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 Management Minute

"Management has a lot to do with answers. Leadership is a function of questions. And the first question for a leader always is: 'Who do we intend to be?' Not 'What are we going to do?' but 'Who do we intend to be?' – Max DePree

This quote from Max DePree led me to reflect that we might have gotten the titling of the Management Minute column all wrong. Maybe it should be called Leadership Minute. Of course, that is not as catchy of a title. And, the fact is, managing is quite often easier to do for the most part than leading. Setting about doing things feels good to people and gives a sense of accomplishment. It's a little more challenging to really pause and grapple with the idea whether the things you are doing are the right things and if these things are actively contributing to who you ultimately intend to be.

Leadership can be downright scary. It implies a higher degree of accountability, responsibility. It conjures up certain inherent characteristics like inspirational, motivational and trustworthy. Leadership, at an organizational level of influence, also suggests the ability to ensure a unity of purpose among many, to drive a mass to collective action and successful results, and to influence peer pressure in positive ways that raise standards and generates a movement. Pretty lofty stuff. Yet, this is the place we need to be as we think about the futuring of AMCHP.  

As we began to analyze the results of our strategic engagement work, there were themes that began to emerge amongst the voluminous data and inputs. In the most recent iteration of this work, we utilized the skills of Jim Meffert, a senior consultant with Tecker International to help us to assimilate what we learned through surveys, social media, e-mail, regional meetings, key informant interviews with partners and in person meetings.

In the draft Tecker report, they note that it's important that the summary of findings is intended to start conversations about a strategic focus for AMCHP, to provide thoughtful and possibly provocative observations on the challenges and opportunities facing AMCHP. The AMCHP board, working with staff, has the job of bringing clarity, conclusion and direction to the organization as they use the inputs to plan strategically for the future.

Here is a consolidated look at the high-level summary of findings. Tecker stipulates that "the observations are themes heard across all forms of input. It is unlikely there is new information to AMCHP although there may be observations some leaders disagree with." Regardless, the observations and analysis should lead to "robust and frank discussions about the strategic direction of AMCHP."

  • AMCHP is a strong organization with a solid reputation and history. It has been viewed as a strong partner with numerous federal agencies, state Title V directors, partner organizations, foundations and members in general. There are no glaring holes in this reputation. This provides a solid foundation for future leadership and action.
  • AMCHP is very good at supporting the needs of existing programs, particularly Title V directors.
  • As a core function of the organization, it seems to be successful at responding to the needs of members and connecting questions with answers and support. In order to perform this well, the enterprise seems to have a solid understanding of the programs and strengths of each of the states.
  • There is a great deal of uncertainty regarding future funding, program structures, role, connection to the public health care payment, structures, private payment systems and overall health care delivery system. This is not unique to MCH and AMCHP. Every health care enterprise, be it public, private, delivery oriented, public health, provider, etc., is faced with a great deal of uncertainty. As a result, associations are asked to identify and project trends more than ever before. There is a very strong desire for AMCHP to take a stronger and more active leadership role in the identification of MCH trends. There is also a very strong and universal desire for AMCHP to play a larger role in not just projecting, but shaping the long-term future of MCH.
  • There is recognition that the role of public health, and MCH will shift in the future. The integration of quality measures, community measurement, an emphasis on preventive services all lead to a shift from public to private funding, stronger integration into private delivery systems, along with uncertainty around traditional programs and sources of funding. This change also will alter the MCH workforce.
  • It is widely recognized, particularly in the private delivery and payment systems, that the status of maternal and child health will be a strong measure of health care quality and set directions in the evolving health care delivery system.
  • AMCHP is viewed as a strong advocate for existing MCH programs, funding and structures. There is hope that this foundation leads to stability for MCH programs and funding.
  • AMCHP has been successful in bringing together groups to develop best practices for new and developing programs. This is an area of strength that many outside groups would like AMCHP to build on.
  • The new requirements under the Title V MCH Services Block Grant application create a challenging dynamic for Title V directors and AMCHP. The new requirements seem to be a response to the demand for immediate quantitative analysis and measurement of results by many political leaders. Given the short-term nature of public budget discussions, this change is viewed as a way to protect MCH funding rather than the development of innovative new approaches. The balancing of maintenance of programs, advocating to sustain and leading change is characterized by this discussion.
  • The change in the block grant application requires a different analysis of programs, uncertainty of the nature, scope and future for many existing programs, along with an increased need for different forms of data collection.
  • AMCHP is in a unique political position. As mentioned earlier, there is a great deal of aspiration for AMCHP to take a lead on advocating for support and MCH lead changes to programs and funding. Those organizations and individuals with the greatest hope are most limited in their individual ability to advocate. State Title V directors are unable to lead beyond their political realities; federal agencies are not able to push for the kinds of changes they may feel are best. The positioning of individuals and the organization in advocating for changes in MCH policy transcends every discussion. As the level of uncertainty grows and the fear of program cuts continue, the pressure for a stronger role in not only supporting existing, but also shaping change will grow.
  • There is great pressure within all of MCH to consolidate. This is clear with many of the changes to Title V programs and state structures. This trend will continue along with increased partnerships in the private sector. There is a sense that AMCHP could play a stronger role in shaping this trend.
  • The change in AMCHP leadership creates some uncertainty about the role and shape of the organization. There is a great deal of hope and anticipation for a renewed focus for the organization. This is a great context for revisiting the vision and direction of the association.

In closing, Tecker was quick to remind us that this information represents broad inputs. "It is important not to draw conclusions about direction." Part of this long-term effort leading up to a revision to the AMCHP strategic plan is to spend the next few months in discussion and deliberation with our leadership.

As we await the final version of the Tecker report within the next week or two, we'll be planning to re-engage our members around these themes. As we head into the home stretch of planning prior to the June board meeting, we'll plan to utilize upcoming regional calls, Management Minute,, social media and our SharePoint site once more to collect your thoughts. We look forward to our continuing conversation and engagement with all of you. In the meantime, if you have any initial reactions to this column, please feel free to email me directly at or