Rowitz On Leadership

In recent years, there has been much discussion about looking at systems from a complexity perspective. In the past, local health departments were very much oriented to the organization and its effectiveness in engaging in public health concerns for its jurisdiction with the public health professionals being seen as experts who would provide their knowledge to improve the health of the public. This period was also linear in that the major effectiveness and efficiency concerns for the agency was viewed primarily as a series of issues related to management. Over the last twenty years, there has been a gradual shift in public health agency work to a community or systems view of public health guided by the paradigm of the essential services of public health. As stated in the 1988 Institute of Medicine report on the future of public health and the public health reports to follow, leadership is needed if the public’s health is to improve. Leadership is need if public health infrastructure is to grow and capacity is also to increase. Public health leaders needed to collaborate with other health partners in the service jurisdiction to work together to improve the health of the public by making sure that the essential public health services were being addressed. This more comprehensive view shifted public health from an organization-centric management approach to a community-wide systems approach. An emerging trend was that the systemic approach was not as easy as professionals though. Relationship-building was not always easy. There was competition and hidden agendas within the service area. First, all the collaboration activities began to get complicated. Then the terrorist attacks of September 11, 2001 changed the picture again with law enforcement, fire departments, the FBI and others becoming involved with public health in the protection of the public. Complexity issues began to predominate the service picture.

Complexity is about building relationships, redefining structure, and unanticipated consequences. We live in a period of constant change. As Ian Mitroff has argued in a number of writings, there has been an increasing number of natural and man-made crises since the 1980s. The resolution of these crises has become more and more complex because of the factors associated with the occurrence of the crisis, the effect of the crisis on the infrastructure of our communities, the response to the crisis by different groups in the community, all the unanticipated results of the crisis, and the difficulties associated with the crisis recovery activities. Leadership is needed to help navigate each of these events. Dealing with an individual organization is less complex than dealing with an entire community. Now another concern has been raised. Solutions at a community level are multi-level with concern not only at the grassroots level but also at the level of infrastructure, county level, state level, and sometimes at the national level. Now leaders must expand their levels of activity to the issues associated with MULTIPLEXITY. This new level of activity involves the integration of a complexity concerns at the horizontal level with our community partners and vertical collaboration and work with partners at higher jurisdictional levels. Putting all the pieces together is a multiplexity set of concerns.