Rowitz On Leadership

About twenty years ago, I was at one of my first meetings at the Centers for Disease Control and Prevention. I noticed that almost every CDC public health professional was carrying a green book. Throughout the meeting, each CDC person opened their green book and took notes or wrote comments on the proceedings. These green books were journals. Since that time, I have observed many public health professionals carry these leadership journals. Today, many of these individuals carry a computer or tablet like the IPAD in which they now write their commentaries. I started carrying a journal a couple of decades back and I am entering the 21^st century by carrying my IPAD in which I continue to jot down my thoughts and ideas. In the public health leadership institute that I have been running for twenty years, we have started to give all participants journals. This one tool has become an essential for many managers and leaders.

Our lives are so busy. Ideas seem to come at breakneck speed. As leaders, we need to keep our eyes and ears focused on many things and issues in the course of a working day. Our journals prevent us from losing many of these high speed ideas from getting lost. I would like to use this posting to briefly discuss some of the uses of our journals. First, you would go back at the end of each week and make a new entry that prioritizes the ideas of the previous week. Then, give a score from 1-3 with one being an idea to really continue to develop and three being an idea that is interesting but not of high priority at the present time. Write a few lines on the issues ranked one and what are the next steps in developing these ideas. Each month, it is necessary to look back at the high scoring ideas and determine your progress in addressing them. Should some be dropped because a dead end has been reached?

A leadership journal needs to be a living document. Share your ideas with other leaders and have then share their ideas with you. Then, idea-sharing becomes a collaborative activity. It will be in the process of working with others that some of your ideas and the ideas of others will lead to new programs and policies. Don’t lose your ideas. Make your ideas live through making them come to life.

Over the last twenty years, I have probably read over a thousand books on leadership and management. A large number of these books present theories about what leadership is and how it works. Many leaders have embraced one theory, combination of theories, or their own theory about leadership and how they practice it . As these theories are examined (see a sample of well-known books that present differing approaches in my February 2010 posting entitled A LEADERSHIP BOOKSHELF), it becomes useful to try to determine the essential skill of successful leaders. To complicate this task, let’s limit the essentials to the five most important skills:

(1)Knowledge with the intelligence to use it- leaders are bombarded with new information on a daily basis from new health data statistics, new public health technical reports, new funding opportunities, and new demands for service based on emerging threats or program emphases. All this new information has to be translated into the context of public health and the governing paradigms that drive public health action.

(2)Empathy and motivation of others- Leaders have learned that the technological expertise that brought them into public health careers has become secondary to their relationships with colleagues and external partners. Leaders struggle to develop the social skills necessary to be an effective leader who is able to collaborate with others with ease. This set of basic skills has come to be called emotional intelligence in recent years.

(3)Risk-taking with action and follow through-leaders need to not only be visionary and creative, they need to be able to take risks and to get their ideas translated into action with well-defined projected outcomes. Every new vision or creative idea has a potential risk associated with it. Many people including colleagues are fearful of change. Risk-taking is the attempt to change the status quo and move in new directions.

(4)Ability to communicate at many different levels- Leaders have to learn to communicate both verbally and in writing. They need to listen to others carefully. They may also have to communicate cross-culturally or to others who do not speak their native language. They need to be able to communicate through the Internet. Social networks can become critical to their work. Most leaders are excellent at using real life events to show how their theories work. They can also be excellent storytellers.

(5)Systems thinkers with an understanding of how complexity impacts their work- leaders understand that they need to concentrate on the big picture. They look at their agency as a whole organization with interacting parts. They see their agency in the context of a whole community. They understand that most of their work is about upsetting the status quo in order to change things for the better. Public health leaders think about the population and how to improve the health of everyone in their geographic jurisdiction. They also understand that the best plans may still lead to unanticipated consequences.

All the other leadership skills that are described by the many leadership writers and by leaders themselves grow out of these five basic leadership skills.

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.

In 1937, Everett Stonequist wrote a book which presented the marginal man concept. Marginal men are individuals who have one foot in one culture and the other foot in another culture. These individuals have a history related to these two cultures. If you picture a vend diagram with two circles with each circle representing a culture, the overlap creates a partial synthesis between these two cultures. I spent the first part of my career working in a practice setting in a state department of mental health and developmental disabilities. For the past forty years, I have worked as a professor in a school of public health. My personal experiences make a strong pitch for academics and practitioners working together. Having worked in both environments, I believe that academics and practitioners can work together in many ways of benefit to both cultures. When the two cultures come together leadership becomes important in making the partnership work.

Public health practice is about collaboration with people about important and relevant health concerns in real time and space. Space is about where we live, our neighborhoods, our communities, and our culture. When academics come out of their classrooms, they do so in order to better understand the health concerns and practices of the public. They gain this understanding through research. Faculty give back to the community through training and service. Practitioners want to serve through evidence-based practices and interventions which the academics help them to implement. In many instances, collaboration between educators and public health practitioners has led to advances in improvements in the health of the service populations. Examples include smoking cessation initiatives and improvements in the problems associated with HIV/AIDS. On the negative side, such events as academics leaving a community after a study is done has left bad feelings among practitioners. Academics have sometimes been disturbed by all the limits the community and its workers put on a research project carried out by the academic researchers. On the whole, these academic and practice partnerships have been more beneficial than harmful.

Over the last twenty years, the Centers for Disease Control and Prevention(CDC) has funded a number of these academic and practice partnerships through the Prevention Centers, Preparedness research and training initiatives, the national and regional leadership development programs, the environmental educational training programs, and many others. These programs have had many successes. Over the past twenty years, these initiatives have helped build trust between many academic public health programs and the practice community. Many of these CDC programs are now in danger of being abolished due to cutbacks in federal funding Because of major deficits at the national and we could add deficits at the state level. This is a major mistake that may obliterate many of the public health successes of the past twenty years. Without continuation of these programs, collaboration will be difficult to maintain and all Americans will lose as a result. It is important for our academic leaders and our practice leaders to fight to maintain and expand these academic and practice partnerships.

Summer is a time for a lighter posting. One of the most looked at postings on this blog was the first one I wrote in December 2008 on HOW (NOT) TO GIVE A KEYNOTE ADDRESS. Last year, I was asked to give a talk as part of an opening session at a national public health meeting. Remembering my first blog article, I opened my talk by providing the audience with a few secrets to giving an opening talk and demonstrated that the two other speakers clearly were aware of six secrets. The first secret is to look at the conference theme and present your comments by constantly referring back to the theme of the meeting. This means that you can probably use old ideas from other presentations as long as you keep referring to the overall conference theme of the present meeting.

The second secret is to not make your speech too long since you will bore your audience. Keep your talk short and concrete. If you are the last speaker, refer to the excellent comments of other speakers since they probably used up half of your presentation time anyway Make sure you give a few specific comments perhaps a short list that the audience will probably remember since you are the last speaker.

Third, put some abstract thoughts into your presentation so that you seem knowledgeable and clearly an expert on your topic. After all, conference planners want experts for their opening and other plenary presentations. The fourth secret is related to Secret three. If you want the audience to remember your talk, present a few ideas that are sticky. You can see the light bulbs go off in the faces of some in your audience as you present a new interpretation of old ideas that clearly impact some people.

Secret Five is to tell a story or two. Good stories often lead to stickiness. Your story can be work related but stories about your children and /or grandchildren bring forth smiles and a chuckle. People seem to remember these stories more than a story about something that happened at work. The final secret is to add a touch of humor to your presentation. It humanizes you and helps the audience remember what you said.

Communication skills are critical to the professional presenter. In fact, good communication skills enhance the presentation of leaders.

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.