Personal Stories in Healthcare and Public Health Leadership

Introduction
In this chapter we share stories of several great leaders in public health and health care that we have encountered throughout our careers. This topic spoke to both of us, as we wanted to learn from experience and example rather than only text. Some of the leaders we interviewed are people we have worked with directly and can personally attest to their leadership abilities. Other leaders we have watched through the public eye, and we were interested in learning more about their leadership journeys. In working together to write this chapter, we first met to discuss how we wanted to go about choosing our leaders. Do we choose people we know personally, or only ones we had heard about? Do we focus specifically on different areas, or pick people we think might agree to meet with us? Turns out . . . it is a little of everything. We wanted to interview leaders that we admired, that we looked up to and wanted to learn from. We discussed who we admired within the healthcare field which led us to Medicaid leaders, medical directors and physicians between both the medical and the public health field. We discussed different areas of public health that were prominent and that interested us – guiding us to disaster management, tobacco cessation, and state and local level public health.

Regardless of our relationships with these leaders, we hoped to gain a fuller understanding of each of these individuals. We thought it important to learn about their journeys so that we can continue their legacy of great leadership in our own careers and for the future of healthcare and public health. Each leader has a unique definition of and approach to leadership that works for them. This supports the idea that there is not one correct way to be a good leader but an array of different characteristics and traits that are evident in “good” leadership. We hope readers of these interviews will be inspired, educated and motivated to see all the ways one can lead, learn to lead, and model effective leadership which expands far beyond the reach you may expect.

The leaders in this chapter shared with us their journeys to achieve where they are today, including obstacles and hardships that they faced. We hope you enjoy reading their stories and take away the important messages each of them has to share. We begin by sharing an overview of public health in order to frame the context of leadership in public health.

Brief History of Public Health
Ask any public health group about personal leadership stories within public health, and you may be met with a resounding ‘John Snow!’ from the crowd. No, not our beloved John Snow from Game of Thrones, although we hope he is up to date on his winter safety tips from his local health department. Public health John Snow of the 1850s studied the local cholera outbreak, and, based on his assessment of illness location and sewer water flow, he was able to conclude how some in the community were falling ill and made necessary changes to manage the outbreak. But before his time, beginning as early as the 1300s, history is filled with many people dedicated to creating theories on the spread of disease, inventing equipment for their studies, and starting the discussions on something that seems as basic as hygiene. We are where we are today because those in our history were willing to ask the needed questions and find the necessary answers. They were true leaders of the profession and for the health of the communities they served (Lamort, 2015).

We can examine other examples of public health leadership that may be more relatable than those of the more distant 1500’s. During the 1980s, the HIV/AIDS outbreak became mainstream news. While something the public knew about and was aware of, many do not know the behind-the-scenes work that took place to determine how the disease was transmitted, methods that could stop it, and interventions that could treat it. Don Francis was an epidemiologist that was part of the team working on managing the AIDS epidemic. Don worked tirelessly to overcome barriers in funding, educate an administration that was resistant, and fight stigma that kept many from remaining safe or having access to safety measures (Frontline, 2006).

Another modern-day example is that of Michelle Obama’s Let’s Move! program which she championed as First Lady. Michelle (we’re on the first name basis) focused on creating a healthy path for ALL children in the early years of their life. She did this through helping make healthy choices available, providing schools with healthy food items, and ensuring that families have access to healthy and affordable food. The reach of this program spanned from schools to corporations and even the private sector. She was a leader full of grace, strength and confidence in her practice. Oftentimes at the hospital where I work I will hear complaints about the vending machines not carrying ‘good’ (healthy) food. Thanks, (Michelle) Obama! (Let’s Move, 2016)
By studying these historical examples and advances in public health, we can see how leadership has developed over time and how individuals have made advances for populations worldwide. When asked about the definition of leadership, popular answers are ‘leading by example’, ‘making changes for the greater good for all people’, and ‘positive energy to keep people motivated’. We have men and women starting back in the 14th century recognizing that changes can be made for their communities and beginning the problem-solving process for poor hygiene and the spread of disease. They took initiative to increase the quality of living for themselves and their communities. While we may not know much about their trials and tribulations to reach these goals, one can assume the path was not easy with a lack of resources and technology; much of which we have today is due to their steps in leadership. We have seen people within the science community and those in positions of great power and influence use their roles to push forward with widespread challenges, like the AIDS epidemic and childhood obesity. Leadership does not have to come in the form of an election or well-known title; it can come in the form of advocacy for those that cannot always advocate for themselves, passion for a cause, persistence to see the fight through, and the knowledge to create an effective and realistic plan of action.

Below we have captured more personal stories of those within our own Ohio State and Central Ohio community who are leaders within the world of public health and healthcare. Each has had their own path, education and experience which they have graciously shared for this chapter.

Leaders in Health Care
Dan Bachmann, MD
Dan Bachmann is a Medical Team Manager for Ohio Task Force 1, leading the medical side of a search and rescue team that operates under the Federal Emergency Management Agency (FEMA). He manages the medical rescues and ensures safety of the team, works side by side with others that manage logistics, technical search and rescue, K-9 missions and materials. Each of the team members are specifically trained within their own scope of practice, ready to hand the reins over when best suited for the rescue. Dan highlights that each leader has something to offer, each complimenting the other members and providing a level of support that keeps the team functioning. This team deploys to some of the worst natural disasters our nation has seen, witnessing the deep human aspect of loss and catastrophic change. This kind of work calls for leaders with insight, quick and thoughtful decision making, and the ability to make tough decisions. During Dan’s ‘day job’ as an Emergency Department physician these traits are part of team leadership theory built on real-life group work. As an ED physician, Dan often has to make timely decisions that affects both the treatment team and the patient outcome. These skills are directly transferred to his role leading rescue missions with TF-1. On each mission, Dan discusses how hard it is to ‘sit back’ and ‘wait your turn’. In this atmosphere, sitting and waiting, rather than doing and working, is the hardest part. Logically, he and the other leaders are aware that resting and creating a well thought out mission is ultimately the most important and efficient way to function, as with so many moving parts and aspects to their team, an ill thought out plan could cause more damage.

Team Leadership
Northouse highlights team leadership as having a flatter organizational structure, not operating from the top down, allowing the team to communicate across the plane and enhancing decision making and problem solving. Dan provides a great example of a leader being able to shift the power around to create the most positive outcomes, and in this case, saving lives. Team leadership also allows for full assessment of both internal and external circumstances which will come into play within a rescue event, creating an environment of assessing ability and determining what control exists in the current climate. As one of the leaders, Dan will need to assess internally the skills of his team, communicate the goals of the mission for the team, and advocate for input from other perspectives to ensure a successful mission. Externally, Dan will communicate with those outside of the direct mission to determine next steps for the group and report back what was successful or challenging to better inform outside sources of circumstances for the team.

Susan Moffatt-Bruce, MD, PhD, MBA
For Dr. Susan Moffatt-Bruce, leadership is a ‘state of mind’ that is cultivated with experience and vision. True to her definition, Dr. Moffatt-Bruce has a vision and a lot of experience in leadership. She currently serves as the Executive Director of University Hospital at The Ohio State University Wexner Medical Center (OSUWMC). Prior to being named the Executive Director, she was the Chief Quality and Patient Safety officer at OSUWMC for six years. Along with the leadership roles she has held, she is also a practicing cardiothoracic surgeon and has a PhD, MBA, and MBOE. Nationally, Dr. Moffatt-Bruce is the Chair of the Board of Directors for America’s Essential Hospitals and sits on a committee at the National Quality Forum. In all of these roles she has had a common vision, to improve the quality and safety of patients. The importance of having a common vision is explained in an article by Oliver (2006) in which she argues that a true leader has the ability to explore and define personal and team motives to accomplish change and achieve a shared goal. Dr. Moffatt-Bruce’s ability to set a common vision, mission, and goal is evident in her work and part of what makes her a great leader.

Adding to her definition of leadership, she recognizes that leadership is different for each individual . . . so the key is for each person to make it ‘real’ for them. She views her particular leadership style as servant leadership. As defined by Parris and Peachey (2013), servant leadership theories emphasize service to others and recognize that the role of an organization (or a leader) is to create people who can build a better tomorrow. She is not a dominant leader but rather a facilitator and prefers to lead by consensus. She recognizes that there are different leadership styles and points out that regardless of one’s leadership style, the main goal of leadership is the same, “the leader needs to create a vision and pull people together, the leader is the connector” (Northouse, 2018). A leader needs to be able to reach out to all the stakeholders and get everyone on board to be successful long term. She notes that one can have all the funding in the world for a project, but without pulling a team together to achieve the vision, they will fail.

When looking back, Dr. Moffatt-Bruce did not think she would become a leader of this scale. She came from a traditional background; her mom was a nurse and her dad was a police officer, and she always knew she wanted to be a doctor. When she got to Ohio State there were a lot of opportunities for leadership and she took an interest in quality and patient safety. She invested a lot of time and effort in leadership development, including taking a strength leaders survey, and her results indicated that she is heavily an achiever. She says this strength has helped leverage her to always excel and climb up the ranks.

As she was describing her journey she also pointed out that she ‘always says yes’ when she sees an opportunity to improve the health care system, which is evident by the numerous roles that were described earlier. Her willingness to take on new roles and projects has a positive effective on the people who work with and under her. In the couple months that she has served as Executive Director of University Hospital at OSUWMC, employees have noticed the email updates she sends out highlighting progress being made on projects and invitations to forums being held to share what is going on in the hospital and where it is heading. People appreciate these updates and the availability of her leadership because it helps create a positive culture which helps them feel more confident, hopeful, and optimistic about their work (Woolley, Caza, & Levy, 2011). Her openness and willingness to take on change are just a couple of the characteristics that make Dr. Moffatt-Bruce a great leader.

When Dr. Moffatt-Bruce took on the position as the inaugural Chief Quality and Patient Safety Officer at OSUWMC, she did not feel prepared. She recalls that she went from being responsible for her own work to being responsible for a team of individuals. This was a big change but she credits her role models and mentors for helping prepare her for the position. When she stepped into her role as the Executive Director of University Hospital and became responsible for even more people, she realized delegation, trust, and prioritization become more important the more you take on. She has also learned that including her family and support system in her work decisions is important, which is not something she previously emphasized. She says she now includes her family in decision making processes and that it has had a positive impact.

‘Change’ is common to the nature of improving quality and patient safety, so she is familiar with leading change within an organization. Although difficult regardless of how you go about it, she says there are a couple different ways you can approach organizational change. She believes you need to have a strong will for change or an attitude of ‘if there is a problem we are going to fix it.’ In her view, leaders are responsible for establishing a burning platform and defining the problem. Once the problem is defined, a team should be pulled together to come up with a solution, measure the change, and then evaluate to determine if an improvement has been made.

When gathering a team and getting people on board with a change, she says it is important to understand why some people are not on board and meet them in the middle when possible. She also sees resonating importance with people, relating to them, and appealing to their sensitivities as approaches to getting people on board. One example she recalls is leading the change requiring surgeons to mark surgical sites prior to entering the operating room. She remembers receiving pushback from the surgeons because they believed this was a job that could be done by residents. To rally support, she had them meet a patient who was part of a wrong surgical site event to make the issue more real and appeal to their sensitivities.

Dr. Moffatt-Bruce’s steps to leading change are similar to those outlined in Osland, Turner, Kolb, and Rubin (2011). Osland et al outlines eight steps to managing change in an organization as:
1. Increase urgency
2. Build the guiding team
3. Get the vision right
4. Communicate for buy-in
5. Empower action
6. Create short-term wins
7. Don’t let up
8. Make change stick

Although these steps are slightly different, as I was reading this chapter, I was very much reminded of Dr. Moffatt-Bruce’s approach to leading change and based on her success in leading different aspects of the OSUWMC. I am not surprised that her method is so well aligned with those that are in the literature. In her final thoughts about leadership, Dr. Moffatt-Bruce says that, “ultimately leadership is a privilege and it is earned, you have to work at it and earn the right to lead people.” Leadership is a privilege she has indeed earned.

Jim Allen, MD
Jim Allen has been the Medical Director of the University Hospital East (UHE) location for just over three years, having taken over in 2014. Leading up to this position, Jim states that he had taken various leadership positions over time, beginning with his time as chief resident during residency. Since then he has taken on a number of positions on councils and committees throughout the hospital, even requesting formal training for physicians in leadership to better prepare himself. While he knows that he has made mistakes and will continue to make some mistakes, his goal is to only make them once, learn from them, and keep moving forward.

Currently, UHE is applying to become a Level 3 Trauma center, something that will affect the entire hospital in multiple ways. When asked how he is leading the change he speaks of ‘cultivating change’. These changes come from a consensus, but the impact will be both positive and negative for others depending on their role and changes they will face. How does he do it? Clear communication. He recommends ‘communicating’ often to ensure the correct message is shared. He likens a lack of communication to a game of telephone – soon it is all rumors and incorrect versions of changes that are spreading like wildfire. He also believes in sharing the vision and reason for the change which is to meet the healthcare needs of the community, not just to advance careers.

Presence is a theme that continued to appear throughout our discussion. When asked how he encourages sharing of ideas and advancement of newcomers, he returns to this act of presence. He attends department staff meetings and rounds daily to not only speak to the staff but to be in their environment, to see what they see, experience their experiences, and give staff the comfort of sharing their ideas and feedback on their own turf. When asked by new doctors “How can I become a medical director?” his advice is NOT to “go get a Masters of Business Administration (MBA).” Rather, his answer is leadership ‘presence’. This means joining committees, speaking up at meetings, and communicating with colleagues. This also means attending different departmental meetings and becoming an active part of the organization. While earning an MBA might help you secure your first job, early ‘involvement’ and ‘presence’ will lead to new opportunities and advancement.

We also read about ‘transformational leadership’ in Northouse which is focused on leaders inspiring followers (Northouse 2015). In this case, physicians and staff working together to accomplish positive outcomes while also focusing on the needs and motives of the staff. Much of what Jim states in how he leads fits perfectly with ‘transformational leadership’. He plays off of the goals of the hospital and those that are choosing to work for the community, modeling positive patient care and acting as an engaged leader. His goal of clear communication creates trust which is another important trait of a transformational leader, making him an ideal candidate for this position.

Transformational leadership also includes role modeling for followers and empowering everyone to work to their fullest potential. Jim meets with staff in their comfort zone and works to see experiences through their perspectives to better support and advocate for not only the staff, but the hospital and community. Personally, I have seen Jim at my monthly staff meetings since he took over his role of Medical Director. He invites and welcomes feedback and innovative ideas but also uses corrective criticism and the occasional reality check, setting limits and boundaries. He is kind and confident in his communication, and thus, garners respect from staff (Northouse, 2015).

Mary S. Applegate, MD
At the Ohio Department of Medicaid, Dr. Mary Applegate is at the forefront of the leadership team. She currently serves as Ohio’s first medical director for the Department of Medicaid. Dr. Applegate is a board certified pediatric physician in both pediatrics and internal medicine and continues to see patients in the clinic one day every week. Dr. Applegate has also served in other leadership roles throughout her career, including Medical Director of Pediatric Services at Memorial Hospital of Union County, Medical Director of Loving Care Hospice Program in Union County, and Deputy Coroner of Union County. In response to how she came into the numerous leadership roles she has held throughout her career, Dr. Applegate said, “I always saw a need and I stepped up to the challenge. I never set out to be a leader, I set out to do the best I could.” Dr. Applegate stepped up to almost every leadership position she has held because she saw a challenge and knew that she could handle it.

Dr. Applegate describes herself as a ‘servant leader’. She believes that one of her roles as a leader is to recognize people’s skill sets and to help them by getting them what they need to be successful. While listening to her describe herself as a servant leader and hearing the passion she has for helping patients, especially children and the underserved, I thought of part of the definition by Sendjaya (2015) who describes servant leadership as an “approach that reflects an internal orientation of the heart to serve others.” Along with making sure people have what they need to succeed, she also sees importance in letting people learn. Her example comes from her time as a resident medical school. She recalls some of her mentors allowing the residents to work through tough cases on their own and only stepping in to help as a last resort. She says that letting people figure things out on their own is a great way for people to build their skill set and knowledge for the future.

One of the things that people need to be successful is a good team. The people on a team and members’ skills can affect the results that the team ultimately achieves. Manz, Pearce, & Sims (2009) write that having an empowered team helps produce more quality outcomes, causing the organization to be more effective. Manz et al point out that sharing leadership among teams can have a powerful impact on the team’s performance and empowers different team members to exercise leadership in different ways at different times. This can help make a team more successful and willing to take on more projects in the future. Dr. Applegate believes that finding those people is accomplished by defining the goal and then letting people bring their voice and passion to the vision. This will give the group a sense of ‘owning’ the project and then, when they are successful, they will want to tackle another project. The dynamics of the team are also very important. Diversity among the group, whether it be skills, careers, gender, cultures, etc., will build a richer product. Obtaining input from a diverse group of people will bring in many perspectives and ideas that a homogenous group likely would not have.

Dr. Applegate sees a lot of importance in good leadership. She believes that, “anytime we do something that is not the status quo, leadership is important.” The leader is there to help guide the team toward a common goal, a key responsibility of the leader also mentioned by Dr. Moffatt-Bruce in her interview. Once that goal is set, the leader should help guide the team but never tell people what to do, as that is not motivating. If the group is passionate they will decide how to get to the goal. The leader should also be just as passionate about the goal as the group. She recalls one point in her career when her boss was leaving and she was worried about what direction the organization would go with a new boss. She remembers one of her coworkers saying, “we will be okay, it matters if you leave because you’re the heart of the organization.”

Another important responsibility for leaders is creating a positive work culture. Dr. Applegate believes that, “leaders help shape (or change when needed) the culture of organizations by practicing consistent behaviors that support priority values.” Among these values she listed honesty, integrity, and fairness. Honesty as a leader is seen by many people as being transparent in your processes and open to sharing your beliefs. Integrity is important as a leader because it gives people trust that their leader will do what is right and stand for what they believe in. Having a fair leader is critical for followers because they want to know that everyone has the same opportunities. These things are evident in how people are treated, how promotions are handled, and how work is performed, creating a safe environment in which can people can feel free to be heard and show their best selves.

In leading change from the bottom, Dr. Applegate believes that one of the most important things one can do is learn as much as possible about the issue at hand. She says that in order to develop a good plan, one needs a deep understanding of what the problem is, how the organization is currently functioning, and a clear vision of what outcome is desired. There also needs to be an understanding of systems that already exist surrounding the issue because it would be inefficient to begin building something that is already established. Once the issue is understood and a vision is produced, there needs to be a large enough group of people who believe in the cause and want to help create a solution for the issue. She said of people who lead these types of bottom up changes, “they often do not realize they are leading something until they have followers.”

Ericka Bruns, MSEd, LPCC-S
Ericka is a personal friend and mentor, and I have been lucky enough to see her journey into leadership firsthand. She was an incredible wealth of knowledge for me when I was fresh out of grad school, practicing community social work, thinking I would easily change the world with my newly acquired skills. Her confidence and brilliant skill level led me to often asking her for help and being in awe of all she knew. She eventually became the supervisor to a very small crisis team of which I was a part (3 employees, including her!), and to be completely transparent, I could have been a better subordinate. This was her first taste of leadership; she was no longer my co-worker but now my supervisor. Our dynamics had shifted, and I did not know if I had a new boss or an old friend. I did not know how to communicate through the change, and we both continued to try to learn. Let’s just say we both learned a few things about leadership and followership.

She now supervises 73 staff members over six programs, including coordinators and entry level staff. Over time, she has championed funding for additional staff and resources to address the growing psychiatric need of our community’s children, as well as advocating for herself for appropriate advancement, compensation and well-deserved respect. Ericka created this empire and made the department what it is today by confidently stating what was needed, not backing down at wrinkles in the plan, and following through with fighting the good fight. Not only do these traits make her someone you want with you when you buy a car, they make her someone that you want with you when you are learning and developing skills in your new career, empowering your team, and advocating for the community.

Ericka says she had no plans to become ‘a leader’ when she was completing her schooling, but she was approached for the small team and accepted the position. She believes she was chosen because she was a good therapist, not a good leader. I would argue that her level of knowledge, confidence in her craft and desire to address the needs of the community made her more of a leader than she was aware. She is currently back in school working on her MBA, learning more skills to help her with the business of leading to continue the success of the department.

Completing assessments on leadership style, learning what that style meant and how to build upon it are steps Ericka has taken to grow in her leadership role. What was the most important thing she has learned? How important emotional intelligence and transparency are to leadership. Emotional intelligence, or EQ, embodies self-awareness, empathy, social skills and motivation. She has learned more about her own EQ and has been able to build on her strengths and address her weaknesses. She firmly believes that without EQ one will fail at leadership. Ericka also deeply believes that transparency with staff is important. Staff can tell if they are being kept in the dark, and this will create tension and remove respect from the equation. She acknowledges that you must be humble and take accountability of your team, but each team member also has a level of responsibility.

After interviewing Ericka and being privy to her story from both experience and friendship, she slides easily into the authentic leadership role. She carries herself as genuine, doing right for her team and for the community, trusting that she will educate herself and listen to the needs of her staff, and responding to the needs and values of those around her. She seeks out ways to improve herself, listens to feedback from her team and actively problem solves to create balance and good outcomes. Ericka shows her purpose and value through her dedication to the team and community and has worked with a number of different departments and services to build strong relationships to achieve goals. She has the self-discipline to focus on the end game and weather the storm along the way, none of which can be achieved without compassion for those that she works for and side by side within the field. (Northouse, 2015).

Leaders in Public Health
Lois Hall, MS
To know Lois Hall, is to love Lois Hall. To be in the midst of Lois Hall, is to LOVE public health. Upon meeting this champion of public health and a radiating woman that encompasses the idea of practicing for the greater good, we quickly see how she is a leader within the public health community. While declaring the hard truths, she follows up with thoughtful solutions backed by research and experience, making one certain that only good will prevail. She encourages the sharing of ideas, inviting them to be shared and developed, as one of them could one day make great advancements in public health.

Lois believes leaders are born with the innate ability to lead, however these skills can be cultivated and built upon over time with being reflective. A natural leader, Lois is able to recognize if another might be better suited or has a different air of passion regarding a certain cause. Lois supervised the AIDS and cancer programs with Ohio Department of Health, followed by becoming the executive director of the Ohio Public Health Association (OPHA), and she is now easing into retirement, advocating for proper grief recovery services for all. When falling into the ED position with OPHA, Lois did not feel qualified but operated by the motto, ‘They won’t care how much you know, until they know how much you care’. Yes, one must have skills and knowledge, but the best leaders have genuine interest and heart, and this is easily conveyed as her truth.

Lois is a delightful mix of ‘trait leadership’ and ‘authentic leadership’ styles. Being around her, it is amazing how naturally she can lead, educate, and move a group into genuine excitement about public health. She possesses a natural awareness of herself, her surroundings and her company, and is open to feedback and discussion to enhance her skills. She will make exclamations of joy when endearing and honest moments are shared, further making those around her buzz with energy (Northouse, 2015). Her sincerity is easily unquestioned when in discussion with her. It is clear that she is not only hearing what is said, but she is listening. She offers advice, references current literature, and makes suggestions on connections for advancing an idea. Lois highlights the characteristic of secure relationships by the strong connection she continues to have with past co-workers, colleagues and students (highlighted by the immediate acceptance to be interviewed for this book). She values sincerity, trust and purpose, all of which become clear within the first minutes of meeting her (Northouse, 2015).

Vince Caraffi, RS, MPH
Vince Caraffi is currently a supervisor with the Cuyahoga Board of Health, overseeing the Environmental Health Service Area for the last 16 years. He came into the role after observing a strong leadership team, and through this, he felt prepared to lead by what he had seen in the past. Although not perfect, Vince is aware that acknowledging and apologizing for mistakes can go a long way – we are all human. He experienced this first hand after a moment of heated interaction between himself and a TV reporter, an experience that Vince draws from in his leadership style.

Maintaining a trusting and a respectful relationship through active listening and open communication has been an important base for Vince in his time with the Board of Health. This again aligns with authentic leadership (Northouse, 2015). Vince values those that work for him as people, their ideas and input, and will listen to identify what needs they might have from him and their career. If he is leading others to achieve goals, this leadership style expresses commitment not only to that goal, but to his followers, as well. Sharing failures and successes with those that are looking to advance provides them with additional knowledge so they can avoid unnecessary challenges. He also understands the benefit in talking with staff, listening to their ideas and perspectives and giving others the chance to succeed.

In talking with Vince, he often alludes to listening to those that he works with and building relationships with all levels of staff, giving an air of ‘appreciative inquiry’ to the way he manages his role. Like ‘appreciative inquiry’, Vince believes in creating dialogue that can generate change and advancements, and much of this transformation can take place within the people he is working with and guiding (Rothwell, Stavros & Sullivan, 2016).

Mary Ellen Wewers, PhD, MPH
With over 30 years of experience in the field, Mary Ellen Wewers, PhD, MPH is a leader in the area of tobacco cessation research. Dr. Wewers started her career as a nurse working in an intensive care unit and quickly became the head nurse for her unit. During her time as a nurse, she became increasingly interested in primary care and disease prevention, so she decided to return to school to get her Master of Science in Nursing. While getting her MSN, she discovered her interest in research and ultimately decided to continue her studies and earn a PhD in Nursing. After working in the field of public health for several years, she then decided to go back to school one more time and earned a Master of Public Health with a specialization in Health Care Management and Policy.

Dr. Wewers has held many different leadership positions throughout her career, for each of which she felt increasingly prepared. When she was first asked to be the head nurse in the ICU, she said she did not feel prepared and thought there were more experienced people for the position. She ultimately accepted the position, however, because she was encouraged by leadership to apply for the job and decided she was up for the challenge. After going back to school and completing her degrees, Dr. Wewers became an associate professor at The Ohio State University in the College of Nursing. She eventually became the PhD program director in the College of Nursing and the Co-Program Director of Cancer Control at The Ohio State University Comprehensive Cancer Center. Her next career move was into the field of public health as a professor and the Interim Director at the Center of Health Outcomes, Policy, and Evaluation Studies. She later became the Associate Dean for Research, served as the Acting Dean, and served as the Interim Chair of Epidemiology. She pointed out that much of her success at The Ohio State University could be credited to the opportunities for leadership development at the university. She recalls receiving good mentorship from her peers and formal leadership training provided by OSU to all deans and chairs across the university.

Dr. Wewers defines leadership as having both a formal and an informal aspect. She says that the formal definition of leadership is an appointment with a title in which there are job responsibilities, people or an agency to oversee, and goals and objectives that must be met. The informal definition of leadership is when a person within a group steps forward with their opinion, behaves in a way to be viewed as credible, and is genuinely interested in achieving a goal. Her definitions of formal and informal leadership are very similar to the definitions described by Pielstick (2000). He differentiates the two by stating that formal leaders are those who are in positions of power and informal leaders are those who do not hold formal positions but are still recognized as being leaders (Pielstick, 2000).

She describes her leadership style as a combination of many different things but her strengths include listening, being respectful, and keeping people’s faith alive when working toward a goal. She believes that when leading, it is important to get a consensus from your team and have a clear vision of what you want to do moving forward. After clearly defining the vision, she says the leader needs to identify where team members stand in terms of supporting or opposing the vision. For those team members who are on board and those who have neutral opinions on the topic, she helps them move toward achieving the end goal. For those who oppose the vision, she says it is important to hear them out, listen to their concerns, and address those concerns. Ultimately, she says you will never get everyone 100% on board, but the goal is to get the majority.

When it comes to following, Dr. Wewers believes it depends on the boss. Some bosses will welcome the opinions of subordinates and let them weigh in, while others will not be so welcoming, so it is all about learning how your boss leads. She says she is fortunate that she has always had good bosses that are willing to listen to others’ ideas. This willingness to listen has been shown in the literature to help raise one’s self-perception on what he or she does well or poorly and helps a leader notice when there is a discrepancy between their own self-awareness and how others perceive them. This can help leaders adjust their behavior and makes followers more apt to provide feedback (Oc and Bashshur, 2013). Along with learning a boss’s leadership style, Dr. Wewers believes it is important for people to ‘do their homework’ on a topic when they want to make a case to their boss so that they seem credible and their boss is more likely to listen. She says ultimately if you want to make a change within your organization, you need to get your boss on board, and if you show passion for the issue, that will likely happen.

Karen Fields, MS, BSN, RN
Karen Fields has been a Sexual Health Clinic Manager for over 10 years for Columbus Public Health, taking over a role that previously had not had a manager stay for more than two years. She credits being able to read her team, make tough decisions, give credit, and encourage laughter and lightness. Karen has taken a leadership course and relates to servant leadership, a role that emphasizes attentiveness to the needs of her followers, empowering them and helping them develop to their full capacity (Northouse, 2015).

While Karen does not necessarily see herself as a follower in any regard (she reports she was always taught to lead), she recognizes that, at times, someone else needs to ‘drive’. She gives the example of geese flying, taking turns leading the group in the direction of their goal. She is part of a team, but the team will not let one member get too worn out before reaching the destination.

Karen also discusses some of her most difficult times as a leader, in dealing with toxic co-workers, both to themselves and to the team, as well as ethical concerns that have led to letting go a beloved team member. From these experiences, she can say that she would have liked to manage the co-worker differently, but has learned more about her own integrity and developed her leadership ability because of experiences such as these.

These kinds of experiences and Karen’s response to them pull from Positive Organizational Scholarship, and have taught her how to look at situations through a new scope and create an atmosphere of resiliency for herself and those working in her department. Keeping laughter and hopeful outlooks have served Karen well on her path to leadership (Bakker, 2013).

Mysheika Roberts, MD, MPH
Although new to her current position as the Health Commissioner and Medical Director for Columbus Public Health, leadership is nothing new for Dr. Mysheika Roberts. Prior to her current appointment, Dr. Roberts served as the assistant health commissioner at Columbus Public Health and has held positions at the Center for Disease Control and Prevention and at the Baltimore City Health Department. She is also a participating member of the community, active on boards at Columbus Medical Association Foundation, Young Women’s Christian Association (YWCA) of Columbus, Mid-Ohio Foodbank, Lifeline of Ohio Minority Advisory Group, and OhioHealth’s Faith, Culture, and Community Benefit Committee.

Dr. Roberts views leadership in many different ways. Individually, she says leadership is believing in something, being confident to take a stand, and acting so that your actions reflect what you believe. From a team standpoint, she sees the leader as someone who will give people the tools they need to be successful and then giving them space and flexibility to work on the task at hand. When leading her team, Dr. Roberts leads by example and never asks anyone to do something she would not feel comfortable doing herself. She also likes to be motivational, giving people a vision and challenging them to execute, something she believes allows people’s skills to shine. When co-leading with another individual, Dr. Roberts sees value in a ‘divide and conquer’ approach. She explained that she likes to take a task, divide it up and reconvene at a later time to gauge progress and either finish or decide the next steps for the project. She says sharing the responsibility, meeting in the middle, and being confident in your colleague are important when working with others.

Leadership has been a part of Dr. Roberts’ life since she was in high school. She recalls she was the class vice president during high school and held a similar role during medical school. She says she always had a leadership ‘vibe’, but she never thought that she would have such high roles as the Health Commissioner at CPH. Due to her natural leadership characteristics, she has never taken any formal leadership courses but admits she is drawn to leadership articles. Her awareness of her own strengths and weaknesses as a leader, desire to uphold her moral values, and ability to communicate the importance of change for the health of the community are some of the characteristics of her natural leadership style that would lead me to describe her as an authentic leader (Woolley et al., 2011). Authentic leaders also recognize the importance of developing a relationship between leaders and followers, so it is no surprise that Dr. Roberts has an open channel of communication with her staff. She also values the perspectives of other leaders she has encountered throughout her career and appreciates their perspectives on things, such as making teams thrive. Her mentors, especially the women, she says, have also helped her build the skills required of her to be a great leader.

Early in her career, many of the challenges she faced were related to race, age, and gender. Being a young, African American female, she felt like people did not take her seriously. She says from this she learned that she needed to “always be prepared, make sure her voice was heard, and to be confident but not cocky.” Now, challenges in her career are more centric to her work. She says there is always a lot to be done and high expectations. She also pointed out that as you move up the chain of command, there is more responsibility to ‘take the heat’ for things that do not go well for the organization but the flip side is that there are rewards for when things go well. She says this is something she is learning from her transition from assistant health commissioner to health commissioner.

Leading change is something she recognizes is hard for most people. Much of the challenge is due to feelings. Osland et al (2011) argue that “people change what they do because they are shown a truth that influences their feelings and less because they are given analysis that shifts their thinking.” This is similar to what Dr. Moffatt-Bruce noted about appealing to people’s sensitivities to lead change and what Dr. Applegate emphasized about finding people who are passionate to make ideas for change reality. Dr. Roberts also says rallying the troops or team to understand that change is good is often the first step and then gathering everyone’s ideas should be next. It is also important for everyone to recognize that just because a change is being proposed does not mean something is being done poorly, rather that it can be done better. She says it is also important for everyone to know that they have the ability to lead change no matter their position. For someone at the bottom, they should have a clear vision, communicate it with the chain of command, and show a sense of leadership and willingness to go above and beyond. She says managers see potential ‘self-starters’ and are usually willing to support their passion.

Concluding her thoughts on leadership, Dr. Roberts says, “Leadership is a journey, leaders are always learning and being challenged. No one should ever feel that their challenge or journey is over.” It is evident by her passion for public health that Dr. Roberts journey is nowhere near being over.

Conclusion
What makes a great leader within health care and public health encompasses a number of different characteristics, behavior, and traits. The case studies we have described reveal a range of approaches to leadership, from those who seek out their own training and education, to those who learn as they go, learning from successes and failures and making changes along the way. When we look at what we can do as health care and public health leaders, we are reminded that a good leader within the field has the ability to assess team and individual performance capabilities and uses a critical eye when necessary. A leader will be able to address barriers head on, such as limited financial support, other economic limitations, and changing agendas due to changes in political leadership. Leadership is also being encouraged to use horizontal connections rather than leading from the top down to encourage all to work together at local, national and world levels (Popescu, G.H, Predescu, V., 2016).

Many of the leaders that were interviewed, including Ericka, Lois, Vince, and Dr. Roberts, exhibited ‘authentic leadership’ (Northouse, 2015). This is telling, highlighting that this leadership style makes a leader approachable, respected, and open to sharing an experience with others willing to learn. Approaching someone that does not value guidance and relationships may very well receive a different response. This makes us hopeful for the future of our healthcare and public health systems that we can choose leaders that lead out of genuine desire for those they serve, rather than for self-serving reasons.

‘Servant leadership’ was also exhibited by several of the leaders interviewed for this chapter, including Dr. Moffatt-Bruce, Dr. Applegate, and Karen. Servant leaders tend to put their followers first, organization second, and their own interests third. This type of leadership fits well with the nature of work that comes with a public health or healthcare career. These types of careers focus on helping improve the health and well-being of patients and the community, so having a leader willing to serve those people first is important. A combination of authentic and servant leadership theories were seen in almost all of the leaders interviewed, which is evident in their approaches to creating and working toward a vision of a healthier population.

‘Teamwork’ was another common topic of discussion in many of our interviews. The leaders we interviewed highlighted the importance of building teams with the skills and abilities to work together to work toward a common goal. Teams allow for the workload to be divided up among many different people and for many different perspectives and ideas to be added to the project, creating a richer product, as pointed out by Dr. Applegate. The ability to create a successful work team also encourages the team members to perform their jobs better and increases the chances that the team will want to work together on projects again in the future.

The willingness of people to want to work together on projects is important in an ever-changing world of health care and public health. Nearly all of the leaders we interviewed had something to say about the importance of change and how to manage it. ‘Leading change’ is something they recognize is not always easy but requires persistence, communication, and the development of a clear vision. As Dr. Roberts pointed out, making changes does not always mean something is being done wrong, but that it could be done better, a truth we in health care and public health know very well, as we are always working toward a healthier population.

Through the wealth of knowledge that was gained in doing these interviews, we are happy to realize that we have come away knowing that working together, listening to one another, and acknowledging that we cannot manage this world of healthcare and public health alone was an overarching theme. We heard about the importance of ‘listening to others’, ‘encouraging ideas’, and ‘giving credit where credit is due’. The leaders we interviewed are the leaders that can bring positive changes to our healthcare and public health systems. These are the leaders we can and will learn from over time. These are the leaders that want us to learn, and in that revelation alone confirms that we have wonderful leadership here in Central Ohio.

We will leave you with the idea behind ‘Public Health 3.0’, as it is gaining steam and becoming increasingly popular within many professional and leadership circles. This idea is encouraging local leaders to serve as Chief Health Strategists, partnering with multiple sectors across the community. We see this as our leaders are working with grief specialists, multiple specialties in hospitals that provide direct patient care in different modalities, and the community directly. This data will be used to address social, environmental and economic conditions affecting health and equity. Our leaders want this data to invite new ideas and strategies to address the needs of our communities and those that we serve. A new mindset is being promoted to get ahead of public health concerns, becoming preventative instead of reactive (DeSalvo, K.B. et al, 2017). Leadership is beginning to take an upstream approach, acknowledging that we may not have all of the power from the top down, but we can use the abilities we do have and make positive changes given the ever-changing policies of current national leadership. In reviewing what our current leaders are doing now and what they can do for the future of healthcare and public health, it is safe to say we are in good hands to begin our path to Public Health 3.0.