Prioritizing Leadership

I’ve been thinking quite a bit about leadership and public health practice given the news of yet another Oregon state government agency mismanaging millions of taxpayer dollars.  From 2013-14, reports about the Oregon Health Authority and its Cover Oregon debacle raised the public’s ire (1). Now it’s the Oregon Energy Department and failures surrounding the Business Energy Tax Credit Program (2) that leave us wondering how such incompetence is possible.

How do these two events relate to public health practice? Something diseased sits at the core of our governance system and allows for the perpetuation of dysfunction. Public health exists within that system. Oregon’s poor showing in the 2015 United Health Foundation annual report of health rankings, which saw the state plummet in one year from twelfth to twentieth place (3), suggests that the ailing governance system is negatively affecting the health and safety of Oregonians.

The core failing likely has many influences, but I see one as a standout. It is what Wim Wiewel, the president of Portland State University, once described as ‘Portland nice,’ but which I would extend to the entire state. He said, “We praise people and organizations for efforts and intentions but are reluctant to hold them responsible for results (4).” Dr. Wiewel is being kind with this statement. Our leaders lack the courage, not merely the reluctance, to hold people responsible. They are not willing to stand up for what is right in the face of difficulty.

Oregon’s Task Force on the Future of Public Health Services laid out a conceptual framework for governmental public health in its report, Modernizing Oregon’s Public Health System. The framework includes seven foundational capabilities, one of which is leadership and organizational competencies (5). (A list of all seven capabilities can be found at the end of this posting.). From what I witnessed in local and state public health agencies, Oregon must prioritize the leadership capability above the others. And here I’m talking about leadership at the administrator and executive levels, because while leaders are needed throughout an organization, administrators and executives have the greatest power to effect change within dysfunctional bureaucracies. Our public health leaders must acquire and apply the proper skill set and fortitude to govern and transform their organizations. If the leadership capability is not prioritized in public health, then the other six foundational capabilities will not gain traction, the public health system will continue to deteriorate, and the stage will be set for a profound failing if the state is ever faced with a significant public health threat.

Most people within the governance system are not intent on doing ill. Rather, a culture develops in which it is easiest to turn a blind eye to problems. But what happens when threats to an organization’s well-being are not addressed?  Let’s take the hypothetical case of a program manager who is a bully. He is incompetent in his work and puts up smokescreens to hide that fact. He convinces his boss not to trust what others say about him. He whines about how no one understands how much work he and his staff must do, with so little money. He hides behind the good works of others and convinces his boss to direct others to take on his program’s responsibilities. How does he survive? He values political gamesmanship over doing his job, and he is an expert at manipulating others, particularly his superiors. He enlists his staff in rumor control about himself and his program through intimidation or by promising favors. If anyone dares to raise concerns about his performance, he starts a smear campaign against that person. His efforts are subtle; well-placed misinformation here and a little lie told there. When his boss finally catches on to his tactics, he works to undermine him. Survival is easy because this manager is a wolf among sheep. He is a bully working with people who dread confrontation and will avoid it at all costs.

The effects of such toxic individuals on an organization are numerous, particular if the agency has already been traumatized by scandals, layoffs, budget cuts, and overwork. Leaders who ignore such threats risk deepening an organization’s dysfunction. Morale plummets. The agency’s personnel, if they even stay in their positions, become resentful and angry or they shut down and under-perform. New bullies arise because people see that this manager’s behavior is tolerated and even expected as a way to advance within the agency. Cynicism becomes so pervasive that any actions taken by leadership to move the agency forward in other areas are met with suspicion and even a desire to see those efforts fail.

In his book, Public Health Leadership, Louis Rowitz listed the top five characteristics of admired leaders as honesty, forward-lookingness, the ability to inspire, competence, and intelligence  (6). I was disappointed that courage was in twelfth place, because it requires real courage to see and address the warning signs that lead to such failures as Cover Oregon or the tax credit program. In his book, The Practice of Adaptive Leadership, Ronald Heifetz and his colleagues state that, “diagnosing the organizational system, the adaptive challenge at hand, and the political landscape in an enterprise takes time, careful thought, and courage (emphasis mine) (7).”  He identifies key characteristics of adaptive organizations, of which two are:

  • Elephants in the room are named, and
  • Leadership capacity is developed

For the health and safety of Oregonians and for the future of the state’s governmental public health system, let’s hope our leaders have the courage to begin pursuing these two characteristics within themselves and their agencies in the coming year.

Your turn

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I wish you good health and happiness this holiday season!  Kathy

Foundational Public Health Capabilities (5)

  1. Assessment & epidemiology
  2. Emergency preparedness & response
  3. Communications
  4. Policy & planning
  5. Leadership & organizational competencies
  6. Health equity & cultural responsiveness
  7. Community partnership development


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  1. First Data. Cover Oregon website implementation assessment report. March 19, 2014. Available at: Accessed Dec. 19, 2015.
  2. Sickinger T. Fed-up officials call for overhaul of Oregon Energy Department. Oregonian. Available at: Accessed Dec. 18, 2015.
  3. United Health Foundation. America’s annual report of health rankings, 2015. Available at: Accessed Dec. 21, 2015.
  4. Weiwel W. Portland’s drop-out epidemic: cradle-to-career route offers a proven route for students. Oregonian. Available at: Accessed Dec. 19, 2015.
  5. Oregon Health Authority. Modernizing Oregon’s public health system. Sept. 2014. Available at:  Accessed Dec. 21, 2015.
  6. Rowitz L. Public health leadership: putting principles into practice. 2nd ed. Boston, MA: Jones and Bartlett Publishers; 2009. Table 2-3, p. 26.
  7.  Heifetz R, Grashow A, Linsky M. The practice of adaptive leadership: tools and tactics for changing your organization and the world.  Boston, MA: Harvard Business Press. 2009. p. 101.

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