Many early health care leadership and administration programs were positioned in schools of public health or linked to public health programs. Why? Public health visionaries substantiated multiple dimensions in public health practice, ranging from maternal-child health, epidemiology, biometry, nutrition, veterinary science, nursing, and administration, among others. To protect the public's health, each specialization addressed a population of interest and concern. Together, the human capital of each specialty created an interprofessional trust that informed the science of population health.
The current pandemic has revived and illuminated an interest in public health. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease, Dr. Deborah Birx, United States Global AIDS Coordinator, Dr. Francis Collins, Director of the National Institutes of Health, and Dr. Robert R. Redfield, Director of the Centers for Disease Control and Prevention are household names and champions for protecting national interests. During each COVID-19 briefing, the nation gains insight on individual well-being, with a focus on prevention education, aggregated and stratified morbidity and mortality data, virus and transmission rates, and the impact of the virus on varying age, socioeconomic, and racial demarcations. Although the virus has no political or other type of affiliation, gaps in the health care system ranging from supply acquisition, workforce availability, bed availability, access to care, and individual versus collective civil rights are inextricably linked to policy and political beliefs.
Leadership development has traditionally focused on individual traits and ability development to enhance self-awareness during interactions with others, environmental scanning, and decision making based on improvisation and principles based on a distinguishing feature—it occurs during events not yet experienced and for which no script exists (Bleich & Kist, 2015). The current pandemic, which has never been experienced, creates an opportunity for leaders to step forward and for educators to advance leadership curriculum development drawn from public health principles and practices. Leadership requires the ability to identify factors outside of the immediate work environments that affect health and generate population and community health interventions in the face of the unknown (Robert Wood Johnson Foundation, 2017).
From Competencies to a Leadership Development Program Framework
Public health documents were reviewed from a leadership lens revealing a compelling reference for professional development educators interested in leadership program development. The Core Competencies for Public Health Professionals, revised and adopted by the Council on Linkages Between Academia and Public Health Practice (2014), is a collaborative of 20 national organizations that provided a set of competencies in eight domains and tiered to three levels of practice: front line staff/entry level, program management/supervisory level, and senior management/executive level. What follows is not a restatement of these competencies. Rather, the topics listed provide the substance that could influence competent leadership across health care sectors and serve as a leadership core beyond public health.
Analytic and Assessment Skills
Analytic and assessment skills are crucial to leadership for two reasons. The first is to serve an environmental scanning function aimed at community and population comprehension, raising awareness of the people, places, and things that elevate or distract from health and well-being. When leaders have this broad perspective, it affords the opportunity for timely problem identification and context-bound decision making. Subject matter suggestions include:
- resourcing public health data
- decision-science and analytics
- bias mitigation to improve reasoning skills
- deep listening to populations of interest through appreciative inquiry
Policy Development and Program Planning
Leaders are obligated to inform, interpret, and evaluate the impact of policy to stakeholders regardless of where it is generated. Several initiatives merit attention, such as the Healthy People 2030 principles that ensure a holistic approach to leading (Office of Disease Prevention and Health Promotion, 2017). Public health principles that are crosscutting include that the nation's health and well-being is a shared responsibility distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors (Office of Disease Prevention and Health Promotion, 2017). Leadership topics that would provide intentional contributions to this work are:
- scalability and measurement to advance Healthy People 2030 goals
- what leaders need to know about promoting health and preventing disease
- the ABCs of health disparities and health equity (i.e., action, behavior, compassion)
- influencing health in social, physician, and economic environments
Additional policy resources that are timely educational references include the Pandemic Response and Opportunity Through National Service Act (2020), and the Coronavirus Aid, Relief, and Economic Security Act (2020).
Communication capabilities are always required for impact and coexistence, so the appearance of communication expertise is no surprise. That said, the ability to communicate across organizational, cultural, and other boundaries is highly relevant in advocating for the public's health. Special attention is given to the clarity and simplicity, communication transference, and perseverant delivery of messages. Suggested topics include:
- field testing important messages for simplicity and clarity
- using social media as a message conveyance tool
- the rationale for perseverant messaging
Leaders recognize that cultural competency is a misnomer in that cultural sensitivity and acceptance is nonending. Therefore, achievement of competence is always evolving. When serving in a leadership role, professional development can include exploring, and sensitivity to, unintended biases toward communities and populations that are increasingly heterogeneous. Talking points in training comprise:
- radical inclusion as an acceptance of differences
- discovering values, beliefs, and perspectives in self and others
- exploring privilege and dominance in health care
Community Dimensions of Practice
Leadership demands within one's organization rarely leave time for immersion experiences in community-based organizations. The creation of intensive immersion experiences, even for one or two days, can impact deeper knowledge of the depth of community services and generate new opportunities for partnerships. Examples of immersion experiences include study in:
- housing and transportation
- environmental concerns related to water and air
- logistics related to food production and distribution
- tracing under- or uninsured in need of health care
Public Health Sciences
Currently, leadership exposure to core public health sciences—biostatistics, epidemiology, social and behavioral sciences, public health informatics, environmental health—is essential, not luxury or peripheral knowledge areas for cross-functional leadership. These subjects can be presented in a variety of learning formats through online education, TED Talks, and immersion experiences as noted above. Accessing public health literature through journals is worthwhile reading; it adds to holistic perspectives that enrich leadership practice in any setting. Topics to present are:
- trauma, congestive heart failure, asthma, and low-birth weight—commonalities through a public health lens
- the epidemiology of poverty
- adherence to public health standards—influencing resistors
Financial Planning and Management
Financial planning and management skills are common across the health care sector. Missing is the maldistribution of resources between and among sectors, and how to distribute resources aimed at prevention and health promotion when the insurance structures are entrenched in payment models that prioritize illness care. To this end, possible leadership development topics might include:
- discovering financial incentives for illness rather than prevention
- the maldistribution of wealth and its impact on financial survival
- finance and economic lessons learned from non-U.S. health care
Leadership and Systems Thinking
The last of the eight domains, and like the previous domain addressing finance, leaders must manifest the capacity to generate transformational change within the health care system. As a point of reference, there are social mandates to revisit longstanding institutions that include education, policing and incarceration practices, and health care. Traditional ways of educating leaders with curricula and programs of previous generations lack the relevance to upcoming generations. The training suggestions listed above are intended to provide an enhanced stimulus for professional development educators in leadership and systems thinking.
Solutions exist to many of the problems faced in health care and leadership. These solutions are buried amid our specializations. Public health has a rich history in leadership development, and it is playing a crucial role during the current pandemic. Spending time in the public health literature created the foundation for a training model that is cross-sectional.
- Bleich, M. R. & Kist, S. (2015). Leading, Managing, and Following in Yoder-Wise, P. Leading and Managing in Nursing (6th ed.). Elsevier.
- Coronavirus Aid, Relief, and Economic Security Act, 116 U.S.C. § 3214 (2020). https://www.congress.gov/116/bills/hr748/BILLS-116hr748enr.pdf
- The Council on Linkages Between Academia and Public Health Practice. (2014). Core competencies for public health professionals. http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2014June.pdf
- Office of Disease Prevention and Healh Promtion. Healthy People 2030 Framework. (2017). https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/
- Framework Pandemic Response and Opportunity Through National Service Act, S. 3624, 11th Cong. (2020). https://www.congress.gov/116/bills/s3624/BILLS-116s3624us.pdf
- Robert Wood Johnson Foundation. (2017). Catalysts for change: Harnessing the power of nurses to build population health in the 21st century. https://www.rwjf.org/en/library/research/2017/09/catalysts-for-change--harnessing-the-power-of-nurses-to-build-population-health.html