Abstract
Introduction
This paper presents the author's perspectives on the leadership skills required for public health and describes the course that has been constructed to enable participants to develop them over time. The paper covers the need for leadership learning and teaching to become part of the culture and practice of public health, the author's interest in leadership, and briefly coves leadership definitions, styles and types and key leadership skills. The paper derives from the author's leadership experiences and the learning from a constantly evolving program of learning and teaching developed since 2008 at the Melbourne School of Population and Global Health at the University of Melbourne, Australia. The design, ethos and manner of delivery of the course are presented. It is aimed at the practice of public health leadership, with particular focus on leadership of self, of knowing oneself, and of knowing and understanding colleagues retrospectively as well as prospectively. The most important outcome is the design and implementation of participants’ own plans for developing and nurturing their leadership skills.
Significance for public health
The nature of public health is changing rapidly and increasing in complexity. These changes include major shifts in the burden of disease and the insatiable demands of clinical medicine swamping those of public health. Public health practitioners have failed over many years to systematically ensure that leadership and management skills are essential parts of public health training (as they are in MBAs for example). This paper describes an approach and an intensive five-day course to assist practitioners to develop the key leadership skills needed to improve public health, whether it be locally, nationally or globally.
Definitions and understanding of leadership
There are, of course, many definitions of leadership. These include the ability to guide, direct or influence people; the ability to inspire confidence and support among the people who are needed to achieve organisational goals; or an act that causes others to act or respond in a shared direction. 1
As explained below, the differing perspectives and definitions, and the sometimes nebulous nature of leadership, make it confusing for many. Therefore, in the course we strongly encourage participants to explore, develop and share
I present my own understanding of leadership (below) but make it very clear it may only be useful for me and emphasize the need for every participant to have their own understanding:
In my experience it is clear that leadership and authority are not the same thing, and that many in authority are ineffective and potentially harmful leaders, whilst many who have little or no authority can be effective and inspirational leaders. I have been particularly attracted to Sinclair's view of leadership as
It is a happy convergence when people in positions of authority and control of considerable resources also have strong leadership skills.
Appreciating styles and types of leadership
As mentioned above there is great diversity and perspectives of leadership and these are well described elsewhere. 3 We present the evolution of leadership from transactional leadership to transformational leadership, transcendent leadership and then to servant leadership.
Transactional leadership entails reward for good work, and
Transcendent leadership involves collective decision making through dialogue and group consensus, and creative and divergent thinking. 4 It highlights the imperative for leaders to be aware of their own weaknesses and biases and exercise self-regulation in order to align their values and intentions with their decision-making and actions. 5
Servant leadership implies that
Why am I interested in learning about leadership: My own experience
In nearly 40 years of working in clinical and public health I have observed and worked with some great public health practitioners and some great leaders. Equally, I have witnessed some very poorly equipped
I have become intrigued by the issues of leadership – and my own learning has been greatly stimulated by my own experiences, especially ones where I felt I had failed as a leader. The first was as medical coordinator of a large Medicins sans Frontieres (MSF) team in eastern Sudan in 1985, nine years after medical graduation. The second occasion occurred when I was appointed as the inaugural Director of Country Programs for the Joint UN Program on AIDS (UNAIDS) in 1995. In the first instance, I was appointed as a leader mainly because I was a doctor (and male) and I had worked previously in eastern Sudan, and on the second occasion it was my experience as a technocrat who understood HIV programs that got me the job. But despite being 19 years post medical graduation, with two post graduate degrees, and experience in a number of leadership positions, I had had no training in leadership and management.
Setting up a new UN program overnight in fifty plus countries is no easy task at the best of times, and was made harder by the active hostility of the UN agencies that UNAIDS was meant to be coordinating. I was tyrannized by an over-loaded and negative email inbox, there seemed to be crises everyday, and my response was to work harder and harder. I was not coping well and felt I was drowning in my work because I had no structure or skills to manage complex issues or to manage my staff. In particular, I had little or no capacity to lead myself in times of considerable stress. In both cases I (and the staff reporting to me) would have benefitted enormously with training in decision making, planning, time management, prioritization, performance management and conflict management.
I continue to observe leadership closely and I am convinced that leadership and management skills must become core components of public health training. The lack of it manifests itself in the continued absence of a skilled and reflective leadership and management culture within many of the world's preeminent health organizations, and in many national ministries of health.
As public health practitioners and as clinicians, our training focuses on care for our patients or solving problems in our communities. We have ignored teaching and learning about how to lead, manage and care for our colleagues, our team members and most importantly, for ourselves. As Bill Roper, a former Director of the US Centres for Disease Prevention and Control said in 1994
From my own experience, observation of leaders, the literature and the feedback from co-facilitators and students we have developed one way, and I emphasize this is just one way of categorizing leadership skills.5,8,9 These are now discussed.
Key leadership skills
These have been grouped, for convenience, into six domains with three or four skills in each. The list is comprehensive, but by no means exhaustive, and domains and skills can be substituted or adapted according to the participants’ needs, or according to differing social, economic and cultural settings (Appendix).
- Vision and decision making: creating vision; decision making; planning (including setting goals and prioritisation) and problem solving
- Communications: communication (including clarity and accuracy); oral presentations; advocacy
- Managing people: managing conflict; managing performance; mentoring and coaching; negotiating
- Technical capacity: intelligence gathering; technical credibility; evaluation
- Emotional intelligence I: reflection; self-awareness: self-regulation; time management (self-organisation)
- Emotional intelligence II: empathy; social skills; networking (influencing and relationship building); motivation
The design and ethos of the learning and teaching
Our teaching and learning has evolved since 2008, and includes the establishment of the subject
The
The intensive five days are based on co-facilitation and collaborative learning where the distance between teachers, facilitators, guests and participants is minimized. It is based on creating an environment where any participant can reveal their stories, successes, failures, preferences and dislikes in a safe manner; on continual, constructive reflection (what am I learning? what does this mean?); on self-assessment and on group interaction involving group presentations and assessments.
Facilitators’ role
The facilitators have to lead by example. It is their responsibility to create a safe environment to enable high levels of interaction where successes, weaknesses, failures and insecurities can be shared, discussed, and learned from as a group. Participants must be included, valued and validated. Feedback emphasizes that the collaborative and
From a recent course participant (Melbourne October 2015):
The use of guest speakers
A key aspect of the course is to include several guest presenters. They come not only from the health sector but also from other fields such as business, community based organizations, politics, cuisine and education. This is to encourage participants to look beyond their known world for inspiration and learning. The guests are asked to reflect as openly and honestly as they can about their own experiences – successful and unsuccessful – and to share insights they've gained. Just as is the case for course participants, the speakers will only reveal their own experience if they are well briefed and feel they are speaking in a safe and trusting environment.
The role of participants
Participants not only work in groups to solve problems (see below) but provide daily reflections on the previous day, and they welcome and introduce the guest speakers and they facilitate a Question and Answer session with the guests after their presentations.
At the end of each day participants are also asked to rate and evaluate each session (using Google® docs online) and to provide additional comments – feedback which is discussed the following day and used to guide immediate changes in the program if required, and to guide the development of the course in future years.
Learning about self: Self assessment
Before the course, participants are asked to share their short 150-200 word biographies and their expectations of the course with the other participants online. They are also asked to complete an Enneagram exercise – the
On the first day the participants are also asked to assess their leadership skills across the 22 skills in the six domains. They are asked to evaluate their own level of skill in each of the following from 1=poor, in need of significant development to 5=excellent, highly developed skill; then list their top five skills and list the five priority skills they need to work on (Appendix). A glossary is now provided to ensure a common understanding of the terms.
Participants then discuss and share their self assessments with one or two of their colleagues. Each participant, including the facilitators, then present their self assessments to the class in open plenary. The aim is to encourage people to be as comfortable as they can be with themselves, their strengths, their weaknesses, their likes and dislikes – and to get a sense of others’ strengths (from whom they maybe able to get help) and weaknesses (for whom they may be able to help), and their likes and dislikes. It is the facilitator's (leadership) role to ensure a safe emotional and physical environment.
Each of the leadership skill domains is covered during the week and in each session clarity is sought by explicitly defining the skill under discussion, how it can be broken down into its component parts or elements, and how the skill can be developed and refined. (Appendix). The list is too long to go into detail for each skill, but the focus is on practice and the practical. In Appendix the example of chairing meetings is provided - a highly relevant situation that requires the development of a number of leadership skills.
Throughout the learning there is a considerable focus on the last two domains – about one's own emotional health and emotional intelligence, as these are the foundations for leadership and for the development and refining of the other skills.
From a recent course participant (Malawi 2016):
Group assessment
Another essential aspect of the students’ learning is to encourage the development of group work skills as unavoidable elements of leadership (and membership, and followership). The reason is that virtually all public health now requires working in teams and groups. As Harvard Business School's John Kotter says:
Each group develops respective scenarios to solve, and analyses what leadership skills will be required. They are encouraged to choose real issues which one of the team members may be facing in their workplaces.
Before jumping straight in to solving the problem, the groups spend a considerable amount of time analysing and understanding the individual leadership skill strengths and weaknesses of all the team members. They then construct a picture of the team's skills strengths and weaknesses. This has to be done with care and mutual respect.
Form another recent course participant (October 2015):
In most workplaces, people really only know each other
Recent experience has shown that the more time the members of the group spend on really understanding each other retrospectively, and putting together a picture of the team's overall skills (strengths and weaknesses), the better the group outcome, which in this case are the quality of group presentations, self-reported functionality of the group, and observed problem solutions. This is an element (Mutual Understanding) that should be added to Bruce Tuckman's well-known Forming-Storming-Norming-Performing model of group development. 12
Leadership of self
In taking the last two skills domains (emotional intelligence) which include reflection; self-awareness: self-regulation; time management, empathy; social skills; networking (influencing and relationship building); motivation and passion, it is clear that they relate much more to the self than to other people or to the organization or to technical issues.
Participants are encouraged to share their experiences of how they look after themselves and how they nurture their own physical and emotional health. They are encouraged to
Learning and refining skills
How can participants develop and practise their leadership skills? This requires the construction of, and adherence to a considered plan. It might involve a host of the following ideas that are presented and discussed throughout the course: Ask others for feedback, for example if giving a talk, chairing or participating in a meeting (but they must make sure to ask for the feedback before the talk meeting starts, not after it has occurred);
- Ask colleagues or friends to review one's written work;
- Find a mentor or coach, and mentor others if the opportunity arises;
- Observe and talk to people that one admires, especially those who acknowledge their weaknesses, not only their strengths;
- Create a supportive
- Use the formal performance appraisal and development process to build leadership skills;
- Take up opportunities that might be available – special courses or groups, media training;
- Practice in other forms of performance such as theatre, music and sport;
- Write for peer reviewed publications; write opinion pieces;
- Give conference presentations;
- Read widely on leadership;
- Work on improving emotional intelligence (meditation, yoga, prayer, a course on emotional intelligence)
- Accept more responsibility, for example take project leader roles within one's organisation;
- Apply for leadership roles outside the organisation in other aspects on one's life: for example a community group, sporting or cultural organisation, a school board, or a local council. Great experience can be gained through volunteer roles which can offer: the practice of leadership, learning in other fields, learning from other people, new contacts and networks which may be increasingly useful as public health becomes even more multi sectorial, potential mentors.
As the final (and major) assessment, participants are asked to describe in detail their unique plan for developing their leadership skills over the next year or two (most choose one year). They are then contacted one year later to report on their progress.
From a recent participant (Melbourne 2014) followed up in 2015:
From another recent participant (Melbourne 2014) followed up in 2015:
But not all is rosy as another recent participant (Melbourne 2014) followed up in 2015. Describes:
Conclusions
The learning described in the paper is only an introduction. As Rowitz describes:
The learning is designed to engage, inspire and encourage participants to be lifelong learners and continue to invest time in developing their skills. As part of this they are asked to actively reflect on what they learned (and what they haven't or should have!), and as mentioned above their final assessment is the development of a one or two-year plan of how they will further develop their leadership skills. A limitation is the fact that only one group to date has been followed up.
The intensive five days requires careful facilitation to ensure a collaborative learning approach in an environment where guests, participants and facilitators can share their learning in a meaningful and considered manner.
Done well, developing leadership skills is fundamentally about developing the skills to become a more effective health professional, a better colleague and a better person.