The ‘doing’ of better management and leadership in global health
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.