Public Health Leadership-Evaluation

What is one of the problems with using competencies as a means of evaluating leadership?

The main problem with competency frameworks is that the competencies are not defined with sufficient specificity to permit their measurement. Competencies need to be broken down into specific components that can be measured. There must be an applied research strategy to evaluate the necessary leadership competencies on a regular basis and the competencies should be updated based on organizational objectives. The process of defining the framework for competency based assessment has only recently been developed and it will take some time for a complete performance standards system to be capable of evaluating leadership outcomes.

What are the pros and cons of credentialing leaders?

The supporters of credentialing argue that credentialing increases the credibility of public health professionals both with members of the public as well as with politicians. Furthermore, they argue that credentialing will enable the development of professional standards. Supporters of credentialing want to link credentialing to licensure. The proponents argue that the process of evaluating professional knowledge helps develop standards for professional performance. The critics argue that no credentialing system is possible because of the multidisciplinary background of public health professionals. Furthermore, they point out that schools of public health are accredited and so a degree from an accredited body should be sufficient evidence of competence.

                I understand both sides of this debate. Before I started graduate school it seemed like such a monumental undertaking that is seemed that graduates must have a special level of expertise. However, as I have neared the end of my course work and gotten to know graduates of this program as well as employees of HHS that have masters degrees, I have come to the conclusion that a person of only ordinary intelligence and character can graduate from a MPH program, and the fact of obtaining this degree may or may not indicate their competence to practice public health. Therefore, I can understand the argument that credentialing may serve to raise the bar and establish readiness to practice. In a sense, the argument that graduating is good enough is akin to arguing that doctors, by virtue of graduating from medical school, are prepared to perform as physicians.  

A report from the association of schools of Public Health discusses the factors that need to be addressed in a sound credentialing program. First role delineation that distinguishes between professionals who have different skills and levels of knowledge is a requisite. Second, the credentialing system must specify the knowledge and skills required to carry out the duties of a credentialed public health leader. Third, the system must determine the education, training, or experience necessary to generate the required competencies. Fourth, a testing procedure or other form of assessment must be devised to determine when a practitioner has achieved entry level competency. Lastly, the system must allow for a process for recertification or maintenance of certification through ongoing professional education.

What are five personal leadership lessons you have learned in the last year?

I have learned that it is important to cultivate emotional intelligence and stay in touch with your feelings. I have also learned that self-care is essential. I have the tendency to want to help everyone else around me and forget to care for myself. It is important for leaders to invest sufficient time in self-renewal and rest. Furthermore the issue of work life-balance is important for public health leaders. In a field where there is so much to be done, and where the workforce is committed to principals of social justice, it is easy for public health leaders to become overly invested in the work they do. I think it is important for leaders to manage their time from an integral perspective, making sure that they preserve work-life balance. Another leadership challenge I have grappled with in the past year is how to inspire a strong work ethic in subordinates. Finally, I have learned to work more effectively with partner agencies by clarifying our respective agendas and better defining our roles in campaigns.

What is a 360 degree assessment?

The 360 degree assessment process involves a multilevel evaluation that focuses on whether the leader’s style of leadership supports or obstructs achievement of the mission and goals of the organization. In a comprehensive 360 degree assessment, all key stakeholders have a voice in evaluating the leader and assessing the direction in which the organization is headed. In order for a 360 degree assessment to be carried out, the leaders of the organization must determine whether sufficient enthusiasm for and commitment to the process exists in the organization and whether they are willing to institute changes based on the results of the assessment. Secondly, they must collect high-quality data. Lastly, they must identify possible responses to the results, such as the development of new training programs and initiatives. The 360-degree assessment utilizes the leadership practices inventory (LPI). The five practices in the LPI are 1) modeling the way, 2) inspiring a shared vision, 3) challenging the process, 4) enabling others to act, and 5) encouraging the heart.

What are some difficulties associated with performing a 360 degree assessment?

A 360 degree assessment is often expensive and time consuming. Measurement instruments must be bought and staff must be trained to interpret the results. Furthermore, leaders must be comfortable revealing their self-perceived weaknesses to their colleagues and subordinates must feel comfortable rating their leaders. The last issue is of special concern in smaller organizations, where animosity could occur between leaders and subordinates if negative feedback is given.  

The rating of leaders is further complicated if subordinates know that ratings will be tied to the compensation of the leader. Regardless of employee’s role (leaders and non-leaders alike) all employees are subject to the exterior phenomena of inflation and if annual salary increases are not provided, then the real compensation of the employee decreases over time. Arguably, one of the key factors that influence health and well-being in American society is SES, which is made up in part by household income. If people are not compensated in such a way as to maintain their household income, their personal well-being may decrease. A public health agency needs to grapple with the issue of fair market value of compensation and how performance and compensation will be linked, when deciding how employees will be evaluated.

A final consideration when an organization is deciding whether to perform a 360 degree assessment, is contemplating whether performing the assessment will make a difference. Perhaps the process for changing leadership is so cumbersome that there is no way a leader can be forced out even if he/she fails to perform at a minimum level. A leader may be protected by political or administrative mechanisms that prevent any punitive action from being taken. If this is the case, a 360 degree assessment could simply be a drain on the organization’s time and resources.

What is qualitative leadership assessment and what are some techniques for performing such an assessment?

A qualitative leadership assessment evaluates the leader based on personal traits and behaviors. There are a number of instruments that can be used to perform a qualitative assessment. These include the Myers-Briggs Type Indicator, The Leader Behavior Analysis II, the Team Leadership Practices Inventory, and the Leader Behavior Inventory.  The Myers-Briggs Type Indicator (MBTI) assessment is a psychometric questionnaire designed to measure psychological preferences in how people perceive the world and make decisions. The Leader Behavior Analysis II is a tool for understanding perceptions of one's style by revealing what direct reports actually experience. It presents leadership situations along with four possible responses. Managers' responses to these situations reveal their leadership style flexibility, their primary and secondary styles, their effectiveness in matching the choice of a leadership style to the situation, and their tendencies to misuse or overuse a particular style. The Leadership Practices Inventory (LPI) is a questionnaire with thirty behavioral statements. Leaders complete the LPI-Self, rating themselves on the frequency with which they think they engage in each of the thirty behaviors. Five to ten other people—typically selected by the leaders—complete the LPI-Observer questionnaire, rating the leaders on the frequency with which evaluators think leaders engage in each behavior. Respondents’ feedback is anonymous. The Leader Behavior Inventory is based on five behavioral factors: Visualizing Greatness, Empowering the “We,” Communicating for Meaning, Managing One’s Self, and Care and Recognition.

Regardless of which instrument is used, public health leaders need to develop the competencies to carry out performance monitoring. They need to ensure that performance measurement is accepted by the staff and that the information gained through the monitoring process is used to improve operations. Performance measures for evaluating the activities of public health leaders and their community partners utilizing a systems perspective and the essential public health services paradigm have been developed by the National Public Health Performance Standards Program.

Why is leadership program evaluation important?

Ongoing program evaluation creates an atmosphere in which effective leadership and organizational learning can flourish. Leaders need to show support for program evaluation and include evaluation as part of the mission and vision of their agency. They need to be involved in the evaluation process and work with other agency officials to ensure that the process is successful. No organization can achieve excellence without opportunities for continual learning provided by training and leadership development programs. There are four major standards for program evaluation: utility, feasibility, propriety, and accuracy.

One of the first steps in program evaluation is to determine whether the training program is really necessary.  Once the topic of the program has been determined to be needed, the programs objectives should be set and the program developed. The third step is to offer the training program itself. Measurements should be done before or at the start of the training program and at its conclusion to determine the scope of the changes that occurred. Research can be done on several measures, including the association between program elements and leadership change, the lessons learned from the training course, measurable leadership competencies, the differences between new leaders and established ones, and the differences between trainees and colleagues who have not been trained.

What is one difficulty in evaluating leadership programs?

Because leadership development is sometimes used as a reward for public health professionals, there is a danger that this reward will benefit the individual and not the public health system if the training opportunity is not relevant to the needs of the system. Another challenge is the fact that a leadership development may not show an immediate return on investment. The delay between leadership development and the development of strategic outcomes creates difficulties in determining the value of training programs.  Another challenge is the lack of funding in public health leadership development for the evaluation function. There is also a lack of understanding about what such evaluations are supposed to accomplish.

How do leadership programs differ from other training or education programs?

Leadership development programs are different from other types of training programs because they seek to influence behaviors beyond specific skill sets. Traditional training or education programs seek to impart skills to the participants- teach them Java Script, how to better deal with conflict, or how a clinical trial can best be designed, etc. Because leadership is multidimensional and dependant on the internalization and projection of the organization’s mission and values, leadership development is much more profound than just learning a series of steps to carry out a project or handle a particular situation. 

What leadership issues do you think should be the focus of research?

I think the biggest challenge that leaders face is inspiring their employees to perform at the level of their personal best 100% of the time. Therefore studying the mechanisms whereby leaders can either inspire employees to perform at their peak level or leave the organization should be the topic of leadership research.

What are some benefits that would be gained by keeping a leadership journal?

Leadership is a complex, multi-faceted form of performance. We cannot know leadership exists unless something happens. Therefore it may be useful for the leader to keep a log of the activities and decisions she/he makes and document the outcomes of those decisions. Documenting situations and decisions over time allows a leader to look back and evaluate her evolution over time. This written record would also serve to help the leader construct case studies which could be shared with fellow leaders.

Public Health Leadership and Communication

As a public health leader, how would you develop a health education program to increase the health literacy of the people in your service area?

In order for a health education program to be effective it should be based on a relevant theory and it should be created based on a needs assessment of the target population. Program creation requires that the relevant background information be reviewed, program objectives be identified, audience segments be determined for targeting; message concepts should be developed and pre-tested, communication channels should be identified, messages should be created and tested, an implementation plan must be created, implementation and process evaluation must occur, outcome and impact evaluation must be carried out, and finally feedback must be integrated to improve the program or effort.

What are the barriers to successful communication and how have you personally overcome them?

There are many barriers to successful communication. The intended recipient’s mental state and cultural frame of reference can be barriers to receiving the sender’s intended message.  Anger, apathy, anxiety, confusion, disinterest, and fatigue can all influence how the intended message is received. Additionally, thoughts and attitudes of the message sender can influence the sender’s body language and pitch and cause the intended conscious message the sender wishes to transmit to be distorted in meaning by subconscious projections. Negative feelings toward or judgment of the other party may cause both the sender and the receiver to negatively influence the communicative process.

There are also many cultural and linguistic barriers to communication that the book did not explore in this chapter. The words of health care providers who are attempting to communicate with people who speak another primary language may be misunderstood. Additionally, cultural beliefs may influence the conceptualization of a message. In Peace Corps, there was a volunteer who was working with a group of women in her village to help them understand their birth control options. In explaining how a condom should be used, she demonstrated how to unwrap and place the condom, by demonstrating with a broom handle. After several months women in the village began to contact her: they didn’t understand what was happening to them. They had put condoms on their brooms and placed them in the corner of their homes exactly as she had done, and yet they had gotten pregnant. The volunteer and the women both had culturally established beliefs that caused them to make leaps of logic and meaning. The village women had a magical-tribal worldview and their health belief system was based on tribal practices. The volunteer had a “western-scientific” world view that caused her to assume that the women would understand that the broom was only the symbol of a penis and that the condom would have to be placed on their partner’s penis.

One of the ways I have found to be most effective in overcoming cultural-linguistic communication barriers, (as well as message corruption with people of the same cultural/linguistic group) is to ask for message receiver teach-back. Asking the message receiver to tell me the message they have just been given can help determine if the message was transmitted effectively and if the meaning they received was my intended meaning.   

What would be a workable communications strategy to get more funds for an expanded childhood immunizations program?

The first step in creating an initiative is to build a coalition of equal partners for the purpose of planning, operationalizing, and evaluating the scope of the issue. The next step is to examine the barriers to effective functioning of the coalition and address how these barriers can be overcome. All partners should have a vested interest in the success of the initiative. After the responsibilities of the partners are defined, the next step is to establish a consensus on the initiative and develop action plans for implementing the initiative.

What strategies might you use to increase your interpersonal communication skills?

Continuous growth in emotional intelligence is imperative for all public health leaders, as they must be careful to avoid allowing hostile feelings to interfere with good judgment. Additionally, there are steps that the leader can take to ensure that their interpersonal communication skills are top notch. Leaders should converse with others in a meaningful way on meaningful topics, they should state their positions assertively (not aggressively), control their hostile feelings, allow people’s demonstrated expertise be the basis for evaluating the their suggestions, make judgments carefully, be open to new ideas, respect other people’s boundaries, and use understandable language that is accessible to the listener.

What are the advantages and disadvantages or oral as opposed to written communication?

One of the major advantages of the written word is that it creates a permanent tangible record, and thus allows verification of past activities and events. At times the written word may be clearer than the spoken word, as the message sender has time to fully develop her/his thoughts before transmitting them. On the negative side, written communication can at times lack tone and inflection, which in spoken word would evoke a different emotion in the message receiver. Another drawback is that written communication takes more time to create. While the spoken word can be created and exchanged instantly face to face, written communication requires the message sender and receiver to set down their thoughts. When writing is intended to convey facts or important research, the message sender must prepare the facts and organize them in a way that will allow the message receiver to understand the message.

What are the characteristics of active listening?

The characteristics of active listening include the intensity of the engagement on the part of the listener, the listeners empathy for the speaker, the listener acceptance of the speakers message without judgment or interjection until the speaker finishes talking, and the listener remains open to the information the speaker is sharing, even if the listener dislikes either the speaker or the speaker’s message.

What are Walton’s five rules of conversational etiquette?

Walton’s five rules of conversational etiquette include the following: 1) don’t hog the floor (the time), 2) don’t change the subject, 3) don’t step on the sentences of others, 4) do hold your tongue, and 5) don’t forget that there is always tomorrow. If you are enraged or confused, it may be well advised to wait until a later time when you have had a chance to cool down and reflect on your feelings.

What speaker’s aids can be used to enhance a public talk and what are their advantages and disadvantages?

Speakers have a number of aids and strategies available to them to help them capture the audience’s attention. Many times the audience may not wish to attend the event, and is present because attendance was mandatory. Especially in those cases, the speaker needs to find ways to engage the audience in order to be able to transmit the message. Depending on the setting, the speaker may be able to ask for volunteers to answer a question, allow members of the audience to put on an impromptu skit about the topic under consideration, or the speaker may tell a joke that leads into the important topic of discussion. In more formal settings, such jovial approaches may not be appropriate and the speaker may attempt to capture the audience’s attention by telling a story or sharing illustrations or key takeaway points with tools such as PowerPoint slides, overhead projector slides, handouts, videos, and product/example demonstrations.

In cultural settings such as that of the United States, listeners are often primed to believe that the most important part of the speech will come at the beginning of the speech. In the United States it is usually best to have the message be clear, remarks be short, and the key idea might be repeated several times to help the audience follow along. In other countries that practice indirect communication, it is more important to use stories to communicate the main point in a way that allow both the audience and the speaker to “save face”. Furthermore, it may be necessary to talk for a longer time than what would be customary in the U.S., because the audience is primed to hear the message at the end of the speech as the most important part, and/or to believe that if a speech wasn’t long, what was said was not important.

What are the guidelines for interviewing job candidates?

Interviewers should prepare a series of questions ahead of time, they should ask all the candidates all of the prepared questions, they should have an appropriate interview structure, they should arrange for an appropriate setting for the interview, they should learn different interview techniques and how to use them appropriately, and they should keep job candidates informed about the process of selection.

What are the differences between media advocacy and public education?

Media advocacy can be defined as a form of empowerment in which public health leaders galvanize community residents to fight for policies that will benefit them. In traditional health promotion programs, the individual is the target audience, and the goal is to alter the individual’s behavior. In media advocacy, the individual becomes empowered and becomes involved in the push for policy changes. Advocacy is aimed at policy makers, and the goal of advocacy is to get beneficial policies legislated and put into action.

What are the advantages of engaging in dialogue before engaging in discussion or debate?

Dialogue is a process whereby people can speak freely. Generally, when people feel free to say whatever is on their mind, their values and agendas will be revealed. Dialogue is a communication process where everyone can win; it encourages win-win thinking. (Win-win thinking seeks to find outcomes where both parties engaged in a discussion feel that they have “won” in the negotiation and everyone is better off).  In dialogue, participants can share information, identify areas of concern, assess causes of conflict, and find new ways to further personal and organizational development. When dialogue is used first, participants have a better chance of using discussion to develop and implement action plans because their different perspectives can be addressed. Discussion is the form of discourse in which attempts to come to an agreement are paramount; hence it is less useful for discovering new information and strategies.

What are the differences between health communication and social marketing?

In health communications the target audience is the community or population at risk, and the long-term goal is to help the population increase control over and improve their health. Social marketing is aimed at increasing the acceptance of an idea, social practice, or social cause among the target audience. The desired goal of public health social marketing is to induce the public and policy makers to support disease prevention and health promotion.

Why is storytelling important? Describe the different types of stories.

Stories are often more engaging that facts and statistics. There are basic stories about the life of the presenter. Such stories can demonstrate the speaker’s values and help her/him build the audience’s trust, either in him/herself or in the speaker’s organization. There are stories that help the speaker define her/his relationship with the audience. Some stories are said to follow a springboard narrative pattern- these stories help move the listener to action. Through stories the speaker is able to reach the audience on an emotional and practical level. There are also stories about the future that can help the audience conceptualize the message shared into future time. Some stories allow knowledge to be shared. There are also stories that help move people towards collaboration, while others create humor or inspire people with a shared vision.