Rowitz On Leadership

Over the past few decades, organizations have looked at their organizations through a continuous quality improvement lens. More recently, public health has tried to apply the CQI model from a wider systems perspective. Since public health professionals look at population health and the social determinants of health, collaboration with other community organizations requires that we see whether health outcomes improve as a result of collaboration. Public health is about the system and the management of change. The public health agency is embedded in the community which informs us about the fact that culture is always an issue in public health work. Leaders must look at the big picture, interpret events from a system view, and communicate change in such a way that it is clear to the people who are impacted by the changes that occur.

Systems thinkers are concerned about the characteristics of change and how to manage it. Change is an action that takes the leader from one place to another. Change often requires a creative effort. Change can have both positive and negative results. When change occurs, the quality improvement paradigm hopes for change being positive. Some of the factors that surround the change process include the relevance and degree of the change itself, the current situation in the agency and the community, the credibility of managers and leaders and how they handled change in the past, leadership style, organizational change, and the determination of the strategies that define how the change process will develop.. In order to understand how change improves quality, it is important to monitor how work or service activities are done. The outcome of the change process produces viable positive differences relative to historic norms and values. Improvements in quality often requires change in the culture of the agency or community. Finally, the change should have some lasting impact.

It is important to see the issue of quality from a system’s perspective. Quality problems always result from faults in the system. Frontline workers are essential to the improvement effort. System changes require action on the part of managers and leaders. It is the customers(community residents) who will determine if the stated improvements are satisfactory or not. On a structural level, the reduction or elimination of quality problems will almost always reduce costs. Relative to the service dimension, service demand is built into the system through the agency’s organizational design processes. It is also important to remember that the agency is part of the public health system but it is not the public health system itself.

It is possible to view the system and quality improvement relationship as a jigsaw puzzle with many parts including the community, the public health system infrastructure, the leadership operations system(planning and implementation), quality improvement and performance measurement strategies, and cultural transformation effects.