Public Health Preparedness & Leadership Louis Rowitz, PhD Director Mid-America Regional Public Health Leadership Institute

We cannot live in a post- September 11, 2001 world with a pre-September 11, 2001 mind. --adapted from Angela Thirkell, 1933

TRADITIONAL AND CRISIS LEADERSHIP TRADITIONAL AND CRISIS LEADERSHIP WHAT ARE THE WHAT ARE THE DIFFERENCES? DIFFERENCES?

DEFINITION OF CRISIS A CRISIS IS CHARACTERIZED BY A HIGH DEGREE OF INSTABILITY AND CARRIES THE POTENTIAL FOR EXTREMELY NEGATIVE RESULTS THAT CAN ENDANGER THE LIVES OF PEOPLE IN A COMMUNITY. A CRISIS IS CHARACTERIZED BY A HIGH DEGREE OF INSTABILITY AND CARRIES THE POTENTIAL FOR EXTREMELY NEGATIVE RESULTS THAT CAN ENDANGER THE LIVES OF PEOPLE IN A COMMUNITY. (ADAPTED FROM KLANN) (ADAPTED FROM KLANN)

TYPES OF CRISES NATURAL DISASTER NATURAL DISASTER ACT OF WAR ACT OF WAR TOXIC CHEMICAL RELEASE TOXIC CHEMICAL RELEASE HAZARDOUS MATERIAL SPILL HAZARDOUS MATERIAL SPILL CRASH OR DERAILMENT CRASH OR DERAILMENT STRIKE OR BOYCOTT STRIKE OR BOYCOTT TERRORIST ACT TERRORIST ACT FINANCIAL CATASTROPHE FINANCIAL CATASTROPHE

BE PREPARED The New Public Health Marching Song

ANALYTIC STRUCTURAL CONCEPTUAL SOCIAL

SYSTEMS THINKING AND COMPLEXITY Do you understand your community?

The Iceberg Events Patterns Systemic Structure Mental Models Vision

SystemCrisisComplexity Issues Recovery

Community Assets Map

Exercise on Forces for Change

CRITICAL ISSUE: HOW DO I KEEP MY FAMILY SAFE?

TIPPING POINT AWARENESS

Public Health Complexity Issues: Leadership Demands The Tipping Point Societal Trends Strategic Challenges P.H. Community Context

Public Health Response Local Public Health Response (Complexity) Societal Pressure Community Crisis and Priorities National Agenda Strategic Challenges

Societal Pressures

Dimensions of Culture (Hofstede, 1997) 1. Power Distance 2. Collectivism vs. Individualism 3. Femininity vs. Masculinity 4. Uncertainty Avoidance

Power distance is the extent to which the less powerful members of institutions and organizations within a country expect or accept that power is distributed unequally.

Individualism pertains to societies in which the ties between individuals are loose; everyone is expected to look after himself or herself and his or her immediate family Collectivism as its opposite pertains to societies in which people from birth onwards are integrated into strong, cohesive in-groups, which throughout people’s lifetimes continue to protect them in exchange for unquestioning loyalty.

Masculinity-femininity as a dimension of societal culture

Uncertainty of avoidance is the extent to which the members of a culture feel threatened by uncertain or unknown situations

STRATEGIC CHALLENGES

NATIONAL AGENDA

Adaptation to Change The Resilience Factor

The Structure of Change Conner Resilience Nature Process Roles Resistance Commitment Culture Synergy

Leadership Styles and Environment Match

StyleGoalOptimumEnvironment Anti-change Protect the status quo Magnitude: Inconsequential Cost of failure: Slight Rational Minimize the melodrama and avoid mistakes Magnitude: Modest Cost of Failure: Noteworthy Panacea Keep people happy Magnitude: Strong Cost of Failure: Significant Bolt-on Take care of as many people issues as feasible, given the constraints. Magnitude: Shocking Cost of Failure: Considerable Integrated Treating people issues as integral to the success of each major project. Magnitude: Breath taking Cost of Failure: Dramatic Continuous Succeed with current projects while ensuring that the organization maintains adequate assimilation resources for the changes it will face in the future. Magnitude: Relentless Cost of Failure: Prohibitive

The Value of Structured Flexibility Do you understand the procedure? Learn It! Is there a need to make and exception? Is there time to get approval/input from others? Check with the appropriate person to get advice or approval to proceed. Follow the Procedure If permission is denied, follow the procedure as directed. If desired, advocate for changing the procedure in the future. Record your learnings for possible incorporation in updated procedures. Go Ahead! Did it work? Would it work in other situations? Record your learnings so we don’t do it again the same way. Record your learnings so we know why it won’t apply elsewhere. No Yes Use your best Judgment, communicate your actions to the appropriate person as soon as possible, and be prepared to explain what was done and why. Yes No YesNo

NATIONAL AGENDA PUBLIC HEALTH CERTIFICATIONS PUBLIC HEALTH CERTIFICATIONS HEALTH ALERT NETWORK HEALTH ALERT NETWORK PUBLIC HEALTH LEADERSHIP PUBLIC HEALTH LEADERSHIP ESSENTIAL PUBLIC HEALTH SERVICES ESSENTIAL PUBLIC HEALTH SERVICES WORKFORCE DEVELOPMENT WORKFORCE DEVELOPMENT PUBLIC HEALTH INFRASTRUCTURE NATIONAL PERFORMACE STANDARDS PUBLIC HEALTH INFORMATICS MAPP EVIDENCE-BASED PUBLIC HEALTH HOMELAND SECURITY

The Neutral Zone Ending, Losing, Letting Go The New Beginning Time Transitions (Bridges)

Social Capital Theory Those resources including trust, norms and associational networks inherent to social relations which facilitate collective action.

New Leadership Pyramid Core Public Health Skills Discipline Specific Content Management Skills Core Leadership Skills Individual Leadership in Practice Team Leadership in Crisis Best Practices PerformancePerformance CapacityCapacity BuildingBuilding

ECOLOGICAL LEADERSHIP ECOLOGICAL LEADERS ARE COMMITTED TO THE DEVELOPMENT OF THEIR LEADERSHIP SKILLS AND COMPETENCIES THROUGHOUT THEIR PROFESSIONAL CAREERS WHILE AT THE SAME TIME BEING COMMITTED TO THE APPROPRIATE APPLICATION OF THESE SKILLS IN THEIR COMMUNITIES CHANGING HEALTH PRIORITIES. ECOLOGICAL LEADERS ARE COMMITTED TO THE DEVELOPMENT OF THEIR LEADERSHIP SKILLS AND COMPETENCIES THROUGHOUT THEIR PROFESSIONAL CAREERS WHILE AT THE SAME TIME BEING COMMITTED TO THE APPROPRIATE APPLICATION OF THESE SKILLS IN THEIR COMMUNITIES CHANGING HEALTH PRIORITIES.

THE DELICATE BALANCE ECOLOGICAL LEADERS IS ABLE TO BALANCETHE NEEDS OF DAY-TO-DAY PRACTICE OF PUBLIC HEALTH IN HIS/HER ORGANIZATION AND COMMUNITY WITH THE SPECIAL SKILLS AND APPLICATIONS NECESSARY TO ADDRESS PUBLIC HEALTH EMERGENCIES ECOLOGICAL LEADERS IS ABLE TO BALANCETHE NEEDS OF DAY-TO-DAY PRACTICE OF PUBLIC HEALTH IN HIS/HER ORGANIZATION AND COMMUNITY WITH THE SPECIAL SKILLS AND APPLICATIONS NECESSARY TO ADDRESS PUBLIC HEALTH EMERGENCIES

Leadership and Preparedness in Crisis Situations

BIOTERRORISM: Competencies for Leaders 1. DESCRIBE the chain of command and management system 2. COMMUNICATE public health information/roles/capacities/legal authority accurately to all emergency response partners 3. MAINTAIN regular communication with emergency response partners

Competencies for Leaders (Continued) ASSURE that the agency has a written updated plan ASSURE that the agency regularly practices all parts of emergency response EVALUATE every emergency response drill ASSURE that knowledge and skills are transmitted to others

WHO’S IN CHARGE? BIOTERRORISM OR DISASTER EVENT INCIDENT COMMAND SYSTEM COLLABORATION NO COLLABORATION

NEW PARTNERSHIPS  Emergency Management System  Police Department  Fire Department  Emergency Medical System  Community Health Centers  FBI  Local Public Health Department  Homeland Security

NEW MODELS OF COLLABORATION 1. Shared Work 2. Maintain Organizational Identities 3. Synergy

CHANGING WAYS TO WORK  CORE  SPECIALISTS  GENERAL WORKERS  COMMUNITY RESIDENTS

MEASURES OF SUCCESS: IN COLLABORATIVE LEADERSHIP  COMMUNICATION  ASSESSMENT  CONFLICT MANAGEMENT  DEVELOPMENT OF TRUST  DECISION-MAKING  ADDRESSING SAFETY CONCERNS

DEFINITION OF EMOTIONAL INTELLIGENCE THE ABILITY TO USE YOUR EMOTIONS IN A POSITIVE AND CONSTRUCTIVE WAY IN YOUR RELATIONSHIP WITH OTHERS THE ABILITY TO USE YOUR EMOTIONS IN A POSITIVE AND CONSTRUCTIVE WAY IN YOUR RELATIONSHIP WITH OTHERS

Self (Personal Competence) Other (Social Competence) RecognitionSelf-Awareness Emotional self-awareness Emotional self-awareness Accurate self-assessment Accurate self-assessment Self-confidence Self-confidence Social Awareness Empathy Empathy Service Orientation Service Orientation Organization Organization RegulationSelf-Management Emotional self-control Emotional self-control Trustworthiness Trustworthiness Conscientiousness Conscientiousness Adaptability Adaptability Achievement drive Achievement drive Initiative Initiative Relationship Management Developing others Developing others Influence Influence Communication Communication Conflict management Conflict management Visionary Leadership Visionary Leadership Catalyzing change Catalyzing change Building bonds Building bonds Teamwork and collaboration Teamwork and collaboration A Framework of Emotional Competencies p. 28 Cherniss and Goleman

Leadership Style EI Competencies Objective Visionary Self-confidence, Empathy, Change Catalyst, Visionary Leadership Mobilize others to follow a vision Affiliative Empathy Building Bonds, Conflict Management Create harmony Democratic Teamwork and Collaboration, Communication Build commitment through participation Coaching Developing Others, Empathy, Emotional Self-Awareness Build strengths for the future Coercive Achievement Drive, Initiative, Emotional Self-Control Immediate compliance Pacesetting Conscientiousness, Achievement Drive, Initiative Perform tasks to a high standard Leadership Style, EI and Organizational Effectiveness

PEOPLE SMART STRATEGIES 1. Flexibility in communication 2. Personal stress management 3. Help others who express pessimism about the future 4. Show respect for others 5. Manage work rage

Exercise on Emotional Intelligence

Relationship between Risk Communication and Crisis Communication

RISK COMMUNICATION SKILLS 1. High Concern-High Stress Situations 2. Trust Determination and Building Trust 3. Strategies for stressed people who do not listen 4. Skills for dealing with negative statements (Covello) 1 N = 3 P 1 N = 3 P One negative = Three Positive One negative = Three Positive 5. Risk perception by the public and skills for dealing with it

CRISIS COMMUNICATION COMMUNITIES MUST FORM A FLEXIBLE AND QUICKLY ACTIVATED CRISIS COMMUNICATION TEAM TO IMPLEMENT A COMMUNICATION PLAN AS A PART OF THE TOTAL RESPONSE EFFORT COMMUNITIES MUST FORM A FLEXIBLE AND QUICKLY ACTIVATED CRISIS COMMUNICATION TEAM TO IMPLEMENT A COMMUNICATION PLAN AS A PART OF THE TOTAL RESPONSE EFFORT

SEVEN STEP COMMUNICATIONS RESPONSE PLAN ACTIVATE THE CCT ACTIVATE THE CCT GATHER AND VERIFY INFORMATION GATHER AND VERIFY INFORMATION ASSESS THE GRAVITY OF THE CRISIS ASSESS THE GRAVITY OF THE CRISIS IDENTIFY KEY STAKEHOLDERS IDENTIFY KEY STAKEHOLDERS IMPLEMENT A COMMUNICATIONS STRATEGY IMPLEMENT A COMMUNICATIONS STRATEGY DEVELOP EXTERNAL MATERIALS DEVELOP EXTERNAL MATERIALS INFORM PARTNERS,STAKEHOLDERS, AND MEDIA INFORM PARTNERS,STAKEHOLDERS, AND MEDIA

INFORMATION TECHNOLOGY: How to use data

KNOWLEDGE OF THE LAW 1. POLICE POWERS 2. PERSONAL RIGHTS 3. CONFIDENTIALITY--HIPAA

FORENSIC EPIDEMIOLOGY

New Leadership Skills for New Times

Major Crisis Leadership Lessons (Mitroff) Prepare for at least one crisis in each crisis family It is not sufficient to prepare for crisis that are normal in community Prepare for the simultaneous occurrence of multiple crisis The purpose of definition are to guide, not predict

Major Crisis Leadership Lessons (Mitroff) continued Every Type of Crisis can happen to every organization No Type of Crisis should be taken literally Tampering is the most generic form or type of crisis No Crisis ever happens as one plans for it Traditional risk analysis is both dangerous and misleading

Major Crisis Leadership Lessons (Mitroff) continued 10. Every crisis is capable of being both cause and the effect of any other crisis 11. Crisis Leadership is systemic 12. Perform a systemic crisis audit of your agency and community 13. Crisis leaders not only recognize the validity of all types of crisis, but they also see the interconnections between them

COMMUNITIES SHOULD MAKE PLANS NOW FOR DEALING WITH ANY RECURRENCES. THE MOST PROMISING WAY TO DEAL WITH A POSSIBLE RECURRENCE IS TO SUM IT UP IN A SINGLE WORD ‘PREPAREDNESS’ AND NOW IS THE TIME TO PREPARE. RUPERT BLUE RUPERT BLUE CIVILIAN SURGEON CIVILIAN SURGEON GENERAL, 1919 GENERAL, 1919

Leadership will involve working at all levels of the system