CHAPTER\u00a026<\/p>\n
Measuring the Leader<\/p>\n
Work experience, hardship, opportunity, education, role models, and mentors all go together to craft a leader.<\/p>\n
\u2014J. A. Conger,\u00a0Learning to Lead<\/p>\n
Leadership is multidisciplinary as well as multilayered, and no single measure of leadership exists. Most quantitative evaluation instruments do not have specific public health leadership dimensions and are quite general to begin with. Case studies, interviews, and stories, of course, provide qualitative information. The quantitative and qualitative information that is available can be used to evaluate the development of leadership skills and determine whether leadership development programs lead to changes in behavior.<\/p>\n
The purpose of this chapter is not to review all the leadership assessment instruments on the market but rather to describe several instruments currently used in various public health leadership development programs. This chapter will also explore the concept of 360-degree feedback and consider recent arguments for and against credentialing public health administrators.<\/p>\n
A LEADERSHIP COMPETENCIES FRAMEWORK<\/p>\n
The late 1990s saw a renewal of interest in training the public health workforce, including public health leaders. The issue of leadership training was addressed by the Public Health Functions Project, which was coordinated by the Assistant Secretary of Health and the Surgeon General.1\u00a0Table 26-1\u00a0presents the 10 tasks this project undertook. A project subcommittee was appointed to:<\/p>\n
Provide a profile of the current public health workforce and make projections regarding the workforce of the 21st century. The subcommittee should also address training and education issues, including curriculum development, to ensure a competent workforce to perform the essential services of public health now and in the future. Minority representation should be analyzed and the programs to increase representation should be evaluated. Distance learning should be explored. The subcommittee should examine the financing mechanisms for curriculum development and for strengthening the training and education infrastructure.2(p.v)<\/p>\n
TABLE 26-1\u00a0Public Health Functions Project<\/p>\n
The following tasks will be undertaken as part of the Public Health Functions Project:<\/p>\n
1. Develop a taxonomy of the essential services of public health that can be readily understood and widely accepted for use by the public health community.<\/p>\n
2. Using the taxonomy developed, assess the public health infrastructure and document the federal, state, and local expenditures on essential services of public health.<\/p>\n
3. Propose a mechanism to ensure accountability for outcomes related to the delivery of essential public health services at the state and local levels, in return for greater flexibility in administration of federal grants to support public health.<\/p>\n
4. Develop a strategy for communicating to the general public and key policy makers the nature and impact of essential public health services.<\/p>\n
5. Document and publish analyses of the health and economic returns on investments in essential public health services.<\/p>\n
6. Identify the key categories of public health personnel necessary to carry out the essential services of public health, assess the nation\u2019s current capacity and shortfalls, and establish a mechanism for ongoing monitoring of workforce strength and capability.<\/p>\n
7. Develop and publish a full set of evidence-based guidelines for sound public health practice.<\/p>\n
8. Collaborate with the PHS Data Policy Committee to identify the information and data needs for the effective implementation of the essential services of public health and develop a strategy for the interface between the personal services and population-wide systems, ensuring the availability of information necessary to both.<\/p>\n
9. Develop a process to ensure the appropriate collaboration of the public health community and adequate inclusion of public health perspectives in the development of national health goals and objectives for the year 2010.<\/p>\n
10. Develop a strategy for regular communication among interested parties at the national, state, and local levels on progress related to these activities.<\/p>\n
Source: Reproduced from Public Health Service,\u00a0Public Health Workforce: An Agenda for the 21st Century, 1997, U.S. Department of Health and Human Services.<\/p>\n
One of the subcommittee\u2019s tasks was to look at the feasibility of a competency-based curriculum. In the past, learning objectives were used to evaluate educational attainment. A competency-based system is intended to be more oriented toward outcomes. Both learning objectives and competency-based outcomes can be useful for gauging a student\u2019s or trainee\u2019s mastery of new skills and abilities. Learning objectives define the key topics of the course or curriculum in a general way, whereas competencies define what a student or trainee is supposed to master over the long run. The critical issue is how to measure progress toward achieving the competencies and objectives.<\/p>\n
The project subcommittee reported on six priority areas for a competency-based curriculum: cultural competency, health promotion skills, leadership development, program management, data analysis, and community organization. It identified a number of action steps for acquiring the competencies.<\/p>\n
The development of competencies is a complex process. At the 1995 annual meeting of National Public Health Leadership Development Network (then under a different name), a project was undertaken to develop a series of leadership competencies for use in the creation and evaluation of state and regional public health leadership programs. The task groups formed at the meeting named four core categories for the competency exercise: transformational leadership skills, political competencies, transorganizational skills, and team-building skills. Over the course of 1996, the framework evolved. With the advent of a concern for competencies for leaders in a public health preparedness environment, Dr. Kate Wright and the Heartland Center for Public Health Preparedness have modified the framework to include these new competencies.\u00a0Appendix 26-A\u00a0presents this updated framework.3<\/p>\n
Transformational leadership skills are needed by public health leaders because leaders are change agents. Leaders need to have a mission and vision and need to motivate and manage change effectively. As for political competencies, leaders need to understand how the political process works, how to negotiate, how to build alliances, and how to market public health and educate the community about public health issues. Because so much public health activity occurs between organizations, public health leaders need transorganizational competencies, including an understanding of organizational dynamics, interorganizational collaboration mechanisms, and social forecasting and marketing. The team-building skills they require include the ability to develop team-oriented structures for purposes of planning and implementing objectives and evaluating progress toward the objectives, the ability to facilitate\u00a0team development, and the ability to mediate when a conflict occurs.<\/p>\n
The framework presented in\u00a0Appendix 26-A\u00a0provides a template for learning and for making sense of the multidimensional aspects of public health leadership. No framework should be etched in stone. It must be allowed to evolve. Data need to be collected to determine if the identified competencies can be taught and put into practice. For example, Discovery Learning has developed a 360-degree public health leadership profile based on the framework that will provide these data in the future.4\u00a0The profile is based on evaluation of such skills as innovation, client service, mentoring, collaboration, team skills, and conflict and negotiation skills.<\/p>\n
The main problem with most competency frameworks is that the competencies are not defined with sufficient specificity to permit their measurement. Take, for example, the competency \u201cIdentify, articulate and model professional values and ethics,\u201d which is obviously very general and difficult to gauge. The solution is to break down each competency into specific components that can be measured. Discovery Learning has attempted to do this. In addition, there must be an applied research strategy to evaluate the leadership competencies routinely and revise them as necessary. None of this is to imply that the leadership competency framework is useless. The process of refining the framework has just begun and will probably take several years to complete. The end result is hoped to be a performance standards system capable of evaluating leadership outcomes.<\/p>\n
CREDENTIALING AND ACCREDITATION<\/p>\n
The credentialing of public health professionals became a live issue in the 1990s. In 1971, the U.S. Department of Health, Education, and Welfare defined credentialing as \u201cthe process by which a nongovernmental agency or association grants recognition to an individual who has met certain predetermined qualifications specified by that agency or association. Such qualifications may include: (a) graduation from an accredited or approved program; (b) acceptable performance on a qualifying examination or series of examinations; and\/or (c) completion of a given amount of work experience.\u201d5<\/p>\n
The supporters of credentialing argue that it will increase the credibility of public health professionals in the political arena as well as with the public at large. Professional standards will be developed that will guide public health programs. Some supporters want to tie credentialing to licensure. The critics argue that no credentialing system is possible because of the multidisciplinary background of public health professionals. Despite this criticism, a credentialing examination for graduates of accredited schools of public health and public health programs was given for the first time in the summer of 2008 and supervised by a newly created National Board of Public Health Examiners.<\/p>\n
Schools of public health point out that they go through an accreditation process overseen by the Council on Education in Public Health. Accreditation would be prima facie evidence that graduating students have the necessary competence to practice public health, and a master\u2019s degree in public health from an accredited school of public health should preclude the necessity of further testing. In contrast, many public health practitioners have not been trained in public health and thus don\u2019t have the stamp of approval conferred by graduation from a school of public health. In addition, there is a question whether schools of public health are teaching the skills that practitioners need to have. For example, leadership courses do not exist in some schools of public health.<\/p>\n
A report to the U.S. Health Resources and Services Administration defined accreditation as follows: \u201cAccreditation is generally used to refer to the evaluation of academic programs which prepare individuals for professional practice and to determine whether such programs meet predetermined standards. Accreditation may be carried out by public and private agencies or associations.\u201d6(p.9)<\/p>\n
Licensure, credentialing, and accreditation are related, although proponents of credentialing may argue that accreditation is not a guarantee that the credentialed public health professional has acquired the desired knowledge or the ability to translate this knowledge into practice. Credentialing proponents point out that a process of evaluating professional knowledge helps develop standards for professional performance, whereas accreditation is tied to an organization rather than a specific individual.<\/p>\n
A report prepared for the Association of Schools of Public Health discussed factors that need to be included in any sound credentialing system.7\u00a0First, role delineation that distinguishes between professionals who have different skills and levels of knowledge is a requisite. Because the role of public health administrators would be distinguished from that of other practitioners in the field, the credentialing of public health leaders could occur. Second, the credentialing\u00a0system must specify the knowledge, skills, and attitudes (KSAs) required to carry out the duties of a credentialed professional and public health leader. Third, the system must determine the education, training, or experience necessary to generate the required competencies. Fourth, a testing procedure or other form of assessment must be devised to determine when a practitioner has achieved entry-level competency levels as well as more advanced levels of ability and knowledge. Finally, the system must include a process for recertification and require certified practitioners to undergo recertification periodically. Because leadership tools and skills change over time, the recertification process would encourage advanced training.<\/p>\n
In the early 1990s, the American Public Health Association looked at the issue of professional credentialing.8\u00a0The committee assigned to the task found very little information in the literature related to credentialing. To further its understanding of the issue, the committee conducted interviews with leaders in the field and with credentialing experts and also surveyed these two groups. The committee found that public health leaders generally did not support the development of a credentialing system. The leaders recognized that a credentialing system would need to be multifaceted and be able to accommodate a number of subspecialties and different education levels. The reaction of the credentialing experts was similar. The committee concluded that, despite the obvious benefits of credentialing, there was no consensus on the form credentialing should take.<\/p>\n
One successful credentialing system was developed by the Society for Public Health Education (SOPHE) for undergraduate health educators.9\u00a0The National Commission for Health Education Credentialing (NCHEC) was organized to carry out the certification of health educators. Since 1988, more than 2,000 individuals have become certified health education specialists. The certification process, which is based on what NCHEC has determined are necessary educational and professional experiences, is voluntary. A health educator cannot take the examination unless he or she has a college degree from an accredited institution. A candidate also must have a minimum of 25 college semester hours in health education.<\/p>\n
At the present time, there are more than 100 sites in the United States where the examination is given twice a year. Those people who pass the certification examination are seen as having met the minimal health education requirements. New criteria were introduced in 2006.10\u00a0A three-tiered model for credentialing was developed for health education practice at the entry level and two advanced levels. SOPHE also became concerned with leadership and developed a leadership program for its members.<\/p>\n
Questions have been raised about the qualifications of local health officers. During the 1990s, the Health Resources and Services Administration gave a three-year grant to the School of Public Health at the University of Illinois at Chicago to develop procedures for credentialing health administrators. A voluntary credentialing program was developed. It is too early to evaluate the experiment, but the experience of public health management and leadership programs around the country indicates that public health leaders gain from the management and leadership development process. What they gain, however, is difficult to determine in other than a general way. The National Public Health Leadership Development Network will begin to discuss the issue of credentialing for public health leaders in 2013.<\/p>\n
360-DEGREE LEADERSHIP ASSESSMENT AND FEEDBACK<\/p>\n
We all have perceptions of ourselves that others around us may not share. Leaders are no exception. They may view themselves one way and be viewed by their colleagues in quite a different way. Therefore, the assessment of a leader needs to include a self-evaluation as well as evaluations by colleagues. In other words, it should be a 360-degree assessment.<\/p>\n
The 360-degree assessment process involves a multilevel evaluation that focuses on whether the leader\u2019s style of leadership supports or obstructs achievement of the mission and goals of the organization. In a comprehensive 360-degree assessment, all key stakeholders have a voice in evaluating the leader and assessing the direction in which the organization is moving.11<\/p>\n
Requirements of a 360-degree assessment include the following:12\u00a0First, the leaders of the organization must determine whether sufficient enthusiasm for and commitment to the process exists in the organization and whether they are willing to institute changes based on the results of the assessment. Second, they must collect high-quality assessment data. Finally, they must identify possible responses to the results, such as the development of leadership training programs or formal mentoring programs.<\/p>\n
There is a much-utilized 360-degree leadership assessment instrument, the Leadership Practices Inventory (LPI), which evaluates leaders based on their performance of best leadership practices.13\u00a0The five practices in the initial LPI were selected on the basis of interviews with senior and midlevel administrators and on leadership case studies. These five practices are still the major emphasis of the LPI. The practices are (1) modeling the way, (2) inspiring a shared vision, (3) challenging the way, (4) enabling others to act, and (5) encouraging the heart.<\/p>\n
The third edition of the LPI has 30 leadership practice items, and for each item there are 10 possible responses, from \u201calmost never\u201d to \u201calmost always.\u201d (In the first edition, there were only five choices for each item, from \u201crarely\u201d to \u201cvery frequent.\u201d) The score for a given practice, therefore, can range from a low of 6 to a high of 60. One version of the LPI is used for self-evaluation, and a second version is used for evaluation by observers (colleagues and stakeholders). The LPI can be used at different times to determine whether the leader has made progress in performing the five leadership practices.<\/p>\n
Using the original LPI, data on 43,000 leaders from around the world were collected, and means, standard deviations, and internal reliability measures were computed.14\u00a0Most of the leaders were from the business sector, but some were from academia and the public sector. The reliability rates fell between 0.81 and 0.91. Enabling others to act was seen by leaders and their observers as the most common practice, followed by challenging the process, modeling the way, encouraging the heart, and, in last place, inspiring a shared vision.<\/p>\n
In a pilot study using the LPI, baseline leadership information was collected from 163 public health leaders selected as fellows by the Illinois Public Health Leadership Institute between 1992 and 1997. There may be a self-selection bias built into the study, because fellows are likely to have identified themselves as leaders before embarking on the leadership program and to be committed to leadership development to enhance their skills. Thus far, public health leaders have not specifically been studied. Comparisons of public health leader self-evaluations and observer evaluations have not been done thus far. Some preliminary data indicate that observers rate their leaders higher than the leaders rate themselves.<\/p>\n
Mean scores for business leaders and public health leaders are presented in\u00a0Table 26-2. The scores for public health leaders are consistently higher, but a confounder is the fact that the sample of business leaders includes academics and human service professionals. The scores for the two groups were not significantly different on the practice \u201cchallenging the process,\u201d an indicator of orientation to change, nor on the practice \u201cinspiring a shared vision\u201d (both groups scored relatively low). The public health leaders scored significantly higher than the business leaders on the other three practices, all of which are associated with the quality of work-related relationships.<\/p>\n
One of the difficulties of using the LPI in studies of leadership is that the main purpose of the instrument is to assess individual leaders through self-evaluation and observer evaluation. The aggregation of LPI data should hide the characteristics of individual leaders, but nonetheless they need to be informed of the fact that their evaluations may be used for research. The instrument also may create biases in the responses because it is tied to a conceptual model that the developers promote. Not every leader supports this model.<\/p>\n
TABLE 26-2\u00a0Means and Standard Deviations for Public Health and Business Leaders<\/p>\n
Note: This study was done with Elanine Jurkowski.<\/p>\n
Another instrument used in several public health leadership programs is the Skillscope 360-degree assessment developed by the Center for Creative Leadership.15\u00a0This instrument assesses information skills, decision-making skills, interpersonal skills, personal resources, and effective use of self. The instrument is flexible to use and can be used for individual assessments tied to coaching and a part of a structured leadership program. On a group level, the Skill-scope can help to establish a group profile related to the strengths of the group and areas that need work. Another instrument developed by the Center for Creative Leadership is the 360-degree Benchmarks profile, which is one of the leadership instruments used in the National Public Health Leadership Institute.16\u00a0Benchmarks is a comprehensive tool that measures 16 success skills and five career derailers. The 16 skills fall into the four categories of meeting job challenges, respecting yourself and others, leading people, and potential for derailment.<\/p>\n
On the negative side, a 360-degree assessment is often expensive and time consuming.17\u00a0Not only must the measurement instruments be bought, but staff need to be trained to interpret the results. Another issue is whether leaders are willing to reveal self-perceived weaknesses to their colleagues and whether subordinates feel comfortable rating their leaders. This issue is of special concern in smaller organizations. If anonymity is not maintained and the observer evaluations are negative, animosity may occur between leaders and their professional colleagues. Finally, there is the question whether the process will make any difference.18<\/p>\n
Despite these issues, the process can result in important information. If the leadership data are linked to organizational needs, organizational efficiency and effectiveness can be improved. The results need to be communicated to the entire workforce, but with a sensitivity for the possible effect on the person who was evaluated. On the whole, the 360-degree approach offers individuals and the organization information that can improve the services provided by the organization.<\/p>\n
QUALITATIVE LEADERSHIP ASSESSMENT<\/p>\n
Public health programming is driven by population-based statistics, including mortality and morbidity rates. The problem is that the vitality of public health as an approach and perspective can get lost in the numbers, with the result that public health loses credibility among community residents.19\u00a0As a consequence, public health leaders need to acquire qualitative information to help them evaluate their performance and to publicize public health as a way of enhancing their credibility.<\/p>\n
Qualitative information often comes in the form of stories and case studies. The case studies of interest to us here describe public health practitioners in action and present conclusions about what was done right and what could have been done better. As we will use the term, \u201ccase\u201d refers to whatever is the subject of a case study (usually a single event or a series of events).<\/p>\n
Case studies, for our purposes, can be divided into four classes: (1) specific empirical studies, (2) general empirical studies, (3) specific theoretical studies, and (4) general theoretical studies. Empirical case studies describe actual cases, whereas theoretical case studies are constructed specifically to illustrate some point. Specific case studies have definable boundaries, and general case studies are examples already available that can be used to demonstrate a perspective.<\/p>\n
The cases chosen for research inquiry are typically different from those chosen for training purposes. In this section, we are interested in the latter, especially their potential to clarify the application of leadership principles in the real world of public health practice. Training case studies describe how professionals handle problems and thus can serve as guides to future action. Leaders can develop their own case studies in order to analyze public health community activities and evaluate their own leadership skills.<\/p>\n
Public health case studies are used for three main purposes.20\u00a0First, they can be used to offer insights into how a public health agency carries out its activities. Second, they can be used to help public health leaders explore different scenarios as part of a problem-solving process.\u00a0Table 26-3, for instance, presents a number of public health scenarios helpful for defining outcomes that might occur if a public health agency instituted a certain policy or embarked in a certain direction. Third, case studies can be used to illuminate why events unfolded in a certain way and to explore better ways to handle an emergency situation, for instance.<\/p>\n
In regard to the last two uses, the role of leadership and the causal consequences of actions need to be interpreted carefully. It is always difficult to tease out the causal factors in a complex set of relationships and happenings. In addition, the events that make up a case rarely repeat themselves in exactly the same way.<\/p>\n
TABLE 26-3\u00a0Public Health Scenarios Based on Schwartz Categories<\/p>\n
Scenario 1: Winners and Losers<\/p>\n
A health reform plan passes Congress. The plan presents a system redesign that is state based and involves local health alliances. The health plans incorporate most of the direct service functions of local health departments. Block grant funds that remain are given directly to the health alliances for distribution. This scenario initially positions the local health department as a loser.<\/p>\n
Scenario 2: Challenge and Response<\/p>\n
The American Public Health Association creates a strong lobbying coalition that includes representatives from all the major public health interest groups and organizations. As Congress reviews changes in the financing of health services, the public health community is able to affect legislation so that CDC and state public health agencies become responsible for collecting all data related to health care, are responsible for oversight of all health programs, become the lead agency for all government-sponsored primary prevention programs, are directly funded for health-related community programs by a block grant, and so on. Public health meets every challenge and wins.<\/p>\n
Scenario 3: Evolution<\/p>\n
There is a major change in the economy of the state. Several new biotechnology companies move to the state, and many new jobs are created. The state unemployment rate drops to 3%. With the increase in employment, the number of people on welfare drops significantly. With new jobs, the teenage pregnancy rate drops, as does the incidence of gang-related violence, because gang members get jobs.<\/p>\n
Scenario 4: Revolution<\/p>\n
Congress passes a major piece of legislation. The government decides to get out of the public health business. All public health activities are transferred to the private healthcare system.<\/p>\n
Scenario 5: Cycle<\/p>\n
Five years after the evolution scenario above takes place, the American economy collapses. A major depression occurs. People lose their jobs. Gang warfare increases. The teenage pregnancy rate expands significantly.<\/p>\n
Scenario 6: Infinite Possibilities<\/p>\n
A health reform package passes that provides universal coverage.<\/p>\n
Scenario 7: The Lone Ranger<\/p>\n
Through the efforts of public health professionals and researchers, a cure for AIDS is found, a chemical substance that purifies all water is discovered, and a vaccine that prevents Alzheimer\u2019s disease is developed. Because of these breakthroughs, the American public unequivocably supports all public health initiatives.<\/p>\n
Scenario 8: My Generation<\/p>\n
The early years of the 21st century see a major increase in births in the United States.<\/p>\n
The above scenarios can be looked at individually or can be combined to form more complex scenarios.<\/p>\n
Source: Adapted from\u00a0The Art of the Long View\u00a0by Peter Schwartz. Copyright \u00a9 1991 by Peter Schwartz. Used by permission of Doubleday, a division of Random House, Inc.<\/p>\n
Some case studies are merely free-flowing stories about examples of leadership, for instance. These stories nonetheless must have a message intended for a well-defined audience.21\u00a0There are three main types of leadership stories. One is the \u201cWho am I?\u201d story. The second is the \u201cWho are we?\u201d story. The third is a story of the realization of a vision. It is possible to add a fourth category consisting of \u201cWhat I learned on my summer vacation\u201d stories. These stories describe what a leader learned from other leaders or from workshops on leadership.<\/p>\n
Case study stories have plots intended to elucidate ideas or values. They should be tested before being released to the public to make sure that their messages are clear. One variant of the personal story is the biographical portrait.22\u00a0A portrait of a historical\u00a0or present-day leader, such as C. Edward Koop or Paul Farmer, can be employed for the same purposes as a personal story. Another variant is to focus on a leader whose values stand in contrast to those of a typical public health leader, such as a senator from a tobacco state.<\/p>\n
An interview can also make up the content of a case study. Questions serve as the mechanism for getting information. For example, the author interviewed more than 130 public health leaders in four countries in order to explore their understanding of the meaning of public health, their vision of the future, and the changing characteristics of leaders. (Table 26-4\u00a0consists of a guide for interviewing public health leaders.)<\/p>\n
An interesting variation on the interview is the focus group, in which leaders, for example, might answer questions as a team. A conversation is another variation\u2014a variation explored in Exercise 26-l.<\/p>\n
A case study protocol for public health practice narratives was developed for public health practitioners in a leadership development program under the assumption that structured case studies provide trainees and other lifelong learners with models of public health practice.23\u00a0Case studies can also be used to explore cutting-edge issues in public health that are in need of resolution. In other words, case studies can be based on completed events or on situations in progress.<\/p>\n
Each case has a unique character.24\u00a0For example, even similar cases will differ in historical background, setting, or economic, political, legal, social, or cultural aspects. They also can have a different slant depending on the reason they were written.<\/p>\n
Case studies, as stories, have characters, a plot, and a setting. Their purpose is to give insight into leadership styles and practices, personality concerns, power concerns, organizational intrigues, politics in action, media involvement, and so on. They can be effective mentoring tools; the mentor can assign a case study for the mentee to read, and then the two can discuss the issues raised in the case study. A problem-based case study can present a possible vision of the future.<\/p>\n
The best case studies are built on real experiences. Whereas ideal cases can be constructed, most people seem to relate better to real-life situations that seem real in their unfolding. That is one of the reasons that every case study in this book is factually based, although names and places have sometimes been changed to protect the actual participants.<\/p>\n
TABLE 26-4\u00a0Interview Guide for Public Health Leaders<\/p>\n
1. What are the reasons you decided on a career in public health?<\/p>\n
2. How would you define public health?<\/p>\n
3. What is your definition of leadership?<\/p>\n
4. What are the necessary leadership practices and skills that a public health leader needs to use?<\/p>\n
5. Are these practices and skills different from the practices and skills of business leaders?<\/p>\n
6. What elements of public health\u2019s organizational system enhance or create barriers to leadership?<\/p>\n
7. What is the role of public health in carrying out the core functions of assessment, policy development, and assurance?<\/p>\n
8. What is your vision for public health in the 21st century? What are the three most important systems issues for the future, and what are the key health issues for the future?<\/p>\n
9. How successful is the system in promoting community coalitions to address the health of the community?<\/p>\n
10. Are public\u2013private partnerships that address public health concerns possible? What is public health\u2019s role in managed care?<\/p>\n
11. Does the public understand public health? If not, what can you do to change this situation?<\/p>\n
12. Should public health be integrated into the general health sector, or should public health be maintained as part of a separate governmental office?<\/p>\n
13. What distinguishes a practitioner, a manager, and a leader?<\/p>\n
14. Is the mentoring of future leaders important? What type of mentoring program do you recommend?<\/p>\n
15. What is the role of politics in public health?<\/p>\n
Most case studies are written as narratives and have a beginning, middle, and end25\u00a0(Table 26-5). The opening should present the issue that the case is intended to illustrate and describe the setting and key characters. The middle, or the body of the case study, describes the events that make up the case. If this is done properly, then the lesson of the case becomes clear. In some instances, elements of the setting and key characters may be described in more detail than was provided in the opening. Political factors that affected the outcome may be critically examined.<\/p>\n
Many case studies include all sorts of supplemental documentation to elucidate the circumstances. The closing reviews the issue in light of the events described and analyzes the decisions made by the key characters.26\u00a0It may explore possible options that might have led to an outcome different from the one that actually occurred. (Some case studies are intended to deal with multiple issues and use a slightly different organization to address the issues in a coherent manner.)<\/p>\n
Case Study 26-A has the classic organization described here. It deals with the issues of privatization of laboratory services and the lack of involvement by public health laboratory directors in public health policy issues. It is also based on variations of real-life situations.<\/p>\n
TABLE 26-5\u00a0Case Study Development Protocol<\/p>\n
Opening (first few paragraphs)<\/p>\n
Name and title of responsible professional<\/p>\n
Date: month and year (fix the case in time)<\/p>\n
Synopsis of decision required or problem setting or issues presented, keeping in the forefront the core functions of health departments<\/p>\n
Case body (no more than four to five pages)<\/p>\n
Department\/agency history, if pertinent<\/p>\n
Environmental setting, if pertinent<\/p>\n
Political concerns<\/p>\n
Expanded description of the decision or problem situation<\/p>\n
Human interaction facts, etc.<\/p>\n
Human element<\/p>\n
Personality impact<\/p>\n
Public relations factor<\/p>\n
Presence\/absence of vision\/enthusiasm<\/p>\n
Organizational relationships<\/p>\n
Other case characters or entities<\/p>\n
Program and process<\/p>\n
Financial concerns, where pertinent<\/p>\n
Closing (last paragraph or two)<\/p>\n
Conclusion of the case<\/p>\n
Suggested methods<\/p>\n
Setting the scene to establish a sense of urgency about the problem or decision<\/p>\n
Setting out a range of decision options<\/p>\n
Source: Reprinted with permission from J. Munson,\u00a0Case Study Development: Guidelines and Protocols for Case Study Development, 2nd ed., 2003. \u00a9 1994, University of Illinois School of Public Health, Mid-American Regional Public Health Leadership Institute.<\/p>\n
Case Study 26-A<\/p>\n
Organization of Public Health and Clinical Laboratory Services in a Reformed Health Service Delivery System<\/p>\n
Jon Counts<\/p>\n
Introduction<\/p>\n
In 2009, the U.S. Congress passed comprehensive legislation that would establish universal healthcare coverage by the year 2012. Congress mandated that each state would develop a strategic plan that would integrate and restructure the public and private healthcare programs. The commissioner of health, Dr. Strangelove, has designated you, Dr. Vision, to develop a plan to define the role of hospital, commercial, public health, and academic laboratories as part of the state of Innovation\u2019s strategy for a reformed health system.<\/p>\n
Case Body<\/p>\n
The result of three decades of heavy clinical laboratory utilization has been the development of a fractured, duplicative, and costly laboratory system in the state of Innovation. The laboratory network in this state fits the general description of the current health system: a patchwork of private and public programs, with goals and objectives as varied as the groups and organizations represented in the system. Clinical laboratories represent a significant component of the rapidly increasing costs of health care. The Health Care Financing Administration estimates that spending on laboratory services composes 4.5% of all national healthcare expenditures.<\/p>\n
Clinical laboratories, like the rest of the healthcare community, have been significantly affected by the nation\u2019s health reform legislation, the Health Services Act of 1993. The primary vehicle for the implementation of the legislation is the new Health Services Commission. The Health Services Act will enable each state to control spending by:<\/p>\n
1.\u00a0shifting the state toward a system of \u201cmanaged\u201d health care<\/p>\n
2.\u00a0defining a uniform benefit package and developing standards of certified health plans through which the uniform benefits package will be provided<\/p>\n
3.\u00a0setting the maximum rate a certified health plan may charge for the uniform benefit package<\/p>\n
4.\u00a0establishing a maximum healthcare inflation rate and lowering the rate until it matches the rate of general inflation<\/p>\n
5.\u00a0setting rules for fair competition among certified health plans<\/p>\n
6.\u00a0minimizing malpractice and its costs<\/p>\n
7.\u00a0simplifying the administration of claims, billing, and information<\/p>\n
8.\u00a0promoting the use of cost-effective healthcare practices and services<\/p>\n
9.\u00a0defining the role and function of public health agencies<\/p>\n
Dr. Vision realizes that the task ahead of him will be a challenge and very controversial.<\/p>\n
1.\u00a0First, the development of any coalition among laboratory organizations, physicians, pathologists, laboratory managers, hospital and commercial laboratories, and government will be exceedingly difficult to achieve.<\/p>\n
a.\u00a0There will be opposition to a government agency leading the discussion about the role of laboratories in a reformed system. There will be suspicion, lack of trust, and concern about the regulatory approach that government agencies might mandate.<\/p>\n
b.\u00a0For the most part, there has been little or no historical interaction among individuals\/organizations who will be involved in the coalition; therefore, the plan must be carefully developed and staged, ensuring that a process for developing consensus has been established.<\/p>\n
c.\u00a0The activities of the coalition will be monitored closely; therefore, there cannot be any secrecy and they must be open to the public, outside review, and scrutiny. There must be a system for dissemination of information and recommendations to the laboratory and medical community.<\/p>\n
d.\u00a0There will be strong opposition to the possibility that the plan will lead to the re-engineering and downsizing of commercial and hospital laboratory staff.<\/p>\n
e.\u00a0The issue of competition between public health laboratories and private sector facilities will be raised as well as the need to consider the privatization of diagnostic services provided by government laboratories. This obviously will be a contentious point because Dr. Vision will have a vested interest in the outcome.<\/p>\n
2.\u00a0The nature of health problems has changed dramatically during the 20th century; chronic conditions have become predominant as well as new and re-emerging infectious diseases.<\/p>\n
3. The utilization of managed care plans and capitation to control costs and share the risk with providers has increased dramatically. The march of managed care, new technologies, and alternative treatment settings will prompt a 34% decrease in inpatient hospital days over the five years from 2009 to 2013. Ambulatory facilities will eliminate many surgical inpatient days, use of birthing centers will increase, mental health care will be delivered more often in residential settings such as halfway houses, and home care will be the most dramatic and fastest-growing segment of the healthcare industry. These changes will have a significant effect on diagnostic laboratory testing. Hospital laboratories will undergo significant reduction in routine and inpatient testing, vertical integration will occur, and regional delivery systems will consolidate and centralize laboratory testing. Large national commercial laboratories will capture the vast majority of testing.<\/p>\n
4.\u00a0The role of laboratory medicine will be expanded into promoting health and preventing disease. Home testing will increase, as will the need to promote direct public access to preventive and screening testing. Genetic testing obviously is going to expand. Hospital and commercial laboratories will play a much more active role in the nation\u2019s disease surveillance, promoting the need for a statewide electronic network between private clinical laboratories and the public health systems. Other anticipated changes in the future laboratory system include:<\/p>\n
\u2022 active management of laboratory utilization, elimination of unnecessary testing, and utilization of practice guidelines<\/p>\n
\u2022 standardization of lab instrumentation and testing methodology and increasing automation<\/p>\n
\u2022 utilization of clinical patient outcome measures of laboratory quality<\/p>\n
Proposal Solution<\/p>\n
The implementation of health reform makes strategic planning imperative for all components of the health system. Historically there have been few efforts to draw the clinical laboratory community together into cooperative efforts toward long-range planning except in the area of laboratory regulation and the credentialing of laboratory personnel. This initiative has been developed to assist the leadership of the clinical laboratory community in the state of Innovation in assessing the effect of health reform and in developing recommendations for integrating the diverse segments of the existing laboratory system into a more cost-effective and efficient structure. The process will include creation of a steering committee to provide recommendations to Dr. Vision for the guidance, direction, and oversight of the initiative. The steering committee may also appoint technical advisory work groups to study and develop specific recommendations on such issues as the following:<\/p>\n
\u2022\u00a0structure and integration of delivery system<\/p>\n
\u2022\u00a0utilization of clinical laboratories in medical decisions or development of practice parameters<\/p>\n
\u2022\u00a0laboratory regulations<\/p>\n
\u2022\u00a0effect of malpractice tort reform on laboratory utilization<\/p>\n
\u2022\u00a0utilization of new technology in laboratories<\/p>\n
\u2022\u00a0personnel resource training and credentialing<\/p>\n
\u2022\u00a0utilization of out-of-state laboratories<\/p>\n
\u2022\u00a0reimbursement policies<\/p>\n
\u2022\u00a0direct billing<\/p>\n
\u2022\u00a0laboratory information systems\u2014collection, analysis, integration, and dissemination of data<\/p>\n
\u2022\u00a0surveillance of emerging infectious diseases<\/p>\n
\u2022\u00a0point-of-care testing<\/p>\n
\u2022\u00a0home testing<\/p>\n
\u2022\u00a0public access to laboratory testing<\/p>\n
The steering committee will consolidate its recommendations into a report to be submitted to the commissioner of health, Dr. Strangelove, for his consideration in establishing public policy.<\/p>\n
Dr. Vision must first establish a process to identify and appoint members from the department and community to the steering committee, individuals who are experts in laboratory science, strategic planning, public policy, development of community constituencies, and consensus building and who are representatives of medical specialties.<\/p>\n
Next, the steering committee must establish a strategic-planning process, including identification and prioritization of major components and issues. In order to address those issues listed, it is essential that a mechanism be developed to collect and evaluate health-related data to determine the need for diagnostic laboratory services. Finally, it must be determined by the steering committee how it will solicit public input.<\/p>\n
Exercise 26-2 provides the opportunity to write a case study. The work of researching and writing the case study, which may take several weeks, is done using teams. The case studies presented in this text can serve as models.<\/p>\n
QUANTITATIVE LEADERSHIP ASSESSMENT TECHNIQUES<\/p>\n
Leadership assessment comes in more than one variety. Part of the explanation is that the standard leadership assessment instruments grow out of different theories of leadership. Another part of the explanation is that there are at least five levels of leadership and different traits and behaviors that are needed for each level. Most leadership assessment techniques are oriented toward the personal level, but leadership can also be evaluated at the team, agency, community, and professional levels.<\/p>\n
Leadership Tip<\/p>\n
Serve refreshments at meetings. It reduces absenteeism.<\/p>\n
Because it is usually the individual who fills out the leadership assessment instrument, most leadership assessment relates to personal traits and behavior, and these traits and behaviors, unsurprisingly, are stressed by psychometricians. One of the best-known personality assessment tools has been adopted by a number of public health leadership programs. The Myers-Briggs Type Indicator (MBTI), based on Jung\u2019s theory of psychological types, measures personality along four dimensions.27\u00a0The first is the extroversion (E) and introversion (I) dimension. Where someone falls along this dimension is determined by whether he or she relates more to the external world or more to his or her inner world. The second dimension, defined by the contrast between sensing perceptions (S) and intuitive perceptions (N), measures whether a person focuses on the here and now or on future possibilities and abstract theory and symbols. The next dimension, defined by the contrast between thinking (T) and feeling (F), measures whether a person responds to situations rationally or emotionally. The fourth dimension, defined by the contrast between judgment (J) and perception (P), measures whether the person tends naturally to engage in organizing, planning, and decision making or instead tends to want to keep options open.<\/p>\n
The MBTI instrument is quite comprehensive28\u00a0and requires the person being tested to answer numerous forced-choice questions. After completing the questionnaire, the person receives a report on his or her profile. The author, who filled out the questionnaire in order to gain a better understanding of how it is used, was found to be an ENTJ. The report said that the author tends to be decisive and frank, quick to take charge of people and projects, applies logic and analysis, prefers action to contemplation, and often pays more attention to tasks than to the people.<\/p>\n
To discover how leaders in the public sector would score, researchers tested and compared five groups of leaders in local, state, and federal government.29\u00a0The first group included 1,394 senior federal government administrators tested from 1983 to 1986. The next three groups, tested in the early 1980s, consisted of managers attending special government institutes at the University of North Carolina. The fifth group consisted of about 100 social service administrators from Nebraska.\u00a0Figure 26-1\u00a0shows how these groups scored on the four dimensions. The point to note is that leaders do not score in a uniform way. Different patterns emerge. Leaders with different styles engage in different leadership practices.<\/p>\n
The Leader Behavior Analysis II instrument differs substantially from the MBTI.30\u00a0It presents the person being tested with 20 typical job situations that involve a leader and one or more staff members. After reading each scenario, the person, putting him- or herself in the position of the leader, selects one of four possible actions. The instrument, which can be self-scored, investigates three dimensions. The first is flexibility (whether the person tends to try to be directive or supportive). There are four score categories for this dimension:<\/p>\n
S1: high directive, low supportive behavior<\/p>\n
S2: high directive, high supportive behavior<\/p>\n
S3: high supportive, low directive behavior<\/p>\n
S4: low supportive, low directive behavior<\/p>\n
The responses to the pertinent scenarios are used to compute a style flexibility score between 0 and 30. The higher the score, the greater the flexibility. The second dimension is leadership effectiveness, and the third is diagnosis.<\/p>\n
FIGURE 26-1\u00a0Myers-Briggs Type Indicator Percentages for Managers in Federal, State, and Local Government.\u00a0Source: Reprinted with permission from M. H. McCaulley,\u00a0The Myers-Briggs Type Indicator and Leadership, in Measures of Leadership, K. E. Clark and M. B. Clark, eds., p. 389, \u00a9 1990, Leadership Library of America, Center for Creative Leadership.<\/p>\n
Scores for these dimensions are computed in roughly the same way as for the first dimension. There is also a form for others to fill out, which allows for a 360-degree personal leadership evaluation.<\/p>\n
A study of an earlier version of this instrument found that\u00a0leadership\u00a0assessment tools help leaders evaluate their\u00a0leadership\u00a0styles and compare their self-perceptions with the perceptions of colleagues.31\u00a0The sample included evaluations of 20,000 leaders from 14 cultures (each evaluation comprised a self-assessment and assessments by others). About 2,000 leaders from industry and education were interviewed, and about 500 in-depth interviews were done. The\u00a0situational\u00a0leadership\u00a0model\u00a0was supported by the data collected.<\/p>\n
There is a Team Leadership Practices Inventory that is basically similar to the LPI developed for leaders and colleagues.32\u00a0The Team LPI is based on the same five leadership practices used in the initial version of the LPI: challenging the process, inspiring a shared vision, enabling others to act, modeling the way, and encouraging the heart. Because the\u00a0use of teams has increased in most organizations, evaluating how teams function is essential. Each team member fills out the Team LPI, which has 30 items. The scores for each practice are totaled and then averaged. By using the Team LPI, a team can determine its strengths as well as the practices that need improvement. The LPI is highly correlated with the Team LPI. Both instruments are less concerned about leadership style than about the practices of leadership.<\/p>\n
There has been growing interest in leadership skills and practices at the organizational level. In 1984, a study of effective organizational leadership was undertaken,33\u00a0and it led to the development of the Leader Behavior Questionnaire (LBQ). The LBQ consists of 50 questions. It is intended to measure focused leadership (listening ability), communication abilities, trust leadership, respectful leadership (how leaders treat others), risk leadership, bottom-line leadership (the belief of leaders that they can make a difference), empowered leadership (sharing power), long-term leadership (visionary leadership), organizational leadership, and cultural leadership (leadership based on the values of the organization). An important underlying assumption of the LBQ is that leadership is multidimensional and that each of its dimensions must be evaluated.<\/p>\n
An important assessment-related breakthrough occurred in the mid-1990s. The healthcare sector became more interested in the measurement of outcomes as a way of evaluating effectiveness.34\u00a0Performance measurement encompasses the measurement of program inputs, intermediate outcomes (process issues), and end outcomes.35\u00a0One goal of performance measurement is to determine whether changes in public health expenditures affect the outputs of public health agencies and the final outcomes for the community.<\/p>\n
Two important new instruments give added clarity to the way talents affect leadership and also thinking and behavioral preferences. The Gallup Organization has been studying managers and leaders for more than 40 years. From its work has come an instrument called Strength Finder (now Strength Finder 2.0).36\u00a0This instrument measures the strengths of an individual as tied to 34 talent themes. Rath has pointed out that it is important to build on individual talents to create strengths at work and not concentrate on individual weaknesses. This instrument is easy to take and is not costly. A leader buys the book, which has a unique access code to the Gallup Organization website. The recipient will receive a profile of the top five strengths.<\/p>\n
Leadership Tip<\/p>\n
Use social media to expand your leadership network.<\/p>\n
The Emergenetics instrument gives the individual a profile in color of his or her thinking preferences and behavioral attributes.37\u00a0This instrument has also been tested on individuals throughout the world. The instrument relates to four major thinking preferences of people: analytical (blue), structural (green), conceptual (yellow), and social (red). Most individuals have profiles that show some mixture of all four preferences, but they tend to have dominance in one, two, three, or four thinking domains. The three behavioral attributes are expressiveness, assertiveness, and flexibility.<\/p>\n
An Institute of Medicine report presented a framework for improving the health of community residents. The community health improvement process is shown in\u00a0Figure 26-2.38\u00a0It encompasses the identification and analysis of health issues, the development and implementation of strategies to resolve the issues, and the monitoring of the implementation process and outcomes. One of the steps is to develop an indicator set that links the implementation of strategies with their outcomes so that the effectiveness of the strategies can be determined, which is the essence of performance measurement.\u00a0Figure 26-3\u00a0presents a performance measurement model consisting of six steps.39\u00a0Despite the existence of this model, public state and local agencies have been slow in adopting the performance measurement approach.40\u00a0This is beginning to change, as mentioned below.<\/p>\n
Performance monitoring is related to evidence-based public health.41\u00a0Evidence-based public health promotes the use of traditional biostatistics measures, epidemiology, healthy communities assessment, and continuous quality improvement methods. Public health agencies and their leaders have not routinely used the tools at hand in an effective manner, nor have they routinely approached their responsibilities from a population-based perspective.<\/p>\n
Public health leaders need to develop the competencies to carry out performance monitoring. Currently, they often assign the task of performance monitoring to other staff members. They also need to ensure that performance measurement is accepted by agency staff and that the information gained is used by the staff to improve operations. In fact, performance measures for evaluating the activities of public health leaders and their community partners utilizing a systems perspective and the essential public health services in the performance process have been developed in the National Public Health Performance Standards Program. The use of performance measurement by leaders will become more prevalent with the accreditation of local health departments, which began in 2011.<\/p>\n
FIGURE 26-2\u00a0The Community Health Improvement Process (CHIP).\u00a0Source: Reprinted with permission from\u00a0Improving Health in the Community:\u00a0A Role for Performance Monitoring, p. 6. \u00a9 1997 by the National Academy of Sciences. Courtesy of the National Academies Press, Washington, DC.<\/p>\n
FIGURE 26-3\u00a0Performance Measurement Step-by-Step.\u00a0Source: Reproduced from\u00a0Improving the Nation\u2019s Health with Performance Measurement, Prevention Report, Vol. 12, No. 1, p. 3, 1997, Office of Disease Prevention and Health Services, U.S. Department of Health and Human Services. Based on example of State of Maryland\u2019s\u00a0Healthy Maryland 2000.<\/p>\n
SUMMARY<\/p>\n
Evaluation plays a multifaceted role in public health. Evaluation techniques are used for uncovering the public health problems that exist in a given community and for assessing the implementation of the programs intended to deal with such problems. They can also be used to assess the level of a leader\u2019s skills and abilities.<\/p>\n
The chapter began with a description of the leadership competencies framework and listed some of the competencies that public health leaders need to have. It then discussed the question of whether a system should be put in place for credentialing public health leaders\u2014a question over which public health leaders are divided.<\/p>\n
Quantitative leadership evaluations are problematic at best. Each instrument incorporates a conceptual\u00a0model on which the instrument is based. The organization in which the leader works is often conceptually different from the model used in the instrument. One alternative is to do a qualitative evaluation using case studies and other qualitative techniques and a battery of several quantitative tools. No matter what type of evaluation is done, however, the evaluation should include the opinions of both the leader being evaluated and the leader\u2019s colleagues. In short, it should be a 360-degree evaluation. Furthermore, the evaluation should cover the leader\u2019s performance at the agency level and also at the community level.<\/p>\n
EXERCISE 26-1:\u00a0Conversations with Leaders<\/p>\n
Purpose:\u00a0to learn how peers view public health and what they think about current public health leadership issues<\/p>\n
Key concepts:\u00a0core functions, evaluation of leadership, focus group, interviewing skills, leadership skills<\/p>\n
Procedures:\u00a0It is possible to learn many things from peers. The class should divide into focus groups of six to eight members. Each group engages in a discussion of leadership using the interview questions in the text as a guide (Table 26-4). The discussion should last at least an hour, although it is not necessary to go through all the questions. The group should allow the discussion to go in any direction it naturally moves. The class can repeat the exercise several times, each time concentrating on a different set of issues.<\/p>\n
EXERCISE 26-2:\u00a0Development of a Public Health Case Study<\/p>\n
Purpose:\u00a0to develop a public health case study to examine how leaders address public health issues<\/p>\n
Key concepts:\u00a0case study, core functions, essential services, leadership, team learning<\/p>\n
Procedures:\u00a0The class should divide into teams of five to eight members. Each team will be responsible for writing a case study using the Munson protocol (Table 26-5). Much of the work will take place outside of class. Select a facilitator to monitor each phase of the project. Identify a public health case worthy of being written about. Investigate the case and collect information for writing up the case. Analyze the case from a policy development perspective. Identify leadership issues involved in the case, and then write up the case (the study should be 5 to 10 pages). Finally, give an oral report on the case to the other teams.<\/p>\n
DISCUSSION QUESTIONS<\/p>\n
1.\u00a0What is one of the problems with using competencies as a means of evaluating leadership?<\/p>\n
2.\u00a0What are the pros and cons of credentialing leaders?<\/p>\n
3.\u00a0What are five personal leadership lessons you learned during the past year?<\/p>\n
4.\u00a0What is a 360-degree assessment?<\/p>\n
5.\u00a0What are some difficulties associated with performing a 360-degree assessment?<\/p>\n
6.\u00a0What is a qualitative leadership assessment, and what are some techniques for performing such an assessment?<\/p>\n
REFERENCES<\/p>\n
1.\u00a0Public Health Service,\u00a0The Public Health Workforce: An Agenda for the 21st Century\u00a0(Washington, DC: U.S. Department of Health and Human Services, 1997).<\/p>\n
2.\u00a0Public Health Service,\u00a0The Public Health Workforce.<\/p>\n
3.\u00a0National Public Health Leadership Development Network and the Heartland Center for Public Health Preparedness (Dr. K. Wright, Director).<\/p>\n
4.\u00a0Discovery Learning,\u00a0http:\/\/www.discoverylearning.com\/products\/profile-public-health.aspx<\/p>\n
5.\u00a0U.S. Department of Health, Education, and Welfare,\u00a0Report on Licensure and Related Health Personnel Credentialing\u00a0(Washington, DC: U.S. Department of Health, Education, and Welfare, 1971).<\/p>\n
6.\u00a0A. C. Gielen et al.,\u00a0Health Education in the 21st Century: A White Paper, report prepared for Health Resources and Services Administration (Washington, DC: Health Resources and Services Administration, 1997).<\/p>\n
7.\u00a0E. Carpenter,\u00a0Proposed Credentialing System for Public Health Professionals: What Would It Mean for Schools of Public Health\u00a0(Washington, DC: Association of Schools of Public Health, 1990).<\/p>\n
8.\u00a0W. C. Livingood et al.,\u00a0Perceived Feasibility and Desirability of Public Health Credentialing: Final Report\u00a0(Washington, DC: American Public Health Association, 1993).<\/p>\n
9.\u00a0Gielen et al.,\u00a0Health Education in the 21st Century.<\/p>\n
10.\u00a0http:\/\/www.nchec.org<\/p>\n
11.\u00a0M. R. Edwards and A. J. Ewen,\u00a0360\u00b0 Feedback\u00a0(New York: ANACOM, 1996).<\/p>\n
12.\u00a0R. Lepsinger and A. D. Lucia,\u00a0The Art and Science of 360\u00b0 Feedback\u00a0(San Francisco: Jossey-Bass, 1997).<\/p>\n
13.\u00a0J. M. Kouzes and B. Z. Posner,\u00a0Leadership Practices Inventory (LPI): Facilitators Guide,\u00a03rd ed. (San Francisco: Jossey-Bass, 2003).<\/p>\n
14.\u00a0J. M. Kouzes and B. Z. Posner,\u00a0The Leadership Challenge,\u00a04th ed. (San Francisco: Jossey-Bass, 2007).<\/p>\n
15.\u00a0www.ccl.org<\/p>\n
16.\u00a0www.ccl.org<\/p>\n
17.\u00a0Lepsinger and Lucia,\u00a0The Art and Science of 360\u00b0 Feedback.<\/p>\n
18.\u00a0Lepsinger and Lucia,\u00a0The Art and Science of 360\u00b0 Feedback.<\/p>\n
19.\u00a0J. M. Kouzes and B. Z. Posner,\u00a0Credibility\u00a0(San Francisco: Jossey-Bass, 2011).<\/p>\n
20.\u00a0H. C. White, \u201cCases Are for Identity, for Explanation, or for Control,\u201d in\u00a0What Is a Case? Exploring the Foundations of Social Inquiry,\u00a0ed. C. C. Ragin and H. S. Becker (Cambridge: Cambridge University Press, 1992).<\/p>\n
21.\u00a0N. M. Tichy,\u00a0The Leadership Engine\u00a0(New York: Harper Business, 1997).<\/p>\n
22.\u00a0G. Wills,\u00a0Certain Trumpets\u00a0(New York: Simon & Schuster, 1994).<\/p>\n
23.\u00a0J. Munson,\u00a0Case Study Manual: Guidelines and Protocol for Case Study Development, 2nd ed., Leadership in Public Health Monograph 1 (Chicago: University of Illinois School of Public Health, Mid-America Regional Public Health Leadership Institute, 2003).<\/p>\n
24.\u00a0R. E. Stake, \u201cCase Studies,\u201d in\u00a0Handbook of Qualitative Research, ed. N. K. Denzin and Y. S. Lincoln (Thousand Oaks, CA: Sage Publications, 1994).<\/p>\n
25.\u00a0Munson,\u00a0Case Study Manual.<\/p>\n
26.\u00a0Munson,\u00a0Case Study Manual.<\/p>\n
27.\u00a0M. H. McCaulley, \u201cThe Myers-Briggs Type Indicator and Leadership,\u201d in\u00a0Measures of Leadership, ed. K. E. Clark and M. B. Clark (West Orange, NJ: Leadership Library of America, 1990).<\/p>\n
28.\u00a0K. C. Briggs and L. B. Myers, Myers-Briggs Type Indicator Step II Booklet (Form K)\u00a0(Palo Alto, CA: Consulting Psychologists Press, 1991).<\/p>\n
29.\u00a0McCaulley, \u201cThe Myers-Briggs Type Indicator and Leadership.\u201d<\/p>\n
30.\u00a0http:\/\/www.kenblanchard.com<\/p>\n
31.\u00a0P. Hersey et al.,\u00a0Management of Organizational Behavior, 11th ed. (Upper Saddle River, NJ: Prentice Hall, 2012).<\/p>\n
32.\u00a0J. M. Kouzes and B. Z. Posner,\u00a0The Team Leadership Practices Inventory\u00a0(San Francisco: Pfeiffer and Co., 1992).<\/p>\n
33.\u00a0W. G. Bennis, \u201cThe Four Competencies of Leadership,\u201d\u00a0Training and Development Journal\u00a038, no. 8 (1984): 15\u201318.<\/p>\n
34.\u00a0G. E. A. Dever,\u00a0Improving Outcomes in Public Health Practice\u00a0(Gaithersburg, MD: Aspen Publishers, 1997).<\/p>\n
35.\u00a0K. E. Newcomer, \u201cUsing Performance Measurement to Improve Programs,\u201d\u00a0New Directions for Evaluation\u00a075 (1997): 8\u201313.<\/p>\n
36.\u00a0T. Rath,\u00a0Strength Finder 2.0\u00a0(New York: Gallup Press, 2007).<\/p>\n
37.\u00a0G. Browning,\u00a0Emergenetics\u00a0(New York: Collins, 2006).<\/p>\n
38.\u00a0National Academy of Science,\u00a0Improving the Nation\u2019s Health with Performance Measurement\u00a0(Washington, DC: National Academies Press, 1997).<\/p>\n
39.\u00a0National Academy of Science,\u00a0Improving the Nation\u2019s Health with Performance Monitoring.<\/p>\n
40.\u00a0H. P. Hatry, \u201cWhere the Rubber Meets the Road: Performance Measurement for State and Local Public Measurement,\u201d\u00a0New Directions for Evaluation\u00a075 (1997): 31\u201344.<\/p>\n
41.\u00a0Dever,\u00a0Improving Outcomes in Public Health Practice.<\/p>\n
APPENDIX\u00a026-A<\/p>\n
Leadership Competency Framework: Public Health Leadership Competencies for State\/Regional Programs<\/p>\n
Adapted by the Heartland Center for Public Health Preparedness, St. Louis University School of Public Health, from K. S. Wright et al., \u201cCompetency Development in Public Health Leadership,\u201d\u00a0American Journal of Public Health, 90, no. 8 (2000): 1202\u20131207.<\/p>\n
I.\u00a0CORE TRANSFORMATIONAL COMPETENCIES<\/p>\n
A.\u00a0Visionary Leadership<\/p>\n
1.\u00a0Articulates vision and scenarios for change<\/p>\n
2.\u00a0Facilitates development of vision<\/p>\n
3.\u00a0Encourages others to share the vision<\/p>\n
4.\u00a0Applies innovative methods for strategic decision making<\/p>\n
B.\u00a0Sense of Mission<\/p>\n
1.\u00a0Articulates and models professional values, beliefs, and ethics<\/p>\n
2.\u00a0Facilitates development of mission and purpose<\/p>\n
3.\u00a0Facilitates reassessment and adaptation of mission to vision<\/p>\n
4.\u00a0Facilitates development of strategies to achieve mission<\/p>\n
C.\u00a0Effective Change Agent<\/p>\n
1.\u00a0Facilitates development of a learning organization<\/p>\n
2.\u00a0Creates systems and structures for transformational change<\/p>\n
3.\u00a0Creates evaluation systems for change strategies<\/p>\n
4.\u00a0Facilitates strategic and tactical assessment and planning<\/p>\n
5.\u00a0Facilitates identification of emerging and acute problems<\/p>\n
6.\u00a0Utilizes change theories and models in strategic development<\/p>\n
7.\u00a0Identifies emotional and rational elements in strategic planning<\/p>\n
8.\u00a0Creates critical dynamic tension within change strategies<\/p>\n
9.\u00a0Facilitates development of effective dialogue<\/p>\n
10.\u00a0Utilizes methods to empower others to take action<\/p>\n
11.\u00a0Models active learning and personal mastery<\/p>\n
12. Models and facilitates cultural sensitivity and competence<\/p>\n
13.\u00a0Models utilization and application of systems thinking<\/p>\n
14.\u00a0Models critical thinking and analysis skills<\/p>\n
15.\u00a0Models appropriate risk-taking behaviors<\/p>\n
16.\u00a0Models group process behaviors: listening, dialoging, negotiating, encouraging, and motivating<\/p>\n
17.\u00a0Models leadership traits: integrity, credibility, enthusiasm, commitment, honesty, caring, and trust<\/p>\n
II.\u00a0POLITICAL COMPETENCIES1<\/p>\n
A.\u00a0Political Processes<\/p>\n
1.\u00a0Directs mission-driven strategic planning at policy and operational levels<\/p>\n
2.\u00a0Articulates political processes and variables operating at federal\/state\/local levels<\/p>\n
3.\u00a0Identifies and assesses critical political issues and related stakeholders<\/p>\n
4.\u00a0Identifies policies and alternatives related to critical public health problems<\/p>\n
5.\u00a0Develops capability for advocacy, community education, and social marketing<\/p>\n
6.\u00a0Utilizes principles of media advocacy to support public policy change<\/p>\n
7.\u00a0Assesses political resources to address needs of diverse and underserved communities<\/p>\n
8.\u00a0Implements collaborative strategies to involve constituencies and stakeholders<\/p>\n
9.\u00a0Utilizes political action models for infrastructure development and capacity building<\/p>\n
10.\u00a0Collaborates to analyze needs and develop regulatory actions and legislative proposals<\/p>\n
11.\u00a0Facilitates analysis and development of legislative action on public health issues<\/p>\n
12.\u00a0Directs development of systems, programs, and services for policy implementation<\/p>\n
B.\u00a0Negotiation and Mediation<\/p>\n
1.\u00a0Identifies emerging public health issues and guides or mediates action to avoid crises<\/p>\n
2.\u00a0Guides and mediates the investigation and resolution of acute public health crises<\/p>\n
3.\u00a0Identifies key stakeholders and resources necessary for mediating, negotiating, and\/or collective bargaining<\/p>\n
C.\u00a0Ethics and Power<\/p>\n
1.\u00a0Models use of professional values and ethics<\/p>\n
2.\u00a0Models use of principles of integrity and high ethical standards<\/p>\n
3.\u00a0Creates collaborative systems using high ethical standards<\/p>\n
4.\u00a0Describes the role of public health law and public health practice<\/p>\n
5.\u00a0Describes the role of clinical\/research ethics in public health practice<\/p>\n
6.\u00a0Develops power-based alliances with a values-based and ethical perspective<\/p>\n
7.\u00a0Utilizes transitional\/conditional ethics when interpreting functions of power structures<\/p>\n
D.\u00a0Marketing and Education<\/p>\n
1.\u00a0Communicates with target audiences utilizing principles of social marketing and health education<\/p>\n
2.\u00a0Communicates with target audiences regarding needs, objectives, and accomplishments<\/p>\n
III.\u00a0TRANSORGANIZATIONAL COMPETENCIES<\/p>\n
A.\u00a0Organizational Capacity and Dynamics<\/p>\n
1.\u00a0Utilizes models to assess environment, needs, opportunities, threats, and resources<\/p>\n
2.\u00a0Utilizes models of new organizational development, behavior, and culture<\/p>\n
3.\u00a0Develop structures for workforce development and organizational capacity improvement<\/p>\n
4.\u00a0Implements structures and capability as need, opportunity, risk, or threat arises<\/p>\n
B.\u00a0Trans-Organizational Capacity and Collaboration<\/p>\n
1.\u00a0Identifies and includes power brokers and stakeholders in collaborative ventures<\/p>\n
2.\u00a0Implements and evaluates collaborative and partnering strategies<\/p>\n
3.\u00a0Facilitates networking and broad and diverse stakeholder participation<\/p>\n
4.\u00a0Facilitates change with a balance of critical tensions within collaborative systems<\/p>\n
5.\u00a0Develops and evaluates collaborative strategic action plans<\/p>\n
6.\u00a0Facilitates transorganizational shared or complementary mission and vision<\/p>\n
7.\u00a0Creates transorganizational systems with an ethical and values-based approach<\/p>\n
C.\u00a0Social Forecasting and Marketing<\/p>\n
1.\u00a0Utilizes social forecasting methods and interprets emerging needs and trends<\/p>\n
2.\u00a0Creates and articulates predictions and potential scenarios<\/p>\n
3. Communicates analysis and interpretation of information to partners and constituents<\/p>\n
4.\u00a0Utilizes social marketing for media, health and risk communications, and community relations<\/p>\n
IV.\u00a0TEAM-BUILDING COMPETENCIES<\/p>\n
A.\u00a0Team Structures and Systems<\/p>\n
1.\u00a0Develops structures for organizational learning and systems thinking<\/p>\n
2.\u00a0Creates systems for team development and evaluation<\/p>\n
3.\u00a0Creates incentive and reward systems<\/p>\n
4.\u00a0Facilitates strategic outcomes-based team activities<\/p>\n
5.\u00a0Develops team systems for customer service and quality improvement<\/p>\n
6.\u00a0Facilitates collaborative leadership and entrepreneurial spirit<\/p>\n
B.\u00a0Team Development<\/p>\n
1.\u00a0Facilitates development of shared vision, mission, and values<\/p>\n
2.\u00a0Facilitates development of clear goals and objectives<\/p>\n
3.\u00a0Facilitates group process and dynamics<\/p>\n
4.\u00a0Implements communication processes for team development<\/p>\n
5.\u00a0Develops problem-solving, conflict resolution, and decision-making skills<\/p>\n
6.\u00a0Communicates need to balance critical tensions for team development<\/p>\n
7.\u00a0Facilitates empowerment and motivation to accomplish objectives<\/p>\n
8.\u00a0Celebrates team culture and accomplishments<\/p>\n
9.\u00a0Facilitates development of cultural sensitivity and competence<\/p>\n
10.\u00a0Facilitates development of appropriate risk-taking behavior<\/p>\n
11.\u00a0Develops servant leadership; selflessness, integrity, and perspective mastery<\/p>\n
12.\u00a0Facilitates development of personal mastery and team learning<\/p>\n
C.\u00a0Facilitation and Mediation<\/p>\n
1.\u00a0Establishes team member roles and responsibilities<\/p>\n
2.\u00a0Facilitates effective workgroup processes and relationships<\/p>\n
3.\u00a0Mediates in non-productive, dissident, or demoralized team situations<\/p>\n
4.\u00a0Facilitates problem-centered coaching<\/p>\n
5.\u00a0Utilizes negotiation to mediate disputes and resolve conflicts<\/p>\n
V.\u00a0CRISIS LEADERSHIP COMPETENCIES<\/p>\n
A.\u00a0Planning for the Unthinkable2<\/p>\n
1.\u00a0Articulates the definition of crisis levels and its elements<\/p>\n
2.\u00a0Articulates the definition of crisis management<\/p>\n
3.\u00a0Articulates the definition of crisis leadership<\/p>\n
4.\u00a0Articulates the difference between crisis leadership and crisis management<\/p>\n
5.\u00a0Articulates the role of leaders before and during crisis events<\/p>\n
6.\u00a0Articulates the systemic nature of crisis leadership<\/p>\n
7.\u00a0Identifies the elements of crisis anticipation and its relevance to crisis leadership<\/p>\n
8.\u00a0Utilizes methods and processes for anticipatory thinking and \u201cthinking the unthinkable\u201d before and during crisis events<\/p>\n
9.\u00a0Identifies the difference between normal\/abnormal accidents\/events and natural disasters<\/p>\n
10.\u00a0Identifies the elements of crisis types and methods for signal detection<\/p>\n
11.\u00a0Identifies and analyzes elements of multiple, inter-related or non-related and unthinkable crises events<\/p>\n
12.\u00a0Analyzes problems that partner organizations experience during multiple crises events<\/p>\n
13.\u00a0Articulates the full range of crises that can potentially affect the organization\/system<\/p>\n
14.\u00a0Articulates the range and scope of crisis for which the organization\/system should prepare<\/p>\n
15.\u00a0Develops the competence and capability necessary to anticipate, prepare for, respond to, and mitigate multiple crises<\/p>\n
16.\u00a0Develops a unified planning, capability, and resource system among partner organizations<\/p>\n
17.\u00a0Develops an emergency management\/unified command system prepared for multiple crises<\/p>\n
B.\u00a0Crisis Patterns and Key Elements2<\/p>\n
1.\u00a0Utilizes the concept of technical and ethical uncertainties in a crisis event<\/p>\n
2.\u00a0Articulates the concept of objectivity as a \u201cturnoff\u201d during crises events<\/p>\n
3. Articulates the concept of the court of public opinion vs. the court of law during crisis events<\/p>\n
4.\u00a0Articulates the importance of no secrets and complete transparency during crisis events<\/p>\n
5.\u00a0Articulates the importance of the concept of lessons ignored and not learned during a crisis event<\/p>\n
6.\u00a0Identifies the six phases of crisis leadership<\/p>\n
7.\u00a0Identifies the set of different crisis types<\/p>\n
8.\u00a0Identifies the effect of different crisis mechanisms<\/p>\n
9.\u00a0Identifies the different crisis families<\/p>\n
10.\u00a0Identifies different crisis stakeholders in relation to crisis types<\/p>\n
C.\u00a0Risk Assessment2<\/p>\n
1.\u00a0Utilizes the four elements of the crisis framework to identify how organizations\/systems responds to crisis events<\/p>\n
2.\u00a0Applies the crisis framework to human-caused crises (normal\/abnormal accidents) and natural disasters<\/p>\n
3.\u00a0Recognizes the basic patterns of organizational\/system response and what elements should be reinforced or changed<\/p>\n
4.\u00a0Utilizes six phases of crisis leadership to redesign effective crisis systems<\/p>\n
D.\u00a0Command Capability and Improvement<\/p>\n
1.\u00a0Develops and implements a unified chain of command for emergency response<\/p>\n
2.\u00a0Demonstrates individual functional and leadership roles\/responsibilities for emergency response<\/p>\n
3.\u00a0Demonstrates ability to make critical decisions and take decisive actions during crisis events<\/p>\n
4.\u00a0Facilitates development of key values and shared vision to guide decisions and actions during crisis events<\/p>\n
5.\u00a0Implements a multiyear emergency preparedness education, training, and exercise system<\/p>\n
6.\u00a0Implements a system for performance measurement, after-action reviews, and improvement planning<\/p>\n
7.\u00a0Identifies, communicates, and retests performance and maturity levels<\/p>\n
E.\u00a0Ethics and Crisis\/Emergency Response3<\/p>\n
1.\u00a0Articulates the role of ethics in crisis leadership<\/p>\n
2.\u00a0Utilizes methods to balance emotion and use of reason during crisis events<\/p>\n
3.\u00a0Identifies historical incidence of leaders who faced moral challenges<\/p>\n
4.\u00a0Utilizes professional ethics in the context of community and society during crisis<\/p>\n
5.\u00a0Models ethical decision-making during emergencies\/crises<\/p>\n
6.\u00a0Utilizes ethical decision making to apply\/alter use of emergency plan procedures<\/p>\n
7.\u00a0Describes the role of public health law during emergencies\/crisis events<\/p>\n
8.\u00a0Describes ethical issues regarding public health challenges and emergency events<\/p>\n
9.\u00a0Describes principles of ethical leadership and caring competence during disasters<\/p>\n
F.\u00a0Personality and Emotional Intelligence4\u00a0Personality Factors and Crisis Response<\/p>\n
1.\u00a0Identifies personality styles of leaders and leadership teams during crisis events<\/p>\n
2.\u00a0Utilizes assessment methods to determine personality style\/preferences and crises<\/p>\n
3.\u00a0Analyzes the relationship of personality type\/preferences to functioning during crises<\/p>\n
4.\u00a0Analyzes the impact of leadership cognitive and emotional intelligence during crises<\/p>\n
5.\u00a0Recognizes and reconciles rational and emotional elements during crisis events<\/p>\n
Emotions and Performance: Leaders<\/p>\n
1.\u00a0Identifies critical emotional intelligence competencies during crisis events<\/p>\n
2.\u00a0Analyzes how feelings affect personal performance in stressful situations<\/p>\n
3.\u00a0Describes emotions that are aroused during crises<\/p>\n
4.\u00a0Describes personal strengths and weaknesses associated with emotions and stress<\/p>\n
5.\u00a0Utilizes methods to resist acting or responding in impulses during high-stress events<\/p>\n
6.\u00a0Utilizes methods to behave calmly in stressful or emergency situations<\/p>\n
7.\u00a0Utilizes methods to stay composed and positive during crisis events<\/p>\n
8.\u00a0Utilizes methods to calm others in stressful situations and emergency events<\/p>\n
9.\u00a0Utilizes methods to change ideas and perceptions under stressful situations<\/p>\n
10.\u00a0Utilizes methods to balance emotional and rational elements for decision making and decisive action during crises<\/p>\n
11. Utilizes methods to handle ambiguity and multiple demands associated with crises<\/p>\n
12.\u00a0Utilizes methods to chronicle individual experience for after-action analysis<\/p>\n
Emotions and Performance: Others<\/p>\n
1.\u00a0Utilizes assessment methods to identify personality style and the relation to performance during crises<\/p>\n
2.\u00a0Utilizes methods to identify moods, feelings, and nonverbal cues of others under stress<\/p>\n
3.\u00a0Analyzes underlying causes for feelings, behavior, or concerns of others under stress<\/p>\n
4.\u00a0Utilizes factual arguments (reason or data) to persuade\/influence others under stress<\/p>\n
5.\u00a0Utilizes the support of influential parties to convince others in stressful situations<\/p>\n
6.\u00a0Utilizes methods to increase perception and perspectives of others during crises<\/p>\n
7.\u00a0Utilizes methods for reducing stereotyping of and reactions to diverse populations<\/p>\n
8.\u00a0Utilizes methods for broad support for increasing persuasive effect during crises<\/p>\n
9.\u00a0Utilizes methods to promote cooperation\/collaboration in stressful situations<\/p>\n
10.\u00a0Utilizes methods to reduce conflict in crisis situations<\/p>\n
11.\u00a0Utilizes methods to chronicle experience of others to prepare for after-action analysis<\/p>\n
G.\u00a0Risk and Crisis Communication5<\/p>\n
1.\u00a0Identifies leadership role\/responsibilities to develop a crises communication plan<\/p>\n
2.\u00a0Utilizes theoretical methods for and stages of risk communication<\/p>\n
3.\u00a0Identifies primary obstacles for use of appropriate risk\/crisis communication in emergency situations<\/p>\n
4.\u00a0Utilizes basic elements of the concept of risk and factors associated with determining magnitude of risk<\/p>\n
5.\u00a0Articulates the Environmental Protection Agency\u2019s seven rules of risk communication<\/p>\n
6.\u00a0Utilizes the 21 guidelines for effective communication by leaders during high-anxiety, stress, or threat situations<\/p>\n
7.\u00a0Utilizes appropriate risk\/crisis communication methods during crisis events<\/p>\n
8.\u00a0Utilizes problem-solving, conflict resolution, and decision-making skills using principles and methods for risk communication<\/p>\n
9.\u00a0Utilizes communication role and methods with team members during emergency events<\/p>\n
10.\u00a0Utilizes communication role and methods with partner organizations during emergency events<\/p>\n
11.\u00a0Utilizes communication role and methods with the media during emergency events<\/p>\n
12.\u00a0Utilizes communication role and methods with the public during emergency events<\/p>\n
H.\u00a0Cultural Competence and Crisis6<\/p>\n
1.\u00a0Understands the difference between cultural diversity and cultural competencies<\/p>\n
2.\u00a0Describes the process for cultural competency development<\/p>\n
3.\u00a0Identifies the role of cultural, social, and behavioral factors in the delivery of public health services<\/p>\n
4.\u00a0Describes the relationship(s) between culture and health<\/p>\n
5.\u00a0Explores and describes knowledge about worldviews, mental models, values, beliefs, practices, and\/or ways of other cultural groups<\/p>\n
6.\u00a0Identifies and discusses differences within cultural groups at the community level as well as across cultural groups<\/p>\n
7.\u00a0Describes the dynamic forces contributing to cultural diversity at the organizational level<\/p>\n
8.\u00a0Interacts with sensitivity and effectiveness with persons from diverse (cultural, socioeconomic, educational, racial, ethnic, professional, age, lifestyle preferences) backgrounds in the practice setting and in crisis situations<\/p>\n
9.\u00a0Actively seeks ongoing education, consultation, coaching, and\/or training experience to enhance understanding and effectiveness with culturally and ethnically diverse populations in both normal and crisis situations<\/p>\n
10.\u00a0Identifies and understands one\u2019s own competence level when interacting with cultural\/ethnically diverse populations in normal and crisis situations<\/p>\n
11.\u00a0Identifies own stereotyping attitudes, preconceived notions, and feelings toward members of other ethnic\/cultural groups and how these dimensions affect decision making<\/p>\n
12. Participates in cultural\/ethnic groups in communities of practice and community settings<\/p>\n
13.\u00a0Develops strategies and adapts approaches to problems and emergency\/crisis situations that take into account cultural differences<\/p>\n
14.\u00a0Identifies institutional barriers that prevent cultural\/ethnic groups from seeking public health services and assistance in emergency or crisis situations<\/p>\n
15.\u00a0Facilitates understanding of the importance of and methods to increase diversity in the public health workforce<\/p>\n
16.\u00a0Recognizes that communication and related actions are culturally bound<\/p>\n
I.\u00a0Legal Basis for Preparedness7<\/p>\n
1.\u00a0Identifies the source and scope of state and federal powers to protect the public\u2019s health, safety, and welfare in the event of emergency events<\/p>\n
2.\u00a0Analyzes and applies how public health law contributes to emergency response<\/p>\n
3.\u00a0Identifies and applies the basic legal framework for public health preparation in emergency events and the roles of federal, state, and local governmental agencies<\/p>\n
4.\u00a0Identifies and applies basic provisions of the governmental unit in the health code and regulations during public health emergencies<\/p>\n
NOTES<\/p>\n
1.\u00a0University of North Carolina School of Public Health Doctoral Program Leadership Competencies were used and adapted in part for use in this domain.<\/p>\n
2.\u00a0Competency sets were developed by the Heartland Centers in collaboration with Dr. Ian Mitroff, Comprehensive Crisis Management, Inc.<\/p>\n
3.\u00a0Competencies were developed by the Heartland Centers in collaboration with Dr. Shugg Yagel-McBay.<\/p>\n
4.\u00a0Comprehensive Crisis Management, Inc., Therese Jacobs-Stewart, M.A., and materials from the Hay Group, Dr. Daniel Goleman, Harvard University.<\/p>\n
5.\u00a0Competencies developed by the Heartland Centers in collaboration with Dr. Vincent Covello.\u00a0http:\/\/centerforriskcommunication.org\/.<\/p>\n
6.\u00a0Competencies developed by the Heartland Centers in collaboration with Dr. Louis Rowitz and adaptation of the Core Competencies in Public Health of the Council on Linkages Between Public Health Practice and Academia.<\/p>\n
7.\u00a0Competencies developed by the Heartland Centers in collaboration with Jason Sapsin, JD, MPH, the Johns Hopkins Center for Law and the Public\u2019s Health.<\/p>\n","protected":false},"excerpt":{"rendered":"
CHAPTER\u00a026 Measuring the Leader Work experience, hardship, opportunity, education, role models, and mentors all go together to craft a leader. \u2014J. A. Conger,\u00a0Learning to Lead Leadership is multidisciplinary as well as multilayered, and no single measure of leadership exists. Most quantitative evaluation instruments do not have specific public health leadership dimensions and are quite general […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[10],"class_list":["post-78358","post","type-post","status-publish","format-standard","hentry","category-research-paper-writing","tag-writing"],"_links":{"self":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/78358","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/comments?post=78358"}],"version-history":[{"count":0,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/78358\/revisions"}],"wp:attachment":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/media?parent=78358"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/categories?post=78358"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/tags?post=78358"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}