Public Health Leadership and Management for the 21st Century

Institute for Health Promotion and Disease Prevention Research GRADUATE COURSE GUIDELINES

PUBLIC HEALTH LEADERSHIP AND MANAGEMENT FOR THE 21ST CENTURY

GLOBAL HEALTH LEADERSHIP REPORTS BEST PRACTICE SOLUTIONS TO ENHANCE THE PERFORMANCE OF HEALTH SYSTEMS

M. RICARDO CALDERÓN, SERIES EDITOR

May 2010 Institute for Health Promotion and Disease Prevention Research

At a Glance INSTITUTE FOR HEALTH PROMOTION & DISEASE PREVENTION RESEARCH Keck School of Medicine University of Southern California (USC) 1000 South Freemont Avenue, Unit 8 Alhambra, California 91803

The Global Health Leadership Reports is a publication of the USC Institute for Health Promotion and Disease Prevention Research (IPR). The opinions expressed herein are those of the editor and author(s) and do not necessarily reflect the views of the University of Southern California. Excerpts from these publications may be freely reproduced acknowledging Global Health Leadership Reports as the source.

Internet: http://mph.usc.edu/ipr/ Internet: http://mrcalderon.com

GLOBAL HEALTH LEADERSHIP TEAM SERIES EDITOR: M. Ricardo Calderón, M.D., M.P.H. Senior Administrative Director, International Training Programs; Associate Professor, Preventive Medicine; Founding Director, MPH Global Health Leadership Track and Regional Director, Latin America and the Caribbean, USC-IPR & Area Director & Health Officer, County of Los Angeles Department of Public Health INFORMATION DISSEMINATION INITIATIVE Carina Lopez, M.P.H. Program Manager

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The GLOBAL HEALTH LEADERSHIP REPORTS series was created by Professor M. Ricardo Calderón during his tenure at the Institute for Health Promotion and Disease Prevention Research (IPR) of the University of Southern California’s Keck School of Medicine (USC). It was designed to provide a forum to faculty and students of the USC Master of Public Health (MPH) Program to share lessons learned and best practice solutions to enhance the performance of health systems around the world. The research, training and service of university faculty and students is published in a variety of peer reviewed and professional journals traditionally and due to scholarly purposes. While this is the acceptable professional and academic manner to contribute with original unpublished research, social science analyses, scholarly essays, critical commentaries and letters to the editors, there is an extensive body of practical information and valuable knowledge that is either not submitted for publication or that takes too long to be published. This lack of information exchange may reflect a missed opportunity to strengthen, expand and diversify knowledge learning and capacity development to trouble-shoot, problem-solve, make informed choices, prioritize investments, implement evidence-based practices and/or lead innovation and change in the healthcare industry and public health systems.

The Global Health Leadership Reports series was created to fill some of the gaps in information dissemination and exchange and, more importantly, the timely integration of research findings and best practice solutions into program development, implementation and evaluation for enhanced institutional performance and population health outcomes. This is accomplished by developing electronic publications that can be easily distributed by e-mail, posted in websites or transmitted by internet around the world. This is also done by capitalizing upon the research efforts and practical solutions developed by faculty and graduate students throughout their teaching and learning experience, graduate education, classroom debates, and group discussions including a variety of projects that are implemented by talented, creative and innovative faculty and students.

We trust that the reader will be open to our publication rationale and approach, and will contribute to further disseminate reliable information for the effective development of community and global health programs, plans and policies. We hope that the Global Health Leadership Reports will stimulate discussion and reflection, propel continued dialogue, and encourage the pioneering of new combinations of innovative approaches and practical solutions to enhance the performance of health systems and improve the health status and wellbeing of individuals, families and communities worldwide. We also hope to contribute to fulfill the vision to create healthy people living in healthy environments locally and globally, and living longer, quality lives in a world with less pain and suffering, less injuries and disease, less health inequities and disparities, and a world where our minds and bodies perform at optimum levels.

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Table of Contents EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 COURSE INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1. Learning Outcomes 2. Course Format and Grading Criteria 3. Teaching Philosophy

I. FUTURE-FOCUSED LEADERSHIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

1. Lecture: Global Health Leadership Track & Interdisciplinary Global Health Training

2. Lecture: Public Health Leadership Framework for the 21st Century

3. Team Exercise: Creating Individual and Shared Visions

4. Discussion: Concept Paper #1: Developing a Visionary Leadership Approach

5. Bibliography

II. LEADING PUBLIC HEALTH INSTITUTIONS . . . . . . . . . . . . . . . . . . . . 26

1. Lecture: Transformational Leadership

2. Individual Exercise: Leadership versus Management

3. Lecture: Public Health Leadership Principles

4. Discussion: Concept Paper #2: Developing Empowered Leaders

5. Lecture: SWOT Analysis

6. Self-Directed Study Project and Paper #1: SWOT Analysis

7. Bibliography

III. FORMULATING STRATEGY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

1. Lecture: Leadership Applications in Public Health 2. Class Exercise: Systems Thinking

3. Discussion: Concept Paper #3: Building Internal and External Partnerships

4. Lecture: Leadership and the Planning Process

2. Lecture & Class Exercise: Asset-Based Community Strategies

6. Lecture: Participatory Strategic Planning

7. Discussion: Concept Paper #4: Building Support for a Strategic Plan

8. Self-Directed Study Project & Paper #2: Creating a Strategic and an Implementation Plan

9. Bibliography

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Table of Contents IV. LEADING AND MANAGING CHANGE. . . . . . . . . . . . . . . . . . . . . . . . . .68

1. Lecture: Leadership and Organizational Culture

2. Individual Exercise: Time Management Matrix

3. Lecture: Peacetime Management & Wartime Leadership

4. Concept Paper #5 Discussion: Implementing Adaptive Leadership

5. Lecture: Managing Personal and Organizational Change

6. Case Study: The Center for Disease Prevention and Control (CDC) Futures Initiative

7. Lecture: Servant Leadership

8. Discussion: Concept Paper #6: Communicating Change

9. Bibliography

V. DEVELOPING PUBLIC HEALTH ORGANIZATIONS . . . . . . . . . . . . . . . . 95

1. Lecture: Building a Learning Organization

2. Lecture: Creating Organizations with Many Leaders

3. Discussion: Concept Paper #7: Creating an Environment for Innovation

4. Lecture: Developing a Performance Oriented Culture

5. Class Exercise: Win as Much as You Can

6. Discussion: Concept Paper #8: Creating Self-Directed Work Teams

7. Self-Directed Study Project and Paper #3: IQ (Intelligence Quotient), Emotional

Intelligence (EQ) and Spiritual Quotient (SQ)

8. Bibliography

VI. IMPLEMENTING STRATEGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

1. Lecture: The Five Fundamental Principles and Ten Commitments of Exemplary Leadership

2. Class Exercise: Collaborative Leadership

3. Lecture: Capstone Initiatives and Action Learning: Collaborative Leadership Change

Project

4. Discussion: Concept Paper #9: Turning Vision into Action

5. Lecture: Crisis and Emergency Risk Communication

6. Lecture: Risk and High Stress Communication

7. Team Exercise: West Nile Virus Message Development

8. Discussion: Concept Paper #10: Becoming Customer Centric

9. Bibliography

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EXECUTIVE SUMMARY: The Institute of Medicine (IOM) published in 1988 a proposal to ensure the efficiency and effectiveness of public health services in the United States. This book, The Future of Public Health, that concluded “The Nation had lost sight of its public health goals and had allowed the system of public health to fall into disarray”. In 2002, the IOM released a related publication, The Future of the Public’s Health in the 21st Century, calling for an overhaul of government public health infrastructure and new partners to address the nation’s health challenges. Inherent in this call to action was the IOM recommendation that “we must be led by those who have the mastery of the skills to mobilize, coordinate and direct broad collaborative actions within the complex public health system…..these skills need constant refinement and honing”.

Consequently, a variety of leadership development institutes were designed and implemented by different academic and public health institutions to enhance the performance of health systems and improve population health outcomes across the United States. At the same time, the need for, and the critical importance of, public health leadership development had already been felt in many health systems around the world and a range of training programs were under development and/or implementation.

As a medical and public health expert with international technical cooperation experience in over twenty countries, I accepted the challenge to restructure and revitalize the public health system in Los Angeles County in 1999. By this time, my work experience had transitioned from private clinical practice and healthcare delivery to a 5,000-Mayan Indian town in Guatemala, to a range of technical and managerial positions including, but not limited to, malaria prevention and control, nation-wide surveillance of endoepidemic diseases, maternal and child health, reproductive health and family planning, nutrition and food programming, pharmaceutical assistance, HIV/AIDS/STDs, health promotion and wellness, and infectious and chronic disease prevention and control. My medical and public health experience, particularly in the developing world, had taught me that (1) health promotion, wellness and disease prevention and control are affected by individual, social, economic and environmental factors within and beyond communities that must be addressed comprehensively, and (2) protecting and improving the health and wellbeing of a population is a shared responsibility among residents, public institutions, private for-profit and non-profit organizations, key stakeholders, opinion leaders and policymakers.

Therefore, I created two strategic approaches to address the challenges to improve health system performance and population health outcomes. First, a Community Liaising Program at the County of Los Angeles Department of Public Health. This program was designed to lead, organize and support a concerted public, private and non-profit sector effort to strengthen, expand and diversify prevention programs and public health services (M. Ricardo Calderón, Series Editor, The Best Practice Collection: Developing a Community Liaising Program in Los Angeles, County of Los Angeles Department of Pubic Health, July 2009). Second, a course on Public Health Leadership and Management for the 21st Century for the Master of Public Health (MPH) Program at the University of Southern California (USC). Ironically, this course was not approved by the MPH program administration during three consecutive years. However, when USC was invited to improve the public health infrastructure in China due to (1) the health and socioeconomic impact of the SARS (Severe Acute Respiratory Syndrome) epidemic in 2003, and (2) the assessment of the Chinese Centers for Disease Control and Prevention (CCDC) revealing a need for public health leadership development at all levels, the course became the pivotal public health leadership development tool offered

by USC in China (M. Ricardo Calderón, Series Editor, Global Health Leadership Reports, Strengthening the Public Health Infrastructure in China to better respond to 21st Century Threats, Institute for Health Promotion and Disease Prevention Research, University of Southern California, June 2005).

A total of ten certificate programs were delivered to the top 1,070 public health directors, physicians, hospital administrators and university professors in China during 2004 and 2005. Two certificate programs were delivered in Public Health Intelligence and Leadership to 144 Chinese professionals. A third certificate program in Public Health Leadership and Emergency Response was given to 110 professionals. This was followed by seven certificate programs in Public Health Leadership and Crisis and Emergency Risk Communication for an additional 816 public health leaders at national, provincial and city levels. The Public Health Intelligence and Leadership Certificate Programs integrated intelligence know-how (scientific knowledge) and leadership skills (executive leadership and management tools) required to successfully direct public health organizations and coordinate public health preparedness and emergency response.

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This publication describes the Public Health Leadership and Management for the 21st Century course in detail. It provides the guidelines of the course as taught to professionals at CCDC/China and MPH students at USC/Los Angeles. It is intended to guide course development and instruction in industrialized and developing countries in academic and informal settings, and to strengthen, expand and diversify the knowledge and skills of population, health and development workforces. It is based on a Public Health Leadership Framework comprising six integrated leadership practices. These leadership practices are interdependent. Altering one will affect all the rest and mastering all will enable leaders to achieve outstanding health system performance and successful implementation of institutional vision and overall strategy. The course and the framework paved the way for the creation of the USC MPH Global Health Leadership Track in 2006 and the launching of the MPH Leadership, Management and Governance Track at the newly created School of Community and Global Health at Claremont Graduate University (CGU) in 2008.

This publication reflects a journey of lessons learned and best practice solutions in a total of twenty seven countries. I cannot possibly acknowledge everyone who has played a role in my professional growth and development. However, I wish to express my gratitude and appreciation to those professors, mentors, friends and institutions most closely connected to my leadership development ---Drs. Paul Torrens, Lester Breslow, Jonathan E. Fielding and Ralph Frericks (University of California, Los Angeles), Michael F. Kipp (Kipp & Associates), James R. Morgan (Strategy and Management Dynamics), Dr. A. Paul Bradley, Jr. (The Bradley Group, Inc), Dr. Robert Brien (The Haveford Group), Paul D. Storfer (HR Technologies), Drs. Alex Norman, Gerard Rossey, Alan Glassman and Richard Moore (California State University, Northridge), Dr. Vincent Covello (Center for Risk Communication), Dr. Hugh H. Tilson (University of North Carolina at Chapel Hill), Rev. Dr. Gary Gunderson (Emory University), Carol Woltring (Public Health Institute), Mark Friedman (Fiscal Policy Studies Institute), Dr. C. Anderson Johnson (University of Southern California and Claremont Graduate University), Dr. Fernando Zacarías (Pan American Health Organization/World Health Organization), and Dr. M. Roberto Calderón (Pan American Health Organization/World Health Organization and World Vision International). Also deeply important in my development are the learning environments of the following “Almae Matres” and institutions: Universidad de San Carlos de Guatemala (USAC), University of California, Los Angeles (UCLA), University of Southern California (USC), California State University, Northridge (CSUN), University of North Carolina at Chapel Hill (UNC), American Management Association (AMA), and the Los Angeles County Training Academy.

Finally, I wish to extend my gratitude and appreciation to Carina Lopez, M.P.H., for her on-the-job and offwork dedication, contributions and assistance as the Project Manager for the Information Dissemination Initiative of two of my publication series ---“The Los Angeles County Best Practice Collection: Reliable Information for Effective Community Health Plans, Programs and Policies”, and the “USC Global Health Leadership Reports: Best Practice Solutions to Enhance the Performance of Health Systems”.

M. RICARDO CALDERÓN, M.D., M.P.H. Los Angeles, California, USA May 2010

Management is doing things right. Leadership is doing the right things

-Peter Drucker

“Rather than saying it cannot be done, let’s find a way to get it done”.

- M. Ricardo Calderón

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COURSE INTRODUCTION: Public Health challenges in the 21st Century include disparities in population health status, new public health stakeholders, evolving epidemiology of global disease and injury, increased performance accountability, and heightened expectations for public health system preparedness (National Public Health Leadership Institute, University of North Carolina at Chapel Hill, 2003). Public Health systems must be led by those who have mastery of the skills to mobilize, coordinate, and direct broad collaborative actions within complex public health systems (Institute of Medicine, 2002), including the ability to lead multi-faceted, multi-sectoral and multi-national initiatives. The Public Health Leadership and Management for the 21st Century Course focuses, therefore, on the knowledge, skills and practical tools needed to direct organizations and small and large-scale initiatives to successful implementation of institutional vision and overall strategy. It is intended for students who will pursue leadership positions in public health and health care settings, including the task to build learning organizations, develop leaders at every level, and create partnerships and networks to maximize individual and organizational performance as well as public health system response. As students prepare for and enter leadership careers, they face a workplace that is very different from the one managers faced a decade ago and one that will change significantly during their tenures. This course will provide them with the know-how and skills to transfer self-understanding, critical reasoning, scientific knowledge, and analytical problem finding and solving skills to rapidly changing environments and public health challenges in the 21st century, including visionary and decision-making skills and emotional intelligence.

1. LEARNING OUTCOMES At the completion of this course, students will be equipped with knowledge, skills and abilities to: • Discuss current challenges to public health and public health leadership • Demonstrate their understanding of leadership skills needed in the 21st Century • Assess their individual change style and its impact on leading change • Explore the role of health departments in working collaboratively in communities • Apply the principles of leading change and collaborative leadership to their work • Partner effectively with communities and stakeholders • Develop institutional vision and strategic plans and assess the extent of their implementation • Make the distinction between manager/management and leader/leadership • Describe various leadership styles and articulate their own • Identify their particular leadership strengths to leverage and areas to target for development 7 Public Health Leadership and Management for the 21st Century

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• Utilize action learning and reflective practice for ongoing growth as a leader • Frame and focus attention to adaptive challenges • Assure development and sharing of organizational learning • Use systems thinking to lead innovation and change • Envision the public health future and develop and lead teams to create it

2. COURSE FORMAT & GRADING CRITERIA This Course is organized into six major Modules –future-focused leadership, leading public health systems, formulating strategy, leading and managing change, developing public health organizations, and implementing strategy. Each Module offers an applied training opportunity to gain advanced knowledge to build executive and managerial skills. Students will engage in lectures, discussions, explorations, self-study and assessments, case analyses, practice and application.

A range of learning approaches will be used to teach specific elements of the course including, but not limited to, Lectures (to convey basic body of information), Self-Directed Learning (intensive study, reading, writing and/or research on particular issues), Audiovisual Materials (to showcase specific themes or topics), Peer Education (sharing of information, knowledge, skills or experience among students), and Class Discussions (in-depth questions and answers). Case Analyses, based on select readings assignments, will be discussed in each of the sessions and will reinforce the learning objectives of the course. These analyses will integrate leadership and management principles with public health practice, policies and programs. In addition, they will reflect on lessons learned and best practices of public health systems in international settings. Students will be expected to attend lectures, participate and in class discussions, complete reading assignments, prepare two-page concept papers, write project papers, make class presentations, and contribute to information sharing and exchange.

Grades will be based on class participation (10%), development of ten two-page concept papers on related class themes and topics (20% [10 @ 2 points each]), presentation of three ten-page, selfdirected study project papers (30% @ 10 points each]), and a final examination (40%). Classes will consist of one 3-4 hour session per week for a total of 16 weeks. Each class will consist of approximately 50-minute lectures followed by corresponding class and team discussions or debates including individual, team and class exercises and presentations.

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3. TEACHING PHILOSOPY My teaching philosophy evolved from many years of teaching and training experience in many countries both in academic and non-academic settings. As I reflect on my values and beliefs regarding teaching and learning, I find that my teaching philosophy focuses on three primary goals supported each by three objectives as follows: 1. Teaching state-of-the-art, practical knowledge, skills and competencies: I am a proponent of (1.1) Action Learning to address issues, challenges and opportunities. In Action Learning, students try to deeply understand a real problem, take wise decisions, and reflect on what they have learned. Students must develop a commitment to questioning, reflection, action, and learning from such actions rather than stopping with recommendations for others, and a commitment to “learning” as well as “results”. Learning is, therefore, as important as the action. I complement this objective with (1.2) Problem-Based Learning. In order to get students to think, I challenge students to “learn to learn” by working cooperatively in groups to seek solutions for real world problems. I utilize problems to engage the students’ curiosity, initiate learning of the subject matter, think critically and analytically, and find and use appropriate learning resources. I also use (1.3) Diverse Teaching and Learning Technologies to encourage discussion and interaction on the themes and topics of the course and, more importantly, to translate theory and ideas into action plans, apply practical knowledge, and deliver results. My learning approaches include, but are not limited to, Lectures (to convey basic body of information), Self-Directed Learning (intensive study, reading or research on particular issues), Audiovisual Materials (to showcase specific themes or topics), Peer Education (to share information, knowledge and experience among students), Class Discussions (in-depth questions, answers and debates), and Case Studies (to reflect on lessons learned and best practices from real life). I expect students to attend lectures, complete reading assignments, lead and facilitate discussions and debates, make class presentations, and contribute to information sharing and exchange.

2. Developing the students’ leadership skills: I believe that globalization and the rapid pace of changes in technology and socioeconomic and political environments require a new teaching and learning orientation. A student who is trained to become a “leader” will do the “right thing”. A student with no leadership training will do “things right”. Doing things right does not necessarily mean implementing the best or more appropriate or cost-effective strategy. One of my teaching goals is to develop “student-leaders” with practical knowledge and tools to do the right thing. I integrate (2.1) Visionary and Systems Thinking Skills to accomplish this. I teach students visionary and futurefocused skills so that they will spend most of their decision-making time looking forward. I combine this with skills to assess what the problem really is and what its wider and systemic causes are. This enables students to examine the root causes and forces that shape the issues and the challenges 9 Public Health Leadership and Management for the 21st Century

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they will face in the workplace. I also try to develop (2.2) an Entrepreneurial Spirit and Life-Long Learning Skills among students. Students must appreciate that the institutions in which they will work operate in a fast changing marketplace that seeks products and services to meet emerging customer, patient or population needs, including 21st public health challenges, emergencies and threats. In view of rapid scientific and technological progress, I encourage students to take charge of their own learning and develop a life-long learning attitude. Also, I encourage them to look for creative ways to connect their institutions to the world around them, exploring and imagining new forms of (2.3) Collaboration and Teamwork that will support their missions and advance strategic plans. This includes strategic partnerships and alliances and a deep appreciation of the strength of diversity to assure a higher level of responsiveness, creativity, innovation and organizational learning.

3. Developing the students’ communication skills: I want all my students to understand that communicating with others is an essential skill in business dealings, governmental settings, academic environments, family affairs, and even in romantic relationships. I engage students in written and spoken discourse to develop their communications skills to (3.1) Educate and Train Others, (3.2) Promote Innovation and Change, and (3.3) Articulate and Defend Technical Positions and Approaches.

My goal is to provide students with intrapersonal and interpersonal processing, listening, observation, questioning, analysis, evaluation and speaking skills. I believe that use of these processes is developmental and transfers to all areas of life ---home, school, community, work, and beyond.

It is through communication that action learning, problem-based learning, teaching and learning methodologies, visionary and systems thinking, entrepreneurial spirit and life-long learning, and collaboration and teamwork occur. Also, I strongly believe that students and adults learn by doing and, in addition to leading and facilitating class discussions and debates and contributing to information sharing and exchange, I expect students to prepare multiple One-Page Concept Papers (brief but cogent well-written essays to develop research, conceptualization, and information consolidation and proposal skills), make PowerPoint Presentations (to develop presentation, public speaking, spokesperson and representation skills), and 10-Page Individual/Team Project Papers (to help students apply the knowledge and skills acquired through the course curriculum to the work they will perform in the future as public health practitioners, leaders and educators). I utilize Project Papers as an opportunity for students to practice being a collaborative leader of change in their future work environments, either internally within their organizations or externally with other institutions or the community. It is also a virtual reality experience in which they (a) assume positions of leadership, i.e., Ministers or Directors of Public Health, (b) assess the strengths, weaknesses, threats and opportunities of a health system, program, policy or service, and (c) develop health system change recommendations based on the knowledge and skills gained in class. Individual Project Papers also provide an opportunity to promote and evaluate the knowledge, creativity, resourcefulness, progress and learning experience of students.

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Finally, I am committed to providing a learning environment that is exciting, fun, inspiring and respectful while comprehensive and thorough. More importantly, I strive to create an environment where students feel valued, appreciated and safe to candidly discuss topics and propose new ideas, and one that empowers the students and teacher to pursue learning and personal and professional growth and development.

I. MODULE 1: FUTURE-FOCUSED LEADERSHIP 1. Lecture: Master of Public Health (MPH) Global Health Leadership Track & Interdisciplinary Global Health Training 1.1. Why Global Health Leadership? a. Track Name & Rationale: • Uniqueness • Responsiveness • Relevance • Integration

b. Statement of Need: A response to new public health challenges and opportunities created by: • Rising inequities in healthcare and health status around the globe • Changing demographic patterns of disease and epidemiological transitions, and • Increasing globalization and 21st Century threats

c. Track Purpose: Train students and develop leaders with world-class knowledge and skills in: • Public Health Leadership and Management principles and • Population-based disease prevention and control, in order to • Improve the health of people around the world, and • Strengthen global public health systems

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d. Track Goals: Prepare students to: • Respond effectively to the full range of 21st Century threats • Use scientific knowledge and leadership tools to guide public health action, and • Create multidisciplinary approaches to enhance global public health research, practice and policy-making

e. Learning Outcomes: •

EXPLAIN the global context in which public health problems occur and the need to respond to the health consequences of international emergencies

•

DESCRIBE how globalization, rising infectious and chronic diseases, and natural and man made disasters make the health and wellbeing of people of the world increasingly interdependent

•

APPRECIATE the increasing influence of determinants arising in foreign countries to any country’s health and safety

•

APPLY leadership and management skills needed in the 21st century to effectively lead lo-

cal, national and global public health systems

• APPLY scientific knowledge and leadership tools and resources to promote health, prevent illness and fight disease around the world • UTILIZE lessons learned and best practices to play leadership roles in promoting global

health through improved research, practice and policy-making

• ADVOCATE for multidisciplinary, multisectoral and multinational disease prevention and control initiatives to improve the health of the people around the world • PROMOTE the mutual benefits of improving the health status and wellbeing of other

countries

• DESCRIBE the advantages of information sharing and expertise exchange among countries and international partners • PROMOTE health system development and reform worldwide through the engagement of world-wide networks, partnerships and public and private health institutions

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f. Program Description:

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1.2. Why Interdisciplinary Global Health Training? a. Perspective for Discussion: • Global health problems cross geopolitical boundaries • Solutions require coordinated interdisciplinary actions by all nations • Research and training is crucial to address 21st century threats • Critical to share experiences and lessons learned across nations

b. Emerging Infections:

1973 ROTAVIRUS

1977 EBOLA VIRUS 1977 LEGIONNAIRES’ DISEASE 1981 TOXIC SHOCK SYNDROME 1982 LYME DISEASE 1983 HIV/AIDS 1983 HELICOBACTER PYLORI

1991 MDR-TB 1992 CHOLERA EPIDEMIC 1994 CRYPTOSPORIDIUM 1998 HONG KONG BIRD FLUE 1999 WEST NILE VIRUS 2001 ANTHRAX 2003 SARS

c. Historical Emerging Infections: Year 610 INFLUENZA IN CHINA (SARS?) Year 644 LEPROSY Year 900 SMALLPOX (RHAZES) Year 1348 BLACK DEAQTH (PLAGUE) Year 1495 THE GREAT POX (SYPHILIS) Year 1510 THE RED SICKNESS (SCARLET FEVER) Year 1546 JAIL FEVER (TYPHUS) Year 1557 MALARIA Year 1567 SMALLPOX

d. Severe Acute Respiratory Syndrome (SARS) • 32 countries, 8464 cases, 799 deaths (11/102 – 06/17/03 WHO) • Estimated Economic Costs (reduction in annual GDP): China $7.2B, Hong Kong $3.0 - $6.6 B, Korea $1.3 - $3.0 B, Taiwan $2.5 – $5.3B • Regional Cost: $16 – $30 B (NY Times & ADB: SARS Economic Impacts and Implications (Fan, E.X. May 2001) • Standard Economic Model: Economic Growth = Health • New Economic Model: Economic Growth < > Health 14 Public Health Leadership and Management for the 21st Century

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e. Protecting Health in a Transforming World: • Preparedness planning • Collaborative response • Training and education • New research agenda • Proactive communication • Linkages between disciplines • Political will • Expect the unexpected

f. China’s Public Health Training Program: Outcomes Approach Logic Model:

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g. USC/CCDC Public Health Intelligence and Leadership Develop Program: The integration of Scientific Knowledge (public health intelligence) and Leadership Skills • Two Certificate Programs in Public Health Intelligence and Leadership (Summer 2004) • A Certificate Program in Public Health Leadership & Emergency Response (Fall 2004) • Seven Certificate Programs in Public Health Leadership & Crisis and Emergency Risk Communication (Fall 2004 and Winter 2005) • 1070 top medical, public health, hospital administration directors (Chinese Center for Disease Control and Prevention and the Ministry of Health) and university professors of China

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h. Public Health Opportunities: Leadership roles

Develop performance-based and accountability structures

Prioritize investments to improve health

Focus on quality assurance in service delivery

Prioritize policies than can improve the public’s health

Ensure public trust in public health organizations

Assure evidence-based practices

Lead innovation Enlarge cadre of public health leaders

i. Desired Future: • Increased public health system efficiency • Enhanced public health emergency response • Improved global health

2. LECTURE: PUBLIC HEALTH LEADERSHIP FOR THE 21ST CENTURY 2.1. FUTURE-FOCUSED LEADERSHIP a. Leadership & Managerial Skill Evolution:

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b. The Role of the Leader-Manager:

Passionate vision

Organizational alignment

External focus

Effective management of human capital

Clear values and strategy

Seamless execution

c. Developing New Perspectives: • Changing perspectives to facilitate organization and program change • Creating new perspectives • Changing mental models

d. Imagination: • If you do not know where you are going, any road will take you there

e. Leadership Abilities and Practices:

Create a vision

Possess entrepreneurial ability

Synthesize knowledge

Set priorities

Be creative, resourceful

Form coalitions & build teams

Foster and facilitate collaboration

Master management techniques

Cultivate systems thinkers

Act as a colleague, friend and humanitarian

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2.2. LEADING PUBLIC HEALTH SYSTEMS a. Leadership Roles: EXTERNAL ENVIRONMENT

SPOKESPERSON DIRECTION SETTER PRESENT

FUTURE

COACH

CHANGE AGENT

INTERNAL ENVIRONMENT

MANAGING

LEADING

Coordinating

Thinking in the Future

Controlling

Inspiring

Administering

Motivating

Scheduling

Influencing

Monitoring

Risk Taking

Planning

Facilitating

Staffing

Empowering

Directing

Mobilizing

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2.3. FORMULATING STRATEGY a. Today’s Public Health Challenges:

Effective preparedness and response to 21st century PH threats

Need for reliable and timely detection, science, communication, integration, action and containment

Emergence of new and re-emergence of old diseases

Explosion of information technology

Changing demographics

Globalization and rapid transportation systems

Population health disparities Enhanced role of prevention Emphasis on accountability and performance

Invisibility of public health

Government and health department reorganization

Shifting public expectations

b. Scientific Examples of Public Health Challenges in China: • Rapidly emerging disease distribution –infectious respiratory disease to chronic disease—as

major causes of death (prior to SARS

• Unprecedented migration from rural to urban centers –30% to 40% of population in some cities • Population disparities and associated mental disease is the greatest economic challenge to

China by 2020 (WHO)

• High levels of anxiety, depression and stress in people who experience either a loss of real income or a loss of income relative to others in their workplace or neighborhood (USC-CSCS) • Exposure to foreign media (movies, TV, magazines, music) is associated with an increase in health risk behavior –smoking, fast food consumption, etc.

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2.4. LEADING AND MANAGING CHANGE a. Paradigm Shifts: Behaviors Consensus Patriarchal Exclusive Needing facts Competitive Solitary vision Hierarchical Functional skills Individual accomplishments Structural Episodic Control Analysis Outcome

Personal capacity Discovery Embracing diversity Holistic Befriending ambiguity Collaborative Collective understanding & shared vision Flexible, horizontal Lifelong learning Community building Relational Sustainable Chaos and creativity Synthesis Process

2.5. DEVELOPING PUBLIC HEALTH ORGANIZATIONS a. Developing Leaders: • Treat people with trust and respect (support, recognize and reward staff) • Build organizational capabilities (created aligned, learning organization; ensure coaching, counseling, mentoring, training and appraisals) • Transition management (embrace change; continuously scan horizon)

22

MANAGERS

LEADERS

Maintain and operate the organization

Innovate and develop the organization

Ask how and when

Ask what and why

Eye on the bottom line (present-oriented)

Eye on the horizon (future-oriented)

Seek stability and control

Seek flexibility and change

Problem solvers

Problem finders

Convergent thinkers

Divergent thinkers

Influence others by rules and systems

Influence others by trust, persuasion & inspiration

Deploy human resources

Serve and empower human beings

Do things right (EFFICIENCY)

Do the right thing (EFFECTIVENESS)

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2.6. IMPLEMENTING STRATEGIES a. Key Competencies: • We must be led by those who have mastered the skills to mobilize, coordinate and direct broad collaborative actions within the complex public health system………..these skills need constant refinement and honing (The Future of the Public’s Health, Institute of Medicine, 2002)

b. Characteristics of Admired Leaders:

CHARACTERISTICS Honest Forward-looking Inspiring Competent Fair-minded Supportive Broad-minded Intelligent Straightforward Dependable

1987 RESPONDENTS % 1995 RESPONDENTS % 83 88 62 75 38 68 67 63 40 49 32 41 37 40 43 40 34 33 32 32

Other Characteristics include: Courageous, Imaginative, Caring, Determined, Mature, Ambitious, Loyal, Self-Controlled and Independent.

2.7. QUESTIONS FOR DISCUSSION: • What are the key elements influencing the future of public health in your country, department, province, city, etc?

• What key behaviors do you need to develop as a leader in order to address this future situation?

• Upon your return, what actions might you take to prepare yourself to shape your public health department or program for the future?

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2.8. ACKNOWLEDGEMENTS: • Michael F. Kipp, President, Kipp & Associates • James R. Morgan, CEO, Strategy & Management Dynamics • A. Paul Bradley Jr., President, The Bradley Group, Inc. • American Management Association (AMA)

3. TEAM EXERCISE: CREATING INDIVIDUAL AND SHARED VISIONS Break large group into small teams (5 or 10 people each). Each team appoints: (1) a facilitator who will coordinate team discussions, (2) a representative or reporter who will be responsible for later reporting back to the whole large group, (3) a person(s) who will draw or paint a vision on flipchart paper that will be provided.

The facilitator will coordinate the group’s efforts to reflect or draw an image or idea on a flipchart of the dream or vision of the team of their institution, community, province, city and/or a specific program or service for the Year 2010. The facilitator will instruct team members to be creative and not to concern themselves with their artistic abilities. The result of this process will be a shared vision of good health, quality services, exceptional performance, a state-or-the-art health department, or any other theme.

All team members come back into the large group and the reporter from each small group will bring their group’s shared vision to the front of the room, tape it to the wall and highlight images and ideas generated.

The reporter for the second small group will tape their action vision next to the previous groups and repeat the process. When all shared visions are taped and all group reporters have reported, the result of this process will be a “gallery of collaborative art” reflecting a variety of end goals, outcomes or horizons resulting from the best efforts of public health leaders to protect and enhance the health status and wellbeing of individuals, families, communities and/or the population at large. All program participants form a single line a conduct a walk-through of the gallery of collective art. Once done, a discussion will take place regarding images and ideas generated and the importance of visionary skills.

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Guiding Concepts and/or Questions: • What an effective institution will look like in the Year 2010?

• What a healthy community will look like in the future?

• How will staff, institutions or communities achieve their vision)?

• How will program or service effectiveness be accomplished?

• Who will participate in the process –staff, institutions, communities, sectors of society?

Time: • 30-45 minutes Supplies: • Flipchart pad and easel, thick markers, crayons and masking tape for each team

4. DISCUSSION: CONCEPT PAPER #1: DEVELOPING A VISIONARY LEADERSHIP APPROACH 5. BIBLIOGRAPHY a. Required Readings • Rowitz, Chapters 1, 2 and 3.

• Institute of Medicine of the National Academies: The Future of the Public’s Health. National Academies Press. Washington, DC: 2003. pp. 1 – 18.

• Heifetz, Ronald A. & Linsky, Marty. The Challenge: In Leadership on the Line. Harvard Business School Publishing, Boston, MA, 2002. pp. 1 – 31.

• Institute of Medicine of the National Academies: Insuring Americas’ Health: Principles and Recommendations. National Academies Press. Washington, D.C., 2004. pp. 15 - 65.

• Hesselbein, Frances et al. Leading the Organization of the Future: Chapters 1, 2, 3: In The Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 1 – 19.

• Hesselbein, Frances et al. Leading the Organization of the Future: Chapters 4, 5, 6: In The Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 26 - 59. Institute of Medicine of the National Academies: The Future of the Public’s Health. National Academies Press. Washington, DC: 2003. pp. 19 - 45.

•

Corrigan, Janet M., et al. Fostering Rapid Advance in Health Care: Learning from Systems Demonstrations. Institute of Medicine, Washington, D.C. 2003. pp. 1- 26.

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b. Optional/Recommended Readings: • Drucker, Peter F., et al. Looking Ahead: Implications of the Present. Harvard Business Review.

September – October 1997. pp. 15 – 27.

• Heifetz, Ronald A. & Linsky, Marty. The Response: Get on the Balcony & Think Politically: In Leadership on the Line. Harvard Business School Publishing, Boston, MA, 2002. pp 32 – 76.

• Blank, Martin and Dazberger, Jaquieline. Creating and Nurturing Collaboration in Communities.Washington DC: Institute for Educational Leadership, 1996. pp. 66 – 75.

• Buckinigiham, Marcus & Coffman, Curt. First, Break All the Rules: In What the World’s Greatest Managers Do Differently. New York, NY: Simon & Schuster, 1999. pp. 1 – 15.

• Vaill, Peter B. Permanent White Water: In Managing as a Performing Art, New Ideas for a World of Chaotic Change. Jossey-Bass Publishers. San Francisco, CA. 1989. pp 1 -32.

•

Glassman, Alan M. Rethinking Organization Stability as a Determinant for Innovation and Diffusion. National Institutes of Health. pp. 132 – 146.

• Goleman, Daniel. What Makes a Leader? Harvard Business Review, November-December 1998. pp. 94 – 102.

• Allen, Kathleen E. et al. Rethinking Leadership. Kellogg Leadership Studies Project 1994-1997. pp.40 – 62.

• Chrislip, David. Collaboration: The New Leadership: in The Healthcare Forum Journal.

November- December 1995, Vol. 38 #6. pp. 1 – 12.

II. MODULE 2: LEADING PUBLIC HEALTH INSTITUTIONS 1. LECTURE: TRANSFORMATIONAL LEADERSHIP: a. Overview of Session: • Discussion of leadership experiences and lessons to be learned from them • Leadership fundamentals to be practiced in all leadership settings • Leadership approaches to be used in concert in various settings • Opportunity to set personal leadership objectives

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b. Management and Leadership:

⇓

• Management is about coping with COMPLEXITY

Planning and budgeting

Organizing and staffing

Controlling and problem-solving

⇓

• Leadership is about coping with CHANGE

Setting a direction

Aligning people

Motivating and inspiring

TECHNICAL CHANGE

ADAPTIVE CHANGE

c. What is expected of leaders?

• Improve Performance: Current and future • Symbolize the Organization: Inside and Outside

d. Your experiences with leadership: Break into buzz groups to discuss: • What have been your best and worst moments as a leader?

• What are the most important things you have learned about leadership from your experiences?

e. Leadership fundamentals: • Integrity • High expectations • Learning These are required no matter what approach to leadership you use!!! e.1. INTEGRITY: • The leadership characteristic most often desired by subordinates • What is integrity?

Being honest, trustworthy, fair, acting on principle

• Why is integrity crucial for leaders?

How can leaders promote integrity in their organizations?

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e.2. HIGH EXPECTATIONS: • Leaders elicit better performance than subordinates thought possible • High expectations of leaders can make the difference between a top company and an average company • Setting appropriately high expectations requires good judgment How can anyone with low expectations be a leader?

e.3. LEARNING: • Leaders promote learning

Current knowledge led to current performance

Learning creates potential for performance improvements

Automobile transmission analogy

• How can leaders learn and help their people to learn?

Without learning, you can’t have high expectations and integrity……..

f. Approaches to Leadership: • Leader-based • Relation-based • Follower-based

g. LEADER-BASED LEADERSHIP: • Influence in based on charisma, energy and ideas of the leader • How? By establishing a vision, using symbols and inspiring people • Can create major change, but may make the organization dependent on the leader

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h. What is a vision?

• A vivid concept of what an organization could be • A sign of a leader who is forward-looking and inspiring • A powerful image that must be communicated and reinforced • A yardstick for measuring progress

i. Symbols of leadership: • Communicate messages that cannot be communicated in words • May either reinforce or distract from values and vision • Are often perceived even when not intended

k. Symbols: TYPES • Awards • Furniture • Types of dress • Presence or absence at events • Graphic identity • Where meetings are held

MEANING • Equality or status differences • What is important • Openness to ideas (or not) • Continuity with past (or not) • What do we stand for?

l. RELATIONSHIP-BASED LEADERSHIP: • Influence is based on trust, respect and mutual obligation • How? By building strong relationships • Addresses differences among people • Time-consuming • Creates a lasting ability to get things done • Relationship-based Leadership is not limited to use with subordinates

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m. Factors influencing Relationship-based Leadership: • You (as boss, subordinate, colleague • Relationship-building skills • Effort to build relationship • Other (as boss, subordinate, colleague) • Relationship-building skills • Effort to build relationship • Similarly (demographic, personality) • Situation (opportunity to interact, time pressure) • How have your relationships been shaped?

n. FOLLOWER-BASED LEADERSHIP: • Leading people to lead themselves • Develops next generation of leaders • The leader empowers, coaches, facilitates and gives up control • Makes the most out of follower capabilities • Follower capability and commitment is crucial

o. Empowerment: • Strengthening employees SENSE OF EFFECTIVENESS • Self-confidence • Personal control over decisions • And then granting them the AUTONOMY to assume more responsibility

p. From Leadership on the Line • “Leadership is an improvisational art. You may have an overarching vision, clear, orienting values, and even a strategic plan, but what you actually do from moment to moment cannot be scripted. TO BE EFFECTIVE, YOU MUST RESPOND TO WHAT IS HAPPENNING (page 73)”.

• How accurate is this statement for public health leadership?

• Which leadership approach is most consistent with this requirement?

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q. Developing and approach to leadership: You should consider: • Your capabilities • The capabilities of your followers • The organization’s needs and culture

r. Setting personal objectives for leadership development: • Please write down one or two objectives for improving your leadership performance over the next two months • You will have the opportunity to share these with the class

s. Acknowledgements: • Jim Dean, Associate Dean of Executive Education Program, Kenan-Flager Business School, University of North Carolina, Chapel Hill.

t. Questions and Answers Session

2. INDIVIDUAL SELF-ASSESSMENT EXERCISE: LEADERSHIP AND MANAGEMENT This is a self-assessment tool based upon ideas presented by Burt Nanus in his book Visionary Leadership (Jossey Bass Publishers, 1992) and Burn Nanus and Warren Bennis in their book Leaders: The Strategy for Taking Charge (Harper & Row, 1985). The qualities and behaviors of executives that act in a managerial capacity are listed in the left hand column. The qualities and behaviors of executives that act in a leadership capacity are listed in the right hand column. Please indicate for each pair the approximate percent of time in a typical day (or a week, or a month) that you devote to each capacity, with each line totaling 100% (see next page).

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PERCENT

MANAGEMENT

LEADERSHIP

PERCENT

TOTAL

Maintaining and operating the organization

Innovating and developing the organization

100%

Scheduling and coordinating (asking how and when)

Policy and strategy forming (asking what and why)

100%

Focusing on bottom line (present oriented)

Focusing on long-term (future oriented)

100%

Promoting organization stability and control

Promoting flexibility and change

100%

Problem-solving, dealing with crises

Problem-finding, seeking opportunities

100%

Optimizing resources, maintaining quality

Renewing, transforming the organization

100%

Directing people, seeking compliance

Inspiring people, seeking commitment

100%

Basing decisions on facts, systems procedures

Basing decisions on trust, intuition, vision

100%

Deploying human resources, forming teams/programs

Serving, developing and empowering people

100%

Doing things right, seeking efficiency

Doing the right thing, seeking effectiveness

100% 100%

TOTALS

Final Task: Calculate the overall time you spend in managerial and leadership activities and list reasons or any obstacles that may prevent you from spending more time on leadership.

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3. LECTURE: PUBLIC HEALTH LEADERSHIP PRINCIPLES (PHLP) a. Concept of Change: “In a society capable of renewal, LEADERS not only welcome the FUTURE and the changes it brings but believe they can have a hand in SHAPING that future.

J.W. Garner, Self-Renewal”.

b. 21st Century Challenges: • IDENTITY CRISIS in public health agencies and professionals • Public’s LACK OF AWARENESS of the nature and accomplishments of public health • Parents and friends still ask public health professionals WHAT THEY DO for a living

c. Definition of Leadership: • Leadership is CREATIVITY IN ACTION • It is the ability to see the PRESENT in terms of the FUTURE while maintaining respect for the PAST

d. Public Health Leadership Principles (PHLP): PHLP #1: The public health infrastructure must be strengthened by utilizing the CORE FUNCTIONS OF PUBLIC HEALTH and its ESSENTIAL SERVICES as a guide to the change that should occur.

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PHLP #2: The goal of public health is to IMPROVE THE HEALTH of each person in the community.

PHLP #3. COMMUNITY COALITIONS need to be built to address the communityâ&#x20AC;&#x2122;s public health needs.

PHLP #4. LOCAL, REGIONAL AND NATIONAL public health leaders must WORK TOGETHER to protect the health of all citizens regardless of gender, race, ethnicity or socioeconomic status.

PHLP #5. Rational community health planning requires collaboration between public agency LEADERS AT ALL LEVELS. PHLP #6. Novice public health leaders must LEARN LEADERSHIP TECHNIQUES AND PRACTICES from experiences public health leaders.

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PHLP #7. Leaders, both born and made, must CONTINUOUSLY work to DEVELOP their LEADERSHIP SKILLS.

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PHLP #8. Leaders must be committed not only to lifelong learning but to their own PERSONAL GROWTH. PHLP #9. PHYSICAL, PSYCHOLOGICAL, EMOTIONAL, EOCNOMIC AND SOCIAL HEALTH are all elements of the health of a community.

PHLP #10. Public health leaders should THINK GLOBALLY and ACT LOCALLY

PHLP #11. Public health leaders need to be good managers

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PHLP #12. Public health leaders need to WALK THE WALK (do first what the ask of others).

PHLP #13. Public health leaders need to be PROACTIVE not reactive.

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PHLP #14. EACH LEVEL of the public health system has a NEED FOR LEADERS.

PHLP #15. Public health leaders must PRACTICE WHAT THEY TEACH.

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e. Questions and Answers Session

4. DISCUSSION: CONCEPT PAPER #2: DEVELOPING EMPOWERED LEADERS

5. LECTURE: SWOT ANALYSIS

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6. TEAM EXERCISE AND/OR SELF-DIRECTED STUDY PROJECT AND PAPER #1: THE SWOT ANALYSIS A Needs Assessment is a fundamental component of any Strategic Planning process. This is an appraisal of the key forces that influence the success the organization will have in achieving its mission and goals. These forces may pose either an opportunity or a threat to the organization, such as changes in economic conditions, population, technology, environment, or statutes. Some planers call this element an Environmental Scan. However, many planers use a SWOT Analysis to determine both internal and external factors that could significantly affect the achievement of the general goals and objectives A SWOT Analysis is a strategic planning exercise that gathers information that is used to look at ways to converge and accentuate Strengths and Opportunities and minimize Weaknesses and Threats. This is vital to any strategic plan because it allows planners to systematically and coherently steer clear of obstacles to success in the strategic planning process.

• Strengths are strong attributes or inherent assets; • Weaknesses represent faults and defects in our programs, services, policies or procedures; • Opportunities highlight favorable circumstances or chances for progress, expansion or advance -ment; • Threats describe situations or risks that delay, stop or damage our image, programs or services.

Team Exercise: The class conducts a rapid needs assessment of the China CDC, the Ministry of Health or any other institution. The class is divided into four teams. Each team is responsible for one component of the

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SWOT Analysis. Each team identifies at least five issues related to each component. Each team records findings and conclusions on a flip chart and a representative or reporter presents a summary to the entire class, thus creating a quick SWOT Analysis for teaching, learning and discussion purposes.

Supplies: Flipchart pad and easel, thick markers and masking tape for each group.

Time: 30 to 45 minutes including individual team discussions and presentations from 4 reporters.

7. BIBLIOGRAPHY Required Readings: • Rowitz, Chapters 4 and 14.

• Hesselbein, Frances et al. Leading the Organization of the Future: Chapters 7 & 8: In The Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 71 - 81.

• Zaleznik, Abraham. Managers and Leaders: Are they Different? Harvard Business Review.

March – April, 1992. pp. 2 - 11.

• Institute of Medicine of the National Academies: The Future of the Public’s Health. National Academies Press. Washington, DC: 2003. pp. 46 - 95.

• Edenet, Jill et all. Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. Institute of Medicine, Washington, D.C., 2002. pp. 56 – 128.

• Hesselbein, Frandes et al. Future Leaders in Action: Chapters 9, 10, 11: In The Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 90 – 111.

• Hernandez, Lyla. Editor. Who will keep the Public Healthy? Institute of Medicine, Washington, D.C., 2002. pp. 1 – 16.

• Pearson, Andrall E. Six Basics for General Managers. Harvard Business Review.

July – August, 1989. pp. 1-8.

• Institute of Medicine of the National Academies: The Future of the Public’s Health. National Academies Press. Washington, DC: 2003. pp. 97 – 177.

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Optional/Recommended Readings: • Longest, Beaufort B., et al. Management and Managers: In Managing Health Services Organizations and Systems, 4th Edition. Health Professions Press. Baltimore, MD. 2000. pp 1 – 17.

• Katz, Robert L. Skills of an Effective Administrator. Harvard Business Review. September – October, 1994. pp. 1-12.

• Charan, Ram and Colvin, Geoffrey. Why CEOs Fail. Fortune. June 21, 1999. pp. 69-82.

• Heifetz, Ronald A. & Linsky, Marty. The Response: Hold Steady: In Leadership on the Line. Harvard Business School Publishing, Boston, MA, 2002. pp 124 – 141.

• Heifetz, Ronald A. & Linsky, Marty. The Response: Orchestrate the Conflict & Give the Work Back: In Leadership on the Line. Harvard Business School Publishing, Boston, MA, 2002. pp 102 – 123.

• Goleman, Daniel. What Makes a Leader? Harvard Business Review, November – December 1998. pp. 94 – 102.

• Hersey Paul and Kenneth H Blanchard. 1976. Leader Effectiveness and Adaptability Description. The 1976 Annual Handbook for Group Facilitators. pp. 1 – 14.

• Kotter, John P. What Leaders Really Do. Harvard Business Review, May – June 1990. pp.

3-11.

III. FORMULATING STRATEGY

1. LECTURE: LEADERSHIP APPLICATIONS IN PUBLIC HEALTH a. USA Vision for Year 2010: Healthy People in Healthy Communities b. The Mission of Public Health: “……to fulfill society’s interest in assuring the conditions in which people can be healthy, The Future of Public Health, Institute of Medicine”.

c. Approach and Rationale (The National Academies: Advisers to the Nation on Science, Engineering and Medicine, and The Institute of Medicine): • Health is a public good and a social goal of many sectors and communities

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• Government has fundamental, statutory duty to assure the health of the public, BUT • Government cannot do it alone • There is a need for inter-sectoral engagement in partnership with government

d. Areas of Action and Change (The Future of the Public’s Health in the 21st Century, Institute of Medicine): • FOCUS on population health including the multiple determinants of health • STRENGTHEN the governmental public health infrastructure • BUILD inter-sectoral partnerships • DEVELOP systems of accountability • MAKE evidence the foundation of decision-making • IMPROVE communication

e. Determinants of Population Health

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f. The Public Health System:

g. Core Functions of Public Health • ASSESSMENT: identification of health problems • POLICY DEVELOPMENT: identification of possible solutions • ASSURANCE: Implementation of solutions (programs and services)

g.1. ASSESSMENT

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g.2. POLICY DEVELOPMENT

g.3. ASSURANCE

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h. Core Functions of Public Health and 10 Essential Public Health Services

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i. Relationship of USA Public Health Approach to Public Health Practice

j. Public Health Leadership Framework for the 21st Century: A SYSTEM FOR SUCCSS

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k. Questions for Discussion • What are the three core functions of public health?

• What are the similarities and differences between organizational practices and the essential services of public health?

• What leadership activities are required to implement the core functions of public health?

l. Acknowledgements: •

Healthy People 2010

•

Institute of Medicine

•

The National Academies

•

Louis Rowitz’ Public Health Leadership

m. Questions and Answers Session

2. CLASS EXERCISE: SYSTEMS THINKING a. Class Discussion: Systems Thinking

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b. Class Exercise: Systems Thinking Supplies: • 4 system puzzles Time: • 30 – 45 minutes Class Exercise: • The class is divided into three or four groups. Each group is given a Systems Puzzle that must be assembled as soon as possible. The following discussion is held once all puzzles have been correctly assembled.

Discussion: Systems thinking addresses how components of a whole- such as departments in an organization- connect and relate to one another. The whole is the “system” and the components are “sub-systems”. A major focus of system thinking is the relationships or “forces” within and between sub-systems, as well as forces acting on the whole system.

Ludwig von Bertalanffy (1901- 1972), early pioneer of general systems theory, was one of the most important theoretical biologists of the first half of the 20th century. His work has led many others to view organizations as organisms (rather than machines) having diverse parts that function together as a whole to maintain overall vitality and activity. When we view an organization in this way, we come to understand how leaders can influence the qualities of connection and relatedness that influence the vitality of organizational life.

HOW DO SYSTEMS BEHAVE? 1. Systems behave as though they are persons with lives of their own.

2. Systems regularly act to preserve themselves. They do this by resisting or adapting to change.

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3. Systems maintain both external and internal boundaries.

4. Systems are always internally connected.

5. Systems assign specialized roles to their members.

6. Systems develop rules and rituals to bond members to one another and thus to maintain and preserve the group.

7. What actually happens in a system is what the system intends to happen.

LEADERS USE SYSTEMS THINKING TO… • Remember that no sub-system exists independent of another. Leaders consider how the tensions of interconnectedness and interdependence play and influence all sub-systems as well as the whole system.

• Focus on the “goodness of fit” between members of a system, not on individual strengths and weakness.

• Regard the actual and potential adaptability of the system, not just what challenges and problems it faces.

• Consider the states of equilibrium and disequilibrium versus stability.

• Notice that many situations require managing, not solving.

• Regard ambiguity and uncertainty as not only sources of anxiety, but of creativity and growth too.

• Consider that demands for many “first order” responses may indicate the need for “second order” responses.

3. DISCUSSION: CONCEPT PAPER #3: BUILDING INTERNAL AND EXTERNAL PARTNERSHIPS

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4. LECTURE: LEADERSHIP AND THE PLANNING PROCESS a. Quote: • “We live in a world where NO ONE IS IN CHARGE. No organization, or institution has the legitimacy, power, authority, or intelligence to act alone on important public issues and still make substantial headway against the problems that threaten us all. J. M. Bryson and B.C. Crosty, Leadership for the Common Good”.

b. Leadership and Planning: • No matter what changes occur in the world of public health, PLANNING will occupy much of the work of their leaders.

• STRATEGIC THINKING SKILLS are essential for all varieties of planning.

• Strategic planning must be driven by the big picture –the leader’s vision of the future.

c. Community Health Planning: • Use approach that generates INNOVATIVE public health STRATEGIES • Keep in mind CORE FUNCTIONS, ORGANIZATIONAL PRACTICES AND ESSENTIAL PUBLIC HEALTH SERVICES. • Develop outcome scenarios for those engaged in planning to have options to choose from.

d. Planning Steps: Planning does not eliminate change but rather fosters change. Planning is a form of RATIONAL DECISION MAKING: • Decide on GOALS AND OBJECTIVES • Determine CONSTRAINTS • Figure out what ACTIONS, POLICIES and PROGRAMS to implement

e. Planning Responsibilities: Assessment is a pre-requisite for planning.

• USE core functions of public health as a foundation • LEARN different planning methodologies • DETERMINE actions necessary to achieve community health goals and objectives • USE premising and scenario building to discover innovative public health strategies • BE INVOLVED in formal planning activities • CREATE community partnerships to carry out planning Public Health Leadership and Management for the 21st Century

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f. Planning Models: Planning models, individually or jointly, are all useful for turning a vision into programs and services.

• Continuous Quality Improvement (CQI) • Re-engineering • Re-inventing government • Strategic Planning

f.1. CONTINUOUS QUALITY IMPROVEMENT • Related to Total Quality Management (TQM) • “|The culture of the organization is defined by and supports the constant attainment of CUSTOMER SATISFACTION through an integrated system of tools techniques and training, A.V. Feingenbaum”.

f.2. RE-ENGINEERING • Restructuring of an organization • “The RAPID AND RADICAL REDESIGN of strategic, value-added business processes –an the systems, policies, and organizations structures that support them—to OPTIMIZE THE WORK FLOWS AND PRODUCTIVITY of an organization, Manganelli and Klein”.

f.3. RE-INVENTING GOVERNMENT • The use of ENTREPRENEURIAL TECHNIQUES by those in the public sector.

• “The fundamental TRANSFORMATION OF PUBLIC SYSTEMS AND ORGANIZATIONS to create dramatic increases in their effectiveness, efficiency, adaptability, and capacity to innovate, Osborne and Plastrik”.

f.4. STRATEGIC PLANNING • Review PARTICIPATORY STRATEGIC PLANNING Lecture

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g. Strategic Planning Terms:

VISION

MISSION

STRATEGIES

TACTICS

GOALS

OBJECTIVES

h. Strategic Planning Guidelines: A Team Process: • Set a DEALINE • Consider how to get the PLAN APPROVED • Create a SCHEDULE for the planning process • DISSEMINATE the results (plan) • Decided on techniques to EVALUATE PROCESS

Community-Oriented Health SystemsPlanning Planning i. Community-Oriented Health Systems

NEEDS ASSESSMENT

COMMUNITY

SYSTEM PERFORMANCE ASSESSMENT

SYSTEM DESIGN

PROVIDERS

ORGANIZATIONAL PERFORMANCE ASSESSMENT

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h. Public Health Leader’s Responsibilities: • LEARN the benefits of planning • PERFORM a stakeholder analysis • EXPAND strategic planning process to community • REMAIN optimistic and motivate others • Do homework to PREPARE for each step • BE REALISTIC about possibilities • PERFORM assessment of organizational capability

j. Public-Private Partnerships: • Public health agencies LEAD THE WAY but CANNOT CARY OUT ALL PUBLIC HEALTH ACTIVITIES needed to protect and improve the health of a community.

• New types of alliances and partnerships:

Joint Ventures

Research sharing

Community-based projects and programs

Semi-structured alliances

k. Public Health Leader’s Responsibilities: • Develop public and private relationships • Share power and responsibilities • Become involved in community activities • Join local community groups and organizations • Act to gain the trust of the community

l. Conclusions: • The NEEDS of the public are constantly CHANGING. • Public health agencies must RESPOND to the changes.

• The first step in responding adequately is to develop a PLAN OF ACTION. • Creating a VISION is not enough. A STRATEGY is needed

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m. Questions and Answers Session Public Health Leadership and Management for the 21st Century

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5. LECTURE & CLASS EXERCISE: ASSET-BASED COMMUNITY DEVELOPMENT a. What determines health?

1. Individual behavior 2. Social relations 3. Physical environment 4. Economic status 5. Access to health care 1 to 4 are least affected by traditional public health interventions but often determine community health.

b. Link between Associational Communities and Health: • “SOCIAL CONNECTEDNESS is one of the most powerful determinants of our weel-being, Robert Putnam, Harvard University”.

c. Health System Tool

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d. Community Tool

e. Realities of the Two Tools

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f. Two Tools for Well-Being

h. Half Empty or Half Full?

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i. Asset-Based Community Development: • “A way of seeing communities as rich in the TALENTS, ABILITIES and CAPABILITIES of its PEOPLE, VOLUNTARY ASSOCIATIONS and INSTITUTIONS, John McKnight, Northwestern University”.

j. Local Assets: • INDIVIDUALS: the talents, gifts, skills and capacities of local residents • LOCAL CITIZEN ASSOCIATIONS: small, face to face groups where members do the work • INSTITUTIONS: non-profits, government and businesses that can support community development work

k. Neighborhood Needs Map

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l. Neighborhood Assets Map

m. Question? Who are the individuals, local citizen associations and institutions in your community? n. Community Needs Matrix

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o. Community Assets Matrix

p. Community Assets Map:

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q. Commuinity Assets Map:

COMMUNITY ASSETS MAP

LOCAL INSTITUTIONS CITIZEN’S ASSOCIATIONS

FITNESS CENTERS

GIFTS OF INDIVIDUALS

BOOK CLUB

LAURIE: Writer & Herbalist LILIA: Bike riding & Repair

MAY: Artist & Yoga Practitioner

PUBLIC LIBRARY

ST. SOPHIA’S CHURCH

DAIRY COUNCIL

MARK: Bilingual & Carpenter

SCOUTS

POLICE DEPARTMENT

KARATE CLUB

TENANT ASSOCIATION

YMCA AMERICAN LUNG ASSOCIATION

JUAN: Cook & Soccer Player

SORORITIES

MASTER GARDENERS

SIERRA CLUB NATIVE PLANT SOCIETY

ASIANAMERICAN COMMUNITY CENTER

VENDING MACHINE OPERATORS

SCHOOL DISTRICT

PTA

KIM: Gardener & Power Walker BRIAN: Coach & Organizer

CITY PARKS

TEACHER’S UNION

GROCERY STORES

BOYS & GIRLS CLUB

FARMER’S MARKET

6. LECTURE: PARTICIPATORY STRATEGIC PLANNING a. What is Strategic Planning?

• “An orderly PROCESS for ENVISIONING an organization’s desired FUTURE and determining the required ACTIONS to attain that future, Strategic Planning Concepts”.

• “Strategic Planning is the PROCESS by which the GUIDING MEMBERS of an organization ENVISION its future and develop the necessary PROCEDURES and OPERATIONS to achieve that future, EnTarga Business Planning”.

• “If I ran my BUSINESS like you run the GOVERNMENT, I’d be out of business in less than a year.

Can’t you run the government more like a business, GPRA 1993”.

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• “Strategic Planning is a PROCESS by which an organization can become all it wants to become”.

• “Strategic Planning involves the future impact of present decisions”.

• “Planning is the rational determination of where you are, where you want to go, and how you will get there”.

b. What is Strategic Planning? Preferred Definition: • “Strategic Planning is a CONTINUOUS and SYSTEMATIC PROCESS, where PEOPLE make DECISIONS about intended future OUTCOMES, how outcomes are to be accomplished, and how SUCCESS is measured and evaluated, Phillip Blackberry 1993”.

c. Key Words: • Continuous • Systematic • Process • People • Decisions • Outcomes • Success

d. Approaches to Planning: • REACTICE: Past-oriented • INACTIVE: Present-oriented • PREACTIVE: Predict the future • PROACTIVE: Create the future

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e. Question? What are the BENEFITS of Strategic Planning?

1.

Focus is placed on IMPORTANT THINGS

2.

Raise an awareness and impact of CHANGING ENVIRONMENT

3. Analyze the internal business CULTURE 4.

Become aware of organizationâ&#x20AC;&#x2122;s POTENTIALS

5.

Identify and analyze available OPPORTUNITIES

6.

May bring about NEEDED CHANGE

7.

Identify STRATEGIC ISSUES

8.

Set more REALISTIC OBJECTIVES

9.

Obtain better information for DECISION-MAKING

10. Accelerate and improve GROWTH 11. Identify POOR PERFORMING AREAS 12. Gain control of operational PROBLEMS 13. Develop better COMMUNICATIONS 14. A ROAD MAP of location and direction 15. Better INTERNAL COORDINATION of activities 16. A FRAMEWORK for budgets and operational plans 17. Gain a SENSE OF SECURITY among employees

f. Question? What are the pitfalls to Strategic Planning?

1.

Jumping from mission formulation to strategy development

2. Top management fails to communicate strategic plan 3. Management rejecting the formal planning mechanism 4. Failing to use the plans as a standard for measuring performance 5. Top management delegating function to a planner 6. Failure to create a climate which is collaborative 7. Not treating planning as a integral part of the whole process 8. Insufficient time spent on planning due to current problems 9. Becoming so formal that process lacks flexibility and creativity

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g. Six Basic Elements of Strategic Planning:

h. The Strategic Planning Process:

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i. Questions and Answers Session

7. CLASS DISCUSSION: CONCEPT PAPER #4: BUILDING SUPPORT FOR A STRATEGIC PLAN 8. SELF-DIRECTED STUDY PROJECT & PAPER #2: CREATING A STRATEGIC AND AN IMPLEMENTATION PLAN Required Readings: •

Rowitz, Chapters 6 and 10 and 15.

•

Institute of Medicine of the National Academies: Setting the Course: A Strategic Vision for

Immunizations. Los Angeles, CA., 2003. pp. 1- 38.

•

Hamel, Gary. Strategy as Revolution. Harvard Business Review. July – August 1996. pp. 21 – 33.

•

Institute of Medicine of the National Academies: The Future of the Public’s Health. National

Academies Press. Washington, DC: 2003. pp. 178 – 211 and 212 – 267.

•

Hesselbein, Frandes et al. Future Leaders in Action: Chapters 12, 13, 14 & 15: In The Leader of

the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 121 – 141.

•

David, Jonathan R. et al. Strategic Planning: in Public Health Systems and Emerging Infections.

Institute of Medicine, Washington, D.C., 2000. pp. 1 – 28 and 68 – 74.

•

Gray, Daniel H. Uses and Misuses of Strategic Planning. Harvard Business Review.

January – February 1986. pp. 88 – 97.

•

Mintzberg, Henry. The Rise and Fall of Strategic Planning. Harvard Business Review,

January – February, 1994. pp 107 – 114.

Optional/Suggested Readings: •

Berkowitz, Eric. 1996. Marketing Strategy: In Essentials of Health Care Marketing. pp. 3 – 38.

•

Berry, F.S., & Wechsler, Barton. State Agencies Experience with Strategic Planning. Public

Administration Review. March – April, 1995, Vol. 55, No 2. pp. 159 – 168.

•

Ginter, Swayne. Developing Strategic Alternatives and Strategic Choice: In Strategic

Management of Health Care Organizations. 2002. pp. 191-249.

•

Collins, J.C., & Porter, J.I. Building Your Company’s Vision. Harvard Business Review.

September – October 1996. pp. 64 – 77.

•

Heifetz, Ronald A. & Linsky, Marty. Body and Soul: In Leadership on the Line. Harvard

Business School Publishing, Boston, MA, 2002. pp 163 – 225.

•

Ghosh, Shikhar. Making Business Sense of the Internet. Harvard Business Review. March –

April 1998. pp. 16 – 34.

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•

Porter, Michael E. What is Strategy? Harvard Business Review. November – December 1996.

pp. 1 – 22.

IV. LEADING AND MANAGING CHANGE 1. LECTURE: LEADERSHIP AND ORGANIZATIONAL CULTURE a. The historical leadership question: • What should the leader of the future be like?

b. What is not new: • Leadership depends on organizational dynamics:

-Specific Situation

-Task to be performed

-Characteristics of the leader’s subordinates

Organizations have different needs and problems at different stages in their evolution

c. Relationship between the Leader and the Organization: • Organizations are DYNAMIC SYSTEMS:

-They have a life cycle with unique challenges and implications for leadership behavior:

--ENTREPRENEURS: people who create organizations

--CHIEF EXECUTIVE OFFICERS, PRESIDENTS OR EXECUTIVE DIRECTORS: people who run

organizations

d. Four challenges that will not change: 1. Creating 2. Building 3. Maintaining, and 4. Changing (evolving) organizations to new forms 68 Public Health Leadership and Management for the 21st Century

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d.1. CREATING: THE LEADER AS ANIMATOR • Supply the ENERGY to get the organization off the ground:

-Try one approach after another

-Face repeated failures

-Transmit energy to subordinates

• Energy born out of strong PERSONAL CONVICTIONS

-Motivate entrepreneurs

-Builds excitement in others

• Leaders breath life into the organization (ANIMATORS) d.2. BUILDING: THE LEADER AS CREATOR OF CULTURE • Entrepreneur’s beliefs, values and basic assumptions are transferred to the mental models of the subordinates:

-Hiring and keeping similar staff

-Training and building relationships with staff (thinking and feeling)

-Behaving as a role model

• The leader’s personality becomes embedded in the culture of the organization • CULTURE DEVELOPMENT:

Conflicts, inconsistent Excellence, quality, policies, uneven clarity, high productivity, patterns of strengths efficiency, great customer and weaknesses, low service, responsiveness, productivity and morale, opportunities, reliability, frustration, staff turnover commitment

• Once culture is embedded in the organization, it cannot easily be changed 69 Public Health Leadership and Management for the 21st Century

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d.3. MAINTAINING: THE LEADER AS A SUSTAINER OF CULTURE • What was good for the YOUNG ORGANIZATION (high energy level and compulsive vision of its founders: creators and builders) may become a liability as the organization finds that it needs to:

-Stabilize itself

-Become more efficient

-Deal with the fact that its products have become commodities (services)

-Evolve new generations of leaders for the future

• CULTURE TRANSITION PROBLEMS: 1. The founder-builder does not want to let go of the leadership role or is emotionally incapable of doing so.

2. The founder-builder creates a variety of organizational processes that prevent the growth of the next generation of leader • Problem: Prevent or undermine potential successors from learning or taking over

• APPROACH OF SUCCESSFUL LEADERS

-Successful leaders at this stage either:

--Have enough personal insight to GROW with the organization and CHANGE their own outlook, or

--Recognize their own limitations and permit OTHER FORMS OF LEADERSHIP to emerge

• Judgment and wisdom are most critical at this stage of organizational evolution

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d.4. CHANGING: THE LEADER AS CHANGE AGENT • The rate of change of technological, economic, political and socio-cultural environmental forces leaders to think like change agents:

-Challenge 1: How to acquire new concepts and skills

-Challenge 2: How to unlearn the things that no longer serve us well

--Anxiety, defensiveness and resistance to change

e. In Problematic Organizations…….

• Leaders need EMOTIONAL STRENGTH to be supportive of the organization while it unlearns processes previously successful (PSYCHOLOGICAL SAFETY) • Leaders need a TRUE UNDERSTANDING of cultural dynamics and the properties of their own organization culture • Therefore: --Leaders cannot arbitrarily change culture

--Leaders evolve culture by building on its strengths and letting weaknesses atrophy over time

f. Culture Change = Cognitive Redefinition 1. NEW SEMANTICS: redefining individualism 2. BROADEN PERCEPTIONS: expanded mental model of individualism that includes collaborative work 3. NEW JUDGMENT AND EVALUATION STANDARDS: change negative competitive behavior to positive collaborative behavior Culture is “changed” ---in reality, EXPANDED, through changes in various key concepts in the mental models of people who are the main carriers of culture

g. Enlarged and Broadened Mental Models: Example 1: A native of GUATEMALA becomes American. He/she does not give up being Guatemalan but adds what it means to be American to his personality.

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Example 2: An organization built on INDIVIDUAL INCENTIVES does not accept teamwork: • Reward individuals for helping others and contributing to other projects:

-Deep individualism is acknowledged

-Concept is broadened to include working with others, building trusting relationships

and opening communication across boundaries

h. Culture Transformation: • A genuine change in the leader’s behavior:

-Walk the Walk and Talk the Talk

• Leaders undergo a personal transformation as part of the total change process

i. Successful Survival Characteristics: • A COMMITMENET to:

-Learning

-Change

-Staff, communities and stakeholders

-Building a healthy, flexible organization

• Without such culture core organizations cannot survive in the long run

j. A look toward the future: • BUILDERS have a strong vision, conviction and energy to create an organization • MAINTAINERS have great judgment, wisdom and skill to develop teams to institutionalize processes • CHANGERS have learning ability and personal flexibility to evolve and change organizations

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k. Perpetual Learning: • Institutions of the past may be obsolete requiring new forms of governance to be learned • Learning is an ongoing process not a one-time event • Perpetual learning and change will remain CONSTANT

l. Characteristics of Future Leaders: 1. Extraordinary levels of perception and insight 2. Extraordinary levels of motivation 3. Emotional strength to manage their own and other’s anxiety 4. Skills in analyzing cultural environments 5. Willingness and ability to involve others and elicit their participation 6. Willingness and ability to share power and control according to people knowledge and skills

m. Leadership: An Emerging Function:

TODAY

FUTURE

The process of appointing Leaders will leaders is a critical be PERPETUAL function of board of DIAGNOSTICIANS able to directors, electorates, empower different people government agencies, etc. at different times and let emerging leadership flourish

n. The Leader of the Future: 1. Can lead and follow 2. Is central and marginal 3. Is fluid within the hierarchy of the organization 4. Is individualistic and a team player 5. Is a perpetual learner 73 Public Health Leadership and Management for the 21st Century

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o. Conclusion: • If an organization is to learn to manage itself better, MORE PEOPLE will have to be leaders and leadership functions will have to be MORE WIDELY SHARED

p. Acknowledgements: • Edgar H. Schein, Professor of Management, Sloan School of Management, Massachusetts Institute of Technology

q. Questions and Answers

2. INDIVIDUAL EXERCISE: TIME MANAGEMENT MATRIX

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3. LECTURE: PEACETIME MANAGEMENT AND WARTIME LEADERSHIP a. Peacetime Conditions: • Predictable events • Sense of comfort and control • No crisis or chaos • Top-down approach • Standard procedures • No major change is needed • People are content with what already exists • Change involved gentle “tweaking” of the system

b. Peacetime Management: • Incremental modification of what already exists • No major disruption or emotional consequences • No sense of urgency • Leaders occupy positions that have power

c. Problem or Challenge: • Common conflict between those who want to lead others through a major change as though it were wartime and those who refuse to become followers, insisting that it is still peacetime.

d. Wartime Conditions: • Change and transition • Crisis and urgency • Uncertainty and turbulence • Fear, apprehension and exhaustion • Downsizing and ongoing reorganization • Budget deficits and spending cuts • Get more done and faster with less staff

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e. Wartime Conditions in the Health Sector in Los Angeles: • Health disparities: infant mortality, diabetes, HIV infections • Overweight and obesity • Bioterrorism, SARS, emerging infectious disease outbreaks • 2.8 million emergency room visits per year • 3.1 million people with no medical insurance • 35% with no dental insurance • 236,000 homeless people

f. Wartime Conditions in the Health Sector in Service Planning Area 3 & 4 (or the specific geographical area where course is being or training is taking place): • CLASS DISCUSSION: -What are the public health challenges, issues or problems that make the current health sector in your jurisdiction a wartime situation?

g. Wartime Leadership: • Problem or Challenge: We have to learn to become wartime leaders, people who embrace major change because they see far more opportunity than threat in turbulence.

Wartime Leadership:

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Desired Future:

g. Psychological Leadership: An Emotional Bond:

PSYCHOLOGICAL LEADERSHIP: AN EMOTIONAL BOND LEADERS GENERATE • COMPETENCE • CERTAINTY • ACTION • STRENGTH • EXPERTISE • COURAGE • OPTIMISM

• FRIGHTENED • VACILLATING • HESITATION • WEAKNESS • FLOUNDERING • COWARDICE • CYNICISM

Conviction that the future will be better

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h. Leadership Characteristics of the Future

LEADERSHIP OF THE FUTURE People are known MORE for...

People are known LESS for...

• WHAT THEY DELIVER • EXPERTISE AND COMPETENCE • WHAT THEY SHAPE • MIND SETS THEY BUILD

• WHAT THEY SAY • TITLE AND POSITION • WHAT THEY CONTROL • GOALS THEY SET

People are known for great personal credibility and organizational capabilities

i. A Learning Organization:

A LEARNING ORGANIZATION MOST DIRECT LEADERSHIP

LESS DIRECT LEADERSHIP

• Commands • Decision about resources & Promotion • Personal Guidance of Individuals & Teams

MOST INDIRECT LEADERSHIP

• Communicates & Inspires Vision & Values • Listens to & Cares for Followers • Leads By Personal Example

• Creates Conditions of Freedom • We Did it Ourselves • Many Leaders

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4. CONCEPT PAPER #5: IMPLEMENTING ADAPTIVE LEADERSHIP 5. LECTURE: MANAGING PERSONAL AND ORGANIZATIONAL CHANGE a.

The Way Change Happens:

80% LEADERSHIP

20% MANAGEMENT

• Establishing direction • Planning • Aligning

• Budgeting

• Motivating

• Organizing

• Inspiring people

• Problem solving

• The single biggest impetus for change in an organization tends to be a new manager in a key job who sees that the status quo is unacceptable

b. The Change Grid:

EXTERNAL/ENVIRONMENT

PAST

DENY

PAST

RESIST

EXPLORE

INTERNAL/SELF

FUTURE

COMMIT

FUTURE

c. Change Style Preferences:

CONSERVERS

PRAGMATISTS

ORIGINATORS

ACCEPT the structure

EXPLORE the structure

CHALLENGE the structure

PREFER change that is incremental

PREFER change that is functional

PREFER change that is expansive

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d. Collaboration:

CONSERVERS

PRAGMATISTS

ORIGINATORS

Prefer to keep current structure operating smoothly

Prefer balanced inquiry

Prefer to challenge accepted structure

Focus on relationships

Focus on shared objectives

Focus on taking risk

Encourage building on what is already working

Encourage looking at the Encourage exploring new possibilities current circumstances

e. Style Summary: CONSERVERS *

CONTRIBUTIONS TO ORGANIZATION • Get things done well on schedule • Work well within organizational structure • Attend to detail and factual information • Demonstrate strong follow-through skills • Encourage and adhere to routine • Respect rules and authority • Handle day-to-day operations efficiently

LEADERSHIP STYLE • Reward following the rules while getting the job done • Attend to practical organizational needs • Expect organizational policies, procedures and rules to be followed • Lead through reliable, stable and consistent behavior • Promote the traditional values of the organization *1999 Discovery Learning, Inc.

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f. Style Summary: PRAGMATISTS * CONTRIBUTIONS TO ORGANIZATION • Address needs as they arise

LEADERSHIP STYLE • Facilitate problem solving among people

• Get things done in spite of the rules, not • Use and adapt past experiences to solve because of them current problems • Negotiate and encourage cooperation and • Build cooperation rather than expecting it compromise • Use a facilitative approach in managing • Take a realistic and practical approach people and projects • Draw people together around a common purpose

• Encourage the organization to have congruence between values and actions

• Organize ideas into action • Have short and long-range perspectives *1999 Discovery Learning, Inc.

g. Style Summary: ORIGINATORS * CONTRIBUTIONS TO ORGANIZATION

LEADERSHIP STYLE

• Understand complex problems

• Catalysts for systemic change

• Bring strong conceptual and design skills

• Energetic and enthusiastic

• Push the organization to understand the system as a whole • Support and encourage risk taking behavior • Provide future-oriented insights and vision • Serve as catalysts for change • Initiative new ideas, projects and activities

• Provide long-range vision • Conceptualize and build new models • Constantly reorganize the whole system • Like to be in charge of the start-up phase • Prefer unique leadership roles to conventional roles • Manage more than one task a the same time

*1999 Discovery Learning, Inc.

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h. Organizational Change: • Leaders alter the way their organizations do business to cope with CHANGE:

-Total Quality Management

-Reengineering

-Reinventing Government

-Mergers and Acquisitions

-Turnarounds • No organization ---large or small, local or global—is immune to change

i. Eight Steps to Transform an Organization: 1. Establish a sense of URGENCY 2. Form a powerful guiding COALITION 3. Create a VISION 4. COMMUNICATE the vision 5. EMPOWER OTHERS to act on the vision 6. Plan for and create SHORT TERM WINS 7. CONSOLIDATE IMPROVEMENTS and produce still more change 8. INSTITUTIONALIZE new approaches • Leading by example is essential to communicating a vision • Leaders balance short-term results with long-term vision

j. Four Sources of Failure: 1. Writing a memo instead of lighting a fire 2. Talking too much and saying too little 3. Declaring victory before the game is over 4. Looking for someone to blame in the wrong places • These common mistakes suggest THREE KEY TASKS FOR CHANGE LEADERS j.1. TASK #1: MANAGING MULTIPLE TIME LINES

• TIME: key strategic resource • Meaningful change takes time Public Health Leadership and Management for the 21st Century

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• Create Short-Term Wins

--Effective leaders make organizational change an ongoing, multiphase process j.2. TASK #2: BUILDING COALITIONS • Engaging the RIGHT TALENT • Growing the COALITION strategically • Working as a TEAM, not just a collection of individuals --Leaders face resistance and must win the support of employees, partners, customers and investors j.3. TASK #3: CREATING A VISION • CLEAR intention • APPEALING to stakeholders • AMBITIOUS yet attainable --A vision of the future is more emotional than rational

k. CONCLUSION: • Leaders exist at all levels of an organization • They are interested in a noble cause • They see things with fresh eyes and challenge the status quo • They connect people’s everyday work to a larger purpose • They continue to take risks and are open to people and ideas • They are driven by goals bigger than what any individual can accomplish and invest tremendous talent, energy and caring in their change efforts • However, the most notable trait of great change leaders is their quest for learning.

l. Questions and Answers Session.

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6. CASE STUDY: THE U.S. CENTER FOR DISEASE PREVENTION AND CONTROL (CDC) FUTURES INITIATIVE a. The Futures Initiative: Achieving Health Impact b. Why Change Now? • Aging population • Emerging global infectious diseases • Obesity • Development of public health workforce and infrastructure • Health disparities

c. Strategic Imperatives: • Health impact • CDC will be a customer-centric organization • Public health research • Leadership for the nation’s health system • Global health • Effectiveness and accountability

d. Health Protection Goals: • PREPAREDNESS: People in all communities will be protected from infectious, environmental and terrorist threats • HEALTH PROMOTION AND PREVENTION OF DISEASE, INJURY AND DISABILITY: All people will achieve their optimal lifespan with the best possible quality of health in every stage of life

e. Organizational Design Principles: • Strategy and goals derive from population health assessments (customers’ health) to achieve health impact • Strategy and goals drive agency’s priorities and allocations • Emphasis on research and innovation • Health protection “marketing” • Consolidation of business and other cross cutting services 85 Public Health Leadership and Management for the 21st Century

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f. Life-Stages • INFANT: By 2015, the U.S. is one of five countries with the highest rates of infant survival (Baseline 28th, 1999).

• CHILD: By 2015, mortality is reduced 20%, saving an additional 800 lives per year (NCHS Baseline).

• TEEN: By 2015, at least 95% of adolescents practice behaviors which protect them from illness and injury now and in the future (NHIS Baseline) • ADULT: By 2015, at least 90% of adults have a healthy weight (NHANES Baseline) • SENIOR: By 2015, average lifespan of older Americans is increased by 2 years

g. The New CDC Organizational Chart

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h. Coordinating Center Roles • Minimize silos • Identify and capitalize on opportunities for coordination of research • Decrease duplication and redundant activities • Provide leadership, management and accountability for cross-center goals

i. Center Roles: • Foundation of CDC’s scientific knowledge • Accountable for quality of programs • Meet statutory requirements • Maintain center’s identities and disease prevention loci

j. CDC’s Futures: FROM

TO

Focus on process

Focus on health impact

Primary focus on infectious disease and preparedness

Primary focus on infectious disease, preparedness and prevention

Disease specific, fragmented global approach

Comprehensive integrated global approach

Inefficient work processes

Efficient work processes

Silos organization

Integrated coordinating centers (maintaining specialization)

No overall measure of success

Clearly articulated goals and performance measurement

Lack of customer segmentation

Segmented customer approach

Limited partner capacity (state and local health departments)

Strong partner network: (a) revitalized state and local health departments, and (b) media, business, health care delivery, schools, communities

Minimal applied research

Increase external/internal agenda

Fragmented approach to customers and partners

Integrated approach to customers and partners

Difficult to do business with

Easy to do business with (standard of good goverenment)

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k. CDC’s Futures Initiative: VISION: IMAGINE A TIME WHEN: • Every infant is born healthy • All children go to school safe, healthy and ready to learn • All people have the knowledge, ability and support to make healthy choices • All people live in communities that are protected from infectious, environmental and terrorism health threats • All people live their full life expectancy and achieve lifelong independence • All people are satisfied with their health status

l. Communicate: • Futures Initiative: IMPROVING HEALTH IMPACT • http://www.cdc.gov/futures

m. Questions and Answers Session

7. LECTURE: SERVANT LEADERSHIP: a. Questions: • What is Leadership? What is Servant Leadership?

b. Becoming a Servant Leader: Do you have what it takes? Ten Principles of Servant Leadership: • Listening • Empathy • Healing • Awareness • Persuasion • Conceptualization • Foresight • Stewardship • Commitment to the Growth of People • Building community

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c.

The Leader Who Serves:

WILL THE LEADER PLEASE STAND UP? BUT

NOT • Person with most distinguished title

• Role model

• Highest paid person in the group

• Risk taker

• Person with best car or home

• Servant

• Person who promotes him/herself

• Promoter of others

• The Administrator

• The initiator

• The taker

• The giver

• The talker

• The listener

d. Servant Leaders: Characteristics • Listen and learn from those they lead • Work at making themselves available • Their door is always open • Talk and listen to people at all levels of the organization • Walk a mile in the other person’s shoes • Become frantic learners • Avoid the trap of success –the arrogance of ignorance • Promote diversity recognizing people’s differences strengthens the group • Are value-driven and performance-oriented • Lead people to do things the right way and to do the right thing • Acknowledge no one person can accomplish the task alone

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e. Why is Servant Leadership Needed? e.1. VISION STATEMENT: • A world free from pain and suffering • A world free from disease • A world where people’s bodies are empowered to perform at their optimal levels • A world where true health and wellness enable people to be absolutely the best they can be with the conditions they were given and the situation in which they now live e.2. GLOBAL BURDEN OF DISEASE:

In the early 1900’s, the world’s leading causes of premature deaths were infectious diseases: • Diphtheria

Today, the world’s leading causes of premature deaths are degenerative ‘ diseases:

• Cardiovascular disease (16.7 M)

• Influenza

• Cancer (8.6 million)

• Tuberculosis

• Stroke (5.5 million)

• Pneumonia

• Respiratory Disease (3.7 million)

According to leading health authorities:

• 600 million suffer from high blood pressure • 300 million are obese • 194 million suffer from diabetes • 165 million suffer from arthritis • 130 million suffer from asthma

• Diabetes (990,000) • 33% of children born in America today are expected to develop Type 2 Diabetes. For black and Hispanic children, the number jumps to 50%.

Sources: World Health Organization, The Arthritis Foundation,

The Internal Diabetes Foundation, and The U.S. CDC.

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e.3. MAIN CHRONIC DEGERATIVE CONDITIONS: • Heart disease • Cancer • Stroke • Diabetes • Osteoporosis • Arthritis • Alzherimer’s • Obesity e.4. CHANGE IN MENTAL MODEL:

e.5. DEFINING THE PROBLEM: GLOBAL • 1/10 people (10%): World Mortality: INJURIES • 3/10 people (30%): World Mortality: INFECTIOUS DISEASES • 6/10 people (60%): World Mortality: CHRONIC DISEASES • 7/10 people (70%): USA Mortality: CHRONIC DISEASES • 8/10 people (80%): Los Angeles Mortality: CHRONIC DISEASES e.5. DEFINING THE PROBLEM: MACRO • Government has a duty to assure the public’s health • Government cannot do it alone, other sectors have a role to play • Need for inter-sectoral engagement

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e.6. DEFINING THE PROBLEM: MICRO • 10 million people in Los Angeles County • 236,000 homeless • 53% low literacy rate • 31% no medical insurance • 35% no dental insurance • Budget constraints (reduction in force, downsizing, and closure of clinics, emergency departments and hospital services and trauma centers) e.7. BECOMING A LEARNING ORGANIZATION

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e.8. SPA 3 & 4 ORGANIZATIONAL CHART (Service Planning Area 3 (San Gabriel Valley) and Service Planning Area 4 (Metropolitan Los Angeles)

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f. Questions and Answers Session

8. CLASS DISCUSSION: CONCEPT PAPER #6: COMMUNICATING CHANGE 9. BIBLIOGRAPHY Required Readings: • Rowitz, Chapter 11 and 12.

• Labovitz, George et al. The New Leadership: Taking Charge of Change. Organizational Dynamics, Inc. Burlington, MA. 2000. pp. 1 - 8.

• Institute of Medicine of the National Academies: Transforming Institutional Climate to Enhance Diversity: in In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Worforce. Washington, D.C. 123 – 152.

• Hesselbein, Frandes et al. Learning to Lead for Tomorrow: Chapters 16, 17, 18, & 19: In The Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 149 – 189. Institute of Medicine of the National Academies: The Future of the Public’s Health. National Academies Press. Washington, DC: 2003. pp. 268 – 306.

• Institute of Medicine of the National Academies: The Future of the Public’s Health. National Academies Press. Washington, DC: 2003. pp. 307 – 357.

• Hesselbein, Frandes et al. Learning to Lead for Tomorrow: Chapters 20, 21, 22, 23: In The Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 199 – 227.

• Kohn, Linda T. Academic Health Centers: Leading Change in the 21st Century. Institute of Medicine, Washington, D.C., 2003. pp. 1 – 20 and 87 – 110.

• Duck, Jeanie D. Managing Change: The Art of Balancing. Harvard Business Review. 1993.

71(6):109-118.

Optional/Suggested Readings: • Kotter, John P. Leading Change: Why Transformation Efforts Fail. Harvard Business Review 1995. 73(2): 59-67.

• Conger, Jay A., et al. Leader’s Change Handbook: An Essential Guide to Setting Direction and Taking Action. San Francisco, CA. Jossey-Bass Publishers, 1999. pp. 1 – 45.

• National Institutes of Health. Accountability, Administration and Leadership: Organizational Change to Meet New Challenges: in Enhancing the Vitality of the National Institutes of Health:.

Bethesda, MD., 2003. pp. 102- 120.

• Kotter, John P. What Effective Managers Really Do. Harvard Business Review. March – April

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1999. pp. 3 – 12.

• Deal, Terrence E. and Bolman, Lee G. Reframing Organizations: Artistry, Choice and Leadership.

Jossey-Bass Publishers, San Francisco, CA. pp. 176 – 211.

• Kanter, Rosabeth Moss. Mastering Change in Learning Organizations. 2002. pp. 65 – 76.

• Sull, Donald N. Why Good Companies Go Bad. Harvard Business Review. July – August 1999. pp. 73 – 85.

V. DEVELOPING PUBLIC HEALTH ORGANIZATIONS 1. LECTURE: BUILDING A LEARNING ORGANIZATION a. Old Truisms and Refrains: • No significant change occurs unless it is driven from the TOP • There is no point in starting unless the DIRECTOR is on board • Nothing will happen without TOP-MANAGEMENT BUY-IN

--Status Quo Mentality = The Way Things Are

b. Two Views of Leadership: View #1 • Only top management can initiate change

-Unwillingness to give up a familiar mental model

-self-protection (hold someone else responsible)

c. Two Views of Leadership: View #2

• Little significant change can occur if it is driven from the top

-Compliance

-Commitment • There is no substitute for commitment in bringing about change

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d. Top Management Approaches and Outcomes: TOP-MANAGEMENT APPROACH

OUTCOMES MANAGEMENT FAILS DUE TO:

• Reorganization

• Fear and defensiveness

• Downsizing

• No imagination or commitment

• Reengineering programs

• No change in the way people think of understanding of trust and interdependence

• Cost reduction programs

• No enhancement of intelligence and skills

e. Enhanced Learning Capabilities: • Systems thinking • Improving mental models • Fostering dialogue • Nurturing personal vision • Building shared visions

--Leaders lead through developing new skills, capabilities and understandings

f. Three Essential Types of Leaders: f.1. LOCAL LINE LEADERS:

-Undertake meaningful experiments to test whether new learning capabilities lead to improved business results

--Designers

--Teachers

--Stewards

-There is no better way to learn than to teach

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f.2. EXECUTIVE LEADERS:

• Support line leaders • Develop learning infrastructures • Lead by example

--Protectors

--Mentors

--Thinking Partners

• Building Operating Environment for Learning:

-Executive Leaders:

--Articulate guiding ideas

--Develop learning infrastructure

--Create environment conducive to change

--Build self-directed work teams

• Leaders embrace staff empowerment f.3. INTERNAL NETWORKERS • Messengers and communicators of ideas • Move freely about the organization • Find people who want change • Aid in diffusion of new learning

-No power is power

g. Question for Discussion or Class Exercise: • Who are the LOCAL LINE LEADERS, EXECUTIVE LEADERS and INTERNAL NETWORKERS in your organization?

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LOCAL LINE LEADERS

EXECUTIVE LEADERS

INTERNAL NETWORKERS

LOCAL LINE LEADERS

EXECUTIVE LEADERS

INTERNAL NETWORKERS

Supervisors, chiefs, heads of programs, projects or units

Ministers, directors, deputy directors

Senior managers, project managers, co-facilitators, learning historians, internal consultants, trainers, personnel staff, front-line workers

h. Conclusion • The challenges of SYSTEMIC CHANGE where hierarchy is inadequate will push organizations to NEW FORMS OF LEADERSHIP based on new principles • These challenges cannot be met by isolated heroic leaders. They will require a unique mix of DIFFERENT PEOPLE, in DIFFERENT POSITIONS, who LEAD IN DIFFERENT WAYS.

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i. Acknowledgements: • Peter M. Senge, Director, Center for Organizational Learning, Sloan School of Management, Massachusetts Institute of Technology

j. Questions and Answers Session

2. LECTURE: CREATING ORGANIZATIONS WITH MANY LEADERS a. LAO TSU:

“The very highest leader is barely known by men

Then comes the leader they know and love

Then the leader they fear

Then the leader they despise

The leader who does not trust enough will not be trusted

When actions are performed without unnecessary speech, the people say,

WE DID IT OURSELVES”

b. A Learning Organization:

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c. Three Approaches to Empowering Many Leaders: c.1. DELEGATING WITHIN A TRADITIONALLY HIERARCHY • Limited scope for big-picture or cross-functional thinking • Delegation is a good first step, but it does not fully meet the needs of information-age organizations c.2. CREATING COMMUNITY • Sense of freedom • Elective participation • Common worth • Information sharing • Appreciation for gifts of ideas, courage and self-appointed leadership

-Community occurs most easily when FREE PEOPLE with some sense of EQUAL WORTH join

together VOLUNTARILY for a COMMON ENTERPRISE c.3. LIBERATING THE SPIRIT OF ENTERPRISE • Innovating • Seeing things in new ways • Changing the ways in which things are done • Replacing hierarchy with indirect methods of leadership

--Greater freedom

--More accurate resource allocation

--Focus on the common good

-Leaders that create a SELF-ORGANIZING SYSTEM motivate followers to excel and

serve people

d. Models of New Forms of Leadership: • Successful Nations (astounding economic growth after the introduction of free markets)

-China

-Singapore

-South Korea

-Peru

-Chile

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e. . Current Debate:

CENTRALIZATION VERSUS DECENTRALIZATION

MONOPOLY VERSUS USERS CHOICE

• Information-age leaders will change the debate to USERS CHOICE: Customer-focused service

f. Creating Space for More Leaders: • Phase I: Organization as HIERARCHY, where the key tool is delegation • Phase II: Organization as COMMUNITY, where the key tools are worthwhile vision and values, a gift economy • Phase III: Organization as ECONOMY, where the key tools are free enterprise, education and effective leadership of core businesses

g. Future-Focused Leadership: THE ORGANIZATION OF THE FUTURE WILL BE: • Communities of entrepreneurs •Structured from many smaller interacting enterprises •Each enterprise requiring leadership

THE ROLE OF THE LEADER WILL BE TO: • Create and communicate vision and values • Create systems that support and guide autonomy

h. CONCLUSIONS: • The greater legacy of future leaders will be the LIBERATION of organizations to a higher level of productivity, innovation and service.

• By listening to their followers, future leaders will become DESIGNERS of the game who brings out the best in others.

• When leaders do their job of indirect leadership well, the people will say, WE DID IT OURSELVES. 101 Public Health Leadership and Management for the 21st Century

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.

i. Acknowledgements: • Gifford Pinchot, Author, Speaker & Consultant, Why You Don’t Have to Leave the Corporation to Become an Entrepreneur • The End of Bureaucracy and The Rise of the Intelligent Organization

j. Questions and Answers Session

3. CLASS DISCUSSION: CONCEPT PAPER #7: CREATING AN ENVIRONMENT FOR INNOVATION

4. LECTURE: DEVELOPING A PERFORMANCE ORIENTED CULTURE a. Leadership Behavior and Organizational Performance: • Shapers and keepers of performance-oriented cultures

• Commander

• Identify and constantly communicate values

• Controller • Decision maker

• Shape values to enhance performance

• Assimilation of power

• Ensure staff capability

• Teller of truths

• Live the commonly held value • Listen a great deal of time • Speak a different language

b. Speaking a Different Language: • Example #1: Chief Executive Officer of Bank One:

“……managing an UNCOMMON PARTNERSHIP that fosters maximum local autonomy for

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.carefully selected managers combined with effective centrally provided services and common performance measures”.

• Example #2: Chairman of the Board of ServiceMaster:

“……looked for a SERVANT’S HEART as the primary criterion in the selection of his successor

to serve as Chief Executive Officer”.

• Example #3: Executive Director of Girl Scouts:

“……ensuring that the organization remains MISSION-FOCUSED, VALUE BASED and

DEMOGRAPHICS-DRIVEN (diversity-driven)”.

• Example #4: Chief Executive Officer of Southwest Airlines:

“…..talks about hiring as a NEAR RELIGIOUS EXPERIENCE” • Tough talk has not produced the kind of results that these leaders have delivered

c. Listening versus Telling: • Example #1:

Front line managers are trained to listen to the needs of customers

⇓ Those who perform well are generally rewarded with promotions away from customers

⇓ With each succeeding promotion people tend to tell more and listen less

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d. Listening versus Telling:

BANK ONE

SOUTHWEST AIRLINES

SERVICEMASTER

• Listens to requests • Connects people with resources

• A day of work in the field cleaning floors, walls and toilets, and service food to staff and customers

• Watches performance numbers

• Open door policy • Goes to employees • Capitalizes always on Employees

e. Listening versus Telling: • A leader does not use information to take action against someone, more often, he/she uses it to:

-Launch new initiatives

-Put people in touch with each other for mutual assistance and support • As long as information is used in this manner, organizations respond and perform

f. Living the Values: • Organizations that embrace values that honor and support ADAPTABILITY claim success and longevity.

-Sensitivity to the needs of customers, employees, supplies and other important

constituencies

• Adaptability requires a different set of leadership behaviors

BANK ONE • People Who Care • Face-to-Face opportunities to listen

SERVICEMASTER • To help people develop (end goal)

GIRL SCOUTS

SOUTHWEST AIRLINES

• Emphasis on Family • Helping every girl achieve her full potential (customers and employers)

• To grow profitably (a means goal) • Extensive charity work

• CEO and > 90% of employees engaged in charity work

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g. Values: h. Ensuring Employee Capability: • In strong performing organizations, the most important determinants of profit and growth are:

-Customer loyalty

-Customer satisfaction • The capability of employees to do their job is the most important determinant of their satisfaction

BANK ONE

SERVICEMASTER

Outstanding products, Spends more than its technological support and competitors to develop processes to people in products and processes local branches responsible that ensure maximum for customer relations productivity and quality Outstanding products, in the work of people it technological support and supervises and to train processes to people in people who apply them local branches responsible for customer relations

GIRL SCOUTS Considers leadership training the key to organizational and individual capability 750,000 volunteers

SOUTHWEST AIRLINES Basic guideline: “Do whatever you feel comfortable doing for the customer”

i. Capability Development: • CEO of Bank One: “…..my role is CHIEF PERSONNEL OFFICER. If I get the right people in the right job, that’s all I have to do”.

• Top-performing organizations take a personal interest in ensuring the capability of their associates.

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j. Redefining, Shaping and Using Core Values:

k. Rediscovering Core Values: • At the heart of the new leadership is a REDISCOVERY of the commonly held core values of the organization • Leaders design and implement initiatives according to the culture of the organization l. Power Through Dignity: • An important source of power is the DIGNITY leaders nurture in those around them and at all levels in their organizations

m. Sources of Power: CHARACTERIZING POWER

REDEFINING POWER

Positional (or bestowed) power

Use of language

Expert power (job knowledge)

Listening skills

Personal attraction (affective appeal)

Propagation of values

Effort (personal commitment)

Enhancement of employee capability Clarification of core values Assurance of dignity

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n. Relational Power: • The power of top leaders lies in their ABILITY TO FOSTER RELATIONSHIPS, both between themselves and others and among others

o. CONCLUSION: • There is a strong linkage between LEADERSHIP, CULTURE AND PERFORMANCE. • In short, STATE OF THE ART LEADERSHIP delivers OUTSTANDING ORGANIZATIONAL RESULTS.

p. Acknowledgements: • James L. Heskett, UPS Foundation Professor of Business Logistics, Graduate School of Business Administration, Harvard University & • Leonard A. Schlesinger, George Fisher Baker Jr. Professor of Business Administration, Associate Dean and Director of External Relations, Harvard University

q. Questions and Answers Session

4. TEAM EXERCISE: X – Y SIMULATION: WIN AS MUCH AS YOU CAN 1. Teams 1. 4 groups 2. Separate physically 3. Each team gets ten ballots 2. Rules 1. Limit communications 2. Name of the game: Win as Much as You Can 3. Won’t answer further questions 4. Tally sheet/payoff schedule handout (ten rows)

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3. Prepare Flip Chart: TEAMS/ ROUNDS

T1

T2

T3

T4

Vote/Payoff/ Cum

Start Game • “1 minute to cast your ballots for round 1” • Collect and post scores •

Round 2, etc.

Variation of Rounds • Bonus rounds • Send a delegate out of the room at round 5 & 9 Debrief Rate your team’s satisfaction with the process (1—5) Rate your team’s satisfaction with the product (1—5)

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Win As Much As You Can

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“Win As Much As You Can” Debrief I.

Who won? Who is the you in Win As Much As You Can?

II.

How do you feel about your team’s performance? How do you feel about the other team’s

performance?

III.

What factors made it difficult for your group to work cooperatively with the other groups in

this activity? How did the other team’s behavior influence your team’s behavior?

IV.

What could have been done to raise the level of trust among the groups?

V.

What analogous conditions create dysfunctional competition or conflict in situations at work?

VI.

When the game was over, was it really over?

VII.

What could be done on real life situations to minimize destructive competition and conflict

between groups?

VIII.

Have each person write down one learning point that they can take back to work.

IX.

If everyone in China CDC or MOH votes “X”, who wins?

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6. CLASS DISCUSSION: CONCEPT PAPER #8: CREATING SELF-DIRECTED WORK TEAMS 7. SELF-DIRECTED STUDY PROJECT AND PAPER #3: IQ (INTELLIGENCE QUOTIENT), EQ (EMOTIONAL INTELLIGENCE), AND SQ (SPIRITUAL QUOTIENT) 8. BIBLIOGRAPHY Required Readings: • Rowitz, Chapter 2 and 13.

• Giener, Ann C. and Knebel, Elisa. The Core Competencies needed for Health Professionals: in Who will keep the public healthy? Institute of Medicine, Washington, D.C., 2002. pp. 45 - 74 • Institute of Medicine of the National Academies: The Future of the Public’s Health. National Academies Press. Washington, DC: 2003. pp. 358 – 402.

• National Public Health Leadership Network. The Public Health Leadership Framework. NPHLN, 2000. pp.1 – 10.

• Drucker, Peter F. Managing Oneself. Harvard Business Review. March – April 1999. pp. 92 – 108.

• Lau, C.M.., et al. A Shared Approach to Understanding Organizational Culture Change: In Research in Organizational Change and Development, 2003. Volume 14: 225-256.

• Norman, Alex J. Managers’ Choices : Building Teams for Effectiveness in Public Service Organizations. Pp. 1 –18.

• Aspden, Phillip, et al. Federal Leadership and Public/Private Partnerships: in Patient Safety: Achieving a New Standard. Institute of Medicine, Washington, D.C., 2004. pp. 71 – 92.

• Keys, Paul R., and Norman, Alex J. Organizational Development in Public Services: The Irresistible Force Meets the Immovable Object. The Haworth Press, INC., 1992. pp. 147 – 165.

Optional/Suggested Readings: • Longest, Beaufort B., et al. Organizational Change:,In Managing Health Services Organizations and Systems, 4th Edition. Health Professions Press. Baltimore, MD, 2000. pp. 78 – 91.

• Marks, Michell Lee and De Meuse, Kenneth P. Resizing the Organization. The Realities of Resizing. 2003. pp. 123 – 135.

• French, Wendell L., and Bell, Cecil L. Definitions of Organizational Development: In

Organizational Development. Behavioral Science Interventions for Organization Improvement,

4th ed. Upper Saddle River, New Jersey, 1990. pp. 28 – 41.

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• Champy, James A. Preparing for Organizational Change: In The Organization of the Future

by Frances Hesselbein, et al. Jossey-Bass Publishers, 2000. pp. 89 – 104.

• Giener, Ann C. and Knebel, Elisa. Challenges Facing the Health System: in Who will keep the public healthy? Institute of Medicine, Washington, D.C., 2002. pp. 45 – 74.

• Herzberg, Frederick. One More Time: How do you Motivate Employees? Harvard Business Review, September – October, 1997. pp. 28 – 42.

• Drucker, Peter F. Managing Oneself. Harvard Business Review. March – April 1999. pp. 92 – 108.

• Butler, Timothy, and Waldroop, James. Job Sculpting: The Art of Retaining Your Best People.

Harvard Business Review. September – October, 1999. pp. 3 – 23.

VI. IMPLEMENTING STRATEGY 1. LECTURE: THE FIVE FUNDAMENTAL PRINCIPLES AND TEN COMMITMENTS OF EXEMPLARY LEADERSHIP: a. Principle #1: CHALLENGE THE PROCESS • Search for Opportunities • Experiment and Take Risks

-Leaders forge into new territory and solve challenges by creating change

b. Principle #2: INSPIRE A SHARED VISION • Envision the Future • Enlist Others

-Visionary leaders always have an eye toward the big-picture –the possibilities

c. Principle #3: ENABLE OTHERS TO ACT

• Foster Collaboration • Strengthen Others

-Leaders concentrate on making it easier for others to act

d. Principle #4: MODEL THE WAY • Set the Example • Plan Small Wins 112

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e. Principle #5: ENCOURAGE THE HEART • Recognize Individual Contributions • Celebrate Accomplishments

-Leaders encourage people to carry on during tough times when everyone feels like

giving up

f. Collaborative Leadership: • Leadership is shared • Capacities are recognized and used • Ideas of all members are heard and respected • Success is celebrated • New members can take on leadership roles

-Individuals have invaluable contributions to make as leaders

g. Who Can Be a Collaborative Leader? In collaborative work, there is room for a variety of leadership styles: • Keep the big picture in sight • Think through details • Carry out day-to-day tasks • Bring others on board • Recognize success

-Collaboratives need a mix of “movers and shakers”

h. Are Leaders Born or Made?

• Some people naturally assume leadership in groups BUT leadership skills can be developed over time

-It is essential to establish an environment conducive to nurturing new leadership

i. Who Are You As a Leader?

• Leadership begins with self-discovery and understanding your personal leadership style

-Leaders exhibit distinct practices that vary little from industry to industry 113

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2. CLASS EXERCISE: COLLABORATIVE LEADERSHIP * Introduction: Look around the room at the signs on the wall. They represent five principles of the kind of leadership that is most successful in communities. You could also call these “leadership styles.”

• Challenge the Process • Inspire a Shared Vision • Enable Others to Act • Model the Way • Encourage the Heart

Instructions: Please get up from your seats and walk to the sign that best represents your current leadership style.

We’re going to ask some of you to share why you chose that principle or style and perhaps give us an example. For example if you choose “encourage the heart,” you might give an example of a community celebration in which you honored community members for their contributions.

• What were some of your experiences with this activity?

• Was it was or difficult to pick a style?

• Were there any insights or surprises you’d like to share?

• Was it difficult to come up with an example?

• What are some of your feelings about a group of people with these leadership traits?

• How did you feel about the example?

Now walk under the sign that represents a principle or style of leadership you wish to work on or grow in. Please share why you chose this principle and a way in which you might start to make this change. * Taken/adapted from the Los Angeles County Department of Health Services’ Office of Organizational Development and Training and the Public Health Institute’s Center for Collaborative Planning.

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3. LECTURE: CAPSTONE INITIATIVES AND ACTION LEARNING: 3.1. COLLABORATIVE LEADERSHIP CHANGE PROJECTS a. Public Health Intelligence & Leadership Learning Principle: • Adults learn by doing:

-I hear and I FORGET

-I see and I REMEMBER

-I do and I UNDERSTAND

--Confucius 551 – 479 B.C.

b. Why a Capstone Project?

• The measure of a SUCCESSFUL EDUCATION will be in the ability of the students to CONNECT THE THREADS between public health intelligence and leadership courses and their own experiences, abilities and talents and effectively APPLY THEM TO THE WORK THEY CURRENTY PERFORM in their institutions and communities

c. Key Concepts: • Improve institutional performance and community health through: 1. Team work 2. Collaboration 3. Partnerships 4. Leading change efforts

d. What is a Capstone Project?

• An applied learning experience where STUDENTS WORK ON AND RESOLVE A PUBLIC HEALTH ISSUE, CHALLENGE OR OPPORTUNITY using an action learning approach 1. Deeply understand a real problem 2. Take wise actions 3. Reflect on what is learned Public Health Leadership and Management for the 21st Century

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e. Who is involved in the Capstone Project?

• Self-directed WORK TEAMS that will be formed during the Public Health Intelligence and Leadership Program

f. When will the Capstone Project take place?

• Activities, timing, implementation, reporting and deliverables will be determined by China CDC and MOH with support from USC

g. How will the Capstone Project be completed?

• Proposal Format and Guidelines: 1.

Title

2.

Team Members

3.

Executive Summary

4.

Public Health Issue, Challenge or Opportunity

5.

Vision for Change

6.

Stakeholders

7.

Expected Outcomes

8.

Strategy and Action

9.

Sustaining the Change

10.

Support Needed

g.1. Public Health Issue, Challenge or Opportunity •

What is the change that needs to happen?

•

How is collaboration needed to make it happen?

•

Is there a state of urgency and, if not, how will a felt sense of urgency be established?

• What is the context –department/program, internal/external stakeholders—in which the change needs to happen? g.2. Vision for Change: • What will the CHANGE look like when you get there?

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g.3. Expected Outcomes: •

What two or three SHORT-TERM GOALS will you want to reach ---benchmarks or measures

of success? g.4. Stakeholders: • Who needs to be part of the change leadership team?

• Who are the major internal and external stakeholders? g.5. Strategy and Action Plan: • What in the culture will support or hinder the change?

• What is the strategy for strengthening those aspects of the culture that will support the change?

• What is the strategy for weakening those aspects of the culture that will hinder the change?

• What is the proposed communication strategy with those who need to be kept informed and with stakeholders? g.6. Sustaining the Change: • What is the proposed STRATEGY to sustain the change and promote continuous learning? g.7. Support Needed: • What RESOURCES or support will be needed to be effective and when will they be needed?

h. Sample Capstone Projects: Los Angeles: • Reducing Animal Bites in Los Angeles County • Enhanced Performance in Community Health Improvement Initiatives • Integration of Performance Measures • Promoting Public Health Initiatives • Introduction of an Evidence-Based, Collaborative Community Change Approach to Improved Birth Outcomes in Los Angeles County • Public Health Measures: Improving Alcohol and Drug Program Administration Effectiveness • Environmental Health: Collaboration for Change • New Methodology for Public Health All Hazards Planning 117 Public Health Leadership and Management for the 21st Century

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• Region-Specific Disaster Roles and Responsibilities • Knowledge Exchange Enhancing the Public’s Health • Improving the Public Health Emergency Preparedness of Vulnerable Populations in Los Angeles County through Program-Division-Community Collaboration • Forging a New Division of Communicable Disease Control and Prevention • Mentoring for Health Facilities Inspection Division Staff • Expanding Cervical Cancer Screening in STD Clinics • Collaborative Model for the Advancement of Information Technology in Public Health for Los Angeles County: Integrated Disease Management Demonstration Project

i. Capstone Project Question: • What is the PUBLIC HEALTH ISSUE, CHALLENGE OR OPPORTUNITY in your institution or community that YOU WOULD LIKE TO ADDRESS with the support and HELP OF YOUR COLLEAGUES in order to ADVANCE THE HEALTH AND WELL-BEING OF PEOPLE and/or ENHANCE THE EFFECTIVENESS OF YOUR PROGRAMS AND SERVICES?

j. Acknowledgements: • The Center for Collaborative Planning, Public Health Institute • The Los Angeles County Public Health Leadership Institute

k. Questions and Answers Session

3.2. LECTURE: ACTION LEARNING a. What is Action Learning?

• Action Learning is a structured process for WORKING ON REAL PUBLIC HEALTH PROBLEMS in TEAMS to IMPROVE PUBLIC HEALTH and DEVELOP THE PARTICIPANTS

b. In Action Learning: • Leaders become “comrades in adversity” • Leaders understand a problem through REFLECTING ALOUD together its causes: PROBLEMFRAMING OR CLARIFICATION • Leaders reflect together about effective and “wise” actions: PROBLEM-SOLVING OR RESOLUTION • Leaders TAKE ACTION and reflect on how effective the actions were and what should be 118

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c. What is Action Learning?

• Action Learning is a PROMINENT LEADERSHIP DEVELOPMENT METHOD in organizations today

d. The Action Learning Cycle:

e. Action Learning Elements: • The work PROBLEM OR OPPORTUNITY • The GROUP (individual or group problem) • The questioning or REFLECTION process • The commitment to taking ACTION • The commitment to LEARNING • The learning coach • The sponsor

f. Case Example: The Capstone Project: • APPLY knowledge and skills to current problems • Practice being a COLLABORATIVE LEADER • Make PROGRESS on the problem • Strengthen your TEAM • Build LEADERSHIP skills 119 Public Health Leadership and Management for the 21st Century

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g. Confucius, 551 -479 B.C.: • I hear and I FORGET, I see and I REMEMBER, I do and I UNDERSTAND.

h. Management Development: • Only 20% of management development occurs in the CLASSROOM, leaving 80% to occur informally through job EXPERIENCES AND RELATIONSHIPS with others” –Sam Campbell, Honeywell, R. Zemke 1985; McCall et al 1988; C. Wick 1990.

i. Reasons for Action Learning: • Goal of professional practice is WISE ACTION in the middle of complexity • Learning from practice to MAKE GOOD JUDGMENTS in challenging situations • Public reflection can help DEVELOP EXPERTISE, INSIGHT AND WISDOM

j. Works Best When Participants…….

• Recognize that there are “many ways to see a problem” and what to do about it • Question, listen and seek to learn • Respect others’ perspective as a means to growth

k. Differences of Action Learning: • A commitment to QUESTIONNING and REFLECTION and LEARNING TOGETHER • A commitment to ACTION rather than only making recommendations • The PROBLEM IS YOURS (ownership)

l. Action Learning Time Distribution:

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m. Capstone Project Question: • What is the public health issue, challenge or opportunity in your institution or community that you would like to address with the support of your colleagues in order to advance the health and well-being of people and/or enhance the effectiveness of your programs and services?

n. Acknowledgements: • Public Health Leadership Institute, Los Angeles County Department of Health Services • Center for Collaborative Planning, Public Health Institute • National Public Health Leadership Institute, University of North Carolina, Chapel Hill

o. Questions and Answers Session p. KEY STEPS IN A CHANGE IMPLEMENTATION PROCESS (Source: Leading Change, Jeffrey & Linda Russell, 2003): These are the core elements of any successful plan for implementing organizational change. Some of the key questions that the change implementation plan should address are identified.

Create a leading change design team: Who must be involved in helping you move your organization or work area in a new direction? What areas, teams, or individuals should be involved in designing the change?

Establish a sense of urgency for change: What are the forces causing the change and what is the impact of these forces on the organization’s future success? Why is there a need for change? What departments, units, teams, or individuals are affected and to what degree? Do the forces causing change suggest a modest, incremental or transformational change? What are the consequences to the organization of not responding effectively to these forces?

Develop a vision for the change: What is the change that needs to occur? What do we need to accomplish or achieve as a result of the change? What problem are we trying to solve? What will the outcomes of the change look like?

Define the impacts on those affected by the change: What are the potential pros and cons of the change for the organization, departments, units, teams, and individuals? Who benefits and who loses?

Are customers or other stakeholders affected and to what extent?

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Create your strategy and action plan: How will you raise awareness of the need for change? How will the losses be reduced, eliminated, or managed? How will employees and other stakeholders be involved in developing the change vision and strategy? What actions will build commitment to the change? How will the benefits from the change be realized? What actions need to occur, when should they occur, and who should take the lead in taking them? What is the implementation timeline?

Identify measures of success: How will the success of the planned change be evaluated? What are the key indicators or measures of success? What benchmarks along the way will be used to help track the progress the organization is making?

Develop your communication strategy: Who needs to be kept informed of the change vision and strategy? What are the methods for communicating with these key stakeholders? What is the ideal frequency of the communications about the change and the progress being made?

Develop your strategy to sustain the change and promote continuous learning: What is your plan for building change leadership skills and knowledge in leaders, managers, supervisors, employees, and (if appropriate) customers and other key implementation strategy? What other methods have you put in place to sustain the change and foster continuous improvement?

4. CLASS DISCUSSION: CONCEPT PAPER #9: TURNING VISION INTO ACTION

5. LECTURE: CRISIS AND EMERGENCY RISK COMMUNICATION a. GOAL: Tools for speaking during an intense public-safety emergency to the: • Public • Media • Partners • Stakeholders

-The RIGHT MESSAGE at the RIGHT TIME is a RESOURCE MULTIPLIER: it helps response

officials get their job done.

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b. Learning Outcomes: Acquire the following understanding: • The psychology of communication in a crisis • Your role as a spokesperson • Working with media during a crisis • Public health law and the media

c. Communicating in a Crisis is Different: In a crisis, all affected people: • TAKE information differently • PROCESS information differently, and • ACT on information differently (Reynolds 2002)

-The way we normally communicate with people may not be effective during and after a crisis

d. Success of Operational Response Depends on: • AMOUNT and • SPEED of relevant official information received

-Real, measurable effect on the well-being of people depends on the WORDS you say and their

SPEED and SINCERITY

e. Five Things the Public Wants: 1. Gain facts needed for protection 2. Make well-informed decisions 3. Have an active role in response and recovery 4. Act as a watch-guard over resources 5. Recover or preserve well-being and normalcy

-The public wants to know what you know

f. Leaders Lead with Goals in Mind: • Decrease illness, injury and deaths • Execute response and recovery plans with minimal resistance • Avoid misallocation of limited resources • Avoid wasting of resources Public Health Leadership and Management for the 21st Century

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g. Communication Decisions: • What to release • When to release it • How to release it • Where to release it • Whom to release it • Why release it

-Well-prepared leaders have COMMUNICATION PLANS and resources in place…….PLAN NOW

h. FIVE COMMUNICATION FAILURES: 1. Mixed messages from multiple experts • People don’t want to JUST PICK ONE of many messages, they want the BEST ONE or the RIGHT ONE to follow • Cumulative, consistent messages may drown out conflicting messages 2. Information released late • If we can not give people what they need when they need it, others will 3. Paternalistic attitudes • Help the people to reach the SAME CONCLUSION you did •

Never tell people DON’T WORRY

4. Not countering rumors and myths in real time • The media will report rumors and hoaxes unless you can ANSWER QUICKLY why it is FALSE

5. Public power struggles and confusion • All PARTNERS need to have clearly defined ROLES AND RESPONSIBILITIES • Turf wars need to end at the moment a crisis begins

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i. FIVE COMMUNICATION SUCCESS STEPS 1. Execute a solid communication plan • The public judges the success of your operation by the success of your COMMUNICATION • Well-prepared leaders have COMMUNICATION PLANS and resources in place…..PLAN NOW 2. Be the first source of information • The public uses the speed of information flow as a MAKER FOR YOUR PREPAREDNESS • The FIRST MESSAGE people receive carries more weight 3. Express EMPATHY early • The public will not be open until EMPATHY is expressed 4. Show competence and expertise • The public assumes you are COMPETENT until proven otherwise 5. Remain honest and open • Any INFORMATION is empowering • UNCERTAINTY is more difficult to deal with than bad news • People go to MULTIPLE SOURCES of information • The FASTER bad news are given the BETTER

j. What People Feel in a Disaster: 1. Fear 2. Anxiety 3. Confusion 4. Dread 5. Hopelessness 6. Helplessness 7. Uncertainty • Psychological barriers interfere with the COOPERATION and RESPONSE from the public

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k. Troublesome Expected Behaviors: 1. Dependence on special relationships 2. Worried Well 3. Multiple unexplained physical symptoms 4. Stigmatization • Leaders confront behaviors in their communication to the public

l. Audience Judgments of Messages: 1. Speed of communication 2. Trust and credibility of the message 3. Empathy and caring 4. Competence and expertise 5. Honesty and openness 6. Commitment 7. Accountability

m. Employ the STARCC Principle: Your message in a crisis must be: • Simple • Timely • Accurate • Relevant • Credible • Consistent

n. Working with the Media: DISASTERS ARE MEDIA EVENTS • The primary tool to get public safety messages to people in a hurry • They know their audiences better than you do

-We need media involved during a crisis. Consider them in your planning.

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o. Early Media Mistakes:

1. Play favorites or hold grudges

2. Set arbitrary new rules to interact with official response group

3. Tell the media how to do their job

-BOTTOMLINE: They are going to be there whether we like it or not

p. What Reporters Want: EXPECT: • Honest answers • Timely release of information • Quick squashing of rumors • Commitment to availability and updates • Subject matter experts • Their calls to be returned • State you do not have the answer • Consistent messages • Understanding of how media works • Respectful treatment

q. Media Changes: • Verification of facts goes down • They abandon their adversarial role early in the crisis • Many of them will lack scientific expertise

-Take the Media to SCHOOL: More information = More Factual.

-Less information = More Interpretative.

r. Successful Press Conferences: • It’s a fast breaking crisis and the public is clamoring to know who is in charge • You have an urgent message or recommendation • You have promised regular updates • You have news

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s. Writing for the Media in a Crisis: • The mistake response officials make is waiting to release information until all the facts are in.

1. Release what you know 2. Acknowledge what you don’t know, and 3. State ho you are getting the answers

t. The Expected Questions: • What happened?

• Are my family and I safe?

• What have you found that may affect me?

• What can I do to protect myself and my family?

•

Who caused this?

• Can you fix it?

• Who is in charge?

• Has this been contained?

• Are victims being helped?

• What can be expected, right now and later?

• What should we do?

• Why did this happen?

• Did you have forewarning?

u. The Leader as a Spokesperson: • Saves lives • Reduces anxiety and fear • Helps people recover more quickly

-A CREDIBLE SPOKESPERSON can influence behaviors that could be life saving

v. What Makes a Good Spokesperson: • Expression of empathy • Risk saying I don’t know, we’re working on it • Telling the truth • Confidence without arrogance • Appropriate emotion 128 Public Health Leadership and Management for the 21st Century

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• Modulated voice • Direct eye contact • Humility or a lack of defensiveness

-Always remember who the audience is……..people hurt, confused, anxious and possibly

angry……not the media!!!

w. Basic CERC Tenets: 1. Give anticipatory guidance 2. Be regretful, not defensive 3. Acknowledge people’s fears 4. Acknowledge the shared misery 5. Express wishes 6. Panic is less common than imagined 7. Be willing to address “what if” questions

x. Know Your Stakeholders • Stakeholders are identifiable groups of people or organizations who can be reached in ways other than through the media • Stakeholders are people or organizations with a special connection to you and your involvement in the emergency

y. Three Categories of Stakeholders: 1. Advocates 2. Adversaries 3. Ambivalents

-Anticipate stakeholder’s reaction and develop a stakeholder’s communication plan

z. Importance of Stakeholders: • They may know what you need to know • They may also be able to help communicate your message for the media

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aa. Five Mistakes Toward Stakeholders: • Inadequate access • Lack of clarity • No energy for response to them • Too little too late • Perceptions of arrogance bb. Media Law: • Learn what legal rights the media have or do not have in a crisis. Consult a media expert if you do not know • The media has the constitutional right to acquire news from any source by any lawful means • The media are given no constitutional right to special access (crime scenes, disaster scenes, police stations, hospital laboratories, and places restricted to the public).

• The media’s access may be restricted if it interferes with legitimate law enforcement actions • The media may have access to what is available an open to the public historically • Articulate, before the crisis, the principles of public information you embrace

cc. Keeping Fit for Duty in a Crisis: • RELIEVE STRESS: 15-minute walk, talk to someone, take a “brain break”, do deep breathing exercises, eat nutritional foods, avoid caffeine and alcohol, get as much sleep as possible, etc.

• More than 24 hours without sleep = job performance equivalent to that of someone legally drunk.

dd. Acknowledgements: • U.S. Department of Health and Human Services (HHS) • Centers for Disease Control and Prevention (CDC), CDC Office of Communication (OC), Office of the Director (OD)

ee. Questions and Answers Session

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6. LECTURE: RISK AND HIGH STRESS COMMUNICATION a. Definition: • A science-based approach for communicating effectively in: 1. High-Concern 2. High Stress 3. Emotionally Charged, or 4. Controversial Situations

b. Literature Review: • 8000 Articles in Peer Reviewed Journals • 2000 Books • Reviews of Literature by Major Scientific Organizations

--USC National Academy of Sciences

--Royal Society of Great Britain

c. Key Messages 1. Risk Communication is a science-based discipline 2. High stress, high concern situations CHANGE THE RULES OF COMMUNICATION 3. Key to communication success is PREPAREDNESS, PLANNING AND PRACTICE

d. 9/11 Major Lesson Learned (2001): • “……the major public health challenges since 9/11 were not just clinical, epidemiological or technical issues. The major challenges were COMMUNICATIONS. In fact, as we move into the 21st century, communications may well become the CENTRAL SCIENCE OF PUBLIC HEALTH PRACTICE”.

--Edward Baker, MD, MPH, Assisstant Surgeon General, USA, 12/2001

e. Lessons Learned from Great Risk Communicators 1. Alexander the Great 2. Julius Ceasar 3. Napoleon Bonaparte 4. Wiston Churchill 5. Rudy Giuliani 6. Julie Gerberding 131 Public Health Leadership and Management for the 21st Century

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f. Trust Determination Factors in High Concern Situations

Listening, Caring, Empathy

50%

Honesty, Transparency

15-20%

Competence, Expertise

15-20%

Dedication, Commitment

15-20%

g. Mental Noise Theory: Reduced Attention Span • When people are stressed or upset, they often lose as much as 80% of the information that is communication to them

h. High Risk Communication Principles (Tactics) ARP Rule

CCO Template

Rule of 3’s

Yes No Template

P & R Rule

1N = 3P Rule

27/9/3 Template

2X Message Enhancements

AGL -4

h.1. APP Rule: ANTICIPATE, PREPARE AND PLAN • Great risk communicators know the answers of at least 95% of the questions

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h.2. Everything in threes: RULE OF 3’s • Three key messages • Key messages repeated 3 times • Each message supported by 3 supporting messages h.3. Speak briefly in threes: 27/9/3 TEMPLATE: • 27 words • 9 seconds • 3 messages h.4. Use simple language: AGL-4 Rule • Average grade level minus 4 years h.5. Demonstrate feelings, determination and hope: CCO TEMPLATE • Compassion • Conviction • Optimism h.6. Use positive counterarguments: 1N – 3P RULE • For 1 Negative use 3 Positive Statements h.7. Don’t get involved in a battle with reporters: YES NO TEMPLATE • You ask me a YES or NO question • It would be difficult for me to answer YES or NO • What I can address is the issue………which is……. h.8. Double the attention span of audiences: 2X MESSAGE ENHANCEMENTS • Personal stories • Visuals • Credible third parties 133 Public Health Leadership and Management for the 21st Century

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7. TEAM EXERCISE: WEST NILE VIRUS MESSAGE DEVELOPMENT a. West Nile Virus Transmission Cycle

b. Message Map

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c. West Nile Virus Summary

d. Acknowledgements: • Dr. Vincent Covello, Director, Center for Risk Communication • David Steffen, Director, National Public Health Leadership Institute, University of North Carolina, Chapel Hill

8. CLASS DISCUSSION: CONCEPT PAPER #10: BECOMING CUSTOMER CENTRIC

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9. BIBLIOGRAPHY Required Readings: • Rowitz, Chapter 2 and 16 • National Research Council. Measuring Health Performance in the Public Sector.

Washington, D.C., 1999. pp. 1 – 48.

• Chrvala, Carole A., et al. Leading Health Indicators for Healthy People 2010. Institute of Medicine, Washington, D.C., 1999. pp. 1 – 24.

• Ginter, Swayne. Control of the Strategy: Strategic Management of Health Care Organizations. 2002. pp. 370 – 392.

• Institute of Medicine of the National Academies: Informing the Future: Critical Issues in Health: Assuring the Public’s Health. 2nd. Edition. Washington, D.C. pp. 63 – 80.

• Hesselbein, Frandes et al. Executives on the Future of Leadership: Chapters 28, 29, 30, 31: In The Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp.

241 - 311. Kouzes, James and Posner, Barry. The Five Fundamental Principles and Ten Commitments of Leadership: In The Leadership Challenge, 1995. pp. 15 – 29.

Optional/Recommended Readings: • Institute of Medicine of the National Academies: Informing the Future: Critical Issues in Health: Health Care Delivery Systems and Performance Capabilities.. 2nd. Edition.

Washington, D.C. pp. 81 – 100.

•

Bensaou M., and Earl, Michael. The Right Mind-Set for Managing Information Technology. Harvard Business Review. September – October 1998. pp. 26 – 44.

•

Institute of Medicine of the National Academies: Imedical Innovation in the changing health care marketplace. Washington, D.C. 2002. pp. 1 – 42.

•

Hesselbein, Frandes et al. Executives on the Future of Leadership: Chapters 28, 29, 30, 31: In The Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp.

241 - 311.

• Bensaou, M., and Earl, Michael. The Right Mind-Set for Managing Information Technology. Harvard Business Review. September – October 1998. pp. 7 – 29.

• Deal, Terrence E. and Bolman, Lee G. Reframing Organizations: Artistry, Choice and Leadership. Jossey-Bass Publishers, San Francisco, CA 176 – 211.

• Rossy, Gerard L., et al. Tailored Management Development as a Vehicle for Strategy Implementation. California State University, Northridge, CA. pp. 641 – 651.

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INSTITUTE FOR HEALTH PROMOTION & DISEASE PREVENTION RESEARCH Keck School of Medicine University of Southern California (USC) 1000 South Freemont Avenue, Unit 8 Alhambra, California 91803 http://mph.usc.edu/ipr/ http://mrcalderon.com © 2008 INSTITUTE FOR HEALTH PROMOTION & DISEASE PREVENTION RESEARCH

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