BUILDING A BOARD OF HEALTH MANUAL

August 31, 2014

Members of Boards of health are expected to be leaders who represent the communities from which they are selected. However, this has not always been the case. Board members are often friends of elected city, county or state officials. Many are retired and can serve at most times. They often define themselves as volunteers rather than trustees of their home communities. Many members have little background in health or even know what local or state health really do. Statutes often require physician and dental members who also do not always understand what public health is all about. Most board presidents or chairs try to give some orientation to new members. With this being said, boards often improve performance if they have a annual to better define their roles and responsibilities. These manuals when they exist tend to be in loose leaf notebooks which allows for new material to be added to the manual as needed. Some experimentation is being given to putting the manuals online. My experience has been that hard copies tend to work better in these groups although background information can clearly be put online.

In 1995-96, a leadership team which included a Board of health member of her team to develop an orientation manual for Board of health members in Illinois. This team was one of the Fellowship teams of the Mid-America Regional Public Health Leadership Institute. Members included Phyllis Reeder, Laura McGee-Otunde, Steve Ochoa, Judith Schlieper, and Mark Schmidt. The manual was developed for use throughout the network The Illinois Association of Boards of Health. Schmidt was able to get the Illinois Department of Public Health to publish the first edition with a copy of the manual for all Boards in the State. The manual is still in use and is updated on a regular basis. Other states have modified the manual for use in their states

The manual should include the following required sections:

    1 .What is Public Health?

    2. Core Functions and Essential Services

    3. Legal Authority/Powers and Duties

    4. By-Laws

    5. Open meetings Act(if applicable)

    6. Board member profiles

    7. Information on Recruitment of Health department Administrators

    8. Functions of Boards and board members

    9. Local board Information

    10.Overview to parliamentary procedure

    11. Statutes and Regulation

    12. Organization Charts including the state health entity

Supplementary Sections can be included at the discretion of the Board and Administrators, eg discussion of health reform, partnership agreements, and other issues. As you can see, the manual offers much to the Board member and his/her leadership responsibilities.


CULTURE OF HEALTH: A LEADERSHIP ISSUE

July 31, 2014

With the implementation of the Affordable Care Act, an increasing acceptance of the importance of both prevention and preparedness, knowing that knowledge management is a good thing, a stress on informatics development, improving access to health care, an awareness of the need to bring together the multifaceted nature and parts of health and health care, the idea of creating a national cultural orientation to health becomes important. It is not that we need to collapse all the health professions into one universal category, but rather we need to make collaboration and partnership our modus operandi. With an awareness that a move to health and a culture of health is also multifaceted, the social determinants of health was a beginning to our understanding of the values associated with health.. A culture of health model is a political, economic, social, personal, family, community, and political set of decisions. Our challenge is that it is not easy to change culture.

Although leadership with a title is an important dimension, the creation or development of a health mindset for all Americans is the end goal. All must take a leadership stance if a true culture of health is to come into being. Each of us must take responsibility for the change since each of us has to personally change our health habits. It is of course critical that our health professionals become more expert in the practice of leadership. Leadership development on the ground will be important. The use of social media will need to increase but in the end relationships and relationship-building will be the secret weapons for bringing a new age of health into being.

To change mental models oriented toward treatment and rehabilitation to a culture of health model with a prevention orientation, public health leaders will need to be proficient in the skills of systems thinking, communication skills, knowledge of the sociological process of cultural systems design(understandingof how mental models can be changed), psychological processes related to behavior change, policy development and advocacy, models of collaboration, informatics, and organization management.


LEADERSHIP 101

June 16, 2014

Over the years, I have been asked to give advice on the development of an introductory course on leadership development. If we assume that the semester class will run 16 weeks in three hour segments, what would be the topics covered in such a course. A second assumption is that the students in the course have not held leadership positions prior to taking the course. A third assumption is that course development is often a subjective process based on the experiences of the course instructor and the textbooks that they may adopt. If you use the following topic outline, feel free to change a specific topic or to rearrange the topics to better suit your own thinking about the course. Some variation will also occur if the course is offered in an online version.

TOPICS

Week 1        Overview to the Course

Week 2        Interface Between Management and Leadership

Week 3    Three Contemporary Approaches to Leadership(Kouzes and Posner, Heifetz and Linsky,and Mitroff)

Week 4    Systems and Complexity Thinking

Week 5    Leadership Wheel and Team Development

Week 6    Values Clarification

Week 7    Mission, Vision, and Goals and Objectives- Key Stages in Planning

Week 8    Leadership Case Study Analysis- Student Presentations

Week 9    Business Plans, Action Plans, and Work Plans

Week 10    Infrastructure Building with Application to Field of Study

Week 11    Crisis Leadership

Week 12    Communication Issues

Week 13    People Development

Week 14    Planning process

Week 15    Decision Making

Week 16     Student Report Presentations

 

Many other topics are possible such as Change, Mentoring and Coaching, Global Leadership, Leadership Style, and so on.


FUNCTIONS OF A BOARD OF HEALTH

May 31, 2014

There still seems to be confusion over why boards of health exist and if they do exist, why. Over the years, I have presented an orientation to about a dozen of these boards. The consensus seems to be that board members see themselves as volunteer without much authority. The boards recognize their role in the hiring and firing of the chief executive of the public health agency. They believe their key role is to micromanage the agency budget. Although the key roles of hiring the CEO and the budget are important, they are not the only roles that the board has.

The National Association of Local Boards of health has struggled with the issue of board function and they now have come up with six broad functions for these boards. The six functions relate to the issue of governance (See my posting on Board Leadership). The first function involves the important set of actions related to POLICY DEVELOPMENT. Policy development involves such activities as developing internal and external policies that support the mission of the public health agency to protect the community’s health. The board needs to work with the agency on the health vision for the jurisdiction. Priorities need to be set which build on evidence-based practice. Policies need to be evaluated and revised as necessary. The second governance function is RESOURCE STEWARDSHIP. This function involves the assurance of adequate resources for the agency to carry out the essential services of public health. Budget considerations are tied to this function. The third governance function involves the exercise of the LEGAL AUTHORITY as defined by law and statute. The provision of quality core services to the population needs to be provided by the local health agency or a community partner.

The fourth function relates to PARTNER ENGAGEMENT. This is an ongoing activity since the engagement of community partners will change over time. Working together with community partners to improve the health of the public is the ultimate goal to this partnership engagement. The fifth function is tied to the important issue of quality and the CONTINUOUS IMPROVEMENT of programs and services over time. This means that the assessment of the health of community people needs to be ongoing. High performance standards need to occur. Training of staff needs to occur as well in emerging tools, strategies, and practice. The final governance function is OVERSIGHT. This function involves the evaluation of the health department administrator. The board needs to make sure that mandates are being carried out. Governance needs to relate to the successful performance of the public health core functions and essential services.

It is clear that board members need to see themselves as not merely volunteers but rather as John Carver(BOARDS THAT MAKE A DIFFERENCE) has argued “trustees” of the community.


KNOWLEDGE SYNTHESIZER

April 30, 2014

It is not a secret that we expect our leaders to have more knowledge and experience than we have. In my leadership book, I discussed this briefly and mentioned that being a knowledge synthesizer was one of the more important leadership practices. At the recent Keeneland Conference in Lexington, Kentucky in early April, 2014 on public health systems and practice research, several of the key speakers discussed the importance of informatics in public health. It was also discussed that an economics perspective as well as an information perspective allows us to compare agencies in a way that a programmatic perspective does not. It was clear to me that leaders need to become more proficient in the use of data of various kinds in order to create a stronger evidence base for public health to guide our future work.

Leaders need to interpret data that is both quantitative and qualitative for their direct reports, their partners, and their service populations. Leaders also need to connect data with various theoretical and conceptual frameworks. Informatics also will have different implications when viewed through an assessment lens. Interpretation for the assurance perspective as well as the policy development one will also lead to different interpretations. How information is presented also has an important values and emotional impact set of reactions. Leaders need to know their audience and react to the emotional interpretation of information by their audience. Information gets filtered through our emotions and we react from anxiety, fear, confusion, and other feelings. Almost anything that appears to disrupt our quality of life must be mediated and interpreted by our leaders.

Thus, leaders need to not only synthesize knowledge and data for us, they need to understand the various emotional factors that can affect the presentation of information. They also need to be able to deal with these emotional reactions that can impact the interpretation of the knowledge presented.


BOARD LEADERSHIP

March 25, 2014

Boards of all kinds are critical to the successful functioning of their organizations or agencies. In the area of public health, many of these boards have been ineffective. Although many of these health boards were conceived as governing bodies as far back as the late 1700’s by the early board member Paul Revere, they have not understood their missions. Boards have been places for older persons to take on a service role in a retirement pay back to the community philosophy. Many board members have been appointed du e to their support for a county commissioner. This post will begin a discussion on what a board need to be in the future. First, a board member is a trustee of the community that he serves. He/she should not see themselves as volunteers with little authority or responsibility. Trustees make policy and volunteers usually do not. Board members need to be leaders with management and leadership experience. Policy-making is an important leadership role.Second, boards are governing bodies.

Third, boards of health have six functions which have been designated by the National Association of Local Boards of Health. The six functions are listed in the next table.

Finally, the characteristics of a board member as a leader has been discussed in detail by Charam and colleagues in the book “BOARD LEADERSHIP.”

I will be discussing boards in more postings in future months.


THE EVOLUTION OF A LEADER

February 26, 2014

In my last posting I mentioned the importance of resilience as a characteristic of a leader. Leaders also realize that it is not tools that make a leader but rather how those tools are used. It is also leadership in practice that provides the real world of leadership for an individual. I have noticed a key difference between students who have limited or no work experience and students who are working in the way they react to a leadership development course. For students in the first group, the content seems abstract while the working student sees the content in a practice modality.

I have used many leadership tools over the years. I have tried some of the fad techniques at times and found some of these tools useful for me as a leader and some of them not so useful. I have continued to use some of the tools even when the fad ended because the tools continued to be useful. An interesting happening is the rediscovery of long ago rejected tools when a new leadership event required the use of an old fad tool. All of this is meant to make the argument that I am not the same leader I was ten years ago or even last month. Leadership is an evolving process nurtured by the new books I read each month, my blog where I test ideas, new work experiences and the new people that I meet. More recently, I have become better at communication as I try different characters in a play reading group that my wife and I have joined. Over the years I have also learned to use skills and approaches from multiple disciplines. Although I trained as a sociologist, I am also a public health professional, a psychologist, an economist, a political scientist, an epidemiologist, a management consultant, and a leadership scholar and practitioner. I collaborate more with people from all these disciplines and we work together on new approaches to problem solving and decision making. Frans Johanssen calls this creative approach from a multidisciplinary perspective, work at the intersection.

The great lesson about the evolution of a leader is leadership doesn’t stop at age 65. It can last a lifetime. The context of our work is also different all the time. Leaders can always be excited by the many new opportunities that their leadership brings about although I do admit that stress still exists.


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