Application of a return of investment analysis for public health training by case study


      • Certification in Infection Control validates profitability of investment.
      • Investing in competency-based training is worthwhile for cost reduction.
      • Leveraging training opportunities for employee retention and ensuring competencies.
      • Providing a business case for training opportunities in public health practice.
      Background: Local health departments require assurance of competence of their workforce to prevent and mitigate outbreaks by supporting the implementation of evidence-based actions in clinical practice, medical procedures and infection control practices. Too often outdated policies or reduction in budgets prevent the appropriate training strategies or resources to recruit, retain or support this capability.
      Design and Methods: In this 2018 case study analysis, we coupled the Phillip's Return on Investment model with a standard financial proforma model to make a business case that investing in training, specifically the Certification in Infection Control (CIC), was worthwhile for cost reduction, improved knowledge, skills and abilities (KSA's) and improved employee retention.
      Results: Our model demonstrated that our initial investment (USD $1,840) was profitable based on the internal rate of return (IRR = 130%, Year. 5), payback period (0.71 years), Benefit Cost Ratio (BCR = 1.41) and Return of Investment (ROI = 41%), if an epidemiologist worked a minimum of 3 healthcare associated infection outbreaks per year. Data from 4 local epidemiologists demonstrated that the application of KSA's reduced investigation hours by 10%-25% for all types of outbreaks with payback periods of less than 6 months and positive ROIs for staff with retention greater than 1 year. Our model demonstrated that at the highest end of our investment costs (US $2940) with an investigation improve efficiency of 25%, the IRR was 85% after year 5 with a payback period of 1.13 years if the epidemiologist worked on 3 HAI outbreaks per year over the 5 years.
      Conclusions: Our results validate the profitability of investment into the CIC for local epidemiologists if they could be retained longer than the payback period. The model provides a method for managers to leverage training opportunities for employee retention while ensuring competencies in the workforce.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • ATD. ATD 2016
        State of the Industry Report.
        The Association of Talent Development, Alexandria, VA2016
        • Yiu L
        • Saner R
        Does it pay to train? ISO 10015 assures the quality and return on investment of training.
        ISO Management Systems. 2005; 5: 9-13
        • Rowden RW
        Exploring methods to evaluate the return on investment from training.
        Am Bus Rev. 2001; 19: 6
        • Lederberg J
        Summary and Assessment: Public Health Systems and Emerging Infections: Assessing the Capabilities of the Public and Private Sectors: Workshop Summary.
        National Academies Press (US), Washington (DC)2000
        • Hilliard TM
        • Boulton ML
        Public health workforce research in review: a 25-year retrospective.
        Am J Prev Med. 2012; 42: S17-S28
        • APHA.
        The Afforadable Care Act's Public Health Workforce Provisions: Opportunities and Challenges.
        American Public Health Association, Washington, DC2011 (June)
      1. CDC. Healthcare Associated Infections-Data and Statistics: Centers for Disease Control and Prevention; 2016. Available at: Accessed March 16, 2016.

        • Scott RD
        The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention.
        Centers for Disease Control and Prevention, Atlanta2009
        • Marchetti A
        • Rossiter R
        Economic burden of healthcare-associated infection in US acute care hospitals: societal perspective.
        J Med Econ. 2013; 16: 1399-1404
        • Goldrick BA
        The Certification Board of Infection Control and Epidemiology white paper: the value of certification for infection control professionals.
        Am J Infect Control. 2007; 35: 150-156
      2. CBIC. Certification Board of Infection Control and Epidemiology, Inc 2018 Available from:

      3. CDC. Legionella (Legionnaires Disease and Pontiac Fever): Centers for Disease Control and Prevention; 2018. Available at: Accessed April 30, 2018.

        • Anaissie EJ
        • Penzak SR
        • Dignani MC
        The hospital water supply as a source of nosocomial infections: a plea for action.
        Arch Intern Med. 2002; 162: 1483-1492
        • Phillips JJ
        • Brantley W
        • Phillips PP
        Project management ROI: a step-by-step guide for measuring the impact and ROI for projects.
        Wiley, Hoboken, N.J.2012 (2012)
        • Kak N
        • Burkhalter B
        • Cooper M-A
        Measuring the competence of healthcare providers.
        Oper Res. 2001; 2(1): 1-28
        • Investopedia L
        Investopedia Dictionary.
        2018 (Available at:)
        Date accessed: January 29, 2019
        • Crowe S
        • Cresswell K
        • Robertson A
        • Huby G
        • Avery A
        • Sheikh A
        The case study approach.
        BMC Med Res Methodol. 2011; 11: 1-9