Introduction: Healthcare and Health Policy Leadership and Organizational Behavior in the 21st Century

We are in a crisis in healthcare and public health leadership. The diverse and rapidly changing political, technological, economic, and socio-cultural shifts in the last fifteen years have had a tremendous impact on healthcare delivery systems and public health. All aspects of the system seem to be shifting and changing with increasing rapidity at all times. We have moved from quality improvement (70’s-80’s) to total quality management (90’s-10’s) and now performance management (10’s and beyond) with increasing pressure to meet the triple aim and value-based healthcare delivery outcomes. We spend more money than other countries, yet we consistently rank low in terms of outcomes related to safety, quality, and cost compared to other first-world countries (Commonwealth Foundation, 2014). Who is ultimately accountable for the health of our nation? What is the role of leadership across healthcare and public health settings? What aspects of leadership theory and models might apply to help us address the gaps and challenges of leading healthcare delivery system change and reform? In this Pressbook, students of the PUBHHMP 6615 course at The Ohio State University, College of Public Health tackle a variety of leadership challenges and apply their experiences, learning, and theories in their individual chapters throughout the book.

The study of leadership is growing, and there are a number of existing leadership theories. The way in which one leads may affect how individual followers, teams, and entire organizations function, prompting leaders to foster an atmosphere of teamwork. We start our journey with a chapter on team science is a collaborative and interdisciplinary approach to study groups, and Hustead explores the intersection of teamwork and leadership in her chapter. Leading virtual healthcare teams is both an art and science and is shared by Clouner. Big-Data and data analytics are a central aspect of 21st century medicine. Mircoff explores central technology enabled/challenging themes like empowerment, transparency and trust, inquiry and innovation, and values related to organizational change. An example of leadership from the top down is provided as Schreiber describes similarities and differences for Chief Medical Officers in central Ohio with a focus on leadership approaches, traits, and skills. Frey provides a personal early journey in leadership and reflects on his practice and understanding of leadership.

Healthcare in the 21st century spans a much wider range than ever before, and Fawley tells us about how leadership in public health can be viewed through a collective impact framework. Personal stories and reflections collected from central Ohio leaders are shared by Finnegan and Baumer and encompass both healthcare delivery and public health. Leadership is important during normal times, but becomes critical during a crisis. Colvell explores a management crisis framework and applies it to the Flint, Michigan public health water crisis.

Culture shifts are occurring within organizations, thus impacting how leaders manage diverse followers and raising important questions. For example, how do we define cultural humility in our LGBTQ communities? Applegate helps us understand critical factors in leading LGBT populations and what leadership theory tells us about managing disparities, empowerment, and skills. Feyes dives deeply into promoting and understanding leadership in diversity in organizations.

Medical errors and safety are a major problem across the U.S. healthcare system, and Roberts explains some of the leadership dynamics like hierarchy and role status. Guido reflects on his experience as a physician hospitalist focused on leadership inclusiveness and psychological safety in the inpatient hospital setting. Communication and the science and art of feedback for leaders is crucial in creating an atmosphere of inclusion and safety. Westrick and Erdeljac explore these themes in their chapter on feedback in leadership. How do great leaders manage conflict that may arise during feedback? Smiley defines what is meant by conflict management and which leadership approaches might be most suited to managing conflict.

Employee wellness programs should be a priority for healthcare and public health leaders. Griffin provides an overview of wellness programs and their effects in the healthcare sector. Schwartz and Rosebrook both explore psychological safety, creating a culture of safety, and developing leadership behavior as a critical factor in setting the tone for well-being at work. In addition to employee wellness, burnout and compassion fatigue are a major concern for caregivers in the field of addiction and substance abuse. Fowler helps us understand how positive organizational psychology may be applied to palliative healthcare settings. In the context of the current opioid epidemic, Moffitt explores contributing and protective factors for individual care providers in addiction treatment facilities.

We encourage you to consider the implications of the above perspectives and insights and apply them in your own healthcare and public health leadership settings. We know change is inevitable. How we embrace change and influence it will be a measure of our leadership effectiveness. We encourage you to join us in exploring healthcare and public health leadership theory and practice.