What is the biggest leadership challenge you have faced in your work and how have you addressed it?
Lisa A. Davis, RN, BSN, MBA
Chief, Family Health Section
RWJ Executive Nurse Fellow
Connecticut Department of Public Health
The State of Connecticut, Department of Public Health, Family Health Section (FHS) receives over $30 million in state and federal funding for a wide variety of programs including, but not limited to CHCs, SBHCs, family planning, intimate partner violence, rape prevention education, case management for pregnant women, CYSHCN and others. With the diversity of programs, lack of a strategic plan and decreased funding, it is easy to become distracted (lose sight of what is important), and dilute existing resources (trying to do too much with the same amount or less funding).
In September, the FHS management staff worked with a consultant to begin to develop a strategic plan to:
1) develop priorities for the Section;
2) realign programs with allocated resources;
3) allow staff to better focus their energy; and
4) ensure effective use of available resources.
As Jim Collins suggests in his book, Good to Great, you have to get the right people on the bus (or in this instance programs in FHS), and get the wrong people off the bus (remove programs from FHS that are not a good fit), and get the right people in the right seats (put the right programs in the right units within FHS), before you drive it.
Chief, Office of Children with Special Health Care Needs
Rhode Island Department of Health
Looking for the opportunities. Several years ago I found myself in a no-win situation. My state's legislature was moving a large program I was supervising to a different state agency. The program and subsequent move was volatile, involving lawsuits, public hearings, scrutiny and nasty politics. About two months into the controversy, I remember thinking there was no way I could come through this unscathed.
To say that every crisis presents an opportunity is so cliche, but true. In the aftermath of losing a well funded, well staffed, well known program, in a state with a hiring freeze, with a somewhat tattered reputation, I had an "opportunity" to remake the office of special healthcare needs in my state, establish a system to address all the Title V assurances, and build a voice for parent/professional partnerships. First, I fell in love with this great guy (my second son) and took an extended leave. When I came back, I embraced the opportunity to build a system of accountability that really met the needs of families raising children with special needs. I am real proud of the system in Rhode Island and thankful for the "opportunities," no matter how stressful the presentation was.
Karen Trierweiler, MS, CNM
Director, Center for Health Families & Communities
Director, Title V MCH Program
Colorado Department of Public Health & Environment
MCH is broad in scope and the Block Grant provides us with great latitude in determining areas for investment. With this flexibility, however, comes the responsibility to assure results. For states heavily focused on direct and enabling services, client counts can serve as process measures documenting “the number of people touched by MCH.” And yet, I wonder just how much these gap-filling services (many in existence for some 20+ years) have improved MCH across all populations. With the advent of the MCH performance indicators, I feel that states have been charged to improve population-based indicators of maternal child health. In order to do so in Colorado, we are moving further down the MCH pyramid, investing in population-based and infrastructure (systems) building efforts. In changing our approach, we have been challenged with the need to define the outcomes of our work, without much formal guidance.
In Colorado, we are addressing this challenge by determining key focus areas for MCH efforts. Instead of being involved in a number of activities “an inch deep,” we are critically evaluating our current work to determine what should be continued, what should be reconfigured or transitioned to other partners, and what should be discontinued. In addition, we are determining if our role is as a lead, partner or monitor. Ultimately, we are looking at investing in fewer areas with greater depth (“a mile deep”) and emphasizing implementation and evaluation at least as much as assessment and planning. Effective interventions tied to a well-crafted evaluation plan are critical in achieving tangible MCH outcomes.
“What are we getting?” is not easily answered, but in the long run there is probably no more important question.