From challenges to triumphs: a journey through leadership in shaping the future of Public Health

As I sit down to write about my leadership journey through public health, I am spirited back to its earliest days. The experience of a young, white, nursing student from Boston Massachusetts, serving the poorest black county in the state of Mississippi is the foundation of this journey. What did I accomplish during those 12 months in the late 1970s? I helped build local acceptance of a new health center, staffed with a nurse practitioner, specifically designed to meet the needs of a poor rural community.  While this may seem like a small accomplishment, it was a life changer because this was a community with limited access to primary care and low life expectancy rates. I’m pleased to say that a new center was built and is still in operation today.

To finalize this accomplishment, that little Mississippi community needed to accept the fact that a specialist nurse - rather than a doctor - could provide primary health care. Further, the local white elected officials needed to accept that the majority black population was entitled to better health care.

I learned many basic leadership lessons in that one year. I learned how to engage and influence a local population; I learned how to organize effectively at a community level; how to listen and project the importance of relationships out of diversity and different viewpoints. I experienced what it was like to be ‘different’ in a different society. I had to learn who I was. Part of that learning meant that sometimes I should be quiet and other times I should be loud, an activist, speaking forcefully for people who were not being heard.

My career has spanned 4 decades and 6 countries. I have worked in leadership development as well as service and space improvement and care delivery. Over the years, I’ve had the opportunities to study with and learn from other successful leaders, and that has sharpened my skills and given me the space to improve my own practices. I’ve created a wide and varied network that’s critical to anyone’s ongoing success. As I learned in Mississippi, in detail, many years ago, success depends on relationships and collective knowledge - you simply cannot ‘go it alone’!

To illustrate this statement in detail, let me turn to my recent CEO hospital role in Qatar. Anyone following the daily news will be aware of the public health challenge to worker safety on building sites in Qatar, this small but significant Middle Eastern country. My leadership skills were stretched in the development of clean, post-discharge, recovery environments for male construction workers.

The housing for Qatar’s imported worker population was large bunk bed-type dormitories that shared kitchens, showers and toilets. Recovery after surgical procedures, therefore, tended to be less than clean or assuredly safe in these dormitory environments. In anticipation of problems, therefore, we added an extra ten days or two weeks to average hospital stays. Our extended hospital stays, however, created secondary problems; that is, men in recovery mode did not want to spend additional time in a restrictive hospital environment. Further, hospital beds were always at a premium: occupancy rates were high.

As you may know, Qatar sponsors a multinational workforce and, fortunately, one of my staff had heard of a medihostel service for homeless people in Australia. With a bit of related research, I had enough information to develop an outline proposal for our patients. We could discharge patients from our hospitals into an off-site, nurse-led, medihostel unit.

My staff and I knew the experiences and opinions of patients who’d had to cope with the long hospital stays.  We drew on both to successfully get our medihostel planning off the ground. However, those experiences and opinions, coupled with my voice, would not have been enough to make medihostels operational in Qatar. Qatari surgeons and - most importantly - the Health Minister herself had to be on board, in full agreement.

My strategy was to ‘plant seeds’ and let ideas grow of their own strength. I suggested the medihostel concepts informally to receptive surgeons and any influential staff members. There was initial resistance, yes, but the overall objective - sustained worker health - was simply too important to abandon. Once my network of ‘seedlings’ had grown large and strong enough, I produced a formal proposal, and I’m pleased to say it met enthusiastic support from the Health Minister right on down. The project was off and running.

For most of those who choose health care as a profession, making the world a better place provides an intrinsic drive. We want to help. We want to contribute to improvements in health. Some of us will focus on the individual patient or his or her family; others will step up, reaching out to leadership in national or international organisations. At any level, by appealing to the intrinsic motivators in our profession, we can build the momentum for positive change.

Now, a look ahead:
Our global experiences of the Covid pandemic prove that we need to transpose all the formidable lessons we’ve learned to challenges that are surely coming. The public health issues arising from climate change can be felt in the heat and seen in the smoke somewhere on the planet every day. The impact is already staggering. As public health professionals, surely we are being called to action. Caring for others is what we do.

Each of us must respond in his or her own unique actions. For instance, I’ve chosen my various teaching platforms to illuminate some of the challenges and highlight some solutions I see.

Part of my network includes a medical doctor from New York City, Dr Cheryl Holder, who is now working in Florida. Dr Holder is leading local, regional, and state-wide efforts to manage the threats of higher temperatures to low-income people.

After starting as a doctor of internal medicine, Doctor Holder is now using both her voice and her leadership skills to make ongoing differences for people who lack proper representation. She has already influenced Florida’s medical school curriculum to include assessments of climate related illnesses, this while serving as co-chair for Florida Clinicians for Climate Action.

My inspiration is reinforced by the work of people like Cheryl Holder. Together we can remain motivated; together we can plant the ‘seeds’ that will mature into positive fields of change. Consider this approach. Join us on this journey if you can.


References:

1. Holder, C. (2020). The link between climate change, health and poverty. TED Talk.
   
2. Kenney, Charles. (2010). Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience. CRC Press.
   
3. Kaplan, G. S., Kornacki, M. J. (2017). Lessons in Leadership: Gary Kaplan. NEJM Catalyst.
   
4. Bohmer, Richard. (2009). Designing Care; Aligning the Nature and Management of Health Care. Harvard Business Press.
   

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Author:
Liz Thiebe

• Qualified in nursing at Northeastern University.
• MBA from Boston University, USA.
• Advisor to the NHS Executive team of two merging hospitals in England.
• International experience having worked with clinical staff in Ireland, Portugal, Libya, Qatar, UK and USA.

Edition:
Joana Carvalho
Soraia Costa