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It’s a pleasure to be with you.
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The title of this talk is “Public Health
and Leadership Introduction.”
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There are no disclosures for this presentation.
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Objectives include:
Define leadership,
00:00:23
Explain why adaptive leadership is important
for public health,
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Define the difference between social marketing
and community engagement, and
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Discuss some basic concepts of extreme leadership
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The following phrases have been used to describe
leadership: the art of mobilizing
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others to struggle for shared aspirations,
sticking your neck out or taking risks when
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it’s
the right thing to do, living dangerously,
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often exceeding authority, withstanding
criticism, is usually lonely, and successfully
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resolves problems.
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I’ve also included Steve Farber’s definition
of leadership, who uses the acronym LEAP,
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including love, edge or energy, audacity and
proof.
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Common traits of leaders include: vision and
values, situational perception and action,
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that relates to anticipation skills, power,
charisma, intelligence and someone who
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people follow or someone who guides and directs
others.
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I would like to focus on the importance of
a leader casting vision.
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DeBuono et al in a book titled “Moments
in Leadership”, stated that “Leadership
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qualities begin with a unique vision”.
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Steve Farber in his book “The Radical Leap”
said “A vision statement doesn’t generate
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energy, love does, great ideas do, principles
and values do.
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But vision from the heart is –
by definition – an expression of love…
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and not only is that more energizing, it is
energy.”
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He used Martin Luther King’s ‘I have a
dream’ speech as an example.
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He didn’t have to hand out 250,000 laminated
cards, his vision statement, at the Lincoln
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Memorial on that hot August day in 1963.
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Watch the tape: it was pure energy.
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The
speech clearly expressed Doctor King’s personal
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vision.
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The speech was alive.
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So, instead of reciting a vision statement,
feel it, take it deep within yourself.
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The vision needs to come from your heart.
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It needs to say “This is who I am.
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This is what I believe.
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This is what I think we can do
together if we put our hearts into it.”
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If you can do that, you don’t need a document
with a printed vision statement, because
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you’ve become a living, breathing vision.
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You must deeply believe in the vision of an
organization or you can’t put your heart
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into
it.
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If you can’t do that, move on, for you surely
can’t cast that vision for others if you
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don’t
believe it.
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You won’t inspire employees and they for
sure won’t want to follow you, and you
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shouldn’t be leading that organization.
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Move on to a place where you can passionately
lead.
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According to Linsky’ and Heifitz’ book,
“Leadership on the Line”, leadership skills
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can be
divided into two broad categories: technical
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leadership, or management, and adaptive
leadership, that I will also call extreme
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leadership.
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Both of the skill sets are needed for effective
leaders.
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Knowing the difference and when to appropriately
use them is extremely important.
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This slide lists some key attributes of technical
leadership or management.
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Management solutions are fairly obvious, with
the fix requiring minor adjustments; no
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major changes in the way things are done.
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Generally, people resist change, rising exponentially
with a major overhaul.
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So, minor changes will likely be less controversial
in the organization than major ones.
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Things will continue much as they have in
the past.
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In these situations leadership can orchestrate
the fix..
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They can manage it.
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The checkers are all on the board, they just
need to be re-arranged a bit.
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There may be some minor resistance in the
organization but these are not earth
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shattering events that upset the apple cart,
so managers face little risk of criticism,
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anger and hostility with many technical management
decisions.
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That is not the case with adaptive situations.
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Adaptive problems are often seen in times
of crises.
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The solution to adaptive problems is not readily
apparent.
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Adaptive situations and solutions need new
approaches and major changes in the way
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an organization functions.
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A leader can throw all the technical management
fixes they can generate at the problem
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and it still persists.
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Adaptive problems require a group process
to find an effective solution.
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So the role of the leader in an adaptive situation
is not to line up the checkers.
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The leader must facilitate the group to find
the checkers.
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This is actually true community engagement,
facilitating communities to own their
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problems and solutions.
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Adaptive skills are essential for a leader
to truly engage a target community.
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Adaptive leadership is also defined as extreme
leadership.
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I want to re-emphasize that effective leaders
need both sets of skills and competencies:
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technical management skills and adaptive or
group facilitation skills.
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According to Linsky and Heifitz in “Leadership
on the Line”, “The single most common
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source of leadership failure we’ve been
able to identify in politics, community life,
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business, or the nonprofit sector is that
people, especially those in positions of
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authority, treat adaptive challenges like
technical problems.”
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In other words, they try to manage their way
out of situations that require group
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process.
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Understanding the difference between technical
and adaptive skills and when to use
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them is critical for effective leaders of
any organization.
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So why are extreme leadership skills needed
in public health?
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I think all of us realize that the future
of public health will be challenging.
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Public health faces complex problems that
will require complex solutions, requiring
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adaptive skills and leaders
that can effectively facilitate group processes.
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This slide list some but not all of the attributes
of extreme leadership and includes taking
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appropriate risks.
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Risk comes with fear and we’ve been conditioned
to believe that fear is bad.
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That’s not totally true.
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Fear can be both good and bad.
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Fear can save your life, keeping you from
doing something stupid, but it can also paralyze
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a person, keeping
them from doing something great, learning
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something new or growing as a leader.
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Another attribute of extreme leadership is
the ability to weather hostility and criticism
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As we’ve mentioned before, adaptive situations
are associated with major changes in an organization.
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People and organizations generally resist
change, especially major change, resulting
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in hostility and criticism.
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Extreme leadership translates into an ability
to handle that hostility and criticism, maintain
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composure and
continue on, which is not easy.
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Another attribute is the ability to compromise,
realizing that the goal is to win wars not
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just a battle.
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Extreme leadership may occasionally need to
push beyond lines of authority.
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In many extreme leadership situation there
is a vacuum of authority.
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Extreme leaders can effectively and with wisdom
go beyond authority, making good decisions,
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and realizing
how far they can push the envelope and still
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survive.
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Extreme leadership focuses on outcomes and
doesn’t shy away from a problem or challenge.
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In fact extreme leadership thrives on challenge
not comfort, often seeking out difficult problems
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to solve.
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As you might expect, extreme leadership relies
on excellent facilitation skills, being able
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to lead a
challenging group process to find an effective
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solution.
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This is heart of community engagement: adaptive
leadership skills.
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One of the major tool sets for public health
is community engagement, that’s why adaptive
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leadership
or extreme leadership is so important for
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effective pubic health leaders.
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This slide just lists the major tools we have
to change risky behaviors.
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First there’s policy developed by governments
(local, state and national), businesses,
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schools and other organizations, implemented
by statute and rule.
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Policy can be either good and bad.
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Good policy sets an environment encouraging
healthy choices.
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Another set of tools is the clinical setting
with clinicians providing one on one
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counseling, a powerful tool.
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The third set of tools are population based
interventions, the domain of public health.
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Population based interventions can be sub-divided
into two sub-sets of tools: social
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marketing and community engagement.
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Community engagement is a common term used
in our society yet true community
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engagement is a relatively new concept in
public health.
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All of these tools, policy, clinical and public
health social marketing and community
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engagement are needed to change risky behaviors.
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The integration of these tools, breaking down
silos, as recommended by the Institute of
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Medicine in their 2012 integration report,
will be a key to effectively impacting risky
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behaviors.
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So let's briefly discuss the major public
health tools to change risky behaviors and
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start
with social marketing.
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Social marketing has been a major part of
health messaging since the1970’s, when
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Kotler and Zaltman demonstrated that the marketing
tools used to sell items could also
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be effective in influencing health-related
behaviors.
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Public health spends millions of dollars each
year, and rightly so, on social marketing.
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The second major sub-set of tools in the public
health toolkit to change risky behaviors
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is community engagement.
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Community engagement has been around since
the beginning of aggregate human
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existence.
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Community engagement, in a nutshell, encourages
cohesive groups of people to own
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their problems and solutions.
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Therefore true community engagement requires
effective group process.
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Community problems are generally complex and
require complex solutions.
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From our previous discussion, these complex
solutions can’t be managed away by a
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leader; it will require the work and effort
of the cohesive group or community.
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Much that’s currently done in the name of
community engagement is actually
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community coercion.
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This slide summarizes the major differences
between community engagement and community
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coercion.
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Community coercion can be illustrated by the
following sequence.
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A community problem or problems are identified
by external specialists like public health
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scientists, often using
public health and health care data sets to
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identify those problems.
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The external specialists then, often with
a small group of experts, develops a plan
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to solve the problems often
based on best or promising practices.
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These external specialists or public health
scientists then apply for and hopefully receive
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a grant.
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Once the grant has been received, the external
specialist or scientist tries to sell the
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idea to the community.
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There are many variations on this theme but
a major point is that with most of these programs
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the control of the
process rests with individuals external to
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the community.
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The community or community leadership may
have been involved but not in control of the
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process.
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In my experience this approach has never resulted
in true community ownership of their problems
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and
solutions.
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It always remains an external program applied
to the community not owned by the community.
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In this situation, when the grant goes away
so does the program.
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Coercion is when things are done to and for
people.
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In true community engagement, things are done
with people.
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This is also known by many other names including
community empowerment.
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True community engagement relies on effective
group process to solve these complex adaptive
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problems.
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In true community engagement the community,
the cohesive group, is involved and in control
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from the very
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beginning, not the external specialist or
scientist.
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The community will determine whether there
will even be a program.
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To do this, public health leaders need special
adaptive skills to facilitate communities
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or cohesive
groups to own their problems and solutions.
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The main point is that in true community engagement
the community owns the program,
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controls and runs it.
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The National Institute of Health said in their
Principles of Community Engagement publication,
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“Engaging a
community is ultimately about facilitating
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community-driven action,” not external driven
action; a key point for
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community engagement.
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Community engagement is facilitating a process
of problem solving not just accomplishing
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a project.
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This is a problem with most of our grants:
project oriented, with strict requirements
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and timelines that
undermines community ownership.
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One of my first international community engagement
situations was in northern Mexico, a rural
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community
outside Monterey.
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The community had a major issue with Amoebiasis,
caused by Entamoeba Histolytica, resulting
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in complications
like liver abscesses and occasionally death.
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Entamoeba Histolytica is passed through the
fecal-oral route, due to poor sanitation.
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The cause was fairly clear.
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On the west side of this town there was a
field used by farmers as a latrine.
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Raw human sewage was running from that field
across a dirt road into a small pond - the
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community’s water
source.
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From my perspective they needed ventilated
improved pit latrines and water protection.
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During meetings with community leaders, the
issue of Amoebiasis was discussed.
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They fully understood the transmission of
this disease.
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When asked what their major health and wellness
goal was, they responded, “We need to build
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a soccer field.”
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That wasn’t what I had expected.
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I didn’t understand their reasoning, but
had to defer to the major core concepts of
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community engagement:
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community ownership and control, and facilitating
a process of problem solving versus a project.
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I encouraged them to build their soccer field
which they did.
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They eventually addressed the sanitation issues
related to amoebiasis but in their, not my,
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priority.
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This is true community engagement: community
control and ownership of their problems and
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solutions.
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Our role as external specialists is to come
along side the community and encourage them
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by
facilitating a process of problem solving
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not just the accomplishment of a project.
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For a few minutes let’s consider the philosophy
of culture.
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This diagram is what I call the cultural egg.
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It’s adapted from G. Linwood Barney’s
Layers of culture.
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The arrow represents the idea that our behaviors
result from deeper influences.
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At the very center of this cultural egg rests
our worldview or deep beliefs.
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These deep beliefs can be divided into four
major categories: our beliefs about
00:17:19
ourselves as human beings, our beliefs about
nature, the supernatural and time,
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the past, present and future.
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These deep beliefs are often aggregated into
what I call are our “ologies”
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including ideology or philosophy of life and
cosmology or how the universe
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formed.
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These core beliefs or worldviews then inform
our values, the next layer of the
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cultural egg.
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These are the things we feel are important.
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These deep beliefs and values then set the
base for the way we do things, our
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institutions including: how we marry, how
we educate our children, how we
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enforce our laws, how we govern ourselves,
how we run our businesses and
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organizations, etc.
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Finally all of those deeper layers emerge
as our individual and organizational
00:18:14
behaviors: the area we want to influence.
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The major concept is that the root cause for
many of our risky behaviors may be
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driven by our deep beliefs and values.
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Let’s now use this cross cultural communications
diagram to discuss how this
00:18:34
relates to technical and adaptive leadership
skills and also social marketing and
00:18:39
community engagement.
00:18:41
Technical situations generally rest at the
institutional and behavior levels of the
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cultural egg.
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Technical fixes operate using the current
deep beliefs and values of the
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organization but require changing the institutional
way of doing things.
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With technical changes we’re not asking
individuals or the organization to
00:19:02
change their deep beliefs and values; they
will remain intact.
00:19:07
Therefore, these changes are not associated
with great risk, major resistance, or
00:19:12
threat.
00:19:13
These are management issues solved by good
technical leadership skills and
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competencies.
00:19:23
Adaptive fixes, on the other hand, seek to
change the deep beliefs and values
00:19:27
that drive the institutions and, ultimately,
behaviors.
00:19:32
Whenever anyone attempts to change our worldview
and values it invariably
00:19:36
results in significant resistance, anger,
criticism and even hostility.
00:19:42
Humans don’t change beliefs and values easily.
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Its the way we think, feel and believe and
from our perspective is “the way to
00:19:49
think feel and believe”.
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We are deeply committed to our deep beliefs
and values.
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If anyone thinks, feels and believes differently
they’re obviously wrong.
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Our emotions are often stirred when our beliefs
and values are challenged.
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Cultural clashes of worldviews and values
has likely been the cause of most, if
00:20:10
not all wars throughout the world’s long
history.
00:20:14
The challenge for an adaptive extreme leader
and facilitator is being able to
00:20:19
remain neutral, suppressing our emotions related
to our beliefs and values, as
00:20:24
we facilitate a community to deal with their
adaptive challenges.
00:20:29
This is not easy since facilitators are human
beings and are deeply attached to
00:20:34
their worldview.
00:20:36
If a community engagement facilitator finds
himself or herself crossing the
00:20:41
threshold, unable to facilitate neutrally,
its wise to transfer the facilitation to
00:20:47
others.
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People will rarely take significant risks
or invest their time and resources in things
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they
don’t deeply believe in.
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They will invest energy, resources and time
to meet their perceived needs, their
00:21:03
priorities, not the priorities and perceived
needs of others unless they’re similar.
00:21:08
So cultural communication’s experts have
taught us that our behaviors are the result
00:21:13
of
deeper influences in each of our lives, our
00:21:16
deep beliefs and values.
00:21:18
In community engagement it’s extremely important
to ascertain and focus on the deep
00:21:23
beliefs and values of the target community
— the things community members feel are
00:21:29
important to them, their priorities, their
perceived needs.
00:21:33
These are the things they will commit time
and resources in to accomplish.
00:21:40
This slide focuses on how the cultural egg
relates to social marketing and community
00:21:45
engagement.
00:21:47
A social marketing expert at a national immunization
conference described it very well when he
00:21:52
said, “I don’t really care what a person
thinks, feels or
00:21:56
believes.
00:21:57
I just want a change in the target behavior.”
00:21:59
In other words social marketing aims at that
outer layer of the cultural egg, the area
00:22:06
of behaviors.
00:22:08
Social marketing does work, that’s why public
health invests millions of dollars each year
00:22:14
in social marketing campaigns.
00:22:16
With convincing presentations, good, culturally
appropriate messages, delivered through effective
00:22:22
messaging channels, at appropriate key times,
risky
00:22:27
behaviors can change, for a time.
00:22:30
The problem with many behaviors is permanency
of change if individuals have unhealthy beliefs
00:22:37
and values that drive those risky behavior.
00:22:42
Excellent social marketing programs may encourage
these individuals to change a risky behavior
00:22:47
for a short time but if those deep beliefs
and values that drive
00:22:51
that risky behavior remain, there will be
recidivism and relapse.
00:22:56
That helps us understand situations that are
geared for social marketing, one-time events
00:23:03
or behaviors, like immunizations or cancer
screenings’
00:23:08
An individual doesn’t need to deeply believe
in those things as long as a good social marketing
00:23:13
campaign can get them to get the influenza
or zoster
00:23:17
immunization or complete a colonoscopy for
bowel cancer.
00:23:20
After that, we can use social marketing to
influence them to do another one time healthy
00:23:25
behavior.
00:23:27
Social marketing uses highly trained communication
specialists who know how to assess, develop,
00:23:33
and deliver appropriate social marketing messages.
00:23:37
These specialists are generally external to
the target communities.
00:23:43
Community engagement specialists would say
that changes in the beliefs, feelings and
00:23:47
thinking of individuals and communities are
essential for permanent
00:23:51
changes of risky behaviors.
00:23:53
The focus of community engagement is at the
level of worldview or deep beliefs and values
00:23:58
of the cultural egg.
00:24:01
If beliefs and values that drive risky behaviors
are changed then more permanent changes of
00:24:06
behavior result with less recidivism and relapse.
00:24:11
Social marketing, clinical counseling and
good policies can reinforce community engagement
00:24:17
programs that target deep beliefs and values.
00:24:21
This underlines the importance of effective
integration, coordination and collaboration
00:24:26
of these tool sets to change risky behaviors
It takes patience to work with communities,
00:24:34
facilitating community discussions around
the difficult task of changing unhealthy beliefs
00:24:39
and values.
00:24:41
We have to realize that the only individuals
that have the right and power to change their
00:24:46
deep beliefs and values are the community
and cultural members
00:24:49
themselves, not external pubic health specialists
or government leaders.
00:24:55
Community engagement, like this, doesn’t
fit most grants with their rigid guidance,
00:25:00
external agendas, project orientations and
timelines, that undermine true
00:25:05
community engagement, the foundation of which
is community ownership and control.
00:25:12
Community engagement requires specialized
skills and techniques to facilitate discussions
00:25:17
around changes in beliefs and values.
00:25:20
Instead of utilizing highly trained communication
specialists, like we discussed in social marketing,
00:25:27
community engagement
commonly focuses on horizontal communication
00:25:31
systems that exist in every true community;
a powerful tool to change beliefs,
00:25:37
values and resultant behaviors.
00:25:45
There are several facilitation techniques
that can be utilized to engage communities.
00:25:51
LePSAS is one technique I have used in Africa
and United States.
00:25:56
It is a participatory teaching method, a facilitation
mechanism, that encourages a community or
00:26:03
group to discuss their problems and seek appropriate
solutions.
00:26:07
LePSA(S) works best in groups of 10-20 individuals.
00:26:12
The facilitator must be neutral, suppressing
the interjection of their personal beliefs
00:26:17
and values
into the discussion.
00:26:20
The acronym for LePSA(S) refers to the following.
00:26:23
The “Le” stands for learner-centered:
moving at the pace and in line with the interests
00:26:29
and
needs of the learner.
00:26:32
This means the facilitator needs to be flexible,
often changing the lesson during a session.
00:26:38
The “P” stands for problem-posing: using
starters like open ended stories that will
00:26:44
lead to
questions regarding community needs and concerns.
00:26:49
The first “S” stands for self-discovery:
discussions that lead to potential solutions
00:26:54
for the
community’s needs and concerns.
00:26:58
The “A” stands for action-oriented: what
can the group do to move toward solution of
00:27:05
identified
problems within a given time-frame?
00:27:09
The last “S” stands for the spiritual
component, often very important and powerful
00:27:14
for changing
risky behaviors.
00:27:17
Many cultures around the world have supernatural
beliefs and values that can positively
00:27:23
influence community behaviors.
00:27:25
No matter the personal spiritual orientation
of the facilitator, he or she must understand
00:27:31
and not ignore the power of community and
spiritual beliefs to influence healthy
00:27:37
behaviors.
00:27:38
Once again, a community engagement facilitator
must be careful not interject their
00:27:43
beliefs and values as they facilitate discussions.
00:27:52
Most people are members of many communities,
not just one.
00:27:56
Let’s start with a definition of community.
00:27:59
I define community as a group of people who
know each other by first name and also have
00:28:05
a sense of shared responsibility for each
other.
00:28:09
This is different than the geopolitical definitions
commonly used in public health.
00:28:15
Groups that meet this definition often can
be engaged using community engagement concepts.
00:28:23
Communities significantly impact their members
in almost every aspect of their lives including:
00:28:29
how they think, what they believe and how
they act.
00:28:33
There are five main community groups including.
00:28:37
Rural towns with populations up to 1000-1500
people.
00:28:42
Some studies suggest that people can know
only about 1000-1500 people by first name.
00:28:49
I was raised in a small rural town, a true
community, in central North Dakota.
00:28:55
As a young boy, if I fell and cut my knee
somewhere in town, someone would
00:28:59
take me in, clean and bandage it, and call
my mom.
00:29:02
If I did something wrong that also was relayed
to my parents.
00:29:07
I was raised by that community.
00:29:10
That
community was like my extended family.
00:29:14
Schools comprise another group of communities.
00:29:17
Schools are complex with several sub-communities:
staff and students stratified by age group,
00:29:24
home rooms and school organizations.
00:29:28
Faith based organizations often function like
communities, expressing supernatural beliefs.
00:29:35
The workplace may occasionally meet the criteria
of community, revolving around economic interests
00:29:43
Then there are other organizations and groups
that may also operate like communities, including
00:29:48
Kiwanis, Optimists, Knights of Columbus, Rotary
International, fraternities, sororities, Internet
00:29:56
groups, like Facebook and Twitter, ethnic
groups, prostitutes, street children, etc.
00:30:05
There are some basic community engagement
concepts that apply to all these five groups,
00:30:10
yet there are unique concepts and skills that
apply to some
00:30:13
groups.
00:30:14
For example, engaging faith-based communities
requires an understanding of how to facilitate
00:30:21
discussions with these groups to use their
beliefs in the
00:30:24
supernatural to deal with risky behaviors.
00:30:28
For schools its important to understand key
differences between the worldview and cultural
00:30:34
dimensions of children and young people versus
adults and
00:30:38
how that impacts things like messaging.
00:30:42
The priority of engaging a workplace community
will need to address the profitability of
00:30:47
the business.
00:30:49
As mentioned previously, community engagement
seeks to find and engage horizontal communications
00:30:56
systems.
00:30:57
All communities have horizontal communicators
often informal leaders, also known as opinion
00:31:03
leaders, champions, and influential individuals
in class.
00:31:09
Horizontal communications systems have incredible
potential to impact the beliefs, values and
00:31:15
behaviors of the community.
00:31:19
Consistent messages across all communities
that an individual belongs to will help individuals
00:31:26
reach a behavioral threshold faster than focusing
on only one
00:31:31
community or sub-community in a target area.
00:31:35
Therefore, a major community engagement strategy
is to reach as many communities in a target
00:31:42
area as possible.
00:31:48
In summary:
Casting a compelling vision is an essential
00:31:52
attribute of successful leaders
A successful leader must have both technical
00:31:59
and adaptive leadership skills
Social marketing and community engagement
00:32:06
are major public health tool sets to
change risky behaviors
00:32:12
Community engagement is facilitating communities
in the process of problem solving
00:32:24
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the next level!
00:32:27
Our specialized certificate
courses give you an opportunity to work systematically
00:32:32
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00:32:36
that material in a capstone project.
00:32:39
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