Making behaviour change work in the new world…some thoughts for the Evidence into practice conference

I’m speaking as part of a panel tomorrow at the Evidence into Practice conference to support the implementation of the new NICE guidance on behaviour change.  This has prompted me to work out my thoughts on what we do next, and how the various roles for various players in the system might come together.

Opportunity : events coming together

A number of things are coming together at the same time in the field of behaviour change and behavioural sciences in public health.  Public Health is busy embedding into local government. Academics are busy articulating the evidence base and developing it, NICE have developed new guidance, and Public Health England are busy developing their national role in behavioural insights. The opportunities for the Social Sciences in Public Health are also becoming clearer and growing.  Equally a new book on the impact of the Social Sciences out this month shows the real potential for social science contributions to public health alongside other fields.

Seizing the opportunity for behaviour change to be effective

Jane Roberts and I said I our introduction to the January 2014 British Academy Report on some social science contributions to Health Inequalities that there were “Four key variables and their interplay will be salient in determining whether the opportunity created by the [Health and Social Care] Act and The Marmot Review is realised:

  1. first and foremost, the leadership of elected members for better health (political leadership makes a key difference);
  2. the quality and calibre of public health specialist staff;
  3. the use of existing resources; and
  4. the availability of evidence and guidance which policymakers can use to make policy and deliver programmes.

We have a major opportunity with behaviour change. New evidence, the development of the field of health psychology and the development of NICE guidance as well as the parameters national and local leadership roles in building a policy and commissioning context where behaviour change is effective are becoming clearer.

We need to be clearer on the portfolio of interventions

At the same time, the portfolio of which interventions work for which population is still not clear, and we are still in the process of articulating the range of interventions which can be used, and what they can be used for. To take an example, in Hertfordshire we are:

  • using the Penn State resilience approach to young people’s resilience in schools
  • using a range of behaviour change approaches to individuals including do something different
  • using behavioural approaches in drug and alcohol recovery
  • using behaviour change with speeding drivers
  • using behaviour change in primary and social care

But we know we can do more, and the NICE guidance creates an opportunity for us to join this together into a framework.

Leadership tasks in making behaviour change work

I mentioned above that there is a set of leadership tasks which are becoming clearer on how we use behaviour change, now that the new local government guidance is with us. I see these as follows:

  • NICE – articulate the architecture of standards, structures and policy (what good looks like) for local areas in their new behaviour change guidelines
  • NICE – provide evidence-based guidance on what works
  • Academics – develop evidence on effective interventions and support policymakers in making good policy in light of that
  • Public Health England – share knowledge, articulate a framework of what methods (nudge and other population based work; health trainers and other individual based work) apply to which issues
  • Local Authority Directors of Public Health – integrating these various products, insights and roles to create a joined up framework and delivery at local level.

Health Psychologists can support at all of these levels and help implement the new system using their expertise. (So getting a health psychologist’s expertise into local public health systems as well as national ones – whether by secondment, sharing, employment or training) is important.

A conceptual framework

This leads me to some thoughts about a conceptual and contextual framework for behaviour change in local government.

I: Policymakers and commissioners need a clear Context within which Behaviour Change is used

  1. The epidemiology of the UK is such that behavioural sciences can make a significant contribution to primary prevention of non-communicable disease, secondary prevention especially self-management and resilience and tertiary prevention (e.g. coping skills for breathlessness in heart failure.) Behaviour change needs to be seen within this context.
  1. This contribution is alongside not instead of policy and population measures (like regulation of tobacco etc). Behaviour change is not the answer to our public health challenges. It is a part of the answer
  1. A balanced public health strategy will have interventions at policy, environmental, social, sub-population and individual levels (eg the 6 levels of public health action in the Hertfordshire Public Health Strategy taken from Dettels et al,2009 http://slidesha.re/1e4CVzY )  . A joined up, integrated context means behavioural interventions and behaviour change has a context in which to fit in, and is not expected to be all in all or a magic bullet.

Table1: The Six Levels of Public Health Strategy (from the Hertfordshire Public Health Strategy. Adapted from Dettels et al, 2009)

Levels

Example of how they can be applied –  Tobacco

Social – changing social norms about health, e.g. acceptability of binge drinking, acceptability of taking smoking breaks Behavioural economics, social marketing Young people
Biological – immunisation, vaccinations, treatments Nicotine replacement therapy and cognitive tools for cravings
Environmental – encouraging green transport, reducing pollution, changing the public realm Environmental cues, display legislationSmokefree playgrounds
Individual Behavioural – helping individuals to stop smoking Individual and group behavioural change and support
Legislative –  the smoking ban, legislation on alcohol sales The ban on smokingLegislation on displays
Structural – policy changes such as workplace health, school health policies Workplace policiesTobacco control partnerships

II: Policymakers need Clarity of the aims and uses for Behaviour Change

  1. Behaviour change can be used at population or individual or sub-population levels. Different theories, approaches and methods work for different settings. Policymakers should be aware of this.
  1. Including behavioural science skills (e.g. health psychologists) in your service is essential to get it right . They need links with the academics to keep track of the field. We’ve recognised the need for links between public health practice and academic public health starting with our training and running all through our careers. It’s time behaviour sciences had this parity of esteem.
  1. Behaviour change can target “automatic” cognitive/emotive processes (e.g. choice architecture and also eye position tracking on cigarette package warnings) or conscious deliberative ones (e.g. behavioural skills to negotiate safer sex.) You need to be clear which you are using for what, and why

 

III: Policymakers need Clarity of methods, settings and audiences for Behaviour Change

  1. The experts in the field need to work with policymakers to create a framework or architecture within which local areas can understand and roll out behaviour change strategies and methods. A preliminary attempt at this is below

 A first step at a ready reckoner for behaviour change tools and methods

This is a very first step at a ready reckoner. It’s mean to be used at the stage before you get into things like choosing which actual intervention you use, or useful tools like Susan Michie’s behaviour change wheel, for example.

Table 2: a first attempt at a ready reckoner for behaviour change tools and methods

You can download a powerpoint version of this here

A   ready reckoner for behaviour   change tools and methods

Population   Level

Group   Level

Individual   Levels

“Automatic”

processes

“Conscious” processes

“Automatic”

processes

“Conscious” processes

“Automatic”

processes

“Conscious” processes

Choice Architecture

Advertising e.g. change4 life

Nudge

Groupwork for behaviour

Targeted social marketing

Choice Architecture Health   Trainers

Motivational interviewing

Behaviourism approaches

Behaviour change support e.g. Health Trainers

Targeted social marketing

We   still have gaps and   weaknesses in science and tools across all of these

(i.e. the science is still   developing)

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Public Health Leadership 2…on being useful

Helen Wilding, a colleague from Newcastle, kindly sent me an article on  preparing leaders in public health to work in a flatter and more distributed world. It’s a good read. And I think it chimes well with both my previous blog on this and the research I’ve been doing, summarised on powerpoint, for our public health leaders of the future at the University of Hertfordshire.

It prompted me to blog the learning I have had from a fantastic peer learning/mentoring set, which has now had its final meeting.  A small number of local govt officers with two private sector folk and some third sector people met every month to work through our strategy and challenges with each other. We did it quietly, and it worked. This, along with being asked by my boss to be the Sponsor from our Strategic Management Board on one of the new cohorts of our own LEAP leadership programme, have been amazing experiences.

The last two months we worked through the special feature on Influencing in the Harvard Business Review from July 2013.  Not what you’d think our usual reading but actually it explained

We each presented our challenge, our strategy and our ambitions for our services and there followed 90 minutes of critical and helpful feedback from our peers, once we had all read (before attending) and then spent 90 minutes discussing the section and especially a really good article on how experts gain influence by Annete Mikes et al (HBR,July/August 2013,pp 71 – 74.)

Members and senior officers often say to me that if all Public Health does is commission what it did in the NHS and no more then we have missed the biggest opportunity in over thirty years. I agree. The big question is, given how small public health functions are, how do we influence across big organisations and wider stakeholders and partners effectively?

We’re not the only ones facing this dilemma. Auditors, housing staff, lawyers, safeguarding, HR, equalities and facilities people all face similar challenges. So we fell on this article with interest and worked through it to see what we could glean.

Time Four Ts: the four competencies of successful expert influencers

Basically, the article looks at some financial institutions and suggests that experts (like lawyers, public health people etc) are good at gaining influence by using four competencies, all starting in T:

  • Trailblazing – finding new opportunities to use expertise
  • Toolmaking – developing and deploying tools that embody and spread expertise
  • Teamwork– using personal interaction to take in others’ expertise and convince people of the relevance of your own
  • Translation – personally helping decision makers understand complex content.”

Those most effective, unsurprisingly, were those experts able to combine these four competencies into useful products and outcomes for others in the organization.  In other words – they added value.

The opportunity for Public Health from this model

This strikes me as a key opportunity for public health, because this kind of stuff should be tailor made for us. But I so often heard colleagues in the learning set and people not in the set but in an outside public health in other areas talk about how public health is not influencing, isn’t getting purchase or indeed is seen as having lost its way or “advising not helping.”

But there is a another side needed to this model

But one thing our learning set reflected on, was on how to be effective in doing this, you really need to get yourself inside the head and mind of the organisation you find yourself in. One of the things we all had in common was that each of us had had a great and clear boss who knew what they wanted, some training or mentoring on specific things, things, knowledge and content about our sector which, in combination with leadership training, made us essentially “armed” with a clear sense of what we needed to achieve and a very clear sense of the tactics, mechanisms and tools we needed to get there. (Hence my working with others to co-produce a strategy, bringing in a four engines of public health model,  identifying the existing system leaders [my amazing partners] and getting work going with partners.)

Armed and dangerous in local government?

I was lucky to go on a series of introductions to local government constitution, finance, procurement and law over the past few years. I was also lucky to go on the Public Health Leadership Programme. And my doctoral studies group is immensely helpful in helping me work through the technical challenges of projects (what do I do about physical activity? What works?) and the tactics of getting it done.  There is a blend I am trying to get to of the science of public health and the art of getting it done.

Leadership programmes for Directors of Public Health are coming, which is great. Colleagues at the Local Government Association will also tell you about the Commissioning Academy and the LGAs own productivity and leadership opportunities. Not many DsPH on these so far, it seems. This will do one facet of helping and supporting us.

To do my small bit towards some of the other stuff (content, mechanisms, tools) I’ve been really luck to work with the good folks ADPH, LGA and LFPHWM to create the first two of  what I hope will be a small series of events to help DsPH become “armed and dangerous” – the rough guide/ boot camp introduction on local government law, one in London and one in Birmingham. These two law seminars are being offered pro bono by two senior local government partners of Bevan Brittan, a law firm which has a justly good reputation. They saw the opportunity and the need immediately when our lawyers approached them, and I have to say I have been impressed by how Bevan Brittan, Herts CC lawyers, and the indefatigable trio of ADPH, LGA and LFPHWM have seized this.

So, what did I learn about the four competencies?

I learned obviously that you need both sides of the coin – the four competencies and the “armed and dangerous” stuff.  On the four competencies I learned enough to create four objectives for my next year’s work. Some of this I am still planning.  I also learned enough so that my Monday early morning “what am I doing this week?” and my Friday evening “how did I do this week?” reflections have changed to incorporate these, and I have used them with some of my team.

Immediately, here are some of the things we have done and are doing:

  • Trailblazing – finding new opportunities to use expertise – applying public health skills to the JSNA, the health and social care integration agenda, helping spread behaviour change tools across the organization, and improving the health of children and older people – these are just some of the opportunities we are trying to deliver
  • Toolmaking – developing and deploying tools that embody and spread expertise – developing easy to use guides to finding and using evidence, running roadshows and helping people be confident in using it,  easy comparators to compare local areas on health outcomes. We need to do more. Pathways and tools for health across the lifespan (early intervention on self harm and mental health, for example) need to come
  • Teamwork– using personal interaction to take in others’ expertise and convince people of the relevance of your own – we get better results when we do this. For example, countryside walks funded by public health are being run by the countryside management service. Who better?
  • Translation – personally helping decision makers understand complex content – an easy guide to public health, explaining what it means, explaining what can be done.

This is just a snapshot. Essentially the whole public health strategy is an exercise in trying to be useful not just commission exactly what we commissioned in the NHS and no more.

And it also reminded me that being useful needs to understand the context one is working in, so that I can understand not only what is useful but how it can be useful.

Voluntary and Community Sectors Workshops on Public Health

We are about to hold a series of four workshops to explore the role the voluntary sector can play influencing the development of public health policy and delivering services.  Below are details of the four workshops and some things to think about before we meet.

The Four Workshops

These meetings are being planned by public health in consultation with the Hertfordshire Councils for Voluntary Service group. The workshops are designed to attract  senior staff employed within voluntary sector organisations that can contribute to the implementation of Hertfordshire’s Public Health strategy. http://www.hertspublichealth.co.uk/

There will be four themed workshops – each to be held at the Focalore Centre in Welwyn Garden City and each meeting will be themed as follows:

  • Wednesday, 26 February, 14:00 – 16:30: Public Health and Younger People
  • Thursday, 6 March, 09:30 – 12:00: Public Health and Older People
  • Tuesday, 11 March, 14:00 – 16:30: Public Health and Long Term Conditions
  • Tuesday, 18 March, 09:30 – 12:00: Public Health and Mental Health

Each workshop will consider three questions:

  1. What is the scope of public health, and what contribution can the voluntary sector make to service delivery, policy development, campaigning and tackling health inequalities?
  2. How can the voluntary sector help improve resilience, self-management and secondary prevention, and so help reduce unnecessary hospital admissions?
  3. How can the voluntary sector be better commissioned to deliver public health interventions? How can relationships between the voluntary sector and commissioners (DH, local public health commissioners, GPs, and others) be improved? What scope is there to apply commissioning innovations such as payment by results or a Total Place approach to public health commissioning?

Voluntary groups make an important contribution to improving and protecting the health of the population – from targeted work with vulnerable people to self-management and direct interventions. Public Health skills and capacity, joined with the voluntary sector’s connections and “can do” mindset could produce a major improvement in the health of Hertfordshire and also help integrate care for people across all sectors.

Places are limited so send your booking request early by e-mail to publichealth@hertfordshire.gov.uk stating your name, position, organisation, and which event(s) you wish to attend.

We will also be making available Royal Society of Public Health Training to agencies. This is the start of our agenda, but it’d be good to start the conversation…

Locating behaviour change in public health practice… some propostions

NICE have recently published their behaviour change guidance http://publications.nice.org.uk/behaviour-change-individual-approaches-ph49 and the British Academy have now released their report on social science interventions in Public Health (press release here http://www.britac.ac.uk/news/news.cfm/newsid/1041  ; report itself here http://www.britac.ac.uk/policy/Health_Inequalities.cfm . )

These two events have come almost simultaneously, and they both highlight the importance contribution of social sciences in health. The British Academy report deliberately focused (as we say in our introduction) on non-individual social science and behavioural science contributions whereas the NICE guidance focuses specifically on behaviour change. These two reports complement each other well and the key issue, as we say in the introduction, is for local areas to find public health strategies which hold population and individual measures, policy/regulatory and behaviour change methods, clinical services and health improvement services in balance. A balanced public health strategy is one which uses appropriate methods and tools for the different facets of the public health challenge we face, especially non-communicable disease.

I’ve read the NICE behaviour change guidance twice now, and I’m using it to bring together our various behaviour change intentions and programmes into a strategy as they recommend. This is a helpful and sane document with wise advice and a good framework for commissioners and providers.

On 28th January Public Health England, NICE and the Local Government Association will be holding Evidence into Practice , the first of a series of events seeking to support the introduction of evidence-based practice.  http://www.local.gov.uk/events/-/journal_content/56/10180/5751863/EVENT

I’m taking part in a panel discussion on the day, and I’ve also recently had colleagues from Public Health England spend a morning with me discusing and sharing how behaviour change approaches fit into a public health strategy.

I believe that there are several big challenges in getting behaviour change working effectively in public health programmes and strategies, and the NICE guidance is an enormous step forward, but we have much more still to do.

1. Having a conceptual framework of where behaviour change fits in public health as part of a strategy is a real challenge and no-one has really articulated this nationally yet in a clear and succinct way.

2. Understanding what method to use- do we target automatic processes or conscious ones, do we do population or individual level?

3. Policymakers often seize on one tool or method because it’s the current buzz topic and attracts a lot of scientific and practitioner interest. That doesn’t always make for  or effective strategy.

4. Many public health departments don’t have expert level behaviour science staff, and often the training we have had relies on models of behaviour change which are no longer used by experts in the field. The field has moved on, our training hasn’t.

4. The field itself is still developing – a bit like public health – and so experts and researchers in the field need to be better at communicating with policymakers

All of this leads me to conclude that we need some propositions about how we as public health practitioners take behaviour change forward.  I intend to share these with participants on 28th January.

Locating behaviour change in public health practice: some propositions

I share this because we ourselves are on the journey of working this out. It needs much more work, but we are already starting to use the framework they help us create.

I: Policymakers and commissioners need a clear Context within which Behaviour Change is used

  • The epidemiology of the UK is such that behavioural sciences can make a significant contribution to primary prevention of non-communicable disease, secondary prevention especially self-management and resilience and tertiary prevention (e.g. coping skills for breathlessness in heart failure.) Behaviour change needs to be seen within this context.
  • This contribution is alongside not instead of policy and population measures (like regulation of tobacco etc). Behaviour change is not the answer to our public health challenges. It is a part of the answer
  • A balanced public health strategy will have interventions at policy, environmental, social, sub-population and individual levels (eg the 6 levels of public health action in the Hertfordshire Public Health Strategy taken from Dettels et al,2009 http://slidesha.re/1e4CVzY ) Another way of looking at this is the Health Impact Pyramid https://www.idph.state.ia.us/adper/common/pdf/healthy_iowans/health_pyramid.pdf

Levels

Example of how they can   be applied –  Tobacco

Social – changing social norms   about health, e.g. acceptability of binge drinking, acceptability of taking   smoking breaks Behavioural economics, social marketing Young people
Biological – immunisation,   vaccinations, treatments Nicotine replacement therapy and cognitive tools for cravings
Environmental – encouraging green   transport, reducing pollution, changing the public realm Environmental cues, display legislationSmokefree playgrounds
Individual Behavioural – helping individuals to   stop smoking Individual and group behavioural change and support
Legislative –  the smoking ban, legislation on alcohol   sales The ban on smokingLegislation on displays
Structural – policy changes such as   workplace health, school health policies Workplace policiesTobacco control partnerships

II: Policymakers need Clarity of the aims and uses for Behaviour Change

  • Behaviour change can be used at population or individual or sub-population levels. Different theories, approaches and methods work for different settings. Policymakers should be aware of this.
  • Including behavioural science skills (e.g. health psychologists) in your service is essential to get it right . They need links with the academics to keep track of the field. We’ve recognised the need for links between public health practice and academic public health starting with our training and running all through our careers. It’s time behaviour sciences had this parity of esteem.
  • Behaviour change can target “automatic” cognitive/emotive processes (e.g. choice architecture and also eye position tracking on cigarette package warnings) or conscious deliberative ones (e.g. behavioural skills to negotiate safer sex.) You need to be clear which you are using for what, and why

III: Policymakers need Clarity of methods, settings and audiences for Behaviour Change

  • The experts in the field need to work with policymakers to create a framework or architecture within which local areas can understand and roll out behaviour change strategies and methods. A preliminary attempt at this is below

IV: A first step at a ready reckoner for behaviour change tools and methods

A   ready reckoner for behaviour change tools and methods

Population   Level

Group   Level

Individual   Levels

“Automatic”

processes

“Conscious” processes

“Automatic”

processes

“Conscious” processes

“Automatic”

processes

“Conscious” processes

Choice Architecture

Advertising e.g. change4 life

Nudge

Groupwork for behaviour

Targeted social marketing

Choice Architecture

Health Trainers

We   still have gaps and weaknesses in science and tools across all of these

(i.e. the science is still developing)

I hope this makes sense, and welcome your comments

Public Health Leadership…putting together the jigsaw

I’ve just finished a lengthy piece of work on putting together a session on strategic public health leadership, requested for public health postgraduates. Delighted to do it but the immediate thing which struck me is the literature on leadership continues to burgeon, and the literature on public health leadership itself is begining to grow very quickly.

It strikes me that trying to be a good public health leader today is about working in a Jigsaw. I feel very lucky to work where I work, with the people I have as managers, leaders, peers and reports. I am lucky every day to meet people who I learn something from.  So the first lesson is value the positive in what you have, while seeing the potential and the needs to change/adapt/correct/develop.

I’ve posted the final effort here so you can judge for yourself whether you think this is any good. http://www.slideshare.net/jamesgmcmanus/adaptive-strategic-public-health-leadership

In some ways this is a development of the work I contributed to led by Solutions for Public Health on the leadership role of the Director of Public Health.

•The colloquium report on co-production of public health for a new world http://www.sph.nhs.uk/sph-documents/local-government-colloquium-report
•My presentation to this on strengthening the leadership role of the DPH http://www.sph.nhs.uk/sph-documents/lg-colloquium-presentations/j.mcmanus-lg-colloquium-presentation

I claim no great expertise in this field other than a) having been interested in the psychology and practice of leadership for some years, b) being involved in running or supporting leadership programmes and c) trying to live up to my own leadership role as best I can.  Some folk will tell you I am a good leader. Some will tell you I am not. Most, I suspect, will tell you I have good points and points I could be better at and things they do better than I do.  Knowing and working with that, I think, is the important thing. After all, not even the saints were perfect. And God knows I’m not.

There remains for me the big issue of self-leadership.  I don’t believe I’m a great leader. I try to recognise my failings but the point of being human is we all have them. I’m on a journey. I have some great people around me but we are all human. That to me is the first thing in trying to lead and the thing I will still be trying to do well every day of my life, and often do less well than I should or perhaps could. There is no “magic fix” leadership or magic read.

Starting with me, hepling you cope with me and me with you

A long time ago (2003 to be precise) I was lucky enough to be on the Public Health Leadership Programme and lucky enough to be on the West Midlands cohort where we did a lot of work on personality, style, experiential learning, understanding ourselves etc.  I think I learned a lot from that, most especially the fact that I will always need to review and look at my leadership style and where we go.  Since then I’ve had the privilege of sponsoring leadership programmes and mentoring for them, and most lately I am sponsor for a fantastic group of people doing a local leadership programme. I learn huge amounts from them. Reflective learning is an important part of  the leadership task, and seeking feedback. I made a list of my leadership role models. Increasingly they are local people.  3/4 of the living ones nationally and internationally are women, several are medics, most not; some are contemplative enclosed religious, some LGBT, a mix of ages and ethnicities and the rest are all long dead but have left deeds and writings which inspire me daily.

Do that exercise for yourself and see what it shows you…do you have people who have radically different leadership styles?  If yes, learn from them about which style works in which situation.

Now try to work out where you can do better and what your weaknesses and learning points are. There are days when you will think people you encounter as a nightmare. The important thing is to remember there are days when they will think you are a nightmare, and they will be right.  Finding the good and strengths in everyone is a good position. Dealing with difficult behaviour is often where we each end up with each other. Such is the human task.

The point for me is that before you try to make sense of the world you are in,  you need to make sense of how you as a person are and what that says about how you are with other people in a team, partnership, management and leadership context. That will be an ongoing journey. So you need to know when to be gentle with yourself and when to expect better (just as you do with your colleagues.)  And then you need to build tools and techniques to work through it all. Adding in a little bit of generosity as well as discipline, along with trying (and undoubtedly failing in part) to model how you want things to be is important.

You’ll notice I take a very positive psychology approach (seeing strengths and opportunities for the good) which is informed by the fact I like the science behind positive psychology.  Some folk think that means I’m in denial about the downsides and difficulties. It isn’t, it means I see them but choose to see them as challenges to overcome in getting to positive outcomes not problems to derail me. (Try it, it makes for a much happier life.) How we see the world is important for our style of leadership. And one of my maxims is never to do pessimism in public. It pays off!

Pieces of a Jigsaw – the roadmap to better public health

So, I mentioned the Jigsaw. Here, so far, are the pieces I think are part of the public health leadership challenge:

  1. The epidemiology of the area
  2. The strategic challenge of what that means for health and the public purse
  3. Where the epidemiology says we need to go
  4. The aspirations and desires of members
  5. Integrating effectively into local government while managing to work well with partners and support the NHS healthcare public health job
  6. The state of the evidence base
  7. The fiscal and strategic context of where we work
  8. Putting all that together into a clear strategy
  9. Articulating it
  10. Delivering it – a jigsaw in itself
  11. Evaluating it
  12. Keeping yourself resilient, reflective and delivering
  13. Keeping others enjoying, learning and delivering
  14. Adapting and changing as the world around us changes

All of these pieces of the jigsaw can be broken down further.  Our strategy is now in place http://www.hertsdirect.org/docs/pdf/p/phstrat.pdf (so one pile of hard work is done, and the next bit of hard work begins.)

The delivery jigsaw

I mentioned this is a jigsaw in itself. Working with delivery partners and other commissioners is crucial. And getting delivery is also crucial. That’s two bits of the delivery Jigsaw. We’re busy rolling out a number of new programmes already (320 people have been referred to our new weight management programme in just six weeks since the doors opened, for example.)

A third bit is configuring the public health service itself. You’ll find that locally we’re using a “four engines” approach of evidence/analysis, technical public health expertise, project management to deliver and commissioning to get delivery. We’re also using amazing delivery partners.  Others take a different approach. You can read about our project management delivery framework here  http://www.slideshare.net/jamesgmcmanus/hertfordshire-programme-management-approach-to-public-health

A fourth part is then articulating the levels at which public health needs to be done. In Hertfordshire we’ve articulated in Chapter 3 of our strategy the components of our model – i) a clear definition of public health, ii) understanding the domains of health improvement, health protection and service delivery and quality and iii) using the six levels of public health from individual to population level.  We’ve also articulated the mechanisms of Boards and so on.  Trying to be a public health leader in this context is about trying to articulate this landscape clearly.  We have more to do on that.

A fifth part of the jigsaw is about articulating where behaviour change sits in this whole world, and what it does for us. (I intend the next blog piece to be about that.)

The jigsaw isn’t complete…I’ve left huge amounts out. some people will wish I’d talked more about evaluation and performance..there is enormous work going on behind the scenes by some colleagues doing painstaking and difficult work on getting existing services right, and it is hard work. But I think we will get there. And we will learn a lot – and hopefully have some fun along the way.

Some Leadership top reads

I provide a fairly detailed bibliography in my powerpoint, but here are my top reads on leadership. But there are a number below which if you have the time I have found very valuable. Some of these you will love, some of these you will hate. Such is the very personal nature of Leadership and writing on it.

SOME OF MY TOP TIPS

Alexander Haslam’s New Psychology of Leadership, 2012

Ayman and Chemer’s 2014 forthcoming re-issue of the 2007 classic An Integrative Theory of Leadership

Daniel Pinnow’s new 2014 Leadership: what really matters

Michael Rumsey’s the Oxford Handbook of Leadership 2012

Martin Iszaat -White and Christopher Saunders forthcoming Leadership by Oxford University Press (if you’ve liked their research, you’ll like their book)

And the forthcoming Oxford Handbook of Political Leadership by Rhodes and Hart, which has an impressive line up of authors on the nature and challenges of political leadership internationally.

SAFE AND GOOD READS

•Haslam, A et al (2010) The New Psychology of Leadership. Psychology Press
•Iszaat-White, M and Saunders, C (2014) Leadership. Oxford: Oxford University Press
•Lane, J, & Wallis, J 2009, ‘Strategic management and public leadership’, Public Management Review, 11, 1, pp. 101-120
•Lewis, Sarah (2011) Positive Psychology at Work. Chichester: Wiley-Blackwell
•Pinner, D (2011) Leadership: what really matters. New York: Springer
•Tummers, L, & Knies, E 2013, ‘Leadership and Meaningful Work in the Public Sector’, Public Administration Review, 73, 6, pp. 859-868
•GOOD FOR THE SHELF
•Linley, P et al (2013) Oxford Handbook of  Positive Psychology and Work. NY: Oxford University Press
•WORTH PRE-ORDERING
•Barling, J (2014) The Science of Leadership. New York: Oxford University Press
•De Haan (2014) The Leadership Shadow. London: Kogan Page