GHLR.PHLeadership21Century

Institute for Health Promotion and Disease Prevention Research
GRADUATE COURSE GUIDELINES
Institute for Health Promotion and Disease Prevention Research
GLOBAL HEALTH LEADERSHIP REPORTSBEST PRACTICE SOLUTIONS TO ENHANCE THE PERFORMANCE OF HEALTH SYSTEMS
M. RICARDO CALDERÓN, SERIES EDITOR
PUBLIC HEALTH LEADERSHIP
AND MANAGEMENT FOR THE
21ST CENTURY
May 2010

Public Health Leadership and Management for the 21st Century May 2010
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INSTITUTE FOR HEALTH PROMOTION &
DISEASE PREVENTION RESEARCH
Keck School of Medicine
University of Southern California (USC)
1000 South Freemont Avenue, Unit 8
Alhambra, California 91803
The Global Health Leadership Reports is a publication
of the USC Institute for Health Promotion and Disease
Prevention Research (IPR). The opinions expressed
herein are those of the editor and author(s) and do
not necessarily reflect the views of the University of
Southern California. Excerpts from these publications
may be freely reproduced acknowledging Global Health
Leadership Reports as the source.
Internet: http://mph.usc.edu/ipr/
Internet: http://mrcalderon.com
GLOBAL HEALTH LEADERSHIP TEAM
SERIES EDITOR:
M. Ricardo Calderón, M.D., M.P.H.
Senior Administrative Director, International
Training Programs; Associate Professor, Preventive
Medicine; Founding Director, MPH Global Health
Leadership Track and Regional Director, Latin
America and the Caribbean, USC-IPR & Area Director
& Health Officer, County of Los Angeles Department
of Public Health
INFORMATION DISSEMINATION INITIATIVE
Carina Lopez, M.P.H.
Program Manager
The GLOBAL HEALTH LEADERSHIP REPORTS series was created by Professor M.
Ricardo Calderón during his tenure at the Institute for Health Promotion and
Disease Prevention Research (IPR) of the University of Southern California’s Keck
School of Medicine (USC). It was designed to provide a forum to faculty and
students of the USC Master of Public Health (MPH) Program to share lessons
learned and best practice solutions to enhance the performance of health
systems around the world. The research, training and service of university
faculty and students is published in a variety of peer reviewed and professional
journals traditionally and due to scholarly purposes. While this is the acceptable
professional and academic manner to contribute with original unpublished
research, social science analyses, scholarly essays, critical commentaries and
letters to the editors, there is an extensive body of practical information and
valuable knowledge that is either not submitted for publication or that takes
too long to be published. This lack of information exchange may reflect a
missed opportunity to strengthen, expand and diversify knowledge learning
and capacity development to trouble-shoot, problem-solve, make informed
choices, prioritize investments, implement evidence-based practices and/or lead
innovation and change in the healthcare industry and public health systems.
The Global Health Leadership Reports series was created to fill some of the
gaps in information dissemination and exchange and, more importantly, the
timely integration of research findings and best practice solutions into program
development, implementation and evaluation for enhanced institutional
performance and population health outcomes. This is accomplished by
developing electronic publications that can be easily distributed by e-mail,
posted in websites or transmitted by internet around the world. This is also
done by capitalizing upon the research efforts and practical solutions developed
by faculty and graduate students throughout their teaching and learning
experience, graduate education, classroom debates, and group discussions
including a variety of projects that are implemented by talented, creative and
innovative faculty and students.
We trust that the reader will be open to our publication rationale and
approach, and will contribute to further disseminate reliable information
for the effective development of community and global health programs,
plans and policies. We hope that the Global Health Leadership Reports will
stimulate discussion and reflection, propel continued dialogue, and encourage
the pioneering of new combinations of innovative approaches and practical
solutions to enhance the performance of health systems and improve
the health status and wellbeing of individuals, families and communities
worldwide. We also hope to contribute to fulfill the vision to create healthy
people living in healthy environments locally and globally, and living longer,
quality lives in a world with less pain and suffering, less injuries and disease,
less health inequities and disparities, and a world where our minds and bodies
perform at optimum levels.
At a Glance

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EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
COURSE INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1. Learning Outcomes
2. Course Format and Grading Criteria
3. Teaching Philosophy
I. FUTURE-FOCUSED LEADERSHIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1. Lecture: Global Health Leadership Track & Interdisciplinary Global Health Training
2. Lecture: Public Health Leadership Framework for the 21st Century
3. Team Exercise: Creating Individual and Shared Visions
4. Discussion: Concept Paper #1: Developing a Visionary Leadership Approach
5. Bibliography
II. LEADING PUBLIC HEALTH INSTITUTIONS . . . . . . . . . . . . . . . . . . . . 26
1. Lecture: Transformational Leadership
2. Individual Exercise: Leadership versus Management
3. Lecture: Public Health Leadership Principles
4. Discussion: Concept Paper #2: Developing Empowered Leaders
5. Lecture: SWOT Analysis
6. Self-Directed Study Project and Paper #1: SWOT Analysis
7. Bibliography
III. FORMULATING STRATEGY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
1. Lecture: Leadership Applications in Public Health
2. Class Exercise: Systems Thinking
3. Discussion: Concept Paper #3: Building Internal and External Partnerships
4. Lecture: Leadership and the Planning Process
2. Lecture & Class Exercise: Asset-Based Community Strategies
6. Lecture: Participatory Strategic Planning
7. Discussion: Concept Paper #4: Building Support for a Strategic Plan
8. Self-Directed Study Project & Paper #2: Creating a Strategic and an Implementation
Plan
9. Bibliography
Table of Contents

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Table of Contents
IV. LEADING AND MANAGING CHANGE. . . . . . . . . . . . . . . . . . . . . . . . . .68
1. Lecture: Leadership and Organizational Culture
2. Individual Exercise: Time Management Matrix
3. Lecture: Peacetime Management & Wartime Leadership
4. Concept Paper #5 Discussion: Implementing Adaptive Leadership
5. Lecture: Managing Personal and Organizational Change
6. Case Study: The Center for Disease Prevention and Control (CDC) Futures Initiative
7. Lecture: Servant Leadership
8. Discussion: Concept Paper #6: Communicating Change
9. Bibliography
V. DEVELOPING PUBLIC HEALTH ORGANIZATIONS . . . . . . . . . . . . . . . . 95
1. Lecture: Building a Learning Organization
2. Lecture: Creating Organizations with Many Leaders
3. Discussion: Concept Paper #7: Creating an Environment for Innovation
4. Lecture: Developing a Performance Oriented Culture
5. Class Exercise: Win as Much as You Can
6. Discussion: Concept Paper #8: Creating Self-Directed Work Teams
7. Self-Directed Study Project and Paper #3: IQ (Intelligence Quotient), Emotional
Intelligence (EQ) and Spiritual Quotient (SQ)
8. Bibliography
VI. IMPLEMENTING STRATEGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
1. Lecture: The Five Fundamental Principles and Ten Commitments of Exemplary
Leadership
2. Class Exercise: Collaborative Leadership
3. Lecture: Capstone Initiatives and Action Learning: Collaborative Leadership Change
Project
4. Discussion: Concept Paper #9: Turning Vision into Action
5. Lecture: Crisis and Emergency Risk Communication
6. Lecture: Risk and High Stress Communication
7. Team Exercise: West Nile Virus Message Development
8. Discussion: Concept Paper #10: Becoming Customer Centric
9. Bibliography

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EXECUTIVE SUMMARY:
The Institute of Medicine (IOM) published in 1988 a proposal to ensure the efficiency and effectiveness
of public health services in the United States. This book, The Future of Public Health, that concluded “The
Nation had lost sight of its public health goals and had allowed the system of public health to fall into
disarray”. In 2002, the IOM released a related publication, The Future of the Public’s Health in the 21st
Century, calling for an overhaul of government public health infrastructure and new partners to address
the nation’s health challenges. Inherent in this call to action was the IOM recommendation that “we must
be led by those who have the mastery of the skills to mobilize, coordinate and direct broad collaborative
actions within the complex public health system…..these skills need constant refinement and honing”.
Consequently, a variety of leadership development institutes were designed and implemented by different
academic and public health institutions to enhance the performance of health systems and improve
population health outcomes across the United States. At the same time, the need for, and the critical
importance of, public health leadership development had already been felt in many health systems around
the world and a range of training programs were under development and/or implementation.
As a medical and public health expert with international technical cooperation experience in over twenty
countries, I accepted the challenge to restructure and revitalize the public health system in Los Angeles
County in 1999. By this time, my work experience had transitioned from private clinical practice and
healthcare delivery to a 5,000-Mayan Indian town in Guatemala, to a range of technical and managerial
positions including, but not limited to, malaria prevention and control, nation-wide surveillance of endo-
epidemic diseases, maternal and child health, reproductive health and family planning, nutrition and food
programming, pharmaceutical assistance, HIV/AIDS/STDs, health promotion and wellness, and infectious
and chronic disease prevention and control. My medical and public health experience, particularly in the
developing world, had taught me that (1) health promotion, wellness and disease prevention and control
are affected by individual, social, economic and environmental factors within and beyond communities
that must be addressed comprehensively, and (2) protecting and improving the health and wellbeing of a
population is a shared responsibility among residents, public institutions, private for-profit and non-profit
organizations, key stakeholders, opinion leaders and policymakers.
Therefore, I created two strategic approaches to address the challenges to improve health system
performance and population health outcomes. First, a Community Liaising Program at the County of Los
Angeles Department of Public Health. This program was designed to lead, organize and support a concerted
public, private and non-profit sector effort to strengthen, expand and diversify prevention programs
and public health services (M. Ricardo Calderón, Series Editor, The Best Practice Collection: Developing
a Community Liaising Program in Los Angeles, County of Los Angeles Department of Pubic Health, July
2009). Second, a course on Public Health Leadership and Management for the 21st Century for the Master
of Public Health (MPH) Program at the University of Southern California (USC). Ironically, this course was
not approved by the MPH program administration during three consecutive years. However, when USC
was invited to improve the public health infrastructure in China due to (1) the health and socioeconomic
impact of the SARS (Severe Acute Respiratory Syndrome) epidemic in 2003, and (2) the assessment of the
Chinese Centers for Disease Control and Prevention (CCDC) revealing a need for public health leadership
development at all levels, the course became the pivotal public health leadership development tool offered
by USC in China (M. Ricardo Calderón, Series Editor, Global Health Leadership Reports, Strengthening
the Public Health Infrastructure in China to better respond to 21st Century Threats, Institute for Health
Promotion and Disease Prevention Research, University of Southern California, June 2005).
A total of ten certificate programs were delivered to the top 1,070 public health directors, physicians,
hospital administrators and university professors in China during 2004 and 2005. Two certificate programs
were delivered in Public Health Intelligence and Leadership to 144 Chinese professionals. A third certificate
program in Public Health Leadership and Emergency Response was given to 110 professionals. This
was followed by seven certificate programs in Public Health Leadership and Crisis and Emergency Risk
Communication for an additional 816 public health leaders at national, provincial and city levels. The
Public Health Intelligence and Leadership Certificate Programs integrated intelligence know-how (scientific
knowledge) and leadership skills (executive leadership and management tools) required to successfully
direct public health organizations and coordinate public health preparedness and emergency response.

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This publication describes the Public Health Leadership and Management for the 21st Century course
in detail. It provides the guidelines of the course as taught to professionals at CCDC/China and MPH
students at USC/Los Angeles. It is intended to guide course development and instruction in industrialized
and developing countries in academic and informal settings, and to strengthen, expand and diversify
the knowledge and skills of population, health and development workforces. It is based on a Public
Health Leadership Framework comprising six integrated leadership practices. These leadership practices
are interdependent. Altering one will affect all the rest and mastering all will enable leaders to achieve
outstanding health system performance and successful implementation of institutional vision and overall
strategy. The course and the framework paved the way for the creation of the USC MPH Global Health
Leadership Track in 2006 and the launching of the MPH Leadership, Management and Governance Track at
the newly created School of Community and Global Health at Claremont Graduate University (CGU) in 2008.
This publication reﬂects a journey of lessons learned and best practice solutions in a total of twenty seven
countries. I cannot possibly acknowledge everyone who has played a role in my professional growth and
development. However, I wish to express my gratitude and appreciation to those professors, mentors,
friends and institutions most closely connected to my leadership development ---Drs. Paul Torrens, Lester
Breslow, Jonathan E. Fielding and Ralph Frericks (University of California, Los Angeles), Michael F. Kipp
(Kipp & Associates), James R. Morgan (Strategy and Management Dynamics), Dr. A. Paul Bradley, Jr. (The
Bradley Group, Inc), Dr. Robert Brien (The Haveford Group), Paul D. Storfer (HR Technologies), Drs. Alex
Norman, Gerard Rossey, Alan Glassman and Richard Moore (California State University, Northridge),
Dr. Vincent Covello (Center for Risk Communication), Dr. Hugh H. Tilson (University of North Carolina at
Chapel Hill), Rev. Dr. Gary Gunderson (Emory University), Carol Woltring (Public Health Institute), Mark
Friedman (Fiscal Policy Studies Institute), Dr. C. Anderson Johnson (University of Southern California and
Claremont Graduate University), Dr. Fernando Zacarías (Pan American Health Organization/World Health
Organization), and Dr. M. Roberto Calderón (Pan American Health Organization/World Health Organization
and World Vision International). Also deeply important in my development are the learning environments
of the following “Almae Matres” and institutions: Universidad de San Carlos de Guatemala (USAC),
University of California, Los Angeles (UCLA), University of Southern California (USC), California State
University, Northridge (CSUN), University of North Carolina at Chapel Hill (UNC), American Management
Association (AMA), and the Los Angeles County Training Academy.
Finally, I wish to extend my gratitude and appreciation to Carina Lopez, M.P.H., for her on-the-job and off-
work dedication, contributions and assistance as the Project Manager for the Information Dissemination
Initiative of two of my publication series ---“The Los Angeles County Best Practice Collection: Reliable
Information for Effective Community Health Plans, Programs and Policies”, and the “USC Global Health
Leadership Reports: Best Practice Solutions to Enhance the Performance of Health Systems”.
M. RICARDO CALDERÓN, M.D., M.P.H.
Los Angeles, California, USA
May 2010
Management is doing things
right. Leadership is doing the
right things
-Peter Drucker
“Rather than saying it cannot
be done, let’s find a way to get
it done”.
- M.Ricardo Calderón

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COURSE INTRODUCTION:
Public Health challenges in the 21st Century include disparities in population health status, new pub-
lic health stakeholders, evolving epidemiology of global disease and injury, increased performance
accountability, and heightened expectations for public health system preparedness (National Public
Health Leadership Institute, University of North Carolina at Chapel Hill, 2003). Public Health systems
must be led by those who have mastery of the skills to mobilize, coordinate, and direct broad col-
laborative actions within complex public health systems (Institute of Medicine, 2002), including the
ability to lead multi-faceted, multi-sectoral and multi-national initiatives. The Public Health Leader-
ship and Management for the 21st Century Course focuses, therefore, on the knowledge, skills
and practical tools needed to direct organizations and small and large-scale initiatives to successful
implementation of institutional vision and overall strategy. It is intended for students who will pursue
leadership positions in public health and health care settings, including the task to build learning
organizations, develop leaders at every level, and create partnerships and networks to maximize indi-
vidual and organizational performance as well as public health system response. As students prepare
for and enter leadership careers, they face a workplace that is very different from the one manag-
ers faced a decade ago and one that will change significantly during their tenures. This course will
provide them with the know-how and skills to transfer self-understanding, critical reasoning, scien-
tific knowledge, and analytical problem finding and solving skills to rapidly changing environments
and public health challenges in the 21st century, including visionary and decision-making skills and
emotional intelligence.
1. LEARNING OUTCOMES
At the completion of this course, students will be equipped with knowledge, skills and abilities to:
• Discuss current challenges to public health and public health leadership
• Demonstrate their understanding of leadership skills needed in the 21st Century
• Assess their individual change style and its impact on leading change
• Explore the role of health departments in working collaboratively in communities
• Apply the principles of leading change and collaborative leadership to their work
• Partner effectively with communities and stakeholders
• Develop institutional vision and strategic plans and assess the extent of their implementation
• Make the distinction between manager/management and leader/leadership
• Describe various leadership styles and articulate their own
• Identify their particular leadership strengths to leverage and areas to target for development

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• Utilize action learning and reflective practice for ongoing growth as a leader
• Frame and focus attention to adaptive challenges
• Assure development and sharing of organizational learning
• Use systems thinking to lead innovation and change
• Envision the public health future and develop and lead teams to create it
2. COURSE FORMAT & GRADING CRITERIA
This Course is organized into six major Modules –future-focused leadership, leading public health
systems, formulating strategy, leading and managing change, developing public health organizations,
and implementing strategy. Each Module offers an applied training opportunity to gain advanced
knowledge to build executive and managerial skills. Students will engage in lectures, discussions,
explorations, self-study and assessments, case analyses, practice and application.
A range of learning approaches will be used to teach specific elements of the course including, but
not limited to, Lectures (to convey basic body of information), Self-Directed Learning (intensive study,
reading, writing and/or research on particular issues), Audiovisual Materials (to showcase specific
themes or topics), Peer Education (sharing of information, knowledge, skills or experience among stu-
dents), and Class Discussions (in-depth questions and answers). Case Analyses, based on select read-
ings assignments, will be discussed in each of the sessions and will reinforce the learning objectives
of the course. These analyses will integrate leadership and management principles with public health
practice, policies and programs. In addition, they will reflect on lessons learned and best practices of
public health systems in international settings. Students will be expected to attend lectures, participate
and in class discussions, complete reading assignments, prepare two-page concept papers, write proj-
ect papers, make class presentations, and contribute to information sharing and exchange.
Grades will be based on class participation (10%), development of ten two-page concept papers on
related class themes and topics (20% [10 @ 2 points each]), presentation of three ten-page, self-
directed study project papers (30% @ 10 points each]), and a final examination (40%). Classes will
consist of one 3-4 hour session per week for a total of 16 weeks. Each class will consist of approxi-
mately 50-minute lectures followed by corresponding class and team discussions or debates including
individual, team and class exercises and presentations.

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3. TEACHING PHILOSOPY
My teaching philosophy evolved from many years of teaching and training experience in many coun-
tries both in academic and non-academic settings. As I reflect on my values and beliefs regarding
teaching and learning, I find that my teaching philosophy focuses on three primary goals supported
each by three objectives as follows:
1. Teaching state-of-the-art, practical knowledge, skills and competencies: I am a proponent of (1.1)
Action Learning to address issues, challenges and opportunities. In Action Learning, students try to
deeply understand a real problem, take wise decisions, and reflect on what they have learned. Stu-
dents must develop a commitment to questioning, reflection, action, and learning from such actions
rather than stopping with recommendations for others, and a commitment to “learning” as well as
“results”. Learning is, therefore, as important as the action. I complement this objective with (1.2)
Problem-Based Learning. In order to get students to think, I challenge students to “learn to learn”
by working cooperatively in groups to seek solutions for real world problems. I utilize problems to
engage the students’ curiosity, initiate learning of the subject matter, think critically and analytically,
and find and use appropriate learning resources. I also use (1.3) Diverse Teaching and Learning Tech-
nologies to encourage discussion and interaction on the themes and topics of the course and, more
importantly, to translate theory and ideas into action plans, apply practical knowledge, and deliver
results. My learning approaches include, but are not limited to, Lectures (to convey basic body of in-
formation), Self-Directed Learning (intensive study, reading or research on particular issues), Audiovi-
sual Materials (to showcase specific themes or topics), Peer Education (to share information, knowl-
edge and experience among students), Class Discussions (in-depth questions, answers and debates),
and Case Studies (to reflect on lessons learned and best practices from real life). I expect students
to attend lectures, complete reading assignments, lead and facilitate discussions and debates, make
class presentations, and contribute to information sharing and exchange.
2. Developing the students’ leadership skills: I believe that globalization and the rapid pace of
changes in technology and socioeconomic and political environments require a new teaching and
learning orientation. A student who is trained to become a “leader” will do the “right thing”. A stu-
dent with no leadership training will do “things right”. Doing things right does not necessarily mean
implementing the best or more appropriate or cost-effective strategy. One of my teaching goals is
to develop “student-leaders” with practical knowledge and tools to do the right thing. I integrate
(2.1) Visionary and Systems Thinking Skills to accomplish this. I teach students visionary and future-
focused skills so that they will spend most of their decision-making time looking forward. I combine
this with skills to assess what the problem really is and what its wider and systemic causes are. This
enables students to examine the root causes and forces that shape the issues and the challenges

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they will face in the workplace. I also try to develop (2.2) an Entrepreneurial Spirit and Life-Long
Learning Skills among students. Students must appreciate that the institutions in which they will
work operate in a fast changing marketplace that seeks products and services to meet emerging
customer, patient or population needs, including 21st public health challenges, emergencies and
threats. In view of rapid scientiﬁc and technological progress, I encourage students to take charge
of their own learning and develop a life-long learning attitude. Also, I encourage them to look for
creative ways to connect their institutions to the world around them, exploring and imagining new
forms of (2.3) Collaboration and Teamwork that will support their missions and advance strategic
plans. This includes strategic partnerships and alliances and a deep appreciation of the strength of
diversity to assure a higher level of responsiveness, creativity, innovation and organizational learning.
3. Developing the students’ communication skills: I want all my students to understand that com-
municating with others is an essential skill in business dealings, governmental settings, academic
environments, family affairs, and even in romantic relationships. I engage students in written and
spoken discourse to develop their communications skills to (3.1) Educate and Train Others, (3.2) Pro-
mote Innovation and Change, and (3.3) Articulate and Defend Technical Positions and Approaches.
My goal is to provide students with intrapersonal and interpersonal processing, listening, observa-
tion, questioning, analysis, evaluation and speaking skills. I believe that use of these processes is
developmental and transfers to all areas of life ---home, school, community, work, and beyond.
It is through communication that action learning, problem-based learning, teaching and learning
methodologies, visionary and systems thinking, entrepreneurial spirit and life-long learning, and
collaboration and teamwork occur. Also, I strongly believe that students and adults learn by doing
and, in addition to leading and facilitating class discussions and debates and contributing to infor-
mation sharing and exchange, I expect students to prepare multiple One-Page Concept Papers (brief
but cogent well-written essays to develop research, conceptualization, and information consolida-
tion and proposal skills), make PowerPoint Presentations (to develop presentation, public speaking,
spokesperson and representation skills), and 10-Page Individual/Team Project Papers (to help stu-
dents apply the knowledge and skills acquired through the course curriculum to the work they will
perform in the future as public health practitioners, leaders and educators). I utilize Project Papers
as an opportunity for students to practice being a collaborative leader of change in their future
work environments, either internally within their organizations or externally with other institutions
or the community. It is also a virtual reality experience in which they (a) assume positions of leader-
ship, i.e., Ministers or Directors of Public Health, (b) assess the strengths, weaknesses, threats and
opportunities of a health system, program, policy or service, and (c) develop health system change
recommendations based on the knowledge and skills gained in class. Individual Project Papers also
provide an opportunity to promote and evaluate the knowledge, creativity, resourcefulness, progress
and learning experience of students.

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Finally, I am committed to providing a learning environment that is exciting, fun, inspiring and
respectful while comprehensive and thorough. More importantly, I strive to create an environment
where students feel valued, appreciated and safe to candidly discuss topics and propose new ideas,
and one that empowers the students and teacher to pursue learning and personal and professional
growth and development.
I. MODULE 1: FUTURE-FOCUSED LEADERSHIP
1. Lecture: Master of Public Health (MPH) Global Health Leadership Track &
Interdisciplinary Global Health Training
1.1. Why Global Health Leadership?
a. Track Name & Rationale:
• Uniqueness
• Responsiveness
• Relevance
• Integration
b. Statement of Need: A response to new public health challenges and opportunities
created by:
• Rising inequities in healthcare and health status around the globe
• Changing demographic patterns of disease and epidemiological transitions, and
• Increasing globalization and 21st Century threats
c. Track Purpose: Train students and develop leaders with world-class knowledge and
skills in:
• Public Health Leadership and Management principles and
• Population-based disease prevention and control, in order to
• Improve the health of people around the world, and
• Strengthen global public health systems

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d. Track Goals: Prepare students to:
• Respond effectively to the full range of 21st Century threats
• Use scientific knowledge and leadership tools to guide public health action, and
• Create multidisciplinary approaches to enhance global public health research, practice and
policy-making
e. Learning Outcomes:
• EXPLAIN the global context in which public health problems occur and the need to respond
to the health consequences of international emergencies
• DESCRIBE how globalization, rising infectious and chronic diseases, and natural and man
made disasters make the health and wellbeing of people of the world increasingly interde-
pendent
• APPRECIATE the increasing influence of determinants arising in foreign countries to any
country’s health and safety
• APPLY leadership and management skills needed in the 21st century to effectively lead lo-
cal, national and global public health systems
• APPLY scientific knowledge and leadership tools and resources to promote health, prevent
illness and fight disease around the world
• UTILIZE lessons learned and best practices to play leadership roles in promoting global
health through improved research, practice and policy-making
• ADVOCATE for multidisciplinary, multisectoral and multinational disease prevention and
control initiatives to improve the health of the people around the world
• PROMOTE the mutual benefits of improving the health status and wellbeing of other
countries
• DESCRIBE the advantages of information sharing and expertise exchange among countries
and international partners
• PROMOTE health system development and reform worldwide through the engagement of
world-wide networks, partnerships and public and private health institutions

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f. Program Description:

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1.2. Why Interdisciplinary Global Health Training?
a. Perspective for Discussion:
• Global health problems cross geopolitical boundaries
• Solutions require coordinated interdisciplinary actions by all nations
• Research and training is crucial to address 21st century threats
• Critical to share experiences and lessons learned across nations
b. Emerging Infections:
c. Historical Emerging Infections:
d. Severe Acute Respiratory Syndrome (SARS)
• 32 countries, 8464 cases, 799 deaths (11/102 – 06/17/03 WHO)
• Estimated Economic Costs (reduction in annual GDP): China $7.2B, Hong Kong $3.0 - $6.6 B,
Korea $1.3 - $3.0 B, Taiwan $2.5 – $5.3B
• Regional Cost: $16 – $30 B (NY Times & ADB: SARS Economic Impacts and Implications (Fan,
E.X. May 2001)
• Standard Economic Model: Economic Growth = Health
• New Economic Model: Economic Growth < > Health
1973 ROTAVIRUS 1991 MDR-TB
1977 EBOLA VIRUS 1992 CHOLERA EPIDEMIC
1977 LEGIONNAIRES’ DISEASE 1994 CRYPTOSPORIDIUM
1981 TOXIC SHOCK SYNDROME 1998 HONG KONG BIRD FLUE
1982 LYME DISEASE 1999 WEST NILE VIRUS
1983 HIV/AIDS 2001 ANTHRAX
1983 HELICOBACTER PYLORI 2003 SARS
Year 610 INFLUENZA IN CHINA (SARS?)
Year 644 LEPROSY
Year 900 SMALLPOX (RHAZES)
Year 1348 BLACK DEAQTH (PLAGUE)
Year 1495 THE GREAT POX (SYPHILIS)
Year 1510 THE RED SICKNESS (SCARLET FEVER)
Year 1546 JAIL FEVER (TYPHUS)
Year 1557 MALARIA
Year 1567 SMALLPOX

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e. Protecting Health in a Transforming World:
• Preparedness planning
• Collaborative response
• Training and education
• New research agenda
• Proactive communication
• Linkages between disciplines
• Political will
• Expect the unexpected
f. China’s Public Health Training Program: Outcomes Approach Logic Model:

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g. USC/CCDC Public Health Intelligence and Leadership Develop Program: The inte-
gration of Scientific Knowledge (public health intelligence) and Leadership Skills
• Two Certificate Programs in Public Health Intelligence and Leadership (Summer 2004)
• A Certificate Program in Public Health Leadership & Emergency Response (Fall 2004)
• Seven Certificate Programs in Public Health Leadership & Crisis and Emergency Risk
Communication (Fall 2004 and Winter 2005)
• 1070 top medical, public health, hospital administration directors (Chinese Center for
Disease Control and Prevention and the Ministry of Health) and university professors of China

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h. Public Health Opportunities:
i. Desired Future:
• Increased public health system efﬁciency
• Enhanced public health emergency response
• Improved global health
2. LECTURE: PUBLIC HEALTH LEADERSHIP FOR THE 21ST CENTURY
2.1. FUTURE-FOCUSED LEADERSHIP
a. Leadership & Managerial Skill Evolution:
Develop performance-based
and accountability structures
Focus on quality assurance in
service delivery
Ensure public trust in public
health organizations
Lead innovation
Enlarge cadre of public
health leaders
Leadership roles
Prioritize investments to
improve health
Prioritize policies than can
improve the public’s health
Assure evidence-based
practices

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b. The Role of the Leader-Manager:
c. Developing New Perspectives:
• Changing perspectives to facilitate organization and program change
• Creating new perspectives
• Changing mental models
d. Imagination:
• If you do not know where you are going, any road will take you there
e. Leadership Abilities and Practices:
Passionate vision
External focus
Clear values and strategy
Organizational alignment
Effective management of
human capital
Seamless execution
Create a vision
Synthesize knowledge
Be creative, resourceful
Foster and facilitate
collaboration
Cultivate systems thinkers
Possess entrepreneurial
ability
Set priorities
Form coalitions & build
teams
Master management
techniques
Act as a colleague, friend
and humanitarian

20
2.2. LEADING PUBLIC HEALTH SYSTEMS
a. Leadership Roles:
SPOKESPERSON DIRECTION SETTER
COACH CHANGE AGENT
EXTERNAL ENVIRONMENT
PRESENT FUTURE
INTERNAL ENVIRONMENT
MANAGING
Coordinating
Controlling
Administering
Scheduling
Monitoring
Planning
Stafﬁng
Directing
LEADING
Thinking in the Future
Inspiring
Motivating
Inﬂuencing
Risk Taking
Facilitating
Empowering
Mobilizing

21
2.3. FORMULATING STRATEGY
a. Today’s Public Health Challenges:
b. Scientiﬁc Examples of Public Health Challenges in China:
• Rapidly emerging disease distribution –infectious respiratory disease to chronic disease—as
major causes of death (prior to SARS
• Unprecedented migration from rural to urban centers –30% to 40% of population in some
cities
• Population disparities and associated mental disease is the greatest economic challenge to
China by 2020 (WHO)
• High levels of anxiety, depression and stress in people who experience either a loss of real
income or a loss of income relative to others in their workplace or neighborhood (USC-CSCS)
• Exposure to foreign media (movies, TV, magazines, music) is associated with an increase in health
risk behavior –smoking, fast food consumption, etc.
Effective preparedness and
response to 21st century PH
threats
Emergence of new and
re-emergence of old diseases
Changing demographics
Population health disparities
Emphasis on accountability
and performance
Government and health
department reorganization
Need for reliable and timely
detection, science,
communication, integration,
action and containment
Explosion of information
technology
Globalization and rapid
transportation systems
Enhanced role of prevention
Invisibility of public health
Shifting public expectations

22
2.4. LEADING AND MANAGING CHANGE
a. Paradigm Shifts:
2.5. DEVELOPING PUBLIC HEALTH ORGANIZATIONS
a. Developing Leaders:
• Treat people with trust and respect (support, recognize and reward staff)
• Build organizational capabilities (created aligned, learning organization; ensure coaching,
counseling, mentoring, training and appraisals)
• Transition management (embrace change; continuously scan horizon)
Behaviors
Consensus
Patriarchal
Exclusive
Needing facts
Competitive
Solitary vision
Hierarchical
Functional skills
Individual
accomplishments
Structural
Episodic
Control
Analysis
Outcome
Personal capacity
Discovery
Embracing diversity
Holistic
Befriending ambiguity
Collaborative
Collective understanding
& shared vision
Flexible, horizontal
Lifelong learning
Community building
Relational
Sustainable
Chaos and creativity
Synthesis
Process
LEADERS
Innovate and develop the organization
Ask what and why
Eye on the horizon (future-oriented)
Seek flexibility and change
Problem finders
Divergent thinkers
Influence others by trust, persuasion &
inspiration
Serve and empower human beings
Do the right thing (EFFECTIVENESS)
MANAGERS
Maintain and operate the organization
Ask how and when
Eye on the bottom line (present-oriented)
Seek stability and control
Problem solvers
Convergent thinkers
Influence others by rules and systems
Deploy human resources
Do things right (EFFICIENCY)

23
2.6. IMPLEMENTING STRATEGIES
a. Key Competencies:
• We must be led by those who have mastered the skills to mobilize, coordinate and direct
broad collaborative actions within the complex public health system………..these skills
need constant reﬁnement and honing (The Future of the Public’s Health, Institute of
Medicine, 2002)
b. Characteristics of Admired Leaders:
Other Characteristics include: Courageous, Imaginative, Caring, Determined, Mature, Ambitious,
Loyal, Self-Controlled and Independent.
2.7. QUESTIONS FOR DISCUSSION:
• What are the key elements inﬂuencing the future of public health in your country, depart-
ment, province, city, etc?
• What key behaviors do you need to develop as a leader in order to address this future
situation?
• Upon your return, what actions might you take to prepare yourself to shape your public
health department or program for the future?
CHARACTERISTICS 1987 RESPONDENTS % 1995 RESPONDENTS %
Honest
Forward-looking
Inspiring
Competent
Fair-minded
Supportive
Broad-minded
Intelligent
Straightforward
Dependable
83
62
38
67
40
32
37
43
34
32
88
75
68
63
49
41
40
40
33
32

24
2.8. ACKNOWLEDGEMENTS:
• Michael F. Kipp, President, Kipp & Associates
• James R. Morgan, CEO, Strategy & Management Dynamics
• A. Paul Bradley Jr., President, The Bradley Group, Inc.
• American Management Association (AMA)
3. TEAM EXERCISE: CREATING INDIVIDUAL AND SHARED VISIONS
Break large group into small teams (5 or 10 people each). Each team appoints:
(1) a facilitator who will coordinate team discussions,
(2) a representative or reporter who will be responsible for later reporting back to the whole large group,
(3) a person(s) who will draw or paint a vision on flipchart paper that will be provided.
The facilitator will coordinate the group’s efforts to reflect or draw an image or idea on a flipchart of the dream
or vision of the team of their institution, community, province, city and/or a specific program or service for the
Year 2010. The facilitator will instruct team members to be creative and not to concern themselves with their
artistic abilities. The result of this process will be a shared vision of good health, quality services, exceptional
performance, a state-or-the-art health department, or any other theme.
All team members come back into the large group and the reporter from each small group will bring their
group’s shared vision to the front of the room, tape it to the wall and highlight images and ideas generated.
The reporter for the second small group will tape their action vision next to the previous groups and repeat
the process. When all shared visions are taped and all group reporters have reported, the result of this process
will be a “gallery of collaborative art” reflecting a variety of end goals, outcomes or horizons resulting from
the best efforts of public health leaders to protect and enhance the health status and wellbeing of individuals,
families, communities and/or the population at large. All program participants form a single line a conduct
a walk-through of the gallery of collective art. Once done, a discussion will take place regarding images and
ideas generated and the importance of visionary skills.

25
Guiding Concepts and/or Questions:
• What an effective institution will look like in the Year 2010?
• What a healthy community will look like in the future?
• How will staff, institutions or communities achieve their vision)?
• How will program or service effectiveness be accomplished?
• Who will participate in the process –staff, institutions, communities, sectors of society?
Time:
• 30-45 minutes
Supplies:
• Flipchart pad and easel, thick markers, crayons and masking tape for each team
4. DISCUSSION: CONCEPT PAPER #1: DEVELOPING A VISIONARY LEADERSHIP
APPROACH
5. BIBLIOGRAPHY
a. Required Readings
• Rowitz, Chapters 1, 2 and 3.
• Institute of Medicine of the National Academies: The Future of the Public’s Health. National
Academies Press. Washington, DC: 2003. pp. 1 – 18.
• Heifetz, Ronald A. & Linsky, Marty. The Challenge: In Leadership on the Line. Harvard
Business School Publishing, Boston, MA, 2002. pp. 1 – 31.
• Institute of Medicine of the National Academies: Insuring Americas’ Health: Principles and
Recommendations. National Academies Press. Washington, D.C., 2004. pp. 15 - 65.
• Hesselbein, Frances et al. Leading the Organization of the Future: Chapters 1, 2, 3: In The
Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 1 – 19.
• Hesselbein, Frances et al. Leading the Organization of the Future: Chapters 4, 5, 6: In The
Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 26 - 59. Institute
of Medicine of the National Academies: The Future of the Public’s Health. National
Academies Press. Washington, DC: 2003. pp. 19 - 45.
• Corrigan, Janet M., et al. Fostering Rapid Advance in Health Care: Learning from Systems
Demonstrations. Institute of Medicine, Washington, D.C. 2003. pp. 1- 26.

26
b. Optional/Recommended Readings:
• Drucker, Peter F., et al. Looking Ahead: Implications of the Present. Harvard Business Review.
September – October 1997. pp. 15 – 27.
• Heifetz, Ronald A. & Linsky, Marty. The Response: Get on the Balcony & Think Politically: In
Leadership on the Line. Harvard Business School Publishing, Boston, MA, 2002. pp 32 – 76.
• Blank, Martin and Dazberger, Jaquieline. Creating and Nurturing Collaboration in
Communities.Washington DC: Institute for Educational Leadership, 1996. pp. 66 – 75.
• Buckinigiham, Marcus & Coffman, Curt. First, Break All the Rules: In What the World’s
Greatest
Managers Do Differently. New York, NY: Simon & Schuster, 1999. pp. 1 – 15.
• Vaill, Peter B. Permanent White Water: In Managing as a Performing Art, New Ideas for a
World of Chaotic Change. Jossey-Bass Publishers. San Francisco, CA. 1989. pp 1 -32.
• Glassman, Alan M. Rethinking Organization Stability as a Determinant for Innovation and
Diffusion. National Institutes of Health. pp. 132 – 146.
• Goleman, Daniel. What Makes a Leader? Harvard Business Review, November-December
1998. pp. 94 – 102.
• Allen, Kathleen E. et al. Rethinking Leadership. Kellogg Leadership Studies Project 1994-1997.
pp.40 – 62.
• Chrislip, David. Collaboration: The New Leadership: in The Healthcare Forum Journal.
November- December 1995, Vol. 38 #6. pp. 1 – 12.
II. MODULE 2: LEADING PUBLIC HEALTH INSTITUTIONS
1. LECTURE: TRANSFORMATIONAL LEADERSHIP:
a. Overview of Session:
• Discussion of leadership experiences and lessons to be learned from them
• Leadership fundamentals to be practiced in all leadership settings
• Leadership approaches to be used in concert in various settings
• Opportunity to set personal leadership objectives

27
b. Management and Leadership:
• Management is about coping with COMPLEXITY TECHNICAL
Planning and budgeting CHANGE
Organizing and stafﬁng
Controlling and problem-solving
• Leadership is about coping with CHANGE ADAPTIVE
Setting a direction CHANGE
Aligning people
Motivating and inspiring
c. What is expected of leaders?
• Improve Performance: Current and future
• Symbolize the Organization: Inside and Outside
d. Your experiences with leadership: Break into buzz groups to discuss:
• What have been your best and worst moments as a leader?
• What are the most important things you have learned about leadership from your
experiences?
e. Leadership fundamentals:
• Integrity
• High expectations
• Learning
These are required no matter what approach to leadership you use!!!
e.1. INTEGRITY:
• The leadership characteristic most often desired by subordinates
• What is integrity?
Being honest, trustworthy, fair, acting on principle
• Why is integrity crucial for leaders?
How can leaders promote integrity in their organizations?

28
e.2. HIGH EXPECTATIONS:
• Leaders elicit better performance than subordinates thought possible
• High expectations of leaders can make the difference between a top company and an average
company
• Setting appropriately high expectations requires good judgment
How can anyone with low expectations be a leader?
e.3. LEARNING:
• Leaders promote learning
Current knowledge led to current performance
Learning creates potential for performance improvements
Automobile transmission analogy
• How can leaders learn and help their people to learn?
Without learning, you can’t have high expectations and integrity……..
f. Approaches to Leadership:
• Leader-based
• Relation-based
• Follower-based
g. LEADER-BASED LEADERSHIP:
• Inﬂuence in based on charisma, energy and ideas of the leader
• How? By establishing a vision, using symbols and inspiring people
• Can create major change, but may make the organization dependent on the leader

29
h. What is a vision?
• A vivid concept of what an organization could be
• A sign of a leader who is forward-looking and inspiring
• A powerful image that must be communicated and reinforced
• A yardstick for measuring progress
i. Symbols of leadership:
• Communicate messages that cannot be communicated in words
• May either reinforce or distract from values and vision
• Are often perceived even when not intended
k. Symbols:
l. RELATIONSHIP-BASED LEADERSHIP:
• Inﬂuence is based on trust, respect and mutual obligation
• How? By building strong relationships
• Addresses differences among people
• Time-consuming
• Creates a lasting ability to get things done
• Relationship-based Leadership is not limited to use with subordinates
MEANING
• Equality or status differences
• What is important
• Openness to ideas (or not)
• Continuity with past (or not)
• What do we stand for?
TYPES
• Awards
• Furniture
• Types of dress
• Presence or absence at events
• Graphic identity
• Where meetings are held

30
m. Factors inﬂuencing Relationship-based Leadership:
• You (as boss, subordinate, colleague
• Relationship-building skills
• Effort to build relationship
• Other (as boss, subordinate, colleague)
• Relationship-building skills
• Effort to build relationship
• Similarly (demographic, personality)
• Situation (opportunity to interact, time pressure)
• How have your relationships been shaped?
n. FOLLOWER-BASED LEADERSHIP:
• Leading people to lead themselves
• Develops next generation of leaders
• The leader empowers, coaches, facilitates and gives up control
• Makes the most out of follower capabilities
• Follower capability and commitment is crucial
o. Empowerment:
• Strengthening employees SENSE OF EFFECTIVENESS
• Self-conﬁdence
• Personal control over decisions
• And then granting them the AUTONOMY to assume more responsibility
p. From Leadership on the Line
• “Leadership is an improvisational art. You may have an overarching vision, clear, orienting
values, and even a strategic plan, but what you actually do from moment to moment cannot
be scripted. TO BE EFFECTIVE, YOU MUST RESPOND TO WHAT IS HAPPENNING (page 73)”.
• How accurate is this statement for public health leadership?
• Which leadership approach is most consistent with this requirement?

31
q. Developing and approach to leadership: You should consider:
• Your capabilities
• The capabilities of your followers
• The organization’s needs and culture
r. Setting personal objectives for leadership development:
• Please write down one or two objectives for improving your leadership performance over
the next two months
• You will have the opportunity to share these with the class
s. Acknowledgements:
• Jim Dean, Associate Dean of Executive Education Program, Kenan-Flager Business School,
University of North Carolina, Chapel Hill.
t. Questions and Answers Session
2. INDIVIDUAL SELF-ASSESSMENT EXERCISE: LEADERSHIP AND
MANAGEMENT
This is a self-assessment tool based upon ideas presented by Burt Nanus in his book Visionary
Leadership (Jossey Bass Publishers, 1992) and Burn Nanus and Warren Bennis in their book Lead-
ers: The Strategy for Taking Charge (Harper & Row, 1985). The qualities and behaviors of execu-
tives that act in a managerial capacity are listed in the left hand column. The qualities and be-
haviors of executives that act in a leadership capacity are listed in the right hand column. Please
indicate for each pair the approximate percent of time in a typical day (or a week, or a month)
that you devote to each capacity, with each line totaling 100% (see next page).

32
Final Task: Calculate the overall time you spend in managerial and leadership activities and list reasons or
any obstacles that may prevent you from spending more time on leadership.
MANAGEMENT
Maintaining and operating the
organization
Scheduling and coordinating
(asking how and when)
Focusing on bottom line (present
oriented)
Promoting organization stability
and control
Problem-solving, dealing with
crises
Optimizing resources,
maintaining quality
Directing people, seeking
compliance
Basing decisions on facts,
systems procedures
Deploying human resources,
forming teams/programs
Doing things right, seeking
efficiency
TOTALS
PERCENT LEADERSHIP
Innovating and developing the
organization
Policy and strategy forming (asking
what and why)
Focusing on long-term (future
oriented)
Promoting flexibility and change
Problem-finding, seeking
opportunities
Renewing, transforming the
organization
Inspiring people, seeking
commitment
Basing decisions on trust, intuition,
vision
Serving, developing and
empowering people
Doing the right thing, seeking
effectiveness
TOTAL
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
PERCENT

33
3. LECTURE: PUBLIC HEALTH LEADERSHIP PRINCIPLES (PHLP)
a. Concept of Change:
“In a society capable of renewal, LEADERS not only welcome the FUTURE and the changes it
brings but believe they can have a hand in SHAPING that future.
J.W. Garner, Self-Renewal”.
b. 21st Century Challenges:
• IDENTITY CRISIS in public health agencies and professionals
• Public’s LACK OF AWARENESS of the nature and accomplishments of public health
• Parents and friends still ask public health professionals WHAT THEY DO for a living
c. Deﬁnition of Leadership:
• Leadership is CREATIVITY IN ACTION
• It is the ability to see the PRESENT in terms of the FUTURE while maintaining respect for the
PAST
d. Public Health Leadership Principles (PHLP):
PHLP #1: The public health infrastructure must be strengthened by utilizing the CORE FUNCTIONS
OF PUBLIC HEALTH and its ESSENTIAL SERVICES as a guide to the change that should occur.

34
PHLP #2: The goal of public health is to IMPROVE THE HEALTH of each person in the community.
PHLP #3. COMMUNITY COALITIONS need to be built to address the community’s public health
needs.
PHLP #4. LOCAL, REGIONAL AND NATIONAL public health leaders must WORK TOGETHER to
protect the health of all citizens regardless of gender, race, ethnicity or socioeconomic status.
PHLP #5. Rational community health planning requires collaboration between public agency
LEADERS AT ALL LEVELS.
PHLP #6. Novice public health leaders must LEARN LEADERSHIP TECHNIQUES AND PRACTICES
from experiences public health leaders.

35
PHLP #7. Leaders, both born and made, must CONTINUOUSLY work to DEVELOP their LEADERSHIP
SKILLS.

36
PHLP #8. Leaders must be committed not only to lifelong learning but to their own PERSONAL
GROWTH.
PHLP #9. PHYSICAL, PSYCHOLOGICAL, EMOTIONAL, EOCNOMIC AND SOCIAL HEALTH are all
elements of the health of a community.
PHLP #10. Public health leaders should THINK GLOBALLY and ACT LOCALLY
PHLP #11. Public health leaders need to be good managers

37
PHLP #12. Public health leaders need to WALK THE WALK (do ﬁrst what the ask of others).
PHLP #13. Public health leaders need to be PROACTIVE not reactive.

38
PHLP #14. EACH LEVEL of the public health system has a NEED FOR LEADERS.
PHLP #15. Public health leaders must PRACTICE WHAT THEY TEACH.

39

40
e. Questions and Answers Session
4. DISCUSSION: CONCEPT PAPER #2: DEVELOPING EMPOWERED LEADERS
5. LECTURE: SWOT ANALYSIS

41
6. TEAM EXERCISE AND/OR SELF-DIRECTED STUDY PROJECT AND PAPER #1:
THE SWOT ANALYSIS
A Needs Assessment is a fundamental component of any Strategic Planning process. This is an ap-
praisal of the key forces that inﬂuence the success the organization will have in achieving its mis-
sion and goals. These forces may pose either an opportunity or a threat to the organization, such as
changes in economic conditions, population, technology, environment, or statutes. Some planers call
this element an Environmental Scan. However, many planers use a SWOT Analysis to determine both
internal and external factors that could signiﬁcantly affect the achievement of the general goals and
objectives
A SWOT Analysis is a strategic planning exercise that gathers information that is used to look at ways
to converge and accentuate Strengths and Opportunities and minimize Weaknesses and Threats. This
is vital to any strategic plan because it allows planners to systematically and coherently steer clear of
obstacles to success in the strategic planning process.
• Strengths are strong attributes or inherent assets;
• Weaknesses represent faults and defects in our programs, services, policies or procedures;
• Opportunities highlight favorable circumstances or chances for progress, expansion or advance
-ment;
• Threats describe situations or risks that delay, stop or damage our image, programs or services.
Team Exercise:
The class conducts a rapid needs assessment of the China CDC, the Ministry of Health or any other
institution. The class is divided into four teams. Each team is responsible for one component of the

42
SWOT Analysis. Each team identifies at least five issues related to each component. Each team
records findings and conclusions on a flip chart and a representative or reporter presents a sum-
mary to the entire class, thus creating a quick SWOT Analysis for teaching, learning and discussion
purposes.
Supplies:
Flipchart pad and easel, thick markers and masking tape for each group.
Time:
30 to 45 minutes including individual team discussions and presentations from 4 reporters.
7. BIBLIOGRAPHY
Required Readings:
• Rowitz, Chapters 4 and 14.
• Hesselbein, Frances et al. Leading the Organization of the Future: Chapters 7 & 8: In The
Leader of the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 71 - 81.
• Zaleznik, Abraham. Managers and Leaders: Are they Different? Harvard Business Review.
March – April, 1992. pp. 2 - 11.
Academies Press. Washington, DC: 2003. pp. 46 - 95.
• Edenet, Jill et all. Leadership by Example: Coordinating Government Roles in Improving
Health Care Quality. Institute of Medicine, Washington, D.C., 2002. pp. 56 – 128.
• Hesselbein, Frandes et al. Future Leaders in Action: Chapters 9, 10, 11: In The Leader of the
Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 90 – 111.
• Hernandez, Lyla. Editor. Who will keep the Public Healthy? Institute of Medicine,
Washington, D.C., 2002. pp. 1 – 16.
• Pearson, Andrall E. Six Basics for General Managers. Harvard Business Review.
July – August, 1989. pp. 1-8.
Academies Press. Washington, DC: 2003. pp. 97 – 177.

43
Optional/Recommended Readings:
• Longest, Beaufort B., et al. Management and Managers: In Managing Health Services Organiza-
tions and Systems, 4th Edition. Health Professions Press. Baltimore, MD. 2000. pp 1 – 17.
• Katz, Robert L. Skills of an Effective Administrator. Harvard Business Review. September –
October, 1994. pp. 1-12.
• Charan, Ram and Colvin, Geoffrey. Why CEOs Fail. Fortune. June 21, 1999. pp. 69-82.
• Heifetz, Ronald A. & Linsky, Marty. The Response: Hold Steady: In Leadership on the
Line. Harvard Business School Publishing, Boston, MA, 2002. pp 124 – 141.
• Heifetz, Ronald A. & Linsky, Marty. The Response: Orchestrate the Conﬂict & Give the
Work Back: In Leadership on the Line. Harvard Business School Publishing, Boston, MA, 2002.
pp 102 – 123.
• Goleman, Daniel. What Makes a Leader? Harvard Business Review, November – Decem-
ber 1998. pp. 94 – 102.
• Hersey Paul and Kenneth H Blanchard. 1976. Leader Effectiveness and Adaptability
Description. The 1976 Annual Handbook for Group Facilitators. pp. 1 – 14.
• Kotter, John P. What Leaders Really Do. Harvard Business Review, May – June 1990. pp.
3-11.
III. FORMULATING STRATEGY
1. LECTURE: LEADERSHIP APPLICATIONS IN PUBLIC HEALTH
a. USA Vision for Year 2010: Healthy People in Healthy Communities
b. The Mission of Public Health: “……to fulﬁll society’s interest in assuring the conditions in
which people can be healthy, The Future of Public Health, Institute of Medicine”.
c. Approach and Rationale (The National Academies: Advisers to the Nation on Science, Engi-
neering and Medicine, and The Institute of Medicine):
• Health is a public good and a social goal of many sectors and communities

44
• Government has fundamental, statutory duty to assure the health of the public, BUT
• Government cannot do it alone
• There is a need for inter-sectoral engagement in partnership with government
d. Areas of Action and Change (The Future of the Public’s Health in the 21st Century, Institute of
Medicine):
• FOCUS on population health including the multiple determinants of health
• STRENGTHEN the governmental public health infrastructure
• BUILD inter-sectoral partnerships
• DEVELOP systems of accountability
• MAKE evidence the foundation of decision-making
• IMPROVE communication
e. Determinants of Population Health

45
f. The Public Health System:
g. Core Functions of Public Health
• ASSESSMENT: identiﬁcation of health problems
• POLICY DEVELOPMENT: identiﬁcation of possible solutions
• ASSURANCE: Implementation of solutions (programs and services)
g.1. ASSESSMENT

46
g.2. POLICY DEVELOPMENT
g.3. ASSURANCE

47
h. Core Functions of Public Health and 10 Essential Public Health Services

48
i. Relationship of USA Public Health Approach to Public Health Practice
j. Public Health Leadership Framework for the 21st Century: A SYSTEM FOR SUCCSS

49
k. Questions for Discussion
• What are the three core functions of public health?
• What are the similarities and differences between organizational practices and the essential
services of public health?
• What leadership activities are required to implement the core functions of public health?
l. Acknowledgements:
• Healthy People 2010
• Institute of Medicine
• The National Academies
• Louis Rowitz’ Public Health Leadership
m. Questions and Answers Session
2. CLASS EXERCISE: SYSTEMS THINKING
a. Class Discussion: Systems Thinking

50

51
b. Class Exercise: Systems Thinking
Supplies:
• 4 system puzzles
Time:
• 30 – 45 minutes
Class Exercise:
• The class is divided into three or four groups. Each group is given a Systems Puzzle that must be
assembled as soon as possible. The following discussion is held once all puzzles have been
correctly assembled.
Discussion:
Systems thinking addresses how components of a whole- such as departments in an organization- con-
nect and relate to one another. The whole is the “system” and the components are “sub-systems”. A
major focus of system thinking is the relationships or “forces” within and between sub-systems, as well
as forces acting on the whole system.
Ludwig von Bertalanffy (1901- 1972), early pioneer of general systems theory, was one of the most
important theoretical biologists of the first half of the 20th century. His work has led many others to
view organizations as organisms (rather than machines) having diverse parts that function together as
a whole to maintain overall vitality and activity. When we view an organization in this way, we come
to understand how leaders can influence the qualities of connection and relatedness that influence the
vitality of organizational life.
HOW DO SYSTEMS BEHAVE?
1. Systems behave as though they are persons with lives of their own.
2. Systems regularly act to preserve themselves. They do this by resisting or adapting to
change.

52
3. Systems maintain both external and internal boundaries.
4. Systems are always internally connected.
5. Systems assign specialized roles to their members.
6. Systems develop rules and rituals to bond members to one another and thus to
maintain and preserve the group.
7. What actually happens in a system is what the system intends to happen.
LEADERS USE SYSTEMS THINKING TO…
• Remember that no sub-system exists independent of another. Leaders consider how the
tensions of interconnectedness and interdependence play and influence all sub-systems as
well as the whole system.
• Focus on the “goodness of fit” between members of a system, not on individual strengths
and weakness.
• Regard the actual and potential adaptability of the system, not just what challenges and
problems it faces.
• Consider the states of equilibrium and disequilibrium versus stability.
• Notice that many situations require managing, not solving.
• Regard ambiguity and uncertainty as not only sources of anxiety, but of creativity and growth
too.
• Consider that demands for many “first order” responses may indicate the need for “second
order” responses.
3. DISCUSSION: CONCEPT PAPER #3: BUILDING INTERNAL AND EXTERNAL
PARTNERSHIPS

53
4. LECTURE: LEADERSHIP AND THE PLANNING PROCESS
a. Quote:
• “We live in a world where NO ONE IS IN CHARGE. No organization, or institution has the legitimacy,
power, authority, or intelligence to act alone on important public issues and still make substantial head-
way against the problems that threaten us all. J. M. Bryson and B.C. Crosty, Leadership for the Common
Good”.
b. Leadership and Planning:
• No matter what changes occur in the world of public health, PLANNING will occupy much of
the work of their leaders.
• STRATEGIC THINKING SKILLS are essential for all varieties of planning.
• Strategic planning must be driven by the big picture –the leader’s vision of the future.
c. Community Health Planning:
• Use approach that generates INNOVATIVE public health STRATEGIES
• Keep in mind CORE FUNCTIONS, ORGANIZATIONAL PRACTICES AND ESSENTIAL PUBLIC HEALTH
SERVICES.
• Develop outcome scenarios for those engaged in planning to have options to choose from.
d. Planning Steps: Planning does not eliminate change but rather fosters change. Planning is a form
of RATIONAL DECISION MAKING:
• Decide on GOALS AND OBJECTIVES
• Determine CONSTRAINTS
• Figure out what ACTIONS, POLICIES and PROGRAMS to implement
e. Planning Responsibilities: Assessment is a pre-requisite for planning.
• USE core functions of public health as a foundation
• LEARN different planning methodologies
• DETERMINE actions necessary to achieve community health goals and objectives
• USE premising and scenario building to discover innovative public health strategies
• BE INVOLVED in formal planning activities
• CREATE community partnerships to carry out planning

54
f. Planning Models: Planning models, individually or jointly, are all useful for turning a vision into
programs and services.
• Continuous Quality Improvement (CQI)
• Re-engineering
• Re-inventing government
• Strategic Planning
f.1. CONTINUOUS QUALITY IMPROVEMENT
• Related to Total Quality Management (TQM)
• “|The culture of the organization is deﬁned by and supports the constant attainment of
CUSTOMER SATISFACTION through an integrated system of tools techniques and
training, A.V. Feingenbaum”.
f.2. RE-ENGINEERING
• Restructuring of an organization
• “The RAPID AND RADICAL REDESIGN of strategic, value-added business processes –an
the systems, policies, and organizations structures that support them—to OPTIMIZE THE
WORK FLOWS AND PRODUCTIVITY of an organization, Manganelli and Klein”.
f.3. RE-INVENTING GOVERNMENT
• The use of ENTREPRENEURIAL TECHNIQUES by those in the public sector.
• “The fundamental TRANSFORMATION OF PUBLIC SYSTEMS AND ORGANIZATIONS to
create dramatic increases in their effectiveness, efﬁciency, adaptability, and capacity to
innovate, Osborne and Plastrik”.
f.4. STRATEGIC PLANNING
• Review PARTICIPATORY STRATEGIC PLANNING Lecture

55
g. Strategic Planning Terms:
h. Strategic Planning Guidelines: A Team Process:
• Set a DEALINE
• Consider how to get the PLAN APPROVED
• Create a SCHEDULE for the planning process
• DISSEMINATE the results (plan)
• Decided on techniques to EVALUATE PROCESS
i. Community-Oriented Health Systems Planning
VISION
STRATEGIES
GOALS
MISSION
TACTICS
OBJECTIVES

56
h. Public Health Leader’s Responsibilities:
• LEARN the beneﬁts of planning
• PERFORM a stakeholder analysis
• EXPAND strategic planning process to community
• REMAIN optimistic and motivate others
• Do homework to PREPARE for each step
• BE REALISTIC about possibilities
• PERFORM assessment of organizational capability
j. Public-Private Partnerships:
• Public health agencies LEAD THE WAY but CANNOT CARY OUT ALL PUBLIC HEALTH
ACTIVITIES needed to protect and improve the health of a community.
• New types of alliances and partnerships:
Joint Ventures
Research sharing
Community-based projects and programs
Semi-structured alliances
k. Public Health Leader’s Responsibilities:
• Develop public and private relationships
• Share power and responsibilities
• Become involved in community activities
• Join local community groups and organizations
• Act to gain the trust of the community
l. Conclusions:
• The NEEDS of the public are constantly CHANGING.
• Public health agencies must RESPOND to the changes.
• The ﬁrst step in responding adequately is to develop a PLAN OF ACTION.
• Creating a VISION is not enough. A STRATEGY is needed
m. Questions and Answers Session

57
5. LECTURE & CLASS EXERCISE: ASSET-BASED COMMUNITY DEVELOPMENT
a. What determines health?
1. Individual behavior
2. Social relations
3. Physical environment
4. Economic status
5. Access to health care
1 to 4 are least affected by traditional public health interventions but often determine community
health.
b. Link between Associational Communities and Health:
• “SOCIAL CONNECTEDNESS is one of the most powerful determinants of our weel-being,
Robert Putnam, Harvard University”.
c. Health System Tool

58
d. Community Tool
e. Realities of the Two Tools

59
f. Two Tools for Well-Being
h. Half Empty or Half Full?

60
i. Asset-Based Community Development:
• “A way of seeing communities as rich in the TALENTS, ABILITIES and CAPABILITIES of its
PEOPLE, VOLUNTARY ASSOCIATIONS and INSTITUTIONS, John McKnight, Northwestern
University”.
j. Local Assets:
• INDIVIDUALS: the talents, gifts, skills and capacities of local residents
• LOCAL CITIZEN ASSOCIATIONS: small, face to face groups where members do the work
• INSTITUTIONS: non-proﬁts, government and businesses that can support community
development work
k. Neighborhood Needs Map

61
l. Neighborhood Assets Map
m. Question? Who are the individuals, local citizen associations and institutions in your
community?
n. Community Needs Matrix

62
o. Community Assets Matrix
p. Community Assets Map:

63
q. Commuinity Assets Map:
6. LECTURE: PARTICIPATORY STRATEGIC PLANNING
a. What is Strategic Planning?
• “An orderly PROCESS for ENVISIONING an organization’s desired FUTURE and determining the
required ACTIONS to attain that future, Strategic Planning Concepts”.
• “Strategic Planning is the PROCESS by which the GUIDING MEMBERS of an organization
ENVISION its future and develop the necessary PROCEDURES and OPERATIONS to achieve that
future, EnTarga Business Planning”.
• “If I ran my BUSINESS like you run the GOVERNMENT, I’d be out of business in less than a year.
Can’t you run the government more like a business, GPRA 1993”.
TEACHER’S
UNION
PTA
SORORITIES
MASTER
GARDENERS
SIERRA CLUB
NATIVE PLANT
SOCIETY
TENANT
ASSOCIATION
KARATE
CLUB
SCOUTS
ST. SOPHIA’S
CHURCH
BOOK CLUB
MAY: Artist &
Yoga Practitioner
MARK:
Bilingual &
Carpenter
BRIAN:
Coach &
Organizer
JUAN:
Cook &
Soccer Player
KIM: Gardener &
Power Walker
LAURIE:
Writer &
HerbalistLILIA:
Bike riding & Repair
CITY
PARKS
SCHOOL
DISTRICT
GROCERY
STORES
BOYS &
GIRLS CLUB
FARMER’S
MARKET
VENDING
MACHINE
OPERATORS
ASIAN-
AMERICAN
COMMUNITY
CENTER
AMERICAN LUNG
ASSOCIATION
YMCA
POLICE
DEPARTMENT
DAIRY
COUNCIL
PUBLIC
LIBRARY
FITNESS
CENTERS

64
• “Strategic Planning is a PROCESS by which an organization can become all it wants to
become”.
• “Strategic Planning involves the future impact of present decisions”.
• “Planning is the rational determination of where you are, where you want to go, and how
you will get there”.
b. What is Strategic Planning? Preferred Deﬁnition:
• “Strategic Planning is a CONTINUOUS and SYSTEMATIC PROCESS, where PEOPLE make
DECISIONS about intended future OUTCOMES, how outcomes are to be accomplished,
and how SUCCESS is measured and evaluated, Phillip Blackberry 1993”.
c. Key Words:
• Continuous
• Systematic
• Process
• People
• Decisions
• Outcomes
• Success
d. Approaches to Planning:
• REACTICE: Past-oriented
• INACTIVE: Present-oriented
• PREACTIVE: Predict the future
• PROACTIVE: Create the future

65
e. Question? What are the BENEFITS of Strategic Planning?
1. Focus is placed on IMPORTANT THINGS
2. Raise an awareness and impact of CHANGING ENVIRONMENT
3. Analyze the internal business CULTURE
4. Become aware of organization’s POTENTIALS
5. Identify and analyze available OPPORTUNITIES
6. May bring about NEEDED CHANGE
7. Identify STRATEGIC ISSUES
8. Set more REALISTIC OBJECTIVES
9. Obtain better information for DECISION-MAKING
10. Accelerate and improve GROWTH
11. Identify POOR PERFORMING AREAS
12. Gain control of operational PROBLEMS
13. Develop better COMMUNICATIONS
14. A ROAD MAP of location and direction
15. Better INTERNAL COORDINATION of activities
16. A FRAMEWORK for budgets and operational plans
17. Gain a SENSE OF SECURITY among employees
f. Question? What are the pitfalls to Strategic Planning?
1. Jumping from mission formulation to strategy development
2. Top management fails to communicate strategic plan
3. Management rejecting the formal planning mechanism
4. Failing to use the plans as a standard for measuring performance
5. Top management delegating function to a planner
6. Failure to create a climate which is collaborative
7. Not treating planning as a integral part of the whole process
8. Insufﬁcient time spent on planning due to current problems
9. Becoming so formal that process lacks ﬂexibility and creativity

66
g. Six Basic Elements of Strategic Planning:
h. The Strategic Planning Process:

67
i. Questions and Answers Session
7. CLASS DISCUSSION: CONCEPT PAPER #4: BUILDING SUPPORT FOR A STRATEGIC
PLAN
8. SELF-DIRECTED STUDY PROJECT & PAPER #2: CREATING A STRATEGIC AND AN
IMPLEMENTATION PLAN
Required Readings:
• Rowitz, Chapters 6 and 10 and 15.
• Institute of Medicine of the National Academies: Setting the Course: A Strategic Vision for
Immunizations. Los Angeles, CA., 2003. pp. 1- 38.
• Hamel, Gary. Strategy as Revolution. Harvard Business Review. July – August 1996. pp. 21 – 33.
Academies Press. Washington, DC: 2003. pp. 178 – 211 and 212 – 267.
• Hesselbein, Frandes et al. Future Leaders in Action: Chapters 12, 13, 14 & 15: In The Leader of
the Future. The Drucker Foundation. San Francisco, CA, 1996. pp. 121 – 141.
• David, Jonathan R. et al. Strategic Planning: in Public Health Systems and Emerging Infections.
Institute of Medicine, Washington, D.C., 2000. pp. 1 – 28 and 68 – 74.
• Gray, Daniel H. Uses and Misuses of Strategic Planning. Harvard Business Review.
January – February 1986. pp. 88 – 97.
• Mintzberg, Henry. The Rise and Fall of Strategic Planning. Harvard Business Review,
January – February, 1994. pp 107 – 114.
Optional/Suggested Readings:
• Berkowitz, Eric. 1996. Marketing Strategy: In Essentials of Health Care Marketing. pp. 3 – 38.
• Berry, F.S., & Wechsler, Barton. State Agencies Experience with Strategic Planning. Public
Administration Review. March – April, 1995, Vol. 55, No 2. pp. 159 – 168.
• Ginter, Swayne. Developing Strategic Alternatives and Strategic Choice: In Strategic
Management of Health Care Organizations. 2002. pp. 191-249.
• Collins, J.C., & Porter, J.I. Building Your Company’s Vision. Harvard Business Review.
September – October 1996. pp. 64 – 77.
• Heifetz, Ronald A. & Linsky, Marty. Body and Soul: In Leadership on the Line. Harvard
Business School Publishing, Boston, MA, 2002. pp 163 – 225.
• Ghosh, Shikhar. Making Business Sense of the Internet. Harvard Business Review. March –
April 1998. pp. 16 – 34.

68
• Porter, Michael E. What is Strategy? Harvard Business Review. November – December 1996.
pp. 1 – 22.
IV. LEADING AND MANAGING CHANGE
1. LECTURE: LEADERSHIP AND ORGANIZATIONAL CULTURE
a. The historical leadership question:
• What should the leader of the future be like?
b. What is not new:
• Leadership depends on organizational dynamics:
-Speciﬁc Situation
-Task to be performed
-Characteristics of the leader’s subordinates
Organizations have different needs and problems at different stages in their evolution
c. Relationship between the Leader and the Organization:
• Organizations are DYNAMIC SYSTEMS:
-They have a life cycle with unique challenges and implications for leadership behavior:
--ENTREPRENEURS: people who create organizations
--CHIEF EXECUTIVE OFFICERS, PRESIDENTS OR EXECUTIVE DIRECTORS: people who run
organizations
d. Four challenges that will not change:
1. Creating
2. Building
3. Maintaining, and
4. Changing (evolving) organizations to new forms

69
d.1. CREATING: THE LEADER AS ANIMATOR
• Supply the ENERGY to get the organization off the ground:
-Try one approach after another
-Face repeated failures
-Transmit energy to subordinates
• Energy born out of strong PERSONAL CONVICTIONS
-Motivate entrepreneurs
-Builds excitement in others
• Leaders breath life into the organization (ANIMATORS)
d.2. BUILDING: THE LEADER AS CREATOR OF CULTURE
• Entrepreneur’s beliefs, values and basic assumptions are transferred to the mental models of
the subordinates:
-Hiring and keeping similar staff
-Training and building relationships with staff (thinking and feeling)
-Behaving as a role model
• The leader’s personality becomes embedded in the culture of the organization
• CULTURE DEVELOPMENT:
• Once culture is embedded in the organization, it cannot easily be changed
Excellence, quality,
clarity, high productivity,
efﬁciency, great customer
service, responsiveness,
opportunities, reliability,
commitment
Conﬂicts, inconsistent
policies, uneven
patterns of strengths
and weaknesses, low
productivity and morale,
frustration, staff turnover

70
d.3. MAINTAINING: THE LEADER AS A SUSTAINER OF CULTURE
• What was good for the YOUNG ORGANIZATION (high energy level and compulsive vision
of its founders: creators and builders) may become a liability as the organization ﬁnds that it
needs to:
-Stabilize itself
-Become more efﬁcient
-Deal with the fact that its products have become commodities (services)
-Evolve new generations of leaders for the future
• CULTURE TRANSITION PROBLEMS:
1. The founder-builder does not want to let go of the leadership role or is emotion-
ally incapable of doing so.
2. The founder-builder creates a variety of organizational processes that prevent the
growth of the next generation of leader
• Problem: Prevent or undermine potential successors from learning or taking over
• APPROACH OF SUCCESSFUL LEADERS
-Successful leaders at this stage either:
--Have enough personal insight to GROW with the organization and CHANGE their
own outlook, or
--Recognize their own limitations and permit OTHER FORMS OF
LEADERSHIP to emerge
• Judgment and wisdom are most critical at this stage of organizational evolution

71
d.4. CHANGING: THE LEADER AS CHANGE AGENT
• The rate of change of technological, economic, political and socio-cultural environmental
forces leaders to think like change agents:
-Challenge 1: How to acquire new concepts and skills
-Challenge 2: How to unlearn the things that no longer serve us well
--Anxiety, defensiveness and resistance to change
e. In Problematic Organizations…….
• Leaders need EMOTIONAL STRENGTH to be supportive of the organization while it unlearns pro-
cesses previously successful (PSYCHOLOGICAL SAFETY)
• Leaders need a TRUE UNDERSTANDING of cultural dynamics and the properties of their own orga-
nization culture
• Therefore:
--Leaders cannot arbitrarily change culture
--Leaders evolve culture by building on its strengths and letting weaknesses atrophy
over time
f. Culture Change = Cognitive Redeﬁnition
1. NEW SEMANTICS: redeﬁning individualism
2. BROADEN PERCEPTIONS: expanded mental model of individualism that includes collaborative work
3. NEW JUDGMENT AND EVALUATION STANDARDS: change negative competitive behavior to
positive collaborative behavior
Culture is “changed” ---in reality, EXPANDED, through changes in various key concepts in the mental
models of people who are the main carriers of culture
g. Enlarged and Broadened Mental Models:
Example 1: A native of GUATEMALA becomes American. He/she does not give up being Guatemalan
but adds what it means to be American to his personality.

72
Example 2: An organization built on INDIVIDUAL INCENTIVES does not accept teamwork:
• Reward individuals for helping others and contributing to other projects:
-Deep individualism is acknowledged
-Concept is broadened to include working with others, building trusting relationships
and opening communication across boundaries
h. Culture Transformation:
• A genuine change in the leader’s behavior:
-Walk the Walk and Talk the Talk
• Leaders undergo a personal transformation as part of the total change process
i. Successful Survival Characteristics:
• A COMMITMENET to:
-Learning
-Change
-Staff, communities and stakeholders
-Building a healthy, ﬂexible organization
• Without such culture core organizations cannot survive in the long run
j. A look toward the future:
• BUILDERS have a strong vision, conviction and energy to create an organization
• MAINTAINERS have great judgment, wisdom and skill to develop teams to institutionalize
processes
• CHANGERS have learning ability and personal ﬂexibility to evolve and change organizations

73
k. Perpetual Learning:
• Institutions of the past may be obsolete requiring new forms of governance to be learned
• Learning is an ongoing process not a one-time event
• Perpetual learning and change will remain CONSTANT
l. Characteristics of Future Leaders:
1. Extraordinary levels of perception and insight
2. Extraordinary levels of motivation
3. Emotional strength to manage their own and other’s anxiety
4. Skills in analyzing cultural environments
5. Willingness and ability to involve others and elicit their participation
6. Willingness and ability to share power and control according to people knowledge and skills
m. Leadership: An Emerging Function:
n. The Leader of the Future:
1. Can lead and follow
2. Is central and marginal
3. Is ﬂuid within the hierarchy of the organization
4. Is individualistic and a team player
5. Is a perpetual learner
FUTURE
Leaders will
be PERPETUAL
DIAGNOSTICIANS able to
empower different people
at different times and
let emerging leadership
ﬂourish
TODAY
The process of appointing
leaders is a critical
function of board of
directors, electorates,
government agencies, etc.

74
o. Conclusion:
• If an organization is to learn to manage itself better, MORE PEOPLE will have to be leaders and
leadership functions will have to be MORE WIDELY SHARED
p. Acknowledgements:
• Edgar H. Schein, Professor of Management, Sloan School of Management, Massachusetts
Institute of Technology
q. Questions and Answers
2. INDIVIDUAL EXERCISE: TIME MANAGEMENT MATRIX

75

76
3. LECTURE: PEACETIME MANAGEMENT AND WARTIME LEADERSHIP
a. Peacetime Conditions:
• Predictable events
• Sense of comfort and control
• No crisis or chaos
• Top-down approach
• Standard procedures
• No major change is needed
• People are content with what already exists
• Change involved gentle “tweaking” of the system
b. Peacetime Management:
• Incremental modification of what already exists
• No major disruption or emotional consequences
• No sense of urgency
• Leaders occupy positions that have power
c. Problem or Challenge:
• Common conflict between those who want to lead others through a major change as though
it were wartime and those who refuse to become followers, insisting that it is still peacetime.
d. Wartime Conditions:
• Change and transition
• Crisis and urgency
• Uncertainty and turbulence
• Fear, apprehension and exhaustion
• Downsizing and ongoing reorganization
• Budget deficits and spending cuts
• Get more done and faster with less staff

77
e. Wartime Conditions in the Health Sector in Los Angeles:
• Health disparities: infant mortality, diabetes, HIV infections
• Overweight and obesity
• Bioterrorism, SARS, emerging infectious disease outbreaks
• 2.8 million emergency room visits per year
• 3.1 million people with no medical insurance
• 35% with no dental insurance
• 236,000 homeless people
f. Wartime Conditions in the Health Sector in Service Planning Area 3 & 4 (or the spe-
ciﬁc geographical area where course is being or training is taking place):
• CLASS DISCUSSION:
-What are the public health challenges, issues or problems that make the current health sector
in your jurisdiction a wartime situation?
g. Wartime Leadership:
• Problem or Challenge: We have to learn to become wartime leaders, people who embrace ma-
jor change because they see far more opportunity than threat in turbulence.
Wartime Leadership:

78
Desired Future:
g. Psychological Leadership: An Emotional Bond:
LEADERS GENERATE
Conviction that the future will be better
• FRIGHTENED
• VACILLATING
• HESITATION
• WEAKNESS
• FLOUNDERING
• COWARDICE
• CYNICISM
PSYCHOLOGICAL LEADERSHIP:
AN EMOTIONAL BOND
• COMPETENCE
• CERTAINTY
• ACTION
• STRENGTH
• EXPERTISE
• COURAGE
• OPTIMISM

79
h. Leadership Characteristics of the Future
i. A Learning Organization:
• WHAT THEY SAY
• TITLE AND POSITION
• WHAT THEY CONTROL
• GOALS THEY SET
• WHAT THEY DELIVER
• EXPERTISE AND
COMPETENCE
• WHAT THEY SHAPE
• MIND SETS THEY BUILD
LEADERSHIP OF THE FUTURE
People are known MORE for...People are known LESS for...
People are known for great personal credibility
and organizational capabilities
MOST DIRECT LEADERSHIP
A LEARNING ORGANIZATION
LESS DIRECT LEADERSHIP MOST INDIRECT LEADERSHIP
• Commands
• Decision about resources
& Promotion
• Personal Guidance of
Individuals & Teams
• Communicates &
Inspires Vision & Values
• Listens to & Cares for
Followers
• Leads By Personal
Example
• Creates Conditions of
Freedom
• We Did it Ourselves
• Many Leaders

80
4. CONCEPT PAPER #5: IMPLEMENTING ADAPTIVE LEADERSHIP
5. LECTURE: MANAGING PERSONAL AND ORGANIZATIONAL CHANGE
a. The Way Change Happens:
• The single biggest impetus for change in an organization tends to be a new manager in a key
job who sees that the status quo is unacceptable
b. The Change Grid:
c. Change Style Preferences:
80% LEADERSHIP
• Establishing direction
• Aligning
• Motivating
• Inspiring people
20% MANAGEMENT
• Planning
• Budgeting
• Organizing
• Problem solving
DENY RESIST EXPLORE COMMIT
EXTERNAL/ENVIRONMENTPAST
PAST FUTURE
FUTURE
INTERNAL/SELF
CONSERVERS
ACCEPT the structure
PREFER change that is
incremental
PRAGMATISTS
EXPLORE the structure
functional
ORIGINATORS
CHALLENGE the structure
expansive

81
CONSERVERS
Prefer to keep current
structure operating
smoothly
Focus on relationships
Encourage building on
what is already working
PRAGMATISTS
Prefer balanced inquiry
Focus on shared
objectives
Encourage looking at the
current circumstances
ORIGINATORS
Prefer to challenge
accepted structure
Focus on taking risk
Encourage exploring new
possibilities
d. Collaboration:
e. Style Summary: CONSERVERS *
*1999 Discovery Learning, Inc.
CONTRIBUTIONS TO ORGANIZATION
• Get things done well on schedule
• Work well within organizational structure
• Attend to detail and factual information
• Demonstrate strong follow-through skills
• Encourage and adhere to routine
• Respect rules and authority
• Handle day-to-day operations efﬁciently
LEADERSHIP STYLE
• Reward following the rules while getting
the job done
• Attend to practical organizational needs
• Expect organizational policies, procedures
and rules to be followed
• Lead through reliable, stable and
consistent behavior
• Promote the traditional values of the
organization

82
f. Style Summary: PRAGMATISTS *
• Address needs as they arise
• Get things done in spite of the rules, not
because of them
• Negotiate and encourage cooperation and
compromise
• Take a realistic and practical approach
• Draw people together around a common
purpose
• Organize ideas into action
• Have short and long-range perspectives
LEADERSHIP STYLE
• Facilitate problem solving among people
• Use and adapt past experiences to solve
current problems
• Build cooperation rather than expecting it
• Use a facilitative approach in managing
people and projects
• Encourage the organization to have
congruence between values and actions
g. Style Summary: ORIGINATORS *
• Understand complex problems
• Bring strong conceptual and design
skills
• Push the organization to understand
the system as a whole
• Support and encourage risk taking
behavior
• Provide future-oriented insights and
vision
• Serve as catalysts for change
• Initiative new ideas, projects and
activities
LEADERSHIP STYLE
• Catalysts for systemic change
• Energetic and enthusiastic
• Provide long-range vision
• Conceptualize and build new models
• Constantly reorganize the whole system
• Like to be in charge of the start-up phase
• Prefer unique leadership roles to
conventional roles
• Manage more than one task a the same
time

83
h. Organizational Change:
• Leaders alter the way their organizations do business to cope with CHANGE:
-Total Quality Management
-Reengineering
-Reinventing Government
-Mergers and Acquisitions
-Turnarounds
• No organization ---large or small, local or global—is immune to change
i. Eight Steps to Transform an Organization:
1. Establish a sense of URGENCY
2. Form a powerful guiding COALITION
3. Create a VISION
4. COMMUNICATE the vision
5. EMPOWER OTHERS to act on the vision
6. Plan for and create SHORT TERM WINS
7. CONSOLIDATE IMPROVEMENTS and produce still more change
8. INSTITUTIONALIZE new approaches
• Leading by example is essential to communicating a vision
• Leaders balance short-term results with long-term vision
j. Four Sources of Failure:
1. Writing a memo instead of lighting a ﬁre
2. Talking too much and saying too little
3. Declaring victory before the game is over
4. Looking for someone to blame in the wrong places
• These common mistakes suggest THREE KEY TASKS FOR CHANGE LEADERS
j.1. TASK #1: MANAGING MULTIPLE TIME LINES
• TIME: key strategic resource
• Meaningful change takes time

84
• Create Short-Term Wins
--Effective leaders make organizational change an ongoing, multiphase process
j.2. TASK #2: BUILDING COALITIONS
• Engaging the RIGHT TALENT
• Growing the COALITION strategically
• Working as a TEAM, not just a collection of individuals
--Leaders face resistance and must win the support of employees, partners, customers and
investors
j.3. TASK #3: CREATING A VISION
• CLEAR intention
• APPEALING to stakeholders
• AMBITIOUS yet attainable
--A vision of the future is more emotional than rational
k. CONCLUSION:
• Leaders exist at all levels of an organization
• They are interested in a noble cause
• They see things with fresh eyes and challenge the status quo
• They connect people’s everyday work to a larger purpose
• They continue to take risks and are open to people and ideas
• They are driven by goals bigger than what any individual can accomplish and invest tremendous
talent, energy and caring in their change efforts
• However, the most notable trait of great change leaders is their quest for learning.
l. Questions and Answers Session.

GHLR.PHLeadership21Century

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