Archive for the ‘Leadership & Management’ Category
It’s been more than two years since we reported on Seattle as the new Geneva, that is, as the new epicenter of global health activity. An article in this morning Journal-Sentinel (Water-engineering firms see potential, challenge in developing countries) – which includes an exclusive interview with the Acumen Fund’s chief executive Jacqueline Novogratz – suggests that Milwaukee is angling to do the same for water technology:
It’s an issue that almost certainly will preoccupy business leaders in metro Milwaukee in their strategy to brand the region as an international hub of water technology. The metro area is home to scores of water-engineering companies. Gov. Jim Doyle and the University of Wisconsin-Milwaukee this month announced plans to invest millions of dollars for UWM to become a center of freshwater research.
An 2008 article from the same newspaper (Area’s tide could turn on water technology) provides more evidence:
[F]our of the world’s 11 largest water-technology companies have a significant presence in southeastern Wisconsin, according to an analysis of data from a new Goldman Sachs report.
Wall Street has tracked automakers, railroads and retailers almost since there were stocks and bonds. But water remains a novelty. Goldman Sachs Group Inc. didn’t begin to research water treatment as a stand-alone industrial sector until late 2005.
While several large MNCs have shown an active interest in clean water in developing countries (e.g., Procter and Gamble, Vestergaard Frandsen, Dow) open questions remain as to what role large MNCs will play in providing access to safe water for the one billion people who don’t have it.
(Thanks to Dr. Jessica Granderson for sending the link)
Cross-posted from Design Research for Global Health.
Giving talks is not one of my strong suits, but it seems to be a part of the job requirement. Earlier this month, I had the opportunity (even though I’m no good, I do consider it an opportunity), to give a couple talks, one to the Interdisciplinary MPH Program at Berkeley and one to a group of undergraduate design students, also at Berkeley. Despite the difference in focus, age, and experience of the two groups, the topic was roughly the same: How do we effectively use design thinking as an approach in public health?
The first session was so-so, and I suspect that the few people who were excited about it were probably excited in spite of the talk. It started well, but about halfway through, something began to feel very wrong and that feeling didn’t go away until some time later that evening. Afterwards, I received direct feedback from the instructor and from the students in the form of an evaluation. I recommend this if it is ever presented as an option. Like any “accident”, this one was a “confluence of factors”: lack of clarity and specificity, allowing the discussion to get sidetracked, poor posture, and a tone that conveyed a lack of excitement for the topic.
It’s one thing to get feedback like this, another to act on it.
The second session went much better, gauging by the student feedback, the comments from the instructor, and my own observations. This in spite of a larger group (60 vs. 20) that would be harder to motivate (undergraduates with midterms vs. professionals working on applied problems in public health). I chalk it all up to preparation and planning. Certainly there are people that are capable of doing a great job without preparation – I just don’t think I’m one of those people.
Most of that preparation by the way was not on slides. I did use slides, but only had five for an hour session and that still proved to be too many. Most of the time that I spent on slides, I spent developing a single custom visual to convey precisely the information that was relevant to the students during this session (see image). The rest of the preparation was spent understanding the audience needs by speaking to those running the class; developing a detailed plan for the hour, focusing on how to make the session a highly interactive learning experience; designing quality handouts to support the interactive exercise; and doing my necessary homework. For this last one, I spent 20 minutes on the phone with a surgeon friend, since the session was built around a case study discussing surgical complications and design.
Three resources I found really useful:
- Why Bad Presentations Happen to Good Causes, Andy Goodman, 2006. This commissioned report was developed to help NGOs with their presentations, but I think there is value here for anyone whose work involves presentations. It is evidence-based and provides practical guidance on session design, delivery, slides (PowerPoint), and logistics. Most importantly, it is available as a free download. I was fortunate enough to pick up a used copy of the print edition for US$9 at my local bookstore, which was worth the investment for me because of the design of the physical book. It’s out-of-print now and it looks like the online used copies are quite expensive – at least 3x what I paid – so I recommend the PDF.
- Envisioning Information, Edward Tufte, 1990. I read this when I was writing my dissertation. Folks in design all know about Tufte, but I still recommend a periodic refresher. This is the sort of book that will stay on my shelf. Also potentially useful is The Visual Display of Quantitative Information. For those working in global health, don’t forget how important the display of information can be: (a) Bill Gates and the NYTimes, (b) Hans Rosling at TED.
- Software for creating quality graphics. The drawing tools built into typical office applications, though they have improved in recent years, are still limited in their capability and flexibility, especially if you’re looking at #2 above. In the past 10 days, three people in my socio-professional network have solicited advice on such standalone tools, OmniGraffle (for Mac) and Visio (Windows): a graphic designer in New York, an energy research scientist in California, and a healthcare researcher in DC. Both are great options. I use OmniGraffle these days, though I used to use Visio a few years back. If cost is an issue, there are open-source alternatives available, though I’m not at all familiar with them (e.g., the Pencil plug-in for Firefox).
Guest post by Khizer Husain, Owner of Shifa Consulting (see also previous post on healthcare in the Emirates)
Three Observations in Arab Healthcare Delivery
I attended the 34th annual Arab Health Congress in Dubai last week. This is the largest regional conference on healthcare. The event was massive: it drew more than 50,000 visitors and 2,300 exhibitors which span all facets of healthcare including care delivery, technology, consulting, staffing. According to the medical director in Abu Dhabi’s Sheikh Khalifa Medical City, ‘Our institution looks forward every year to Arab Health as a means of reviewing the latest technology; networking with suppliers and vendors and to update medical knowledge. The increased participation and attendance at Arab Health is of value to all of us in the healthcare field.’ Here are some observations on the delivery of healthcare in this part of the world:
Economic Downturn Putting Projects on Hold
The global financial meltdown has not spared the Middle East and the UAE in particular. There are many sites that are empty pits with cranes standing idle. Hospitals have put on ice new expansion plans. Overall, it is estimated that 8% of the labor force in Dubai has left the country in the last four months due to the worsening economic climate. I heard a couple of people talk about the thousands of cars that were left abandoned at the Dubai airport as people could not pay their loans and thought it best to flee the country. Up until last year, healthcare expenditures in the region were growing 16% per year and exceeding $74B.
The silver lining here is that global steel prices are down 75% and smaller construction projects at well-capitalized institutions can for the first time gain traction. A notable exception to the economic dip is Qatar. According to ArabianBusiness.com, Qatar’s economy (http://www.arabianbusiness.com/541046-qatar-economy-could-grow-by-10-in-2009) could grow 10% in 2009 as it expands exports of liquefied natural gas, making it the world’s fastest growing economy.
Thirst for World-class Standard of Healthcare
There is a strong desire in the Gulf to catch up to the healthcare levels of the industrialized world. Until just a few years ago, the only way to bridge the gap between what national populations desired and what was offered in their native countries, was to open the doors (wide open) to medical tourism. The UAE reportedly spent over $2B per year to ship its citizens to foreign countries for medical treatment. Not only were these expenditures unsustainable, but they put these countries at a competitive disadvantage for recruiting highly skilled expatriates. The only way to turn down the medical tourism spigot was to invest locally in building healthcare expertise. Due to poor perceived quality in local healthcare, stymied access to care, and perverse financial incentives to go abroad for care, medical tourism is still a powerful force.
Enter Multinational Healthcare Corporations
The landscape for international healthcare providers with business in the Middle East is becoming increasing crowded with the major players hailing from the US, Europe, and Canada. There seem to a few dominant models:
a. Market Destination Hospital: A number of institutions have outposts in the Middle East that they use to run clinics and make the necessary arrangements to funnel patients to the flagship entities. Mayo, Washington Hospital Center, University of Chicago follow this model. The Great Ormand Street Hospital in London sends in a rotational team of pediatric specialists to run clinics close to the patients.
b. Secure Management Contract: This is where the cash is. Running a tertiary hospital in the UAE can yield $6M per annum. The big players in this sector include Cleveland Clinic—which runs Sheikh Khalifa Medical City and will run the new Cleveland Clinic Abu Dhabi when it finishes in a few years. Johns Hopkins International has three affiliate hospitals in the UAE and a hospital in Beirut. UPMC runs the gamut of managing whole hospitals to managing individual departments like the emergency room. The Methodist has teamed up with property development company Emaar to create an outpatient clinic which they will manage—the Burj Medical Centre. Emaar has aggressive plans to expand clinics and hospitals throughout the Middle East and North Africa.
c. Joint Venture: South African Mediclinic obtained ownership share of Emirates Healthcare in 2007 for $53M. With two hospitals and three clinics in the pipeline, they are the largest private provider of healthcare in Dubai. Mediclinic derives nearly half of its profits from overseas ventures (in the Middle East and beyond).
While it is quite exciting to see all this development in healthcare, everyone agrees that the only way to have real, sustainable progress in region is to build an army of indigenous healthcare workers. Unfortunately, the curse of petrodollars is that it leaves little incentive for nationals to aspire to become nurses and doctors, let alone outstanding clinical managers. In the meantime, India and the Philippines serve as the golden geese.
More from our leadership and management folks over at MSH. By Sylvia Vriesendorp:
Leading and managing is not just about doing things differently by intentionally using the practices that we have identified for managing and leading. There is also a ‘being’ element involved. One of the things we have discovered as we implement our programs that shifts are taking place in the way people are and in their perspective on their work. We have called these “leader shifts.’
We have observed five shifts:
1. A shift from a focus on the lone heroic leader who will save us and solve our problems to the power of collaborative action that is fueled by commitment and a personal stake in success.
2. A shift from pessimism, despair and cynicism to a sense of hope, possibility and optimism.
3. A shift from blaming others to identifying challenges and taking personal responsibility to tackle them, one at a time.
4. A shift from intense busy-ness and multiple streams of activities by different groups and people that do not add up to significant positive change to coherent action by multiple parties that is driven by a shared purpose.
5. A shift from a focus on self and one’s own comfort and well-being to generosity and a concern for the greater good.
These shifts are not permanent, once made. Each time we find ourselves in a corner or a bad place, we tend to shift back to the left side: waiting for someone to save us, pessimism, blaming others or other things for our situation, incoherent action, if any and a focus on our own needs. It takes awareness and focus to shift back to the right column.
So a critical question in enabling and developing leadership is what tools might be available to do so. One are we have explored is support in a virtual space, as such we can reframe the question to this – Can we develop leadership in virtual space?
Read the rest of this entry »
This is a follow up post by Sylvia on global health leadership:
In my previous writing I mentioned the importance of having a language around leadership and management that is actionable. The trait approach to leadership, which focuses on inborn personality characteristics, is not very helpful. After all, we cannot change people’s personalities. But behavior is changeable. This is why we are focusing on practices, action verbs if you will. We studied effective public health leaders and asked people who closely work with them to describe in behavioral terms what they do that earned them the label of ‘effective leader.’ We did a content analysis of the hundreds of pages of interviews and the following 8 practices emerged. These are the practices of leading that we are now teaching others to use to improve health services:
- Scanning (taking in information and being aware of internal and external environments)
- Focusing (directing energy and attention to priorities),
- Aligning/mobilizing (bringing others on board and moving towards a shared vision) and
- Inspiring (calling on the best in everyone to contribute to the greater good)
The practices of managing are
- Planning (thinking through and preparing the way forward),
- Organizing (lining up the necessary resources and putting in order the necessary systems)
- Implementing (doing the work) and
- Monitoring & evaluation (observing, examining and assessing progress).
The nice thing about these practices is that most people already know how to use them in their work, albeit it not intentional and not enough of some of them or too much of others. The leadership training helped them become more intentional and systematic.
We are seeing that more intentional use of the practices of leading and managing affects a teams’ work climate, makes managers more invested in setting up good management systems and makes them more aware of the importance to stay abreast of developments and trends in the internal and external environment that requires a change. We have discovered that when this happen, services tend to improve, even if, at first it is only in a very limited area.
In programs where we have helped teams to use the practices of good management and leadership we have seen them produce significant improvements in health indicators. For example, staff in health facilities in Aswan governorate in Egypt, by being intentional about their leading and managing practices, have more than doubled the number of antenatal care visits per woman and increased the use of contraceptives. What had changed was their sense of responsibility for making things happen. One of the doctors, focusing on improving the cleanliness of his clinic discovered a child with a heart murmur and shifted from his lesser challenge that was focused on the clinic’s appearance to the detection of children in the community with rheumatic heart disease. This disease is primarily caused by repeated attacks of tonsillitis and easy to treat if it is discovered early. Through his use of the practices of leading and managing he was able to mobilize his staff to go out in the villages and do a simple screening (the practices of scanning and focusing). By doing this he prevented much more serious complications later in the life of those children. It is one of those measurable results that is immeasurable in its impact of the affected families.
Introductory post by Sylvia Vriesendorp, our new guest blogger:
“We want better leadership!” It is an often heard call in health programs around the world. Yet when asking those who make this call what exactly they’d like to see done or changed that would produce the missing leadership, the voices stop. Let’s look at reproductive health: one woman dies every minute in pregnancy and childbirth; 99% of these women live in developing countries (UNFPA). These women are not dying of medical mysteries; they are dying because they do not have access to simple, inexpensive, life saving interventions. They are dying because they do not have access to modern contraception methods, even when there are supplies in the country and trained staff to dispense them.
Why is that so? We believe this is happening because many health programs are poorly managed and led. And as long as we believe that only a handful of exceptional human beings, like Mother Teresa, Ghandi or Mandela, can lead and manage us out of these tragic circumstances, we are forced to stand by or throw technical solutions at what are, in essence, challenges of management and leadership. This is a huge dilemma that is exacerbated by a lack of actionable language about management and leadership. After all, if leadership and management cannot be defined, how can we know what to teach? It is also a dilemma for those who manage and lead health organizations. How can you get your staff to become better managers and leaders when you don’t have any language to help them develop? How can you yourself become a better manager and leader if you adhere to the theory of ‘Great and Exceptional Men and Women’ as they only people who can lead us out of our current stagnation?
There are countless models of leadership; many emphasize personality traits and characteristics (like charisma) that assume that true leaders are wired a particular way, from birth. If leadership were to be innate like that, we are in trouble. We are especially in trouble when we take talented health professionals away from their clinical practice and promote them up to a level where their technical skills are no longer useful and where they discover they have no clue on how to manage and lead. We have turned, in this way, countless superb clinicians into mediocre managers who do not lead. Worst of all, such an approach gives us no guidance on how to prepare current and future generation of managers who lead and produce intended results.
So what to do? We are engaged in remedying this situation in many countries and at many levels, a few teams of health managers at a time. In the process we are learning much about how to turn passive and unempowered midlevel managers into inspired activists for better health. We’d like to share these with you.