Succession Planning for Behavioral Health Leaders: “Necessary and Insufficient”

Did you know that DC’s public-health chiefs stayed at their post about half as long as the national average between 1980 and 2017? A study of state health officer tenures in the Journal of Public Health Management and Practice that indicated that DC had the most frequent state health officer turnover, with directors of the DC Department of Health averaging a 2.1-year tenure compared to a 4.1-year national average [1]. The study’s authors emphasized the particular importance of merit-based selection criteria for health officials, urged creation of regional exchanges, and recommended investing in leadership development as early as possible in a leader’s tenure.

Resources available from the Center for State and Local Government Excellence (CSLGE) [2] and the Association of State and Territorial Health Officials (ASTHO) [3] suggest and build out the need for succession planning to resolve both the likelihood and impact of turnover in upper echelons of health departments and behavioral health agencies. Backdropping the urgency of health-official turnover are demanding changes to policy and technological landscapes that pile onto the enormous existing task of managing health service provision in an environment constrained by politics, budget, and workforce [1, 2, 3]. The effects of officials’ departures in such agencies are especially harsh because the agencies often contract out service delivery, and departures of department administrators place strain on contractor relations, according to a 2003 article published in the State and Local Government Review [4].

Succession planning should be ongoing, formalized, and undertaken prior to a leader’s announced departure [2, 3]. Succession planning scopes out the possible effects of agency departures, identifies core competencies, relationships, and tasks required in the present position, and develops a clear pipeline of potential replacements into the positions [2].

Successful Succession Planning for Agency Leaders

Succession planning requires asking,

  • Which roles require or benefit from succession planning?
  • What are the probability and effect of departures from these roles?
  • What is desired from a successor to fill this role well?
  • How well are these needs met by the bench of possible successors?
  • How can we groom possible successors to familiarize them with these needs?

And, for top roles, asking,

  • If this individual departed today, how immediately could the role functions and relations be continuously carried on, and by whom? [2]

Succession Planning is Strategic Planning

When done correctly, lessons gleaned from succession plans integrate with strategic planning for the organization. For instance, the ASTHO Succession Planning Guide highlights a convocation of public health officers and providers around Arizona to discuss leadership needs, common workforce concerns, and organizational staff development plans [3]. The subsequent Arizona Department of Health Services strategic plan included objectives and plans developed at the gathering.

There are plenty of ways a farsighted government might implement succession planning, but Darriell and others’ 2013 report to the CSLGE reported that fewer than one in thirteen local health departments have formal succession planning for “key leadership,” representing just 16 (7%) of 225 departments [2]. This indicates prevalent processes don’t match prevalent needs: more than half of surveyed health departments (56%) had sought a new key leader in the past 18 months. Planning around so common an organizational occurrence, formally and in advance, would mitigate the predictable disruption of an unplanned departure. In fact, planning at all would be ideal: about one-third of health departments (29%) performed no succession planning at all according to the 2013 survey.

Let’s hope that DC, with its particular rocky history, can implement these best-process, does not fall into that bucket. A cursory check [5] doesn’t look promising.


[1] Halverson, P. K., Lumpkin, J. R., Yeager, V. A., Castrucci, B. C., Moffatt, S., & Tilson, H. (2017). High Turnover Among State Health Officials/Public Health Directors: Implications for the Publicʼs Health. Journal of Public Health Management and Practice, 23(5), 537–542.; Public manuscript available at

[2] Darnell, J., Cahn, S., Turnock, B., Becker, C., Franzel, J., & Wagner, D. M. (2013, November). Local Health Department Workforce Recruitment and Retention: Challenges and Opportunities. Retrieved from

[3] Becker, C. (2009, June 15). Succession Planning Guide. Retrieved from

[4] Clingermayer, J. C., Feiock, R. C., & Stream, C. (2003). Governmental Uncertainty and Leadership Turnover: Influences on Contracting and Sector Choice for Local Services. State and Local Government Review, 35(3), 150–160.


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