Adaptive strategic public health leadership

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Adaptive strategic public health leadership

  1. 1. “Doing the mix” with confidence.. Adaptive leadership is strategic Public Health leadership in distributed systems (full lecture version) Jim McManus, CPsychol, CSci, AFBPsS, FFPH, FCIEH, FRSPH Director of Public Health, Hertfordshire Visiting Senior Clinical Fellow Jim.mcmanus@hertfordshire.gov.uk January 2014 With thanks to @pash22 @kirstieclegg @Kersten1england @KateAlvanley for the conversation which inspired this
  2. 2. Some Background • The colloquium report on co-production of public health for a new world http://www.sph.nhs.uk/sph-documents/localgovernment-colloquium-report • My presentation to this on strengthening the leadership role of the DPH http://www.sph.nhs.uk/sph-documents/lgcolloquium-presentations/j.mcmanus-lgcolloquium-presentation
  3. 3. Biographical Note • • • • • • • • Jim McManus is Director of Public Health for Hertfordshire, and leads the Hertfordshire Public Health Service, which is part of Hertfordshire County Council He is a Chartered Psychologist, Chartered Scientist and Associate Fellow of the British Psychological Society, He has worked on leadership development in the private, public and charitable sector for over fourteen years He is a Visiting Senior Clinical Fellow at the University of Hertfordshire and a Visiting Research Fellow in the Dept of Pastoral Studies at Heythrop College, University of London Between 2001 and 2004 he held appointment from the Lord Chancellor to the committee of the Judicial Studies Board for England and Wales which advised the judiciary on equal treatment and diversity before the Courts and Tribunals of England and Wales and contributed to the Equal Treatment Bench Book for judges, magistrates and Tribunal Chairs. In 2011 he was awarded the Good Samaritan Award for excellence in Healthcare by Pope Benedict XVI (previous holders include Sir Andrew Fleming) He undertakes pro bono teaching on public health and leadership with students and professionals from developing countries In his spare time he cycles, reads (theology and Scottish economic and social history), enjoys the cinema and does weight-lifting
  4. 4. Top Leadership Reads • IN PRINT • Haslam, A et al (2010) The New Psychology of Leadership. Psychology Press • Lane, J, & Wallis, J 2009, 'Strategic management and public leadership', Public Management Review, 11, 1, pp. 101-120 • Lewis, Sarah (2011) Positive Psychology at Work. Chichester: WileyBlackwell • Pinner, D (2011) Leadership: what really matters. New York: Springer • Tummers, L, & Knies, E 2013, 'Leadership and Meaningful Work in the Public Sector', Public Administration Review, 73, 6, pp. 859-868 • GOOD FOR THE SHELF • Linley, P et al (2013) Oxford Handbook of Positive Psychology and Work. NY: Oxford University Press • WORTH PRE-ORDERING • Barling, J (2014) The Science of Leadership. New York: Oxford University Press • De Haan (2014) The Leadership Shadow. London: Kogan Page
  5. 5. If you only buy one thing • Do yourself a favour and work through Derek Mowbray’s guide to personal resilience • http://www.mas.org.uk/publications/personal -resilience.html
  6. 6. Top reads on diversity psychology • Jones, J et al (2013) The Psychology of Diversity. Chichester: Wiley • Neal, J (2012) Handbook of faith and spirituality in the workplace. New York: Springer • Stockdale, M et al (2003) The Psychology and management of workplace diversity. Oxford: Blackwell • Tjosvold, D (1995) Psychology for Leaders. NY: Wiley
  7. 7. An unhappy position statement • 'Offline: Where is public health leadership in England?' 2011, Lancet, 378, 9796, p. 1060. • Lambasted the state of public health leadership and Science in the UK • Called for Action • In the context of the Government reforms • But was a useful spur for reflection
  8. 8. Where are we? • Public health in a distributed (some would say fragmented) system • The DPH role could be more strategic than it has ever been (but still carries a service and operational role and challenge) • Local Government has strategic leadership by the truckload, DsPH and senior PH staff often feel we are playing “catch up” • Senior public health people very technically trained • Trained to manage in a different context • New leadership challenges and situations • Is this crisis, opportunity, challenge or all three?
  9. 9. A “history” of leadership psychology • • • • • • • • • • As much art and discourse as science Separating “pop” from well researched “Great Man theory” (charismatic) The Big 5 Personality Traits Industrial Studies – transactional / laissez-faire Public Sector Studies – transactional vs transformational Situational Leadership Transformational Leadership Emotional intelligence Multi-Style Leadership(2006? Onwards)
  10. 10. The upshot of this... • Almost whatever you say about Leadership, someone will contradict you or disagree • So, how on earth do you find your bearings? • And how do you do this while managing the competing job of senior public health role?
  11. 11. The Literature • There is no single “orthodox” view of leadership • Your personality and experience is important in which styles, theories, models you use • Important thing is to be open enough to pick a suite of them for different situations and different people
  12. 12. What can we say about leadership without fear of (too many) people contradicting us? • Leadership is a set or portfolio of influencing mechanisms and tools • Different situations and organizations and cultures do seem to require different styles and behaviours (some multiple) • Leadership is almost always context-bound • Leadership needs to be for a context (organization,culture and person fit) • The person, the organization and team and the role are all important in determining which set of influencing mechanisms and tools (aka leadership style) will be effective • Calls on leader to understand and monitor self, others and results • Leadership is a dynamic process which is about “sense-making” of the world we are in, “direction setting” of where we need to be and modelling the behaviours, styles and actions needed to get us there. • So of course it will be different from setting to setting
  13. 13. And who you and others are intimately affects this.... • • • • • • Gender Age Sexuality Religion Nationality Ethnicity I could take any example to illustrate this (growing literature on age and leadership) But let me take two examples below See also Snaebjornsson,et al 2013 on Gender, Nationality and Leadership Style • All of these and more affect our preferred leadership approaches and repertoires
  14. 14. Example 1 - Leadership and RC Religious Orders • Editrice Rogati (Italy) • Series on Leadership • Synthesised psychological research and applied to context • (Useful model for Public Health) • Integrating psychology with pastoral/theological training to address new challenges (e.g. Safeguarding crisis as I used it for 3 years in UK) Poli et al, 2003
  15. 15. Example 2a : US gay male executives • Synder (2006) popularised LGBT executives and did some empirical research • Gay execs adapted to and used organizational context for success • Some feminist comment on gendered nature of this
  16. 16. Example 2b : LGBT Leadership theory – context is important • • • • Fassinger, Ruth E. ; Shullman, Sandra L. ; Stevenson, Michael R. (2010) Toward an Affirmative Lesbian, Gay, Bisexual, and Transgender Leadership Paradigm American Psychologist, Vol.65(3), p.201-215 research on LGBT issues in leadership almost nonexistent, but several bodies of literature that can contribute to an understanding of the unique leadership challenges faced by sexual minority people. literatures on stigma and marginalization, leadership in particular status groups (e.g., college students, women), and LGBT vocational issues (especially workplace climate and identity disclosure). Authors propose multidimensional model of LGBT leadership enactment that incorporates s – sexual orientation (particularly regarding identity disclosure), – gender orientation (including leader gender), and – the situation (conceptualized here as group composition); • • the model also is embedded in context, (remember what we said earlier about context being important?) State that most relevant factors that affect the enactment of leadership are stigma and marginalization.
  17. 17. What does that mean for Public Health? The variety of challenges • • • • The Strategic Challenge across our agency and geography The distributed Challenge across agencies and stakeholders The Professional challenge across domains of healthcare The practice challenge to remain competent and practice well • The protective challenge of planning and responding to health protection incidents • The managerial challenge of tasks and resources • The personal challenge of resilience during this All this means different leadership styles and tools are needed See for example Lutz Allan et al, 2013
  18. 18. Personal Resilience/Self-Care • An absolute essential for any leader, when things start to derail it’s often because of this • Especially in long-hours cultures • The “2/3 on 1/3 switch off principle” • Derek Mowbray’s personal resilience book – http://www.derekmowbray.co.uk/ – http://www.mas.org.uk/publications/personalresilience.html
  19. 19. The Multi-Style Leader – made for public health? • Harper, S 2012, 'The Leader Coach: A Model of Multi-Style Leadership', Journal Of Practical Consulting, 4, 1, pp. 22-31 (See also Rao, 2013 on soft leadership) • Leadership style is an indicator of organisational success • Most influential approaches use multiple leadership styles • Interesting example of multi-style leadership looking at coaching as the “overall framework” for integrating different styles of charismatic, laissezfair, transformational, transactional and servant • Studied a range of commercial agencies • add value to their companies by enhancing the quality of their leaders with the adoption of leadership coaching as a strategy for human capital development and organizational enhancement. • Transformational style is not always the best (Currie and Lockett, 2007)
  20. 20. The Person of the Public Health Leader • Great Man theory – probably rubbish but charisma is a part, and has a big dark side • Charismatic leadership and laissez-faire leadership can lead to disaster without reflexivity and context • Resilience, agility and emotional intelligence are important • The Big 5 Traits- some fans, some critics • Emotional Intelligence – is important • Perfection – no one is perfect • Preferred styles – we all have them, the important thing • Context, reflexivity and multiple styles seem needed • Response style is important in choosing which style (Moors, 2012) • Wellbeing of staff and stakeholders (Kelloway et al, 2012)
  21. 21. Crucial Situational Factors • • • • Leadership doesn’t happen in isolation Multiple environment and collaborative (Getha-Taylor,2013) One key thing which makes a good leader is followers Ethics – the bright and dark sides of leaders The Personality of the Leader Strategic and Partnership Environments The factors determining which style you need for which Public Health challenge The issue itself Pandemic or health improvement? Team and Organization Organizational Culture
  22. 22. Trying to put it simply... • The Strategic Leadership role in Public Health is to – Make sense of the environment/context and issues [Grant,2012] [Elcock, 2012] – Work with multiple stakeholders including communities and their leadership (the new context of Localism) [Purdue et al] – Set direction and model it – Get others to follow it inside and outside organization and team – Know which issue requires which style – Know and articulate what “good” looks like – Self leadership is every bit as important as other leadership (we’re not perfect and we can cause as much trouble as solve it) [Furtner et al] – See also localis report on localism public health http://www.localis.org.uk/article/1485/In-Sickness-and-in-Health.htm
  23. 23. Conceptualising this in domains... 1. Technical, 2. Interpersonal professional and and influencing transactional styles skill sets 3. Strategic Awareness, context, ability to use multiple styles depending on situation 4. reflexivity, adaptability, emotional intelligence 5. Organizational 6. Personal 7. Professional situation, context resilience competence and support Moors, 2012 – response style is salient
  24. 24. A word about the psychological contract • A “bank account” of Good Will between employer or stakeholder and employee or partner (Robertson and Cooper) www.robertsoncooper.com • Feels like DPH has to have multiple accounts • Crucial to develop psychological contracts with employees that suit their organizational and human resource (HR) strategy. • When managers' styles are out of sync with strategy, this mismatch can lead to poorer performance through ineffective and unfulfilled psychological contracts. • See McDermott, A, Conway, E, Rousseau, D, & Flood, P 2013, 'Promoting Effective Psychological Contracts Through Leadership: The Missing Link Between HR Strategy and Performance', Human Resource Management, 52, 2, pp. 289-310,. See also Kelloway et al on employee wellbeing and transformational leadership
  25. 25. Health Protection and Emergency Resilience: Flexible Leadership styles in the spotlight • Canton, LG 2013, • the role of being a leader in accomplishing a resilience goal. • in achieving a resililience goal, it is categorized into two which are directive leadership and persuasive leadership. • having credibility and being able to guide fellow workers are based on the ability of persuasive leadership • being authoritarian in obliging subordinates, is an example of a directive leadership. • DIFFERENT styles always seem to be used in disaster or health protection emergencies to achieve results
  26. 26. One take on flexible leadership style • Medlar, M 2011, 'A FLEXIBLE APPROACH TO LEADERSHIP', Public Management (00333611), 93, 2, p. 23, • every employee is different, and all have different needs for their well-being in the workplace. • only by being flexible and drawing from all experiences that an individual can truly become an outstanding leader at the local level of government
  27. 27. Portfolio Leadership Styles • This isn’t new (Fisher, 2007) • Training should contain specific roles and responsibilities with several policy maker, negotiator and power broker.
  28. 28. The Leadership Context for Public Health • • • • Distributed Rights, Powers and Duties Distributed roles Fiscal Austerity Some seemingly intractable problems (non communicable disease) • All this is why I think the NHS Leadership model isn’t right for public health now
  29. 29. Shoemaker et al (2013) ..comparisons from business..the adaptive strategic leader • The more uncertain your environment, the greater the opportunity-if you have the leadership skills to capitalize on it. • Research involving more than 20,000 executives to date, has identified six skills which allow leaders to think strategically and navigate the unknown effectively. • abilities to – – – – – – anticipate, challenge, interpret, decide, align, and learn. • article describes the six skills in detail and includes a self-assessment that will enable you to identify the ones that most need your attention. • strength in one skill cannot easily compensate for a deficit in another. • An adaptive strategic leader has learned to apply all six at once. Schoemaker, P, Krupp, S, & Howland, S 2013, 'Strategic Leadership: The Essential Skills', Harvard Business Review, 91, 1, pp. 131-134,.
  30. 30. So. • • • • • • Adaptive Strategic Resilient Use of different styles Monitors self and others Means you need mentors/coaches/supports or learning sets • Communicates well and adaptively [De vries et al]
  31. 31. Slight problem • No programmes seem to be designed to do this integrative work with public health leaders • Most local govt leaders have picked this up on the job, by formal and informal learning • We have some work to do
  32. 32. The Doctorate in Public Health as a Leadership Training Route • • • • Does some of this but not all Means we need to develop some new programmes Gets technical and policy and integrative competencies right What about personal style and qualities and leadership? • Cardenas, V, Concepcion Roces, M, Wattanasri, S, Martinez-Navarro, F, Tshimanga, M, Al-Hamdan, N, & Jara, J 2002, 'Improving Global Public Health Leadership Through Training in Epidemiology and Public Health: The Experience of TEPHNET', American Journal Of Public Health, 92, 2, pp. 196-197, Fried, L, Begg, M, Bayer, R, & Galea, S 2014, 'MPH Education for the 21st Century: Motivation, Rationale, and Key Principles for the New Columbia Public Health Curriculum', American Journal Of Public Health, 104, 1, pp. 23-30, Calhoun, J, McElligott, J, Weist, E, & Raczynski, J 2012, 'Core Competencies for Doctoral Education in Public Health', American Journal Of Public Health, 102, 1, pp. 22-29, • •
  33. 33. Summary • • • • • • Adaptive Flexible Portfolio of influencing tools and techniques Self-learning and leading Resilience Context and distributed environments require different styles • There is no “right” answer...only trying always to get best fit between challenge/opportunity and desired outcome • Art and science
  34. 34. Bibliography 1 • • • • • • • • • • • • • IN PRINT Haslam, A et al (2010) The New Psychology of Leadership. Psychology Press Iszaat-White, M and Saunders, C (2014) Leadership. Oxford: Oxford University Press Lane, J, & Wallis, J 2009, 'Strategic management and public leadership', Public Management Review, 11, 1, pp. 101-120 Lewis, Sarah (2011) Positive Psychology at Work. Chichester: Wiley-Blackwell Pinner, D (2011) Leadership: what really matters. New York: Springer Tummers, L, & Knies, E 2013, 'Leadership and Meaningful Work in the Public Sector', Public Administration Review, 73, 6, pp. 859-868 GOOD FOR THE SHELF Linley, P et al (2013) Oxford Handbook of Positive Psychology and Work. NY: Oxford University Press WORTH PRE-ORDERING Barling, J (2014) The Science of Leadership. New York: Oxford University Press De Haan (2014) The Leadership Shadow. London: Kogan Page
  35. 35. Bibliography 2 • PSYCHOLOGY OF DIVERSITY • Jones, J et al (2013) The Psychology of Diversity. Chichester: Wiley • Neal, J (2012) Handbook of faith and spirituality in the workplace. New York: Springer • Stockdale, M et al (2003) The Psychology and management of workplace diversity. Oxford: Blackwell • Tjosvold, D (1995) Psychology for Leaders. NY: Wiley
  36. 36. Bibliography 3 • • • • • • • • • • • • • • • • • • • • • • • Alban-Metcalfe, J, & Alimo-Metcalfe, B 2013, 'Reliability and validity of the "leadership competencies and engaging leadership scale"', International Journal Of Public Sector Management, 26, 1, pp. 56-73 Alimo-Metcalfe, B, & Alban-Metcalfe, J 2006, 'More (good) leaders for the public sector', International Journal Of Public Sector Management, 19, 4, pp. 293-315 Bellé, N 2014, 'Leading to Make a Difference: A Field Experiment on the Performance Effects of Transformational Leadership, Perceived Social Impact, and Public Service Motivation', Journal Of Public Administration Research & Theory, 24, 1, pp. 109-136 Calhoun, J, McElligott, J, Weist, E, & Raczynski, J 2012, 'Core Competencies for Doctoral Education in Public Health', American Journal Of Public Health, 102, 1, pp. 22-29, Canton, LG 2013, 'Disaster Planning and Management: Does One Leadership Style Work for Both?', Journal Of Leadership Studies, 7, 3, pp. 47-50, Cardenas, V, Concepcion Roces, M, Wattanasri, S, Martinez-Navarro, F, Tshimanga, M, Al-Hamdan, N, & Jara, J 2002, 'Improving Global Public Health Leadership Through Training in Epidemiology and Public Health: The Experience of TEPHNET', American Journal Of Public Health, 92, 2, pp. 196-197, Czabanowska, K, Smith, T, Stankunas, M, Avery, M, Day, M, Shickle, D, Smith, K, Zakariasen, K, Oliver, T, Otok, R, & Moskol, J 2013, 'Transforming public health specialists into public health leaders', Lancet, 381, 9865, pp. 449-450 Currie, D 2011, 'The Socially Just Face of Public Health Leadership... Linda Rae Murray', American Journal Of Public Health, 101, 2, pp. 209-211 Currie, G, & Lockett, A 2007, 'A critique of transformational leadership: Moral, professional and contingent dimensions of leadership within public services organizations', Human Relations, 60, 2, pp. 341-370, Day, M, Shickle, D, Smith, K, Zakariasen, K, Oliver, T, & Moskol, J 2012, 'Time for heroes: public health leadership in the 21st century', Lancet, 380, 9849, pp. 1205-1206 De Vries, R, Bakker-Pieper, A, & Oostenveld, W 2010, 'Leadership = Communication? The Relations of Leaders’ Communication Styles with Leadership Styles, Knowledge Sharing and Leadership Outcomes', Journal Of Business & Psychology, 25, 3, pp. 367-380. 'Drawing On Community Organizing To Advance Public Health In Minnesota And Beyond' 2012, Health Affairs, 31, 12, pp. 2799-2800 Easterling, D 2012, 'Scaling Up Civic Leadership: Combining Individual-Level Change and Culture Change', National Civic Review, 101, 4, pp. 51-64 Eitel, DF 2012, 'International Collaboration in Local Government Leadership Development: Insights Gained from a U.S. and Ireland Partnership', International Journal Of Public Administration, 35, 10, pp. 684-694 Elcock, H, & Fenwick, J 2012, 'The political leadership matrix: a tool for analysis', Public Money & Management, 32, 2, pp. 87-94 Fassinger, Ruth E. ; Shullman, Sandra L. ; Stevenson, Michael R. (2010) Toward an Affirmative Lesbian, Gay, Bisexual, and Transgender Leadership Paradigm American Psychologist, Vol.65(3), p.201-215 Fisher, F 2007, 'The twelve competencies: Leadership training for local government officials', National Civic Review, 96, 2, pp. 28-35 Ford, L, & Green, M 2012, 'New development: Making partnerships work—a local politician's guide to leadership', Public Money & Management, 32, 4, pp. 315-319 Freeman, T 2013, 'Comparing the content of leadership theories and managers' shared perceptions of effective leadership: A Q-method study of trainee managers in the English NHS', Health Services Management Research, 26, 2/3, pp. 43-53 Fried, L, Begg, M, Bayer, R, & Galea, S 2014, 'MPH Education for the 21st Century: Motivation, Rationale, and Key Principles for the New Columbia Public Health Curriculum', American Journal Of Public Health, 104, 1, pp. 23-30, Furtner, M, Baldegger, U, & Rauthmann, J 2013, 'Leading yourself and leading others: Linking self-leadership to transformational, transactional, and laissez-faire leadership', European Journal Of Work & Organizational Psychology, 22, 4, pp. 436-449,
  37. 37. Bibliography 4 • • • • • • • • • • • • • • • • • • GETHA-TAYLOR, H, & MORSE, R 2013, 'COLLABORATIVE LEADERSHIP DEVELOPMENT FOR LOCAL GOVERNMENT OFFICIALS: EXPLORING COMPETENCIES AND PROGRAM IMPACT', Public Administration Quarterly, 37, 1, pp. 71-102 Grant, AM 2012, 'Leading with Meaning: Beneficiary Contact, Prosocial Impact, and the Performance Effects of Transformational Leadership', Academy Of Management Journal, 55, 2, pp. 458-476 Hambleton, Robin, and David Sweeting. 2004. "U.S.-Style Leadership for English Local Government?." Public Administration Review 64, no. 4: 474-488 Harper, S 2012, 'The Leader Coach: A Model of Multi-Style Leadership', Journal Of Practical Consulting, 4, 1, pp. 22-31, Howieson, W. (2012). Mission command: a leadership philosophy for the Health and Social Care Act 2012?. International Journal Of Clinical Leadership, 17(4), 217-225. Kelloway, E, Turner, N, Barling, J, & Loughlin, C 2012, 'Transformational leadership and employee psychological well-being: The mediating role of employee trust in leadership', Work & Stress, 26, 1, pp. 39-55,. Koh, H, & Nowinski, J 2010, 'Health Equity and Public Health Leadership', American Journal of Public Health, 2 April, Lane, J, & Wallis, J 2009, 'Strategic management and public leadership', Public Management Review, 11, 1, pp. 101-120 Leeson, D, & Millar, M 2013, 'Using the 7 Habits programme to develop effective leadership', Nursing Management - UK, 20, 6, pp. 31-37 Lovegrove, N, & Thomas, M 2013, 'TRIPLE-STRENGTH LEADERSHIP', Harvard Business Review, 91, 9, pp. 46-11 Lutz Allen, S, Smith, J, & Da Silva, N 2013, 'Leadership Style in Relation to Organizational Change and Organizational Creativity: Perceptions from Nonprofit Organizational Members', Nonprofit Management & Leadership, 24, 1, pp. 23-42 McDermott, A, Conway, E, Rousseau, D, & Flood, P 2013, 'Promoting Effective Psychological Contracts Through Leadership: The Missing Link Between HR Strategy and Performance', Human Resource Management, 52, 2, pp. 289-310,. Medlar, M 2011, 'A FLEXIBLE APPROACH TO LEADERSHIP', Public Management (00333611), 93, 2, p. 23, Moors, G 2012, 'The effect of response style bias on the measurement of transformational, transactional, and laissez-faire leadership', European Journal Of Work & Organizational Psychology, 21, 2, pp. 271-298
  38. 38. Bibliography 5 • • • • • • • • • • • • • • • O'Neill, B 2013, 'LEADERSHIP AND THE PROFESSION: WHERE TO FROM HERE?', Public Management (00333611), 95, 2, pp. 20-23 Oborn, E, Barrett, M, & Dawson, S 2013, 'Distributed Leadership in Policy Formulation: A Sociomaterial Perspective', Organization Studies (01708406), 34, 2, pp. 253-276. OREG, S, & BERSON, Y 2011, 'LEADERSHIP AND EMPLOYEES' REACTIONS TO CHANGE: THE ROLE OF LEADERS' PERSONAL ATTRIBUTES AND TRANSFORMATIONAL LEADERSHIP STYLE', Personnel Psychology, 64, 3, pp. 627-659, Business Source Premier, EBSCOhost PORTER, M, & LEE, T 2013, 'THE STRATEGY THAT WILL FIX HEALTH CARE', Harvard Business Review, 91, 10, pp. 50-70 Purdue, D 2005, 'Community leadership cycles and the consolidation of neighbourhood coalitions in the new local governance', Public Management Review, 7, 2, pp. Rao, MS 2013, 'Soft leadership: a new direction to leadership', Industrial & Commercial Training, 45, 3, pp. 143-149, Saleh, S, Williams, D, & Balougan, M 2004, 'Evaluating the Effectiveness of Public Health Leadership Training: The NEPHLI Experience', American Journal Of Public Health, 94, 7, pp. 1245-1249 Schuh, S, Zhang, X, & Tian, P 2013, 'For the Good or the Bad? Interactive Effects of Transformational Leadership with Moral and Authoritarian Leadership Behaviors', Journal Of Business Ethics, 116, 3, pp. 629-640 Schoemaker, P, Krupp, S, & Howland, S 2013, 'Strategic Leadership: The Essential Skills', Harvard Business Review, 91, 1, pp. 131-134,. Snaebjornsson, I, & Edvardsson, I 2013, 'Gender, Nationality and Leadership Style: A Literature Review', International Journal Of Business & Management, 8, 1, pp. 89-103, Trapence, G, Collins, C, Avrett, S, Carr, R, Sanchez, H, Ayala, G, Diouf, D, Beyrer, C, & Barai, S 2012, 'From personal survival to public health: community leadership by men who have sex with men in the response to HIV', Lancet, 380, 9839, pp. 400-410 Umble, K, Steffen, D, Porter, J, Miller, D, Hummer-McLaughlin, K, Lowman, A, & Zelt, S 2005, 'The National Public Health Leadership Institute: Evaluation of a Team-Based Approach to Developing Collaborative Public Health Leaders', American Journal Of Public Health, 95, 4, pp. 641-644 Wright, K, Rowitz, L, Merkle, A, Reid, W, Robinson, G, Herzog, B, Weber, D, Carmichael, D, Balderson, T, & Baker, E 2000, 'Competency Development in Public Health Leadership', American Journal Of Public Health, 90, 8, pp. 1202-1207,

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