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.

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
•My presentation to this on strengthening the leadership role of the DPH

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 (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

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.


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.


•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
•Linley, P et al (2013) Oxford Handbook of  Positive Psychology and Work. NY: Oxford University Press
•Barling, J (2014) The Science of Leadership. New York: Oxford University Press
•De Haan (2014) The Leadership Shadow. London: Kogan Page

2 thoughts on “Public Health Leadership…putting together the jigsaw

  1. Thanks, very interesting article!

  2. Hi Jim
    You may find this article by Kimberly interesting too

    Click to access Kimberly.pdf


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