Managing the Post-Pandemic Pivot—A Public Health Leadership Challenge

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As the public health workforce adjusts to working in a world in which the COVID-19 pandemic seems to be receding, many are faced with the need to “pivot” from the past into a future state which is still impacted by a range of pandemic experiences. Since the virus is now at an endemic stage, public health professionals are faced with the challenge of preparing for future threats while addressing a growing range of public health concerns. As that transition process evolves, public health professionals may benefit from taking time to look back into the emotional impact of working through the pandemic and then to consider the implications of that reflection on the future. In this column, we will consider the dynamic of managing a “post-pandemic pivot” along with offering a few practical suggestions on ways to navigate successfully the road ahead. Managing the Post-Pandemic Recovery Period As noted in previous Management Moment columns,1,2 research by CDC and others noted significant mental health impacts on public health workers as they struggled through the COVID-19 pandemic. Many noted symptoms of post-traumatic stress disorder (PTSD), depression, and other mental health challenges. These conditions had a pervasive and lasting impact of the well-being of public health professionals and on their productivity within public health organizations. Even though the “acute phase” of these conditions may have faded, many of these signs and symptoms persist to this day as we enter a “post- pandemic” period. The recent Public Health Workforce Interests & Needs Survey (PH WINS)3 highlighted the stresses reported by public health workers during the pandemic. Despite the feeling of being overwhelmed and burned out, staff concurrently identified pride in public health work as a driving force and valued teamwork in accomplishing the mission of public health. Along these lines, many staff have been (and continue to be) overworked, underappreciated, and underpaid. Further, there seems to be a generational shift in attitude in how new public health professionals view the work experience and managing expectations (eg, remote work options, position titles, immediate career growth opportunities, etc.). In addition to this shift in attitudes, frontline or senior-level staff may experience some overt heckling or more subtle challenges to their role or authority (eg, outreach workers encountering anti-vaxxers, health inspectors encountering push back from area businesses, and members of the elected body challenging the value of appropriations to support governmental public health). The combined impact of these forces must be considered as leaders look into the future to support their workforce as this transition evolves. Individual public health leaders may themselves need to adopt practices which support their own energy and long-term effectiveness during this transition. For example, leaders may now experience the beneficial and cathartic experience of reconnecting and reengaging at educational conferences and in working groups as a way to empathize and support one another during this recovery phase. This process requires an investment of time and resources to reprioritize our trade-offs in order to stay “fueled up” to prepare for the next major public health event. In addition to internal individual and organizational challenges, public health leaders face significant external challenges. In this context, community partners have reminded us that there needs to be a delicate balance with respect to maintaining and nurturing the trust established during the pandemic in many circles and the added visibility of the role of health departments. Further, leaders will increasingly experience “push back” as public health policies and actions impact the livelihood of sectors on the ground (eg, business/school closures and the impacts of H5N1 on the lives of farmers). Thus, public health leaders must maintain an external focus on the evolving nature of public health practice in the communities which they serve while remaining attentive to the needs of the workforce in the agencies that they lead. A Few “Bright Spots” In addition to the real stresses of the COVID-19 pandemic and their lingering impacts on the public health workforce, some “bright spots” have been noted along the way. As noted in an excellent research report in this journal using data from the PH WINS database,4 public health workers highlighted “the importance of leaders prioritizing safe and supportive environments for employees, fostering teamwork alongside employees, and advocating for and demonstrating appreciation for employees. In addition, effective leadership communication was reported to be motivational and alleviate uncertainty during crisis situations.” In a second excellent article5 by the same authors, there was evidence that public health workers valued “opportunities for on-the-job learning to gain new technical and practical skills including communicating with the public and also experiencing new roles and responsibilities leading to career growth and leadership opportunities.” A third excellent article6 by this group emphasizes the value of teamwork and collaboration during the pandemic. In some departments, infusion of new funding (eg, the Public Health Infrastructure Grant) has enabled leaders to add staff and to promote those already employed to higher levels of responsibility and salary. During the pandemic, leaders have recognized tremendous skill growth at all levels of the organization. Many people stepped up and took on new roles during the crisis. Staff members became team leads, trainers, contact tracers, writers, clinic coordinators, and customer service agents. To retain staff and recognize their newfound skills, leaders have made concerted efforts to transition staff into new roles that allow them to fully utilize their capabilities. For example: A front desk clerk is now a disease intervention specialist for HIV. An administrative assistant is now a billing coordinator. A clerk in the city museum started helping at a mass vaccination site and was hired by the department as the full-time adult immunization coordinator. To streamline the flow of COVID-19 reports, a longtime preparedness staff member figured out how to tackle data issues, discovered a knack for data analysis, and is now revamping informatics systems for disease surveillance. These job promotions are life-changing for staff and their families. Some staff have received salary increases of over 25%, which allowed them to move their families into better neighborhoods with better schools, thus impacting their families for the future. Potential Strategies for Managing the “Pivot” To address the lingering impact of the pandemic on the public health workforce, we advocate for an intentional consideration of these past experiences at a personal, organizational, and societal level. First, some public health leaders have openly acknowledged the stress and trauma of the COVID-19 pandemic work on staff (both personally and professionally). Having done so, public health leaders have organized intentional processes to recognize staff hardships during the pandemic and to look at how the department should function to focus on individual, team, and organizational development. In some cases, leaders have had to be more sensitive to the effects of “survey fatigue” and “training fatigue” as we enter into the endemic state of the pandemic. A range of strategies and tactics may be implemented to support the workforce during this transitional period to promote recovery from the lingering impacts of the COVID pandemic on workforce morale and daily functioning. These approaches may be simply characterized as “pacing, pivoting, and pushing.” Pacing: Leaders can take a few moments during the day to reflect on the complex forces that characterize the “post-pandemic period” by: Anchoring mindfulness activities within the structure of each meeting agend

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