Session Type: Case Study Accepted by MIG(s): Public Time Allotted: 75 Scaling Up Successful Public Health Interventions through a Locally Owned and Sustained Leadership Development Program in Rural Egypt Description: Applied leadership development among health workers in Egypt enabled them to sustain a local leadership program with their own resources, and focus on improving health results, including reducing maternal mortality rates across a governorate of 2 million people. Abstract: Problem: In 2003 the Egypt Ministry of Health and Population (MOHP) faced the challenge of improving access to and quality of services in rural Upper Egypt in the face of low morale among health workers and managers.
Local setting: From 1992 to 2000, the MOHP, with donor support, succeeded in reducing the nationwide maternal mortality ratio (MMR) by 52%. Nevertheless, a gap remained between urban and rural areas.
Relevant changes: In 2002 the MOHP, with funding from the US Agency for International Development and assistance from Management Sciences for Health, introduced a Leadership Development Program in Aswan Governorate. The program aimed to improve health services in three districts by increasing managersˇ¦ ability to create high-performing teams and lead them to achieve results.
The program introduced leading and managing practices and a methodology for identifying and addressing service delivery challenges. Ten teams of health workers participated. In 2003 the districts of Aswan, Daraw, and Kom Ombo increased the number of new family planning visits by 36%, 68%, and 20%, respectively. The number of prenatal and postpartum visits also rose.
After USAID funding ended, local doctors and nurses scaled up the program to 184 health care facilities (training more than 1000 health workers). From 2006 to 2007, The LDP program participants in Aswan Governorate focused on reducing the MMR as their annual goal. They reduced the MMR from 50.0 per 100,000 live births to 35.5 per 100,000. The reduction in MMR was much greater than rates in similar governorates in Egypt. Managers and teams across Aswan demonstrated their ability to scale up effective public health interventions though their increased commitment and ownership of service challenges.
Lessons Learned
To scale up a sustainable process for service improvement using available resources:
• empower front-line managers and their teams with leading and managing practices and a simple process for improving service results that is based on their shared vision of the health outcomes they want to achieve;
• ensure that program materials, processes, and tools are simple and easy to adapt and contribute to measurable results that people care about;
• support managers and their teams in playing the lead role in facilitating, adapting, and sustaining health improvement programs.
Joan Bragar Mansour, Boston Center for Leadership Development
Bio: Joan Bragar Mansour is a leadership development consultant who has taken the best practices in transformational leadership development and applied them to work with health workers in the public sector in the developing world.
Morsi Mansour, Management Sciences for Health
Bio: Dr. Morsi was a doctor with the Ministry of Health in Egypt when he co-designed and led a leadership development program for health workers. He is now a Leadership Development Specialist with Management Sciences for Health
The Vision Implementation Project: Developing Public Leaders within Tennessee' Department of Human Services Description: Since 2006, Vanderbilt University researchers and consultants has partnered with Tennessee's Department of Human Services to identify and address effective leadership strategies within one of state's largest public agencies. The result is a state-wide technology delivered strategic leadership action plan aimed at the growth/ development of the organization's entire workforce. Abstract: Public human service organizations have traditionally provided a public safety net for society's neediest children and families and have been widely acknowledged as working at the forefront of services that impact the health and quality of life within a community. The demand for programs and service from these organizations is likely to increase (Lampkin & Pollak, 2002) as the demands on such organizations to move beyond providing needy families with cash assistance to enabling low-income parents prepare for work and self-sufficiency (Meckstroth, Pavetti, Johnson, 2000). Public human service organizational leaders are faced with the need to reinvent their organizations to avoid the inefficiency and ineffectiveness exacerbating the very problems they seek to ameliorate. The top-down mandate approach to leadership is outmoded, and calls for good public leadership to translate social policy into action are warranted. Human service organizations must develop into learning organizations that embrace change and create new ways of doing business (Wolf, 2004). However, the research literature pays scant attention to the process of change in large public human service organizations.
Since 2006, a team of Peabody College of Vanderbilt University researchers and consultants has been partnering with the Department of Human Services (DHS) in Tennessee to identify the development needs of employees and the barriers to effective public leadership in a large state-run organization. DHS is a 4500 employee public organization dedicated to the service of economically disadvantaged youth and families in Tennessee. This initiative has been known as the Visions Implementation Project (VIP) and has been aimed at identifying the growth and development needs that can significantly impact employee performance and ability to implement change within DHS. During the process of working with senior DHS officials, management, work teams, and local employees, the Vanderbilt team has gained important insights into the barriers to effective public leadership, and discovered specific ways in which large-scale organizations like DHS can enable significant and broad change through employee growth and development.
Theoretical Framework and Methodology
The theoretical grounding for the VIP initiative was in John Kotter's model of organizational change and process of training employees based on the National Academy of Sciences' How People Learn framework. Kotter's model encompasses the need for organizations to enact change by increasing urgency, building guiding teams, getting the vision right, obtaining buy-in, enabling action, creating short-term wins, and institutionalizing the change (Kotter, 1996). To begin by building urgency and guiding teams, Vanderbilt'ss research team conducted two large research studies to aid the DHS key leaders in adequately understanding the issues that facing in their change endeavors. The first was exit interviews to identify the factors that led to employee turnover, and the second was a large-scale survey of current employees designed to understand perspectives about supervisory and executive leadership, understanding of the mission, and potential areas of employee dissatisfaction.
The VU research projects discussed above attempted to answer two key questions:
1. What were the major issues that past and current employees see as contributing to high turnover and high dissatisfaction?
2. Based on research question 1, what would facilitate the growth of employees’ abilities and skills in leading change that could address high turnover and high dissatisfaction?
The results of the two research studies were fed back to senior leadership, who began to formulate a new direction for the organization. Next, the Vanderbilt team worked with all levels of the organization to interpret and discuss the results, and through this, a course of action (known as The Roadmap to the Future) was created. This Roadmap identified barriers and facilitators of change and, in turn, set forth specific actions and outcome measures of the actions that would lead to higher satisfaction and attrition among the employees. The Roadmap enhanced training curriculum was based on the constructivist learning theory of "How People Learn" (Bransford, et. al., 1999). This innovative and participatory professional development was disseminated to over 4000 employees.
Findings and Implications for Public Leadership
Vanderbilt's large-scale research studies and Roadmap training yielded some important lessons for leadership within DHS. First, DHS needed a clear, well articulated vision that guided decision-making and set the stage for the empowerment of workers and citizens. More than a written statement, the organization's leadership had to become more participatory both in implementing change at the local levels and shaping organizational policies at the highest levels. Although DHS commissioner made a concerted effort to visit local agencies, employees reported a lack of care from senior leadership, insufficient feedback and evaluation from supervisors, and ill-communicated changes in policy impacting their work. The Roadmap began to address these issues, articulate a way forward, and real changes began to take place at all levels of the organization. Continual communication of vision, goals and strategies; monitoring of workforce satisfaction measures; establishing a dedicated guiding team mobilizing decision-making at the point of contact with clients; and recognizing, rewarding and modeling new behavior were all critical lessons and recommendations for improving leadership within DHS.
References
Bransford, J., Brown, A. L., & Cocking, R.R. (Eds.). (1999). How people learn: Brain, mind, experience, and school. Washington, D.C.: National Academy Press.
Kotter, John (1996). Leading change. Cambridge, MA: Harvard Business School Press.
Kotter, John & Cohen, Dan (2002). The heart of change : real-life stories of how people change their organizations. Boston, Mass: Harvard Business School Press
Lampkin, Linda & Boris, Elizabeth. Nonprofit Organizational Data: What We Have and What We Need. American Behavioral Scientist, Jul 2002; vol. 45: pp. 1675-1715
Meckstroth, A., Pavetti, L., & Johnson, A. (2000). The future is now: Transforming the welfare system to identify and address chronic barriers. Policy & Practice of Public Human Services, 58(3), 8-12.
Pearl Sims, Vanderbilt University
Bio: Dr. Pearl Sims is a faculty member in Peabody's Department of Leadership, Policy, and Organizations where she teaches classes in leadership and in instructional technology. Her primary research interest is educational and organizational leadership and in using technology for professional development. She has her doctorate in educational leadership from Vanderbilt University and has been awarded over $8 million in research grants during the past five years for her work in the use of technology for leadership and organizational development. She is a national facilitator for Microsoft's Partners in Learning and has researched the Bill and Melinda Gates Foundation's professional development efforts in Tennessee since 2001. Most recently she helped conduct an international study of U.S. Dept. of Defense Schools, served as the educational specialist on the Governor's Task Force for Welfare Reform, and directed Peabody College's highly successful Principals' Leadership Academy. She also conducted a $3.9 million dollar research project aimed at using technology for large scale organizational change within the State of Tennessee. She is currently one of the lead faculty members for a new partnership with South China Normal University and Viet Nam National University. As a former member of two elected officials, Pearl has served on a wide variety of local, state, and national level task forces and committees. She is active in many civic and education organizations and is the recipient of multiple leadership awards.Josh Hayden, Cumberland University
Bio: Dr. Josh Hayden is an Assistant Professor in the School of Education and Public Service at Cumberland University. Dr. Hayden was a Post Doctoral Research Fellow at Peabody College of Vanderbilt University where he conducted research on the relationship between the degree of public knowledge about higher education and public opinion about affordability and quality of colleges and universities. His research also focused on the relationship between the various components of human well-being and moral judgment in college students. As an an adjunct instructor at Peabody for four years, he has taught courses in the undergraduate Human and Organizational Development program. Josh has over ten years of experience in various leadership roles within higher education and has his doctorate in higher education leadership and policy from Vanderbilt University. Return to complete program |
