Public Health Leader Support Theory

Public health leaders face decision making processes and challenges that come with their decisions every day. Some of the public health decisions can be stressful especially in today's political environments with public health financial and benefit cuts. The Leader Support Theory (LST) proposed in this paper attempts to come up with supportive elements to a public health leader that can improve public health outcomes through increased support. The hope of the LST is that the public health leader feel more supported and there would be increased satisfaction in the decision making process as well as in the outcomes thus less vacant public health leadership positions and less turnover will be present in public health offices.

Public Health Leader Support - Introduction

Public health leaders face complex health issues and environmental treats that can potentially threaten the population every day (Koh & Jacobson, 2009). Not every potential health treat can be addressed quickly or effectively, based on the data or resources available which creates accusations and blaming of public health leaders (Mullen, 2016). There is a lack in supporting public health leaders in their decision-making process. Decisions and retrospective fallouts when decisions are not made quick enough or the decisions made seem to be incorrect to other entities creates a conflict put public health leaders in difficult positions (Mullen, 2016). There is a high need to support public health leaders who face these challenges every day. Making the correct decision is a skill that public health leaders need to be basing on all the available researched evidence they have and their experience in the field (Aarons, Ehrhart, Farahnak, Sklar, 2014 & Kansagra, Farley, 2011). Using leadership elements from team leading, transformational, and situational leadership styles can help current public health leaders feel more supported by showing adaptability, charisma, serving others and supporting leadership decision making (Gupta, 2009 & Gupta, 2011 & Nahavandi, 2015). The above-mentioned leadership styles give mentors and leaders in the public health arena to support and help each other with difficult decision making processes and fallout.

Literature Review

A comprehensive literature review was conducted to evaluate the current research available on public heath leader support. Academic search complete and Psych INFO databases from the Walden University library was searched with the words public health + leader + support with no results. Searching CINHAL and MEDLINE databases for the last 5 years for the same words yield 149 results with some relevance to public health, narrowed down to a few articles related to the topic. Pub Med was searched and returned thousands of results with no relevance to the topic. Science Direct was searched with public health leader support with 29 results of no relevance to the topic. Cochrane database searched with no results. Searching Google, I had found an article from the Journal of Public Health addressing the issue and yielding meaningful reference list in the topic area addressed. Leadership exist in many forms in public health. Public health can change very quickly and situations that are unforeseen can emerge putting leaders in vulnerable positions where delicate or quick decisions might need to be made. Public health leadership barriers needed skills and support to help leaders succeed in their field identified in the articles found. There was a limited number of articles found in this topic for public health leader support.

Leadership Barriers

Providing guidance and backing leaders before and after decision making is lacking in public health leadership. Support needed for public health leaders, director of nursing leaders at local health departments.

Reyes et al (2013) describes the difficulties the leaders face with the rapid changing environment, financial problems, and system barriers (Reyes et al 2013). Barriers to effective leadership can include the ambiguity in the constantly changing public health front and dissonance as an ethical conflict between the leader's own belief and the decision that need to be made for the population at hand (Koh & Jacobson, 2009 & Reyes et al 2013). Reyes et al (2013) identifies barriers system wide and by the individual leader's competency including inadequate leadership support, lack of mentorship, inadequate resources, scope limitations, limitations in leadership skills including program planning, negotiation, confidence in risk taking and political judgement (Reyes et al 2013). Public health problems can be so complex that it is difficult to decide even on what the problem is as well as what could be a possible solution (Koh & Jacobson, 2009).

High turnover in public health leadership positions is an additional barrier that creates a leadership deficit in public health Mullen (2016) describes public health officials whom need to defend themselves from criticism from legislators that they are not making decisions quick enough and not mobilizing the resources that needed (Mullen, 2016). Lack of leadership flexibility to collaborate with other departments which can be difficult for some traditional leaders inside or outside of public health creates a barrier to a new type of leadership that is needed today when all allies need to collaborate to achieve goals and the support needed to address complex public health problems (Mullen, 2016). Another aspect of the problem can be related to not enough training in the public health school system on leadership, situations that can arise during decision making processes (Sibbald, Speechley & Thind, 2016).

Leader support

Leader support based on the interviews with the nursing directors that the public health departments can include encouraging and providing tools for lifelong learning, offering mentorship to support the leaders by an individual as well as providing organizational support (Cameron et al 2012 & Reyes et al 2013).

To be able to make a good public health decision leader need the knowledge of the current strongest research based evidence available in the public health field (Aarons et al 2011 & Kansagra, Farley, 2011). Collaboration with other departments and leaders can help individual leaders feel more supportive and guide them toward the correct decision need to be made based on the public health issue at hand (Aarons et al 2011).

Collaboration can help leaders solve problems and come to a decision that is beneficial to the public; an example described by Koh & Jacobson (2009) is the problem with organ donation and need in Massachusetts when the collaboration with other agencies become a successful and supportive task force with a same goal (Koh & Jacobson, 2009). Koh and Jacobson also asserts that a public health leader should not stand alone but need support and collaboration to succeed (Koh & Jacobson, 2009).

Mullen (2016) describes support from outside entities like businesses, housing support, communities, from individuals that can help public health leaders achieve their goals (Mullen, 2016).

Czabanowska et al (2014) created their research to come up with a support new public heath leaders need including ideas for a new curriculum, the research had found that leaders need support to learn now to work together with other groups creating a network to work together with stakeholders (Czabanowska et al 2014).

Leadership Skills

Proper training and ongoing support for public health leaders in their challenging field is needed for ongoing success. Koh and Jacobson describes (2009) the leadership skills necessary to succeed in the constantly changing and controversial public health environment as collaboration with stakeholders, communication with all parties involved, tactical strategy, interpersonal skill set, team building, political will, being calm and interdependent (Koh & Jacobson, 2009).

Mullen (2016) elaborates on a new type of public health leadership skill strategy of being a follower and collaborate with others whom are fighting for the same cause, she explains that working together with allies both in and out of the health area and going together with them instead in front of them creates a new type of collaboration (Mullen, 2016). Approaches that can work in this case could be team leadership, situational or transformational leadership styles (Gupta, 2009, Gupta, 2011 & Nahavandi, 2015).

In a European study interviewing at public health leaders by Czabanowska et al (2014) have found that a new type of leadership skill is necessary in public heath that requires collaboration, ability to connect things together, being innovative and politicly well informed, a leader that can work together with all parties needed to complete a common goal for the public (Czabanowska et al 2014). A common theme of transformational leadership style had emerged from all articles as a supportive leadership style that can help public health leaders become efficient in their roles. Transformational leadership has major components that include charisma, inspiration, servant leaders, leading by example, intellectual stimulation, individual reflection (Gupta, 2011 & Nahavandi, 2015).

Yphantides, Escoboza and Macchione (2015) envision public health leaders with a vision of understanding heath and behavior, influence based on knowledge that is interdisciplinary and a set of values that allow collaboration and the ability to be flexible and change based on the need and benefit for the public, be a leader that serves the public (Yphantides, Escoboza & Macchione, 2015). Team based leadership approaches would be an example for this leadership style that can help and support public health leaders (Nahavandi, 2015).

Sibbald, Speechley and Thind (2016) discuss the public health work force and the integrated case based training program focusing on a case based education with team approach and competency testing (Sibbald, Speechley, & Thind, 2016). This type of teaching allowing real life scenarios to be discussed in the classroom, in a collaborative team and group based setting allowing critical thinking and collaboration within a small group than a bigger group setting thus students will be more prepared to real case scenarios as entering the workforce as public health leaders (Sibbald, Speechley, & Thind, 2016).

Problem Statement

Public health leaders are under a lot of pressure today that is caused by complex and quickly emerging public health problems that include managing emerging new viruses like the coronavirus including COVID 19, SARS- CoV, MERS-CoV, the Zika epidemic, focusing on prevention of cardiovascular diseases and opiate deaths, curving childhood mortality would be just a few to mention. There is a current theoretical gap of supporting public health leaders in their compound decision-making process regarding complex health care issues that portray the public landscape today. The fallout from decisions create leadership position changes and empty public health positions creating difficulties to serve our population effectively. The goal of this project to create a better understanding of this problem and help identify solutions of support for public health leaders to create a positive social change that will benefit public health leaders thus the public they protect.

Personal Public Health Leadership Theory

My Public Health Leadership Theory includes parts and combinations from other theories, leadership styles and support systems for public health leaders. The theory is called Public Health Leader Support Theory (LST). The idea behind the theory is that current public health leaders need additional help and support with the decisions and high stress situations they face every day. Elements of the theory focus on leader support systems. The Public Health Leader Support Theory includes five parts that are surrounded around the leader. The parts are mentoring, skill building, self-preparation, education, and support systems. The LST is based on the idea of the skills public health leaders need to possess to be successful. Successful public health leaders have leadership styles that include parts of transformational leadership, situational leadership, team based leadership (Nahavandi, 2015). Mentoring from other leaders and public health professionals support the leader, gives him or her a chance to look for guidance and support from others. Having the ability to ask questions and past experiences from other more experienced leaders gives a base sense of security and trust that can help and support a leader in public health. Skill building allows the public health leader to further knowledge in current public health strategies, and new evidence based practice that helps and support current practices in the public health field. Self -preparation gives the public health leader the ability to evaluate current skills and improve their skills and abilities as need to become a better and more prepared public health leader. Education including current masters and doctorate programs can support upcoming public health leaders so they can be adequately prepared to be a public health leader after finishing school and starting their career in the public health sector. Combining all the five elements gives the public health leader the support, encouragement, and the ability to face the everyday public health decision making and decision making in greatly stressful times when major public health issues arise, and catastrophes happen. Mentors can include leaders from public health field, teachers, professors, leaders from other leaders from medical and health field as well as business, political and law fields. Skill building can be gained from additional courses in public health, experiences, projects, new research and organizational workshops, conferences. Self -Preparation can be anything that the leader themselves feel useful and helpful to become a better public health leader including self-evaluations, self -awareness and the ability to recognize and improve upon weaknesses. Education allows the public health leader to step out in the public health world with adequate preparation and readiness to face public health challenges.

Visual Representation of Public Health Leadership Theory

There is a current theoretical gap that shows the need of supporting public health leaders in their complex decision-making process regarding public health care issues. One of the solutions that can support for public health leaders include a good foundation in theory, skills and a new public health leadership theory that supports leaders and addresses the current theoretical gap.

Leadership perspectives - Integration

Public health leaders deal with extremely high complexity of issues that require tremendous knowledge and skills to be able to navigate, understand and lead in the system (Koh &Jacobson, 2009). To be an effective leader in public health there are numerous skills needed to be able to translate knowledge into practice and offer effective support and solutions to public health problems (Nahavandi, 2015). A new leader might have difficulty integrating new knowledge and applying it into practice thus they need the support and coaching of experienced leaders (Koh, Jacobson, 2009 & Nahavandi, 2015). Mentoring when a more experienced leader support a newly emerging leader can be a highly effective tool to support incoming leaders and build lifelong positive relationships, mentoring can be formal or informal (Nahavandi, 2015).

Visual representation of Leader Support Theory

Elements of the leader support theory include: skills training, mentoring, curriculum preparation, check-in, role preparation, practice scenario opportunities, collaboration, communication training, recap and reevaluation, self-preparation, motivation, encouragement, peer support, public support, media support (Cameron et al 2012, Koh, Jacobson, 2009 & Mullen, 2016 & Nahavandi, 2015 & Reyes et al 2013). Additional elements include case and team based learning models (Sibbald, Speechley, & Thind, 2016).

Leader Support Theory Model for Public Heath

The Leader Support Theory Model above shows a simple circle with outlining elements that can help public health leaders feel supported in their role. The model was developed with System's thinking in mind looking at Public Heath as a system and all the other systems that are effected including education system, the public health leader, other leaders from public health and other disciplines, support systems that include the public with different roles and expectations from the public health leader. The model shows the skills and support necessary for the public health leader to succeed. Using all the elements of support including self - preparation that is the individual leader's responsibility to having proper education that is the public health schools responsibility to mentoring that is the responsibility of every public health leader as well as leaders in other fields to support each other, continuing skill building that is the individual leader's responsibility as well as the public health organizations responsibility and support systems that can be personal, workplace or coming from other organizations. When all the elements are present in the public health leader's life and work, leadership decisions can be less burdensome as the leader has someone to turn to and have the training and knowledge to trust his or her decision-making process and the consequences related to the decision.

Leader Support Theory- Explanation

The current gap that was identified that there is a high need for additional support for our Public Health Leaders. The Leader Support Theory Model as five elements that break down to additional elements with the public health leader in the middle and the supportive bubble around. Skill building includes learning new skills as evidence based practice recommends, recognizing weaknesses and strengths, and taking the initiative to improve on current skills, attending recommended skill building classes available at the organization the public heath leader working for. Mentoring includes: Have multiple mentors formally within the public health organization and informally people who had been or currently are in leadership positions and dealing with complex health care issues. Mentoring provides support based on experience, the public heath leader has someone to turn to with questions, concerns, and feedback for growth. Self - Preparation Includes: Knowledge of the public health issue at hand and the skills needed to work on the public health problem that can include skills like communication, collaboration multidisciplinary and transdisciplinary, understanding and synthetizing public health issues (Leischow et al 2008). Education Includes: The support of current public health schools and public health workplaces providing up to date leadership development classes, coping skills of what to do when things are not going well, available resources that could include newsletters of current publications, leadership seminars, classes, discussion forums, focus groups. Support systems include public and private systems. Public systems include the media and the individuals of our society who benefit from public health efforts. The media could include more positive elements of public health, currently public health is only in the news if there is a problem, would be beneficial to have positive media on public health efforts that keep our population safe including suicide prevention trainings, immunization efforts, disease prevention efforts, health advises. Individual support can be a friend, family member, member of a pubic, co-worker (Koh & Jacobson, 2009). Education of the public and information on what public health leaders do could gain increased support for public health leaders.

Leader Support Theory - System Thinking

Public health is a complex system with continuously changing front, science, and new challenges (Koh, Jacobson, 2009 & Leischow et al 2008). System's thinking or the fifth discipline is essential to the complex public health system to function well (Leischow et al 2008). Some of the main ideas of system's thinking include transdisciplinary and multidisciplinary collaboration, training, maintaining networks and relationships (Leischow et al 2008). The Leader Support theory (LST) supports system thinking by incorporating these elements. System's thinking encourages collaboration, the LST recommends mentoring and support systems that collaborate. There is a new approach to public health Generation Public Health that includes all areas that can influence health and the way to move toward that health goal is system thinking and collaboration with all involved parties that could be businesses in the area, transportation, school systems, government systems work together to achieve the common goal of improved public health (APHA, 2015 & APHA, 2016). System's thinking encourages collaboration as well as LST encourages collaboration and support with the current education system for public health, current public healthy leaders, co-workers the public and media.

Empirical Evaluation Plan for a Public Health Leadership Theory

There are many elements of an evaluation process. To assess if the newly developed leadership theory addresses the public health leadership problem there is research need to be done. Any new theory needs research and evaluation to prove efficiency and positive outcomes (Nahavandi, 2015). Research study can be designed to address all elements of the leader support theory including the effects and effectiveness in leader support of mentoring, skill building, self-preparation, education, and support systems. Research study can be qualitative, quantitative, or mixed method. Case studies can also be a part of the evaluation process (Nahavandi, 2015). Additionally, studies can be designed as experimental, quasi-experimental and observational (CDC, 1999). The research study need to be feasible, ethical, efficient, and accurate (CDC, 1999). The theory evaluation need to address if there are any issues had been raised by stakeholders related to the theory (CDC, 1999). Importance of identifying theory strengths and weaknesses for improvement are both essential part of the evaluation process (Nahavandi, 2015). Looking at other elements besides the leader support theory that can affect the public health leader needs to be taken into consideration during evaluation including but not limited to outside factors in the leader's life like any stress causing agents and traumatic events like injuries, divorce, death would be some examples. Differences can be outlined by gender as well looking at female versus male public health leaders, their support systems and decision making process once supported by the LST.

Methodological steps include identifying type of study needs to be done. What data need to be collected and how to collect the data. Identification of what need to be evaluated and how, who will participate in the evaluation process, would people around the public health leader be involved including other employees or family members, members of the community (CDC, 1999). Paying attention to other factors including culture, race and religion need to be evaluated in the process.

Measures include performance of public health leaders, including frequencies of positive outcomes from public health leadership decision making, employee and leader satisfaction can be measured on a scale and or by interviews, (Nahavandi, 2015). Additional measures of proactivity, commitment, employee engagement, innovation, organizational atmosphere can be tested in interviews and scales introduced in surveys (Nahavandi, 2015).

Analytic techniques include using qualitative ad well and quantitative research analysis methods based on the type of study decided. Programs including Microsoft excel and SPSS can be used to analyses the data collected. Data collection include interviews with public health leaders. Additional data collection techniques can include surveys that have different type of scales that can rate the leader and employee's skills, emotions. Data collection of filled leadership positions and turnover rates can be collected. Data collection must be precise, without bias. Ultimately the type of data and the way the data will be collected will depend on the type of study chosen to evaluate LST.

Conclusion

Public health leaders need additional support and the Leader Support Theory and Model can be one way to add to their development and provided the needed support and encouragement closing the gap that currently exist in this area. Public health leaders are under tremendous pressure and responsible for population health. The more support that can be provided as shown above with the LST Model the higher chance to decrease burnout, stress, and changing professions. Good, effective leaders are needed in today's fast changing environment and public health leaders can use more support to guide them in their roles. The goal of the LST is to be a framework in providing the needed guidance for developing public health leaders. Providing all the supportive elements of the model public health leader and employee satisfaction should increase. This is a new developing theory, once tested additional changes and adjustments might be needed based on current research. This theory has elements of other leadership styles including transformational leadership that had been researched, thus have a positive viability and outlook for effectiveness (Nahavandi, 2015). Additional evaluation and research is needed to prove further effectiveness on of the LST model.

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