title: Should they stay or should they go? Leader duration and financial performance in local health departments.
abstract: BACKGROUND
  The delivery of programs by local health departments (LHDs) has shifted from "if we do not have the money we don't do it" to LHD directors should "identify and fund public health priorities." This shift has subsequently increased performance expectations of LHD leaders. In the for-profit sector the leaders' failure to perform has resulted in a shortening tenure trend. Tenure is a proxy for human capital accumulation. In LHDs, the nature of association, if any, between leader tenure and agency performance is unknown.
  
  
  OBJECTIVE
  Examine association between financial performance of LHDs with short-, average-, and long-tenured LHD leaders.
  
  
  METHODS
  Variation in leader characteristics and percent change in expenditure were examined using a longitudinal cohort design and positive deviance methodology. Bivariate analysis of LHD financial performance and leader characteristics was conducted, and a logistic regression model was developed to test association between leader tenure and LHDs that experienced a positive percentage expenditure change.
  
  
  METHODS
  From a total of 2523 LHDs, 1453 were examined. The cross-sectional surveys of US public health agencies conducted by the National Association of County and City Health Officials in 2008 and 2010 contain the leader and LHD variables.
  
  
  RESULTS
  Approximately 44% of LHDs experienced a positive percentage expenditure change. Leader tenure, age, gender, and education status were significantly associated with a positive percentage expenditure change using a chi-square test of independence. From the logistic regression analysis tenure, educational status, employment status, area population, governance, classification, and jurisdiction were statistically significant. Local health departments with leaders whose tenure was less than 2 years were less likely than those with average tenure to experience a positive percentage expenditure change.
  
  
  CONCLUSIONS
  The odds ratios for tenure suggest that tenure is positively associated up to a threshold level and then declines. Implying that LHD financial performance is sensitive to leader tenure.
authors.affiliation: Department of Health Management and Policy (Drs Jadhav, Holsinger, and Mays) and Department of Biostatistics (Dr Fardo), University of Kentucky College of Public Health, Lexington.
authors.forename: Emmanuel D
authors.initials: ED
authors.lastname: Jadhav
authors.forename: James W
authors.initials: JW
authors.lastname: Holsinger
authors.forename: Glen
authors.initials: G
authors.lastname: Mays
authors.forename: David
authors.initials: D
authors.lastname: Fardo
mesh_terms: D000288:Administrative Personnel / Q000592:standards*; D003430:Cross-Sectional Studies; D004651:Employment / Q000191:economics / Q000592:standards; D005376:Financial Management / Q000592:standards*; D006801:Humans; D007857:Leadership; D009111:Local Government; D015980:Public Health Practice / Q000191:economics* / Q000592:standards