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DR. J E PARK MEMORIAL ORATION
Year : 2020  |  Volume : 64  |  Issue : 3  |  Page : 209-215  

Leadership through the eyes of a public health professional: A journey of 43 years


Chairperson, Indian Academy of Public Health, IPHA, Kolkata, West Bengal; Former Senior Advisor, UNICEF, Kampala, Uganda, Former Director, IIHMR, Delhi, India

Date of Submission12-May-2020
Date of Decision05-Jun-2020
Date of Acceptance12-Jun-2020
Date of Web Publication22-Sep-2020

Correspondence Address:
Sanjiv Kumar
M15, 2nd Floor, South Extension Part 2, New Delhi - 110 049
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_512_20

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   Abstract 


Leadership skills in a public health professional (PHP) are more important today in view of rapidly changing disease pattern, higher priority to universal health coverage, health in all policies, health being demanded as a human right, and emergence of pandemics from zoonotic diseases. Most of us become accidental leaders as we never receive training in leadership skills. This not only undermines the effectiveness of PHP but also undermines the credibility of public health as a specialty. Jim Collin's five levels of leadership are useful to understand the various levels of leadership for a PHP. Technical excellence which denotes first level of leadership is necessary but not sufficient to become a leader. One needs team work, emotional competencies, prioritization ( first things first), listening skills, advocacy, negotiation, networking skills, along with conviction, commitment, and courage to do what one thinks is right. Leadership is a life-long journey, not a destination. Being engaged in leadership for more than a decade, I developed a three domain leadership capacity development model very useful in designing and conducting leadership development trainings to develop leadership skills among PHPs, academicians, and health researchers.

Keywords: Accidental leader, levels of leadership, public health, skilled leader, three domains model of capacity development for leadership


How to cite this article:
Kumar S. Leadership through the eyes of a public health professional: A journey of 43 years. Indian J Public Health 2020;64:209-15

How to cite this URL:
Kumar S. Leadership through the eyes of a public health professional: A journey of 43 years. Indian J Public Health [serial online] 2020 [cited 2020 Oct 26];64:209-15. Available from: https://www.ijph.in/text.asp?2020/64/3/209/295797




   Introduction Top


All public health professionals (PHP) take up leadership role right from their first assignment. They have to interact with community, community leaders, and bureaucrats to implement various national health programs to achieve assigned targets. The faculties in the departments of community medicine or public health are the role models for their students and leave a lifelong impression about public health. They play an important role in attracting bright students to take up public health as career. Leadership skills among PHPs are even more important today as disease epidemiology is rapidly changing, focus on achieving universal health coverage with launch of Pradhan Mantri Jan Arogya Yojana and Health and Wellness Centres, need to work with other sectors in view of the need for health in all policies, emergence of health as a human right and frequent pandemics. India has become a global economic power and the fifth largest economy in the world but its health indicators are worse than economically less developed countries such as Bangladesh, Nepal, and Srilanka.[1]

Leadership is a process whereby an individual influences team members and people in the organization to achieve common goals.[2] Leadership is leading a group of people or an organization to achieve the results. In its essence, leadership in an organization involves establishing a clear vision, sharing that vision with others which they follow willingly, providing them information, knowledge, and methods to realize that vision, and coordinating and balancing the conflicting interests of all members and stakeholders.[3] This article is based on my reflections of 43 years of experiences starting from primary health center to state level and then to national and international level. I share real life stories to highlight need for various leadership skills at the every level of work of a PHP. It also includes a few concepts for developing leadership skills based on the leadership courses I have designed and conducted over a decade.

The faculties of community medicine have an important role in attracting students to the specialty and are effective role models. In my case, three teachers influenced me immensely. The dedication and persistence of Prof. George Joseph during MBBS. He was so loving and caring that I did not miss any class or field visit after the first PSM field visit that I bunked with all my classmates. Prof Joseph walked into our hostel and lovingly escorted us to the field. He also convinced me and others to volunteer in “Youth Against Famine” program in the Udaipur District of Rajasthan. This gave me an opportunity to live in a village hut and work with and closely observe village life for 3 weeks. Professor LM Nath whose excellence in technical knowledge and multi-tasking made him my role model and Professor CS Pandav, known as “Iodine Man” for his contribution to elimination of Iodine Deficiency Disorders in India and beyond. I am indebted to these public health leaders who attracted me to community medicine and guided my career. It was an honor for me to be listed among 13 eminent public health leaders who emerged from the Centre for Community Medicines, All India Institute of Medical Sciences, New Delhi (AIIMS) at 60th Anniversary Celebration of AIIMS.


   Accidental and Skilled Leaders Top


We have two kinds of leaders in public health. One is “Accidental” Leaders who land up in a leadership positions without leadership skills and second is “Skilled” leaders who have acquired leadership skills. Most of us start our public health career as an accidental leader as we do not have any formal training in leadership during MBBS or MD. One may learn leadership skills by hit and trial, self-learning by reading, observing other leaders, or taking up formal courses.[4] An average health professional moves up in the hierarchy based on seniority reaching leadership positions. There is no formal leadership training in both undergraduate and postgraduate medical education. There is formal leadership training in many sectors such as defense services and bureaucracy. In medical field, there are many in-service training courses available, but these are neither integrated into career progression nor compulsory. I also started my public health journey as an accidental leader till I got formal training at the age of 53. I reflect on my experiences in public health from PHC upward [Table 1], and the leadership skills I should have had to deal with those situations.
Table 1: Author's experiences in public health from PHC upward and needed leadership skills

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Formal training in leadership

I started as an accidental leader till I realized the need for formal learning of leadership. After considering various options, I decided to join an online MBA in Strategic Management which included a course on applied leadership at a college in Zurich, Switzerland, affiliated to University of Wales, UK. It included a course on “Applied Leadership” which put me on the road to strengthen my leadership skills. I found the course very interesting and read six books and more than 100 articles including the course material. Each one of these described leadership differently mostly at theory level. This confused me and I yearned for a practical tool which prompted me to synthesize my understanding of leadership based on the literature and my life experiences. The result was the three domain model of leadership capacity building.[5]


   Three Domain Model of Capacity Building for Leadership Top


There are numerous models available in the literature of leadership; however, I did not come across any to guide one to develop one's own or others' leadership skills. The three domain model helps in planning and facilitating leadership skills and how skills in three domains interact with each other.[5] A good leader needs to develop skills in all the three domains. As one moves up the leadership hierarchy the team domain and later external environment domain become more important. The skills mentioned below in the three domains for the capacity development are only indicative and can be added or deleted for the various capacity development initiatives in an organization depending on the needs assessment. The three domains and their inter relationship are depicted in [Figure 1].[5] There are skills in each domain that a public health leader should have which are:
Figure 1: Three domain model of capacity building for leadership.

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Self-domain

No one can become a leader unless one leads self well. A leader has a vision for self, organization and each one of his team members. He has charisma. He is self-aware of his strengths and weakness and knows strengths and weakness of his team and asks for outside help in areas needed. He has strong communication and listening skills. He possesses change, social, intellectual, and emotional intelligence. He is the model of behavior and values he wants to inculcate in others. He is keen to learn new skills and acquire knowledge in emerging areas. A public health leader has to keep himself updated on the technical areas. If a PHP does not have technical competencies, he cannot remain a leader.

Team domain

A leader enables the team by actively developing individuals, inculcating team spirit. He keeps changing his approach based on what he learns through his network to maximize the efforts to achieve organizational objectives. This domain includes the skills for developing individuals in the team and the organization to effectively work together for the achievement of team and organizational goals. The leader enables the team and organization by developing the individuals in his/her team and the organization. A leader builds, strengthens, and facilitates team spirit and work. Through his/her traits, skills, and attributes, the leader helps his/her team to execute his/her vision. A leader does this by developing the skills in each individual in the organization through putting the right person in the right job, motivating, facilitating learning, and skill development in the staff through training, coaching, and mentoring. Leader is strategic in his/her approach and aligns human and other resources to achieve the organizational goals to fulfill the vision. A leader is in constant touch with his/her employees through his/her formal and informal networks and keeps changing his/her approach based on what he/she learns through his/her network to maximize efforts to achieve the organizational objectives. He/she transforms the individuals in the organization and motivates them to get the best out of them and channels every one's efforts so that they work in synergy to get the best results.

Environment domain

The leader keeps an eye on what is going on outside the organization, how things in the sector and outside the sector are changing, and what are the implications for the organization. A good leader should know how the diseases pattern, trends, and projections and factors within and outside health sector are contributing to this change and how these affect his/her organization. He/she keeps an eye on how the availability of technology and its application in health sector is changing or going to change the way health institutions function and are managed. The newer health interventions are changing management of health problems. He/she plans ahead and prepares his/her organization to benefit from these developments. He/she also keeps in mind how his/her organization contributes to benefit the society. No organization exists in vacuum, and its existence and growth is linked to the society, its norms and values. The leader develops and uses a strong network of formal and informal contacts beyond the organization/team he/she leads to get a regular feedback on how the organization he/she leads is perceived.

Interactions between three domains

The three domains of leadership capacity building are not watertight compartments, and there is a close relationship and overlap in the three domains as reflected by the double arrows in the model. The skills of the leader help him/her in learning from the changing environment in health and related sectors and develop and manage individuals and teams within the organization to adapt to that change. The leader also needs to review his/her personal skills and way of working, identify gaps, and acquire new skills and/or adopt new ways of working.


   Complementarity of Administrative, Managerial or Leadership Actions Top


Leadership, managerial, and administrative skills are often understood as the exclusive skills. However, in real life, these skills are complementary and synergistic. According to John Kotter, “Most organizations are over managed and under led.”[10] It is also true for public health in India. A good leader knows and takes administrative, managerial, and leadership action as the situation demands. It is common to the individuals in the leadership positions who continue to be an administrator or a manager and “micromanage” their subordinates. These leaders are still stuck in transactional style and need to move to transformational style, which is necessary for a leader. A leader may take administrative or managerial actions at times but is more focused on creating vision, mission and mandate, develops and transforms the organizations and individuals, creating right environment, anticipating future, and adapting the organization for it. Whereas managerial actions are focused on creating structures to achieve specific targets through effective and cautious use of available resources with stability. [Table 2] below gives the examples of administrative, managerial, and leadership actions in day-to-day work.[11]
Table 2: Examples of administrative, managerial or leadership actions

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Progressive levels of leadership in public health professionals

Leadership among PHP can be divided into five levels which is adapted from Jim Collin.[12] It is important to realize that the role of a PHP changes as one moves up the ladder in the hierarchy. The five levels of public health leadership as shown in [Figure 2] (Adapted from Jim Collins' model of five levels of leadership). Level 1 leader is a highly competent PHP who makes productive contributions through her talent, knowledge, skills, and has very good work habits. It is important for health professionals to understand that technical competencies are essential but not sufficient to become a good leader. They need to develop skills of higher levels to become effective leaders. In the health system, professionals are promoted by seniority as the sole criteria. Thus, it is quiet common to see a technically competent person promoted to Chief Medical and Health Officer or Professor Level due to their seniority alone. Most of them do not have skills to perform higher level functions. Level 2 refers to the ability to a competent team player. At this level, an individual does his work well and also helps others in the department or team to achieve their individual objectives. A level 2 leader works effectively with others in the team and the helps them to achieve the team objectives. A level 3 leader is a competent team manager and leads a department or a team well, has skills to organize people and resources toward achieving the team objectives. As a team leader, leads his team to achieve the team objectives with judicious use of available resources. Level 4 is an effective public health leader who can lead an organization well by catalyzing the commitment in vigorous pursuit of a clear and compelling vision for the organization and stimulates higher performance standards. Level 5 is visionary leaders who possess the skills of levels 1–4 and have a blend of personal humility and strong professional will. They are incredibly ambitious, but their ambition is for the institution to bring it to greatness, not for themselves. Level 5 leaders build cultures, processes and systems in the institutions which continue to do well even long after they have left. One important aspect of developing leadership skills is continuous and lifelong learning, starting with self-awareness of leadership skills or lack of these, address weaknesses, and build on strengths, regular review of application of these skills. This cycle of the identification of areas for improvement, learning, application, and review of progress in leadership skills continues life-long.
Figure 2: Five levels of leadership in public health.

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Leadership and management program of International Clinical Epidemiology Network for the (LAMP) leadership in health research

INCLEN had developed and conducted Program LAMP in 2002. We found NHS, UK leadership program approach of Fact, Reflect, and Act very suitable to develop leadership skills. This was adapted to develop Fact, Reflect, Act, and Review approach [Figure 3] to conduct LAMP training. Fact refers to learning about the major leadership skills which are covered during the face to face training. Reflect refers to the participants reflecting on their leadership skills based on the learning. This starts before the face-to-face training through the assignments to assess each participants' leadership skills. They reflect on these assignments after the plenary session on each leadership skills. They identify the gaps and strengths each participant has to become a good leader. Act refers to the preparation of individualized leadership development plan based on Fact and Reflect. Each participant's progress is reviewed during the post workshop contacts. The participants are encouraged to keep reviewing their performance as a leader even after the contacts are over. Six courses have been conducted so far. These four steps continue to guide learning throughout the life course of a leader. A summary of approach and skills covered in this course have been published.[4],[8],[12],[13],[14],[15],[16],[17] The programme is under revision based on a recent Wellcome Trust DBT leadership in health research in India study conducted by INCLEN. This four steps approach has also been used in workshops for leadership in academics and for leadership for PHPs and found effective.
Figure 3: Four steps cycle of continuous leadership development.

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Skills for leadership

There are various skills a PHP should have. Technical competencies in public health are foundational and essential for every PHP. It is vital that they keep updating their knowledge through regular readings about public health in India and globally. The other skills for moving up the levels of leadership include

  1. Team working, team leadership including mentoring and coaching
  2. Communication with focus on listening
  3. First things first (time management), setting priorities, and work-life balance
  4. Advocacy and negotiation
  5. Organizational culture, values, vision, and mission
  6. Networking
  7. Emotional competencies
  8. Dealing with difficult people.


Many other skills can be added to the above eight. The details of these skills can be read elsewhere.[4],[8],[12],[13],[14],[15],[16],[17],[18]

Family support for public health leaders

Family support is very important for a PHP for his professional growth and focus on his work, especially when one is posted away for long periods of time. Very often, these places are non-family duty stations or family cannot accompany them as spouse is working or children are going to school or basic amenities are not available at the place of posting. One may be posted and has to live in the field practice area away from family. A PHP has to undertake frequent travel for project work, attend/facilitate trainings, assignments within the country or abroad. To mitigate anxiety and the impact on children and spouse, one may plan for them to visit the place of work and stay in regular contact with family through telephone and social media such as WhatsApp, video calls, etc. Moving up the leadership ladder with family falling apart is a not true characteristic of real leaders.


   Conclusion Top


Every PHP is a leader, accidental, or learned as they are always leading a team, advocating with their supervisors, bureaucrats, and politicians. Unfortunately, these skills are not imparted during our training in public health. This has been illustrated through my work from PHC to the international level as a PHP. To become a skilled leader one can learn and improve one's leadership skills through formal or informal learning. Three domain models, five levels of leadership in public health, and four steps cycle of fact, reflect, act and review can be used as the effective approaches for developing and conducting trainings in leadership.

It is very important for leaders and those aspiring to become leaders to understand that leadership is a journey and not a destination. One has to reflect on one's action as a leader and keep learning and improving every day. In the absence of this approach, one may become over confident or arrogant and lose out on becoming and remaining a good leader.

This article is based on my JE Park Award Oration on March 1, 2020, at 43rd Annual Conference of Indian Public Health Association held at AIIMS, New Delhi, India. I acknowledge the inputs received from Prof Neeta Kumar, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, in writing this article and the conceptual framework of Three Domains, Four steps of learning and five levels of Public Health Leadership.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kumar S, Bothra V, Mairembam DS. A dedicated public health cadre: Urgent and critical to improve health in India. Indian J Community Med 2016;41:253-5.  Back to cited text no. 1
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2.
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4.
Kumar S, Adhish VS, Deoki N. Introduction to strategic management and leadership for health professionals. Indian J Community Med 2014;39:13-6.  Back to cited text no. 4
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Kumar S, Adhish VS, Deoki N. Making sense of theories of leadership for capacity building. Indian J Community Med 2014;39:82-6.  Back to cited text no. 5
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6.
Kumar S, Murthy GV. Community participation in child health promotional activities at a primary health centre in Haryana. Indian Pediatr 1989;26:710-3.  Back to cited text no. 6
    
7.
Kumar S, Murthy GV. Prevalence of post- polio residual paralysis in under-five children in a PHC in Haryana. Indian Pediatr 1988;25:1128.  Back to cited text no. 7
    
8.
Kumar S. Improving coordination between health and ICDS at grassroot level: Rajasthan experience. ICCW J 1995; Special Issue:65-70.  Back to cited text no. 8
    
9.
Bang AT, Bang RA, Tale O, Sontakke P, Solanki J, Wargantiwar R, et al. Reduction in pneumonia mortality and total childhood mortality by means of community-based intervention trial in Gadchiroli, India. Lancet 1990;336:201-6.  Back to cited text no. 9
    
10.
Brown LM. Leading leadership development in Universities. J Manage Inquiry 2001;10:312-23.  Back to cited text no. 10
    
11.
Haldar UK. Leadership and Teambuilding. New Delhi: Oxford University Press; 2011.  Back to cited text no. 11
    
12.
Collins JC. Jim Collins Five Levels of Leadership. Good to Great. New York: Harper Collins Publishers Inc.; 2001.  Back to cited text no. 12
    
13.
Kumar S, Adhish VS, Chauhan A. Managing self for leadership. Indian J Community Med 2014;39:138-42.  Back to cited text no. 13
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Kumar S, Adhish VS, Chauhan A. Managing bosses and peers. Indian J Community Med 2015;40:14-8.  Back to cited text no. 14
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Kumar S, Deshmukh V, Adhish VS. Building and leading teams. Indian J Community Med 2014;39:208-13.  Back to cited text no. 15
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Kumar S, Kumar N, Deshmukh V, Adhish VS. Change management skills. Indian J Community Med 2015;40:85-9.  Back to cited text no. 16
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17.
Kumar S, Kumar N, Adhish VS, Reddy RS. Strategic Management and Leadership for Health Professionals-Skills To Leverage Resources To Achieve Health Goals. Indian J Community Med 2015;40:158-62.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Kumar S, Kumar N. Chapter 14 Leadership in Public Health. In: Goel S, Aggarwal AK, editors, Health Management. NOIDA, UP: Oxford University Press; 2020.  Back to cited text no. 18
    


    Figures

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