MPHA/MEHA Conference October 9, 2013 Barry Kling, MSPH Leading and Following in Public Health

1. MPHA/MEHA ConferenceOctober 9, 2013Barry Kling, MSPHLeading and Followingin Public Health

2. Humbling… …to be asked to speak about leadership to a group that includes so many leaders. Such talks often amount to the speaker’s war stories as a leader. But I want to give you something more substantial and evidence-based than that.

3. Today I’ll talk about: Two evidence-based models that help me understand my experience as a leader and a follower in public health. Good to Great by Jim Collins The Good to Great study Level 5 Leadership Meta-Leadership Originated in emergency preparedness, but generally useful. 5 Dimensions of Meta-Leadership

4. Keep thinking… I’m not going to talk at you for an hour. I’m going to leave plenty of time for discussion so be ready to talk about your own experiences as a leader and follower.

5. Some common threads Followership is as important as leadership Because we are all followers at some level. Because constructive followership is a critical aspect of good leadership. You can’t be an optimal leader if you’re not capable of being a good follower.

6. Some common threads Not here to praise flashy charismatic leaders. Effective leaders do have some particular characteristics, but they don’t have to fit the charismatic leader or the dynamic genius mold.

7. Why talk about Good to Great? Generally I don’t put much stock in popular management books. The subtext is usually, “Be more like me and you too can be a great leader.” I always wonder what his/her secretary or assistant would say about that. But this one is different because it is based on meaningful research.

8. The Good to Great Study 11 companies meeting strict criteria for sustained success over 15 years. Compared to 17 similar companies without sustained success over those years. Studied company data, but also did extensive interviewing and re-interviewing, as well as observation of the companies. Took 5 years to complete.

9. Their own findings surprised them. “We were surprised, shocked really, to discover the type of leadership required for turning a good company into a great one. Compared to high-profile leaders with big personalities who make headlines and become celebrities, the good-to-great leaders seem to have come from Mars. Self-effacing, quiet, reserved, even shy – these leaders are a paradoxical blend of personal humility and professional will.” Good to Great, pp 12-13.

10. Or, as Harry Truman said… “You can accomplish anything in life, provided that you do not mind who gets the credit.”

11. Five levels of Leadership Highly Capable Individual – Makes productive contributions through talent, knowledge, skill and good work habits. Contributing Team Member – Contributes to group objectives and works effectively with others. Competent Manager – Organizes people and resources toward pre-determined objectives. Effective Leader – Catalyzes commitment to and vigorous pursuit of a clear and compelling vision, stimulating higher performance standards. Level 5 Executive – Builds enduring greatness through a paradoxical blend of personal humility and professional will.

12. Level 5 leaders… “…channel their ego needs away from themselves….It’s not that Level 5 leaders have no ego or self-interest. Indeed, they are incredibly ambitious – but their ambition is first and foremost for the institution, not themselves.” Good to Great, p. 21

13. Level 5 leaders… May be inspirational, but they don’t spend much time and effort trying to motivate people. Instead, they try to surround themselves with highly self-motivated people. True and lasting motivation comes from within, not from a charismatic leader.

14. Can Leaders Motivate People? I believe a leader can help focus people’s motivation. Can encourage them to care about and work toward shared goals. But can a leader motivate someone who does not already care? True and lasting motivation comes from within, not from a charismatic leader.

15. Leaders and Motivation With people who already care about doing a good job for their own internal reasons, leaders can make a big difference. Leaders rarely if ever create motivation where it didn’t already exist… …although they can do a lot to stifle motivation that does exist.

16. Leaders and Staff Selection If this is true regarding motivation, it has implications for staffing. It says, hire and keep those who are internally motivated to do a great job, and then help them focus on shared goals. It also says, you probably can’t motivate those who don’t care already, so don’t spend a lot of effort trying.

17. In Good to Great Terms: The way Collins puts this in Good to Great is to say, “Get the right people on the bus… …and the wrong people off the bus.” Be rigorous, not ruthless. Even when cutting, do so selectively. This can be done, even in the public sector, though it may be slower there. If you can’t get the wrong people off the bus right away, focus on getting the right ones on.

18. Avoid the “Genius with a Thousand Helpers” model A “genius” leader who sets a vision and then hires (or retains) a bunch of people to help him make the vision happen. This tends to falter when the genius moves on. Instead, focus first on getting the right people on the team. Then work with them to decide what to do. Who comes before what.

19. Confronting the brutal facts. “The good-to-great companies faced just as much adversity as the comparison companies, but responded to that adversity differently. They hit the realities of their situation head-on.” A culture that gives people the opportunity to be heard. A culture in which the truth can be spoken even when it’s unpleasant.

20. To Create a Truthful Culture… Lead with questions, not answers. Engage in dialogue and debate, not coercion. Conduct autopsies without blame. Build red flag mechanisms that turn information into information that cannot be ignored.

21. Implications Leadership charisma can be a liability as well as a strength. The strength of your personality can deter people from bringing you the brutal facts. “Leadership does not begin just with vision. It begins with getting people to confront the brutal facts and act on the implications.”

22. Focus The good-to-great companies eventually (after a few years) found one or two big things to focus on. They figured out what they could be best at, and let that relentlessly drive their decisions. “Stop doing” lists are more important than “to do” lists.

23. How does that work in public health? A health department already has a basic mission defined by statute. But within that role there are a lot of options. If the implicit focus is to “do a good job on whatever programs are assigned to us” you may achieve competence but probably not greatness. More focus is possible.

24. For example… Our new Secretary of Health in Washington State is working toward this level of focus. Part of his approach is to ask a few key colleagues, what’s the problem we’re going to address? Here’s an early draft, for the sake of discussion.

25. Problem statement The Preventable Illness Gap: Too many Washingtonians are suffering from problems that could have been prevented. A Shaky Foundation: Support for basic public health services has eroded to the point where they are endangered in many communities. Yet we still need these services. You can see how this could lead to a clear focus on a few key things, rather than a diffuse focus on “doing our programs well.”

26. Disciplined accountability Good to great organizations hold themselves responsible for results, not just process or inputs. A “culture of self discipline.” “It doesn’t really matter whether you can quantify your results. What matters is that you rigorously assemble evidence – quantitative or qualitative – to assess your progress.”

27. It takes a while Good to great transformations take a few years of gradually building momentum. “Good to great transformations often look like dramatic, revolutionary events to those observing from the outside, but they feel like organic, cumulative processes to people on the inside.” “The good to great leaders spent essentially no energy trying to ‘create alignment,’ ‘motivate the troops,’ or ‘manage change.’ Under the right conditions, the problems of commitment, alignment, motivation and change largely take care of themselves..”

28. Will + Humility = Level 5 Leadership Professional Will Personal Humility Acts with quiet, calm determination; relies principally on inspired standards, not inspiring charisma, to motivate. • Demonstrates an unwavering resolve to do whatever must be done to produce the best long-term results, no matter how difficult.

29. Will + Humility = Level 5 Leadership Professional Will Personal Humility Channels ambition into the company, not the self; sets up successors for even greater success in the next generation. • Sets the standard of building an enduring great company; will settle for nothing less.

30. Will + Humility = Level 5 Leadership Professional Will Personal Humility Looks out the window, not in the mirror, to apportion credit for the success of the company – to other people, external factors, and good luck. • Looks in the mirror, not out the window, to apportion responsibility for poor results, never blaming other people, external factors, or bad luck.

31. Will + Humility = Level 5 Leadership Professional Will Personal Humility Demonstrates a compelling modesty, shunning public adulation; never boastful. • Creates superb results, a clear catalyst in the transition from good to great.

32. “The great irony is that the animus and personal ambition that often drive people to positions of power stand at odds with the humility required for Level 5 leadership. When you combine that irony with the fact that boards of directors frequently operate under the false belief that they need to hire a larger-than-life, egocentric leader to make an organization great, you can quickly see why Level 5 leaders rarely appear at the top of our institutions.” Good to Great, pp. 36-37

33. Level 5 – Good Match for Public Health Most public health leaders are in it because they believe in the values of public health. If they’re in it for fame and money, someone needs to give them a clue. We have our share of leaders with an ego problem, but there is a strong element of altruism in public health that fits will with Level 5 Leadership.

34. “Unexpected Findings” “Larger-than-life celebrity leaders who ride in from the outside are negatively correlated with going from good to great. Ten of eleven good-to-great CEOs came from inside the company, whereas the comparison companies tried outside CEOs six times more often. Level 5 leaders attribute much of their success to good luck, rather than personal greatness. We were not looking for Level 5 leadership in our research, or anything like it, but the data was overwhelming and convincing. It is an empirical, not an ideological finding.” Good to Great, p. 40

35. The Business Fallacy So are we saying here that public health should just be more like the private sector? Collins wrote an excellent short monograph on this titled “Good to Great in the Social Sectors.” You can get it as a booklet from Amazon and others. “We must reject the idea…that the primary path to greatness in the social sectors is to become ‘more like a business.’ Most businesses – like anything else in life – fall somewhere between mediocre and good. Few are great.” 90% of new businesses fail. Try that on your Board… Most of “Good to Great” can be generalized to any organization.

36. Not everyone can be CEO at once. There is a lot of value in the Good to Great findings for any manager (and lots of good info on matters other than leadership). But since not everyone can be a Level 5 CEO or health department director… I would like to also share a complementary model called Meta-Leadership, which also applies to public health leadership at any level.

37. Meta-Leadership Had its origins in Emergency Management, in particular Harvard’s National Preparedness Leadership Initiative at their School of Public Health. But has broad applicability. Derived from extensive observations of leaders in crisis situations. Five key dimensions of Meta-Leadership

38. What is a Meta-Leader? Not just a good top-down leader. “Leaders whose scope of thinking, influence and accomplishment extents far beyond their formal or expected bounds of authority.” “These leaders are driven by a purpose broader than that prescribed by their formal roles, and are therefore motivated and capable of acting in ways that transcend usual organizational confines.”

39. What is a Meta-Leader? “Meta-leaders seek to achieve results that cannot be accomplished by one organization, unit, or department alone….” “Meta-leaders inspire others…appealing to more than just personal gain or parochial organizational promotion.” “Meta leaders convincingly make the case that by acting and interacting above, beyond, and across the confines of their own bureaucratic entities, the overall enterprise will know more and accomplish more....”

40. Five Dimensions of Meta-Leadership The Person of the leader. “Integrative strategists…allows stakeholders to…leverage one another in order to accomplish shared objectives.” “Emotional intelligence” – knowledge of self, ability to have constructive collaborative relationships with others. Not overly competitive. Ability to see the big picture A sense of humor and irony are usually important. Retains composure and balance even in moments of real crisis or threat.

41. Five Dimensions of Meta-Leadership 2. Situational Awareness Brutally honest about what is and isn’t known. Capacity to develop a “factual, evidence-based, clear and actionable description of what is occurring.” Recognizing gaps and ambiguity in available information. Maintaining a “strategic” situational awareness beyond the narrower focus of any one organization. Has the “confidence and courage to make decisions and take action based on calculated speculation and risk.”

42. Five Dimensions of Meta-Leadership 3. Lead the Silo To work effectively with partners, you first need a solid base in your own organization. Crossing silos doesn’t mean the silos go away. Meta-Leaders make sure they and their organization do their jobs well. M-Ls seek to empower strong, smart capable followers; are not threatened by them. Fosters “meta-followers”: people who think and collaborate beyond usual boundaries in the interest of meaningful solutions. A meta-follower can be a meta-leader at his or her level.

43. Five Dimensions of Meta-Leadership 4. Lead Up: Influencing the Boss(es) “The great meta-leader is a great subordinate: dependable, honest, reliable and loyal.” Enables M-L to speak truth to power within own silo. To lead across domains/silos, you also have to be able to influence the bosses of other silos. This requires the combination of will and humility emphasized in Good to Great. It also requires sharp insight into the perspective of other silos and their bosses.

44. Five Dimensions of Meta-Leadership 5. Lead Across “…the ability to generate…involvement among entities that look at a problem from very different yet complementary vantage points.” Rather than focusing on differences among stakeholders, focusing on shared values, objectives and circumstances. This is the classic public health emphasis on partnerships and community based coalition building. But only works really well when the first 4 dimensions are in place.

45. 5 Dimensions of Meta-Leadership The person of the meta-leader. Strategic situational awareness. Leading your silo. Leading Up. Leading Across. You can’t do #5 optimally unless you can do 1-4 well.

46. Connectivity: Meta-Leadership’s Effect Meta-Leaders “connect the intentions and the work of different organizations or organizational components to achieve a shared purpose.” M-L does not mean “tearing down silos.” Silos have important functions. Connectivity means silos working together to better leverage each other’s strengths. Those silos might be divisions within your health department, groups of health departments, or various community partners.

47. Meta-Followers You don’t have to be a CEO or Director to use these principles. They apply to anyone with a broad understanding of the purposes of her work, and who wants to be effective not only within her own unit or organization, but across boundaries. You can exert leadership among your colleagues; “lead-up” by giving honest feedback to your bosses in a form they can accept, and “lead across” by working with other parts of your organization effectively.

48. If you… …do a great job of directing your health department’s communicable disease unit, you’re a leader. If you work effectively with Environmental Public Health to jointly manage food-borne outbreaks…you might be a meta-leader.

49. If you… …are an effective Health Department Director, you are a leader. If you work with other community agencies to address a health problem more effectively than they could working separately (and have your Board’s support in doing so)…you might be a meta-leader.

50. If you… …are an effective Health Department Director, you are a leader. If you work with other health departments and your state DOH to address problems in the public health system statewide…you might be a meta-leader.