastructure to respond to disasters and major disease outbreaks\u0026rdquo;.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Succession planning is also a key requirement in achieving and maintaining accreditation.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e The Public Health Accreditation Board (PHAB) is the accreditation body for health departments. Domain 8 of the PHAB 2022 standards for initial accreditation outlines succession planning requirements including development and retention of staff and goes on to highlight that workforce planning must align with the strategic plan.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In the PHAB 2022 reaccreditation standards, leadership succession planning is mentioned in depth. Measure 8.2.1.3, states, \u0026ldquo;the intent of this requirement is to describe efforts to develop future managers or leaders.\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Public Health Workforce Interests and Needs Survey (PH WINS) shows regions 7 and 8, of which Nebraska is a part, has higher intent to leave in one year (28%) than the national average and that this marker of immediate potential turnover trended up significantly from 2017 to 2021.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e While succession planning is an important workforce sustainability strategy\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, the utilization of succession planning in Nebraska HDs was not known. To better understand the use of succession planning as a workforce retention strategy, HD leaders across Nebraska were interviewed to (1) assess the current state of succession planning in Nebraska HDs and (2) evaluate succession planning needs across rural and urban HDs. The information collected was used to develop and deliver education on succession planning for Nebraska HD leaders and was conducted as a quality improvement opportunity rather than a traditional research study.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eOur study design was qualitative using semi-structured interviews (see Appendix A for the interview questions). Purposive sampling was used to identify a list of HD leaders. Leaders were defined as the agency head (i.e., Health Director). Participating leaders were identified through the University of Nebraska Medical Center Office of Public Health Practice. Participants were contacted via email to participate in a virtual one-hour interview to assess current succession planning practices and succession planning needs for their HD. All ten HDs contacted agreed to participate in the study. Participants were given the option to include additional members from their HD; two health departments included their accreditation coordinators. Ten interview sessions with a total of twelve HD leaders were conducted using a semi-structured format with a list of questions developed to determine succession planning definitions, practices and needs. Thematic saturation was reached after the ten interviews and final themes were presented to HD leaders for further refinement. The lead author (TW) conducted the interviews while the second author (DV) took notes to record interviewee responses.\u003c/p\u003e \u003cp\u003eFollowing each interview, the notetaker cleaned and synthesized the key themes discussed, then the lead author further developed overarching themes based on the frequency with which different concepts and key terms were mentioned. The interviewers reviewed the themes together to ensure accuracy in capturing the key terms and concepts.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSuccession Planning Definition and Attitudes\u003c/h2\u003e \u003cp\u003eThere was variation in the definition of succession planning. Some HDs saw succession planning as continuity of operations during emergencies, some saw it as a tool for workforce planning (e.g. retirement planning) and others saw it as both. In addition, some saw succession planning as a strategy while others saw it as a tactical tool (e.g. job role definition) while some saw it as both. Succession planning themes in Nebraska HDs included (1) succession planning is valuable, and (2) resources and training on succession planning are valuable.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSuccession Planning Practices\u003c/h3\u003e\n\u003cp\u003eWe also found variation in the utilization of succession planning. Some HDs were not using succession planning, and some were fully using succession planning. For those using succession planning, there were strong themes of (1) utilizing succession planning for business continuity followed by (2) using succession planning strategies to fill critical positions and finally, (3) tying succession planning into activities like talent development. HDs interviewed viewed all positions as important to consider in succession planning rather than focusing only on leadership positions. There was a difference between rural and urban HDs interviewed. Most urban HDs were not fully utilizing succession planning, including incorporating specific strategies such as cross-training, while most rural HDs interviewed were. This may be because two of the rural locations interviewed were preparing for the retirement of long-term directors and because of the difficulty recruiting to rural areas, factors noted by interviewees in their responses.\u003c/p\u003e\n\u003ch3\u003eSuccession Planning Needs\u003c/h3\u003e\n\u003cp\u003eHDs did not feel there was not a common source on succession planning they could reference at a national, regional, or local level. In discussion of which critical components succession planning resources should include, the following items were mentioned: a methodology for approaching succession planning, a way to evaluate job roles critical to ongoing operations, how to evaluate where talent is in the organization (who are the successors for roles), a methodology for identifying and outlining the critical components of each role (job actions), and finally, supporting retention via talent development strategies such as cross-training. Alignment with accreditation/re-accreditation requirements was not widely mentioned specific to succession planning, but themes around the overall importance of accreditation and re-accreditation were present in the interviews. Key findings are outlined in Table A.\u003c/p\u003e\n\u003ch3\u003eOut of Current Scope\u003c/h3\u003e\n\u003cp\u003eSeveral other HD needs arose during our interviews that were out of scope for succession planning but are important to mention in understanding the landscape of HDs. Sourcing and recruitment of employees was a top need identified across the interviewees. Supporting job transitions, including a process and check list with detailed job responsibilities for position handoffs and onboarding of new employees was frequently mentioned. Difficulties recruiting to rural areas was highlighted by rural HDs. Other needs mentioned with less frequency included policy and job description templates, mentoring programs for people new to leadership roles, resources for departments seeking accreditation, education in population health for front-line workers new to public health, and general education on human resources management functions including conducting more impactful performance reviews, hiring interviews and exit interviews, and understanding compensation philosophy.\u003c/p\u003e "},{"header":"Discussion and Conclusions","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003cp\u003eIn our study, we found variation in definitions of and utilization of succession planning, but common themes included HD leaders believe succession planning is valuable and resources and education on succession planning are needed. For those departments utilizing succession planning, the primary utilization of succession planning was for continuity of operations during emergencies, which represents an opportunity for improved utilization of succession planning. A similar state-level study of succession planning practices in Washington state revealed that while many HDs in Washington state utilized succession planning, there was an opportunity to formalize and further leverage succession planning in the state. Through surveying HDs, the authors also found key impediments to formal succession planning included competing priorities for leadership time and a belief that the departments were too small to need structured planning. The researchers went on to recommend the need to create \u0026ldquo;a greater sense of urgency by focusing on agency retirement profiles and emphasizing the need for workforce development plans for accreditation.\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese findings present an opportunity for greater focus on succession planning overall and for continuing education development, especially with the workforce gaps that existed in public health prior to the pandemic and worsened with COVID-19.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e We utilized these findings to develop succession planning resources and educate Nebraska HD leaders on succession planning. Specific focuses included education on the full spectrum of succession planning including workforce planning and talent development as well as on utilizing specific tools such as successor identification strategies.\u003c/p\u003e \u003cp\u003eSeveral other valuable ideas emerged from our meetings with HDs that were outside of the original intent of our interviews but offer opportunities for insight, future research directions, and development of education and training. While our focus began with succession planning, the needs and ideas outlined are interrelated. Acting on these findings with additional research, resources, education and training will create improved public health workforce sustainability in Nebraska and can serve as a roadmap for other states.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePublic Health Implications\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eGaps in the public health workforce have direct, negative impacts to the safety and health of the public.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSuccession planning is important to public health workforce sustainability.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eVariation exists in definitions and utilization of succession planning among HDs in Nebraska.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eResources on succession planning and overall strategies for workforce sustainability in public health are valued but are viewed as lacking by HD leaders.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProviding additional training and resources to HDs on succession planning can improve workforce sustainability.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eResearch reported in this publication was supported by the University of Nebraska Medical Center Office of Public Health (OPHP),the Nebraska Department of Health and Human Services (DHHS) and through the Centers for Disease Control (CDC) Cooperative Agreement for Emergency Response: Public Health Crisis Response-2018 Award # 6NU90TP922166-01-04\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosures\u003c/strong\u003e: The authors do not have any additional funding related to this work to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB statement:\u0026nbsp;\u003c/strong\u003eOur research is exempt from IRB review per the UNMC IRB policy because this research is a quality improvement activity, and all data is shown in aggregate without individual identifiers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u0026nbsp;\u003c/strong\u003eInterview subjects gave their informed consent to participate in the study. Separate consent to publish was not obtained because all data is shown in aggregate without individual identifiers. Individual subjects are unidentifiable in the published results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe authors do not have any potential conflicts of interest to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: The authors thank the University of Nebraska Medical Center OPHP, DHHS and CDC for supporting this work and thank the Nebraska Health Department leaders who contributed to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. White was the co-lead researcher and lead author including writing the main manuscript text and preparing Table A. Dr. Verhoeven was the co-lead researcher and contributed to the main manuscript text and preparing Table A. Ms. Ehrenberg and Dr. Brandert reviewed the manuscript and Table A and recommended edits. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDarnell, J. S., \u0026amp; Campbell, R. T. Succession planning in local health departments: results from a national survey. Journal of public health management and practice: JPHMP, 2015; 21(2), 141\u0026ndash;150.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeider JP, Castrucci BC, Robins M, et al. The Exodus Of State And Local Public Health Employees: Separations Started Before And Continued Throughout COVID-19. Health Aff (Millwood). 2023;42(3):338\u0026ndash;348. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1377/hlthaff.2022.01251\u003c/span\u003e\u003cspan address=\"10.1377/hlthaff.2022.01251\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarper, E., Leider, J. P., Coronado, F., \u0026amp; Beck, A. J. Succession Planning in State Health Agencies in the United States: A Brief Report. Journal of public health management and practice: JPHMP, 2018; 24(5), 473\u0026ndash;478.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMichaels, I., Pirani, S., Fleming, M., Arana, M. M., D'Angelo, E., Dyer-Drobnack, C., DiManno, M., Ravenhall, S., \u0026amp; Gloria, C. T. Enumeration of the Public Health Workforce in New York State: Workforce Changes in the Wake of COVID-19. International journal of environmental research and public health, 2022; 19(20), 13592.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmalzried, H., \u0026amp; Fallon, L. F., Jr. Succession planning for local health department top executives: reducing risk to communities. Journal of community health, 2007; 32(3), 169\u0026ndash;180.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Public Health Accreditation Board (PHAB). \u003cem\u003eStandards \u0026amp; Measures for Initial Accreditation Version 2022\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://phaboard.org/wp-content/uploads/Standards-Measures-Initial-Accreditation-Version-2022.pdf\u003c/span\u003e\u003cspan address=\"https://phaboard.org/wp-content/uploads/Standards-Measures-Initial-Accreditation-Version-2022.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed January 10th, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Public Health Accreditation Board (PHAB). (2022). \u003cem\u003eStandards \u0026amp; Measures for Reaccreditation Version 2022\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://phaboard.org/wp-content/uploads/Standard-Measures-Version-2022-Reaccreditation.pdf\u003c/span\u003e\u003cspan address=\"https://phaboard.org/wp-content/uploads/Standard-Measures-Version-2022-Reaccreditation.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed January 10th, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Public Health Workforce Interests and Needs Survey (PH WINS). \u003cem\u003eExplore Staying and Leaving\u003c/em\u003e. https://phwins.org/national/dashboard?\u0026amp;type=public\u0026amp;fi=3_7\u0026amp;topic=3\u0026amp;fe=all_employees\u0026amp;c=0_1\u0026amp;ci=OFF\u0026amp;dl=point_estimate\u0026amp;sort=def#void.Accessed May 1st, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiesman, J. M., Babich, S. M., Umble, K., \u0026amp; Baker, E. L. (2016). Succession Planning and Management Practice in Washington State Local Public Health Agencies. \u003cem\u003eJournal of public health management and practice: JPHMP\u003c/em\u003e, 2016; 22(6), 512\u0026ndash;519. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/PHH.0000000000000397\u003c/span\u003e\u003cspan address=\"10.1097/PHH.0000000000000397\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable A \u0026ndash; Succession Planning Themes and Practice Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eSuccession Planning Aspects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 298px;\"\u003e\n \u003cp\u003eThemes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003ePractice Considerations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eSuccession Planning Definitions and Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 298px;\"\u003e\n \u003cp\u003eThere is variation in the definition of succession planning\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSuccession planning is viewed as valuable\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResources and training on succession planning were viewed as valuable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eEducation and resources can serve to level-set definitions of succession planning, and this may further advance the value equation for using succession planning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eSuccession Planning Practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 298px;\"\u003e\n \u003cp\u003eThere is variation in the utilization of succession planning\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSuccession planning was used for (1) business continuity followed by (2) filling critical positions and finally, (3) tying into activities like talent development\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHD leaders viewed all positions as important to consider in succession planning rather than focusing only on leadership positions\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMost urban HDs were not fully utilizing succession planning while most rural HDs interviewed were\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eEducation and resources should represent the full spectrum of and value of succession planning including examples of succession planning and talent development at all levels of the organization. Further, resources should also include specific strategies for talent development (e.g. cross-training)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eSuccession Planning Needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 298px;\"\u003e\n \u003cp\u003eThere was not a common source on succession planning health department leaders felt they could reference at a national, regional or local level\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSpecific needs mentioned included a methodology for approaching succession planning, a way to evaluate job roles critical to ongoing operations, how to evaluate where talent is in the organization (who are the successors for roles), a methodology for identifying and outlining the critical components of each role (job actions), and finally, supporting retention via strategies such as cross-training\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAccreditation/Reaccreditation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eEducation and resources should include the specific needs outlined by HD leaders and made easily accessible for all HD leaders\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLeadership development ideas from PHAB include: (1) develop leadership skills by exposing people to more complex initiatives (2) empower people to act in leadership roles on an interim basis, (3) provide opportunities to perform specialized tasks such as conducting a skills assessment and (4) provide training on specific leadership skills such as strategic planning or negotiation.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dihs","sideBox":"Learn more about [Discover Health Systems](https://www.springer.com/44250)","snPcode":"44250","submissionUrl":"https://submission.nature.com/new-submission/44250/3","title":"Discover Health Systems","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"succession planning, health departments, public health workforce sustainability","lastPublishedDoi":"10.21203/rs.3.rs-5835118/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5835118/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e. To (1) understand the current state of succession planning in Nebraska health departments (HDs) and (2) understand succession planning needs in Nebraska HDs. Study Design. Qualitative interviews with a semi-structured format.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e. Purposive sampling was used to identify a list of HD leaders. Interviews were conducted in 2024 with twelve HD leaders representing 10 HDs in Nebraska (50% of state-funded HDs in the state). Themes were developed based on the frequency with which different concepts and key terms were mentioned.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e. We found variation in the definitions and utilization of succession planning amongst those interviewed. However, consistent themes included that Nebraska health department leaders believe succession planning is a beneficial public health workforce sustainability strategy and resources and training on succession planning are considered valuable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e. Variation in utilization of succession planning exists and resources to help health department leaders are sparse. Succession planning is an important workforce sustainability strategy with direct implications for the safety and health of the public. Providing more training and resources to HDs on succession planning can improve workforce sustainability.\u003c/p\u003e","manuscriptTitle":"Succession Planning in Nebraska’s Local Health Departments","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-14 11:28:11","doi":"10.21203/rs.3.rs-5835118/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-08T09:54:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-13T14:59:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179944915045303737144616454509364347587","date":"2025-05-09T18:09:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83768998386230147763828597773299469747","date":"2025-05-09T17:49:19+00:00","index":"hide","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-23T10:30:06+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-11T13:25:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-10T09:17:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Health Systems","date":"2025-03-18T18:30:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dihs","sideBox":"Learn more about [Discover Health Systems](https://www.springer.com/44250)","snPcode":"44250","submissionUrl":"https://submission.nature.com/new-submission/44250/3","title":"Discover Health Systems","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c0672026-eb08-4e77-92f5-8df570f2b59b","owner":[],"postedDate":"April 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T11:38:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-14 11:28:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5835118","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5835118","identity":"rs-5835118","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}