Leadership Challenges for Rural Health Departments Louis Rowitz, PhD Director Mid-America Public Health Training Center

THE CHALLENGES

RURAL HEALTH DEPARTMENTS HAVE TO DO MORE WITH LESS  LESS MONEY  LESS STAFF  GEOGRAPHIC ISOLATION  LIMITED TECHNICAL RESOURCES  POOR SALARIES  FEWER PARTNERS

RURAL HEALTH DISPARITIES  HIGHER SMOKING RATES AMONG TEENAGERS AND ADULTS  FEWER DENTAL CARE VISITS  LACK OF HEALTH INSURANCE  HIGHEST DEATH RATES FOR UNINTENTIONAL INJURIES IN GENERAL AND MOTOR VEHICLE INJURIES SPECIFICALLY  HIGH DEATH RATES FOR CHILDREN AND YOUNG ADULTS(AGES1-24)

DIVERSITY OF RURAL COMMUNITIES  DIFFERENCES IN ECONOMIES  AGRICULTURE  TOURISM  MANUFACTURING  MINING  ENERGY

DIVERSITY (CONTINUED)  DEMOGRAPHIC DIFFERENCES  MOSTLY CAUCASIANS  INCREASE OF MIGRANT STREAM FROM MEXICO IN SOME AREAS  AGING POPULATIONS  LARGE SEGMENTS OF THE POOR  LOWER LEVELS OF EDUCATIONAL ATTAINMENT  MANY ON PUBLIC PAYMENT SYSTEMS IN SOME AREAS

DIVERSITY (CONTINUED)  DIFFERENCES IN POPULATION DENSITY  FRONTIER ISSUES  SERVICES ARE OFTEN TIED TO POPULATION DENSITY

DIVERSITY (CONTINUED)  DIFFERENCES IN TERRAIN  DISTANCES ACROSS OPEN PLAINS DIFFERENT THAN MOUNTAIN DISTANCES  ADEQUACY OF ROAD AND TRANSPORTATION DIFFERENCES  REGIONAL WEATHER PATTERNS

DIVERSITY (CONTINUED)  PROXIMITY TO URBAN AREAS INCREASES ACCESS TO SERVICES

DIVERSITY (CONTINUED)  DIFFERENCES IN AVAILABILITY OF RESOURCES  LACK OF SOCIAL CAPITAL  ACCESS TO TECHNOLOGY  AVAILABILITY OF EDUCATION AND TRAINING OPPORTUNITIES  AFFORDABLE HOUSING  GOOD SCHOOLS  TRAINED WORKFORCE

DIVERSITY (CONTINUED)  DIFFERENCES IN PUBLIC HEALTH PRESENCE

THE LEADERSHIP ISSUES

 COLLABORATION  LACK OF RESOURCES  DIFFICULITES IN CARRYING OUT THE CORE FUNCTIONS AND ESSENTIAL SERVICES

 UNTRAINED STAFF  CREDENTIALING AND ACCREDITATION  PUBLIC HEALTH PREPAREDNESS

 TOO FEW STAFF  OLD EQUIPMENT  DIFFICULTIES IN DISTANCE LEARNING  FEAR OF THE BOARD

 BILINGUAL AND CULTURAL ISSUES  AGING POPULATIONS  BORDER HEALTH CONCERNS  LACK OF MONEY

 HARD TO GET AND PAY CONSULTANTS  MIGRANT ISSUES  SHARING LEADERSHIP CONCERNS

 COMMUNITY ASSESSMENT DIFFICULTIES  PERFORMANCE STANDARDS COMPLEX  SYSTEMS THINKING WITHOUT A SYSTEM

LEADERSHIP STRATEGIES

LEADERSHIP TEAM BUILDING VALUES CLARIFICATION MISSION VISION GOALS & OBJECTIVES ACTION IMPLEMENTATION EVALUATION POLICY DEVELOPMENT ASSESSMENT POLICY DEVELOPMENT ASSURANCE POLICY DEVELOPMENT ASSURANCE POLICY DEVELOPMENT Rowitz, p. 88, Figure 5-3 LEADERSHIP WHEEL

BUILD SOCIAL CAPITAL WITH YOUR BOARD

PARTNERSHIPS UTILIZING A REGIONAL MODEL

ASSETS PLANNING

BUILDING COALITIONS UTILIZING DIFFERENT MEETING MODALITIES -THE MOVEABLE FEAST

DIFFERENT TRAINING APPROACHES

ADOPT THE SYSTEMS MODEL OF THINKING WITH PUBLIC HEALTH SEEN AS A SYSTEMS ISSUE AND NOT THE SOLE RESPONSIBILITY OF A LOCAL HEALTH DEPARTMENT

CHANGE IS INEVITABLE LEADERSHIP IS CRITICAL

MORAL COLLABORATION IS THE SECRET TO SOUND LEADERSHIP PRACTICE. BUILD TRUST AND SHARE POWER