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  1. Boedigheimer, Steven F. MBA
  2. Yeager, Valerie A. DrPH
  3. Chapple-McGruder, Theresa PhD
  4. Moffatt, Sharon BSN, MS
  5. Halverson, Paul K. DrPH
  6. for the SHO-CASE Steering Committee


Context: Senior deputies work closely with state health officials (SHOs) in state public health agencies and are a valuable resource for understanding their roles, responsibilities, and characteristics.


Objective: Examine senior deputies' perceptions of SHO success factors.


Design: Qualitative study including nominal group technique focus groups, a small expert focus group, and interviews.


Setting: US state public health agencies.


Participants: Senior deputies in state public health agencies 2016/2017.


Main Outcome Measures: Perceptions of SHO success factors.


Results: The most commonly perceived professional characteristics of a successful SHO included the following: credible trusted voice with internal respect/external credibility; improves public health prominence/visibility with an evidence-based agenda; and grows the agency/leaves it stronger. Perceptions of the most common personal attributes for success included excellent listening skills; credibility/honesty/trustworthiness; and public health experience/knowledge. The most commonly perceived signs of SHO derailment included when SHOs have a visible lack of support of elected officials (eg, governor/legislators) and when the SHO is "bypassed" by elected officials.


Conclusions: A key finding of this study centers on the relationship between the SHO and the governor; meeting the expectations of the governor was identified as a significant professional characteristic of success. Findings highlight the expectation that SHOs have a clear understanding of the governor's priorities and how to relate to the governor's office early in their tenure. This goal should be a priority for transition teams that aid new SHOs as they begin in their new roles. Study insights can help better prepare for orientation/onboarding of new SHOs. Development of key transition documents and tools for rapid onboarding should be considered. Transition teams should assist new SHOs in establishing an understanding of the governor's priorities and how to best communicate with to the governor's office early in their tenure. Strong senior management teams should be prioritized and fostered.