UNDERSTANDING WORKFORCE RESILIENCY CONSIDERATIONS AND APPROACHES IN DEVELOPING AND IMPLEMENTING LEGISLATIVELY MANDATED RESTRUCTURINGS OF STATE HEALTH AGENCIES IN THE U.S.

Meeting evolving population health needs through innovation requires health systems to adapt and transform continuously. (1) The COVID-19 pandemic underscored this need as public health leaders faced mounting pressure to keep pace with demands for organizational change. (2) During and immediately after the COVID-19 emergency response, five states enacted and implemented legislation to reshape government-provided health services: Iowa, North Dakota, South Carolina, Utah, and West Virginia. As policymakers consider additional mandated changes to the structure of state health agencies (SHAs), it will be important to assess the workforce’s capacity to implement them. Implementation challenges of mandated changes by policymakers include potential financial costs, as well as costs to agency personnel and functions. (2) Meanwhile, SHA leaders tasked with managing the implementation of these changes are currently confronted with a distressed, understaffed, underfunded, and overworked public health workforce. (3–7) Understanding recent considerations and actions by policymakers and agency leaders in developing and implementing mandated restructuring of SHAs will assist others undertaking similar efforts in the future. This is particularly relevant as some states look to align with federal trends to enhance government efficiency. (8) This dissertation examines legislatively mandated restructurings of U.S. SHAs between 2020 and 2025. This study builds on existing change readiness and resiliency models to develop an updated model for building organizational change capacity. By examining this historical reshaping of SHAs, the findings clarify workforce resiliency considerations and approaches that policymakers and agency leaders have used to develop and implement state laws reorganizing government-provided health services. A multi-pronged, semi-exploratory qualitative case study design was used, including a document analysis of eight pieces of legislation across five states and semi-structured interviews with seven SHA leaders, three lawmakers, and one legislative staff. The study’s findings indicate that workforce-related factors were considered in the development and implementation of the identified state legislation restructuring SHAs. While strategies employed in the development and implementation of laws were primarily absorptive, adaptive and transformative strategies were also identified. Capacity strategies to support workforce resiliency had the potential to increase with the level of engagement of the resources supporting the activity.