How to develop public health leaders for the 21st Century
Katarzyna Czabanowska1, Ken Rethmeier2, Tony Smith3
1 Department of International Health, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands;
2 President and Founder, The Rethmeier Group, LLC, Bermuda Run, North Carolina, USA & Department of Health Policy and Management, School of Public Health, University of North Carolina, Chapel Hill, NC, USA;
3 Centre for Leadership in Health and Social Care, Sheffield Hallam University, Sheffield, the United Kingdom.
Corresponding author: Katarzyna Czabanowska
Address: Department of International Health, Faculty of Health, Medicine and Life Sciences, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
Telephone: +31433881592; E-mail: kasia.czabanowska@maastrichtuniversity.nl
Abstract
Skills to work across disciplines and especially trans-disciplinary education are essential for leadership in public health. Further, effective leadership skills are required to affect constructive change in health care settings and practices. Several influential professional development programs such as Health Care Management (HCM) program developed and delivered by Project Hope. The project Developing European Leadership Through Action-learning in Healthcare (DELTAH) aimed to improve the performance of participating healthcare organisations through fostering the level of leadership skills amongst healthcare managers. However, few programmes have been developed to equip public health professionals with leadership competencies which specifically reflect public health discipline. “Leaders for European Public Health” (LEPHIE) Project funded by the European Commission Lifelong Learning Programme was designed to develop a curriculum for European Public Health Leaders. The public health leadership content is aimed to be applicable to the performance in diverse European Public Health practices and contexts and reflects the priorities and objectives of the European Health Program. The programme is competence based. A competency framework has been developed to support the curriculum and facilitate self-assessment. The Module uses innovative training methods, such as problem-based and blended learning formats. We believe that the integration of modern technology with a collaborative approach to learning by professionals, supported by interdisciplinary competency-based educational design, will result in a transformative learning experience.
Keywords: competencies, educational innovation, leadership, public health.
Given the challenges facing public health professionals such as globalisation, health threats aging of the workforce (1), social and health inequalities which result in the increased level of unpredictability, a cross-disciplinary public health workforce is needed supported by new skills and expertise (2,3). Skills to work across disciplines and especially trans-disciplinary education are essential for leadership in public health (4,5). Further, the skills required to affect constructive change in these challenging time are not the traditional technical and academic skills but those of effective leadership. These leadership skills can help to deal with the complexity of health settings and practices (6). The leadership skills are the key skills required to facilitate the implementation of the organisational changes necessary to improve the performance of healthcare systems. The leadership skills are vital to work successfully across traditional departmental, organisational, inter-sectoral and national boundaries to develop productive partnerships with a range of stakeholders, including service users and healthcare professionals. The investment should be made in innovative and creative leadership programmes. Public health education and training need to be transformative and interdependent (7). The particular type of leadership required is not of a traditional command and control variety but rather akin to what has been termed “adaptive” leadership: leading in contexts where there is considerable uncertainty and ambiguity, and where there is often imperfect evidence and an absence of agreement about both the precise nature of the problem and the solutions to it (8).
Organisations and professionals worry about the capacity of future Public Health leaders (9) and policymakers are concerned about the future responsiveness of the discipline. The presence of competent leaders is regarded as crucial to achieve progress in the field (10) and solve complex Public Health challenges (11). It appears that there is a need to support Public Health leadership development. It can be done through the design of specially tailored educational curricula which can be defined as “the way the subject matter is conceptualised and how its major components are arranged, in order to provide direction for curriculum development” (12). The key challenges in public health curriculum development are to ensure that the content covers the competencies required in the field and that there is a clear understanding of what Public Health leadership entails (9). Wright and colleagues identify four key areas of public health leadership practice: transformation, legislation and politics, trans-organisation and team and group dynamics which are necessary to build interdisciplinary Public Health practice, strong collaborative networks and teams at every level of the Public Health system, from politicians and policymakers to the mass media and the general public. In order to design a public health leadership curriculum for professionals, a comprehensive concept of public health including a variety of elements of Public Health practice is needed. Thus, the Essential Public Health Services (13) or Operations (8) have the potential to serve as a good framework to base the program content on and competency frameworks which specifically address the leadership qualities. On the other hand, it is vital to look for good practices and experience elsewhere.
One of the best professional development programs designed specifically for healthcare leaders in Central and Eastern Europe was the Health Care Management (HCM) program developed and delivered by Project Hope. The primary focus of the HCM was to provide participants a solid foundation in the following content areas: strategy, quality improvement, financial management, and human resources. The HCM was not designed to specifically address leadership development from the perspective of leader competencies, but it did set the stage for what is now seen as an excellent opportunity to introduce a rigorous program of leadership development.
Another influential leadership program was: Developing European Leadership Through Action-learning in Healthcare (DELTAH) a three – year Action Research Project, which aimed to improve the performance of participating healthcare organisations in the UK, Poland and the Netherlands, through improving the level of leadership skills amongst healthcare workers.
However, few programmes have been developed to equip public health professionals with leadership competencies which specifically reflect public health discipline. Our objective is to introduce the “Leaders for European Public Health” (LEPHIE) Project funded by the European Commission Lifelong Learning Programme to the readership of the Albanian Medical Journal as an example of the integrated, collaborative and public health focused practice targeting busy public health professionals. The aim of the project was to develop a curriculum for a European Public Health Leadership. The following course objectives were set to guide the curriculum development process:
“Examine the key debates around Leadership in Public Health in relationship to political, economic, social and, technological change and their implications for leaders within organisations.
Introduce key theoretical frameworks that underpin leadership learning, and enable the critical use of this knowledge and understanding by applying theory to actual practice within the context of Public Health.
Develop the ability to reflect on the Public Health leadership role and development needs of individuals.
Stimulate self-assessment of leadership competencies by public health professionals” (14).
The course is competency-based, process and output oriented. It is embedded in the Public Health paradigm, designed to address Public Health core functions and services. The public health leadership content is aimed to be applicable to the performance in diverse European Public Health practices and contexts and reflect the priorities and objectives of European Health Program. The course aims at the development of leadership competencies excluding management skills. Based on the review of public health and public health leadership competencies frameworks and leadership literature and expert reviews panels a framework has been developed to support the curriculum and facilitate self-assessment. The competencies are distributed around nine domain areas of development, which is described elsewhere (15): Systems Thinking, Political Leadership, Building & Leading Interdisciplinary Teams, Leadership and Communication, Leading Change, Emotional Intelligence & Leadership in Team-based Organisations, leadership Organisational Learning & Development, Ethics and Professionalism, and Global Values Leadership (14).
The Module uses innovative training methods such as problem-based and blended learning formats (combination of face-to-face and online learning). The students are viewed as active participants in learning, rather than a passive recipient of knowledge and should take responsibility for and plan their own learning as they construct or reconstruct their knowledge networks. Learning becomes a collaborative process. Moreover, students also play an active role in monitoring and evaluating the learning process in which the following conditions are met: students have a common goal, share responsibilities, are mutually dependent on each other for their learning needs, and are able to reach agreement through open interaction (16). Knowledge transfer can be facilitated by learning in meaningful contexts, and problem-based learning nurtures the ability of learners to solve real-life problems whilst fostering communication and cooperation among students (16). Such an educational approach proves to be successful in the LLL context. The participants are offered interactive lectures, tutorial group meetings and other collaborative sessions at a distance. The course is delivered via an intranet such as Blackboard or Moodle and course material can be directly downloaded from the intranet.
LEPHIE is a first, yet innovative, attempt to develop an integrated Public Health leadership curriculum in which each on-line session is delivered by different universities based on their interdisciplinary expertise. After being successfully piloted at the Sheffield Hallam University, Maastricht University, Medical University of Graz and Kaunas University of Health Sciences, the international blended learning leadership course worth 7 ECTS will be offered to public health professionals as Continuous Professional Development (CPD) training. We believe that the integration of modern technology with a collaborative approach to learning by professionals supported by interdisciplinary competency-based educational offerings transcending institutional boundaries will result in a transformative learning experience. LEPHIE is all about developing leadership attributes (7) and will constitute a small step towards inter-professional and trans-professional education of the skills that they require to maximise the impact of public health initiatives. This is the future of professional development of Public Health leaders in the 21st Century.
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