Public Health Leadership
The United States failed to meet 85 percent of the goals set out in Healthy People 2000, largely due to insufficient resources and poor public health leadership in getting community support for this project. Public health departments operate in a bureaucratic environment that relies heavily on rules and regulations and this environment often blocks ingenuity and inventiveness. Bureaucratic organizations do not work well in times of rapid change, and this is especially true in government-run public health departments. Public health agencies are often faced with annual budget cuts along with political appointees placed in charge of their operations. Often these bureaucratic organizations block change because it threatens the power of the manager. Public health departments in the United States have a very important role to play in reforming the health care system in our country. That role requires excellent leadership and the use of creativity and innovation, along with collaboration with the private health care sector, so that these departments can develop and implement health education initiatives designed to improve the health of the population. To be successful, public health departments need transformational leaders skilled in empowerment of public health employees and collaboration with other health-related agencies.
As stated previously in this chapter, public health departments are very political because they usually receive their funding from the government and their directors usually report to a city mayor or a board of county commissioners. Public health directors usually have very short tenures and are well aware that they can lose their coveted appointment and the power that goes with it if they anger anyone with political power. This makes them very reluctant to innovate in their approaches to disease prevention, for fear of political risk. At the same time, the current epidemic of chronic diseases that this country faces requires creativity and innovation from the leaders of public health departments and therefore a willingness on their part to take great political risks.
The entire U.S. health care system, including public health, is facing monumental change that must be led to success through community-level collaboration. The important thing to remember about major change is that it forces organizations to adapt Strong leadership is the skill that allows the organization to adapt, look for change, and grow. The successful public health leader will use adaptation to empower public health workers and community collaborators to concentrate on the accomplishment of the vision.
One of the most important attributes of a successful leader is the ability to gain the trust of his or her followers. Such trust is an absolute necessity for those leading a bureaucratic agency in the attempt to adapt to a rapidly changing environment where bureaucracies are unable to achieve their goals. Public health departments face a lack of trust because they usually represent the government. It is the public health leader's job to regain the trust of public health employees and of the community where they work. According to Horsager (2009) no matter who you are or what your position entails, trust affects your ability to influence the people you are attempting to lead. In short, in order to be an effective public health leader, you must first gain the trust of your followers.
Public health departments have experienced a great deal of success in their various programs to reduce the numbers of communicable diseases affecting our population. These same departments have a less than stellar performance in their attempt to reduce the epidemic of chronic diseases and their complications that is responsible for the escalating costs of health care. Our failures with this epidemic are evidence that public health departments are in need of innovative solutions to the increasing numbers of Americans acquiring one or more chronic diseases as they age.
Echeverria (2013) argues that there is great tension for the leader who attempts to promote organizational creativity and innovation and who must then also be successful at getting these new ways of doing things actually implemented. This is an especially difficult task for public health departments operating under a stifling government bureaucratic structure, but it can be done with leadership.
Public health leaders need to produce a work environment of trust that allows employees the freedom and resources that are so necessary to make new ideas realities. According to Diamandis and Kotler (2012), individuals, by their very nature, will always attempt to block breakthrough ideas until these ideas become reality. Public health leaders not only need to encourage innovation but also must lead their followers in adopting a strategy of innovation for developing and implementing public health programs. In their new book Abundance: The Future Is Better Than You Think, Diamandis and Kotler (2012) identify four motivators that push innovation along: curiosity, fear, a desire to create wealth, and a desire for significance. These motivators can easily be promoted by public health leaders to their followers in the development of strategies designed to reduce the incidence of chronic diseases in our country.
Most individuals who work in public health departments desire to improve the health of the population and have a number of ideas on how to develop new programs and a curiosity about how to make these new programs work. This curiosity is an excellent motivator to become innovative in the development of new programs to improve the health of a given population. Fear is also a motivator for innovation in that public health employees are afraid of the consequences of a failure to deal with the challenge of chronic diseases. The last two motivators discussed by Diamandis and Kotler can also be present in the development of public health prevention programs. The increased wealth can be found in an increased public health budget that is critical for new program development. The desire for significance is a widespread human desire and requires only that the leader listens to the employees' thoughts and desires concerning the improvement of the health of the population.
Public health departments are likely to assume a new role in the improvement of the health of the population in the next several years. These departments have the skills and the knowledge necessary to develop, implement, and evaluate prevention programs that can reduce the incidence of chronic diseases and prevent many chronic disease complications. In order to assume these new responsibilities these agencies require leadership training for all their employees, with an emphasis on collaborating with communities in the implementation of community-based programs designed to improve the health of the population of every community in our nation. Health care reform efforts have produced an enormous opportunity for public health departments to make yet one more major contribution to the good health of Americans. The starting point for this new public health leadership can be found in the challenge produced by the chronic disease epidemic.