Rowitz On Leadership

Over the last two decades, public health leaders and by extension human service leaders have struggled with the need to build the infrastructure of the public health and the human services system. Since the publication in 1988 by the Institute of Medicine of THE FUTURE OF PUBLIC HEALTH, the issue of the human services system and its infrastructure has been on the table. This article will address some of the building block issues related to strengthening the infrastructure of public health and other health and human services systems. First, the most important building block relates to people. Workforce development is a key building block. The education that each professional has before entering the human services arena is not sufficient over the long run. Lifelong learning and the ability to adapt to changing realities is critical to the future adaptability of the human services fields. Second, public health has spent the last twenty years promoting the core functions and essential public health services paradigm and has developed its programs on the basis of these core service dimensions. Strengthening the infrastructure of public health will require support for this service paradigm and the data systems necessary to support this paradigm. I would argue that this paradigm is applicable to most human services systems as well as to the emerging concerns related to emergency preparedness and response. A common language and governing paradigm are critical components for building infrastructure.

Third, it is important to assess the health of the people in our service areas on a regular basis so that our human services systems are more responsive to emerging health and mental health needs of the public. It is for this reason that the development of model service standards and assessment tools become important to a nimble public health and human services system. Public health leaders have pointed out to me over the years that assessment strategies have been a real strength of the public health system. Assessment as well as other epidemiologic techniques are also strong components of the human services system and its infrastructure. The fourth enhancement to infrastructure building is an increasing awareness that a performance management approach to organizational effectiveness and the various tools that measure performance are also important aids in strengthening our health service systems. Closely allied to performance measurement as a fifth factor is the incorporation of quality improvement methodologies into the culture of our human services and public health infrastructure. Leaders need to support this cultural shift. Another technique which is emerging as important for the improvement in quality of agency programs and services the community balanced scorecard methodology

Development of an accreditation system for local public health agencies creates a level of excellence as well as trust and credibility for public health. Recognition of the good work of public health raises public awareness as well. These standards of excellence for agencies also build infrastructure. A voluntary accreditation program for local health departments will be implemented in 2011. The seventh building block is closely tied to accreditation and that is certification. Certification refers to the individual and standards of excellence for the work of the public health professional. Certification can be tied to the field of practice of the individual as well as to evidence of management or leadership skills in practice Health administrator and Board of Health member certification would be beneficial to the successful direction of local public health and human services agencies. Accreditation informs us of the quality of the work of the agency and certification tells us how effective these professionals are in these quality organizations.

It is impossible to build infrastructure without well trained leaders. Most of our professional education programs do not include much if any management and leadership training. There are now a number of public health leadership programs to train health professionals in management and leadership. These programs explore the differences in the practice of leadership in governmental and not for profit agencies in contrast to business organizations. Leadership is a critical building block in infrastructure capacity-building. Finally, all of the above concerns need to be addressed if we want to reach more positive health outcomes. The effectiveness and efficiency of the work of our organizations needs to be measured against the successes of our work on health outcomes.