Public Health Leadership: the conversation continues

Having been working on leadership styles appropriate to public health in the new English system, I thought it was about time to share the results of some of the conversations I’ve been having, since the last time I posted.

I’ve had conversations with a range of people about leadership and DsPH and domain skills and way back in 2011 there was a colloquium on leadership and local government at which I presented from an organizational psychology perspective and as a DPH in local government, about the leadership styles and roles of the DPH. You can find this here.

My perspective

I come at this as a psychoogist, who is CIPD qualified and qualified in strategic learning and development. I have been involved in leadership development in local govt, nhs, third sector and faith settings since about 2000. I started doing leadership development for community safety managers in local government at the time, on secondment to the Home Office.

I’ve also done leadership development in third sector, faith and safeguarding contexts, including work on self-care for leaders.

Most importantly, from my perspective, I found a lot of the models then being discussed not very helpful for a number of reasons. Some models being advanced were too focused on technical competence. Others focused more on “holding the ring” , while others seemed to suggest a largely transactional style focused on statutorily defined functions.

I argued at the time that we need a larger model of different domains for public health leadership, and three years (and many workshops, seminars, learning sets and my own reflection on my leadership style) later, I still think that multiple domains of competence for leaders are where we need to go.  My own colleagues and teams may tell you I am good, bad, rubbish or (as I think myself) a mixed bag on my own leadership. Personally I think as leaders we are always “on the way” and need to reflect and learn as we go.

So I set about doing three pieces of work. The first was developing further the work I presented in 2011. The second was doing some work on what types of leadership “style” might be suited to public health leadership today. The third is working with ADPH and others to develop some specific “content” for public health leaders – like the seminars on understanding how local government law is crucial to working in local government these days. I hope to do more of this content stuff.

Developing future leaders is different from supporting existing ones

Public Health England have been working with a number of other agencies to produce a  programme for future public sector directors (which I think will be excellent), and will focus on building new leaders and directors across childrens’ service, adult social care, nhs, local government and public health together. This could be very powerful at integrating  and producing leaders working across the whole system. But while this is excellent, we still need some work to develop further and support existing public health leaders.

Why existing initiatives may not work for current senior public health leaders in local government

My own view is the leadership models from the NHS and those proposed by a number of agencies don’t work for the following reasons:

  • Existing models and programmes don’t necessarily incorporate the multiple domains of skill and competence the DPH needs to show to be effective
  • Another major area is how to influence across systems, when many DsPH have been trained to be technical not system leaders and some are better at it than others. Similarly the training scheme doesn’t always prepare trainees to come off it ready to do this at the level they need to in local government.
  • A third area is the domain specific knowledge and competencies for local government which need to be added to technical public health domains.
  • A fourth area is partnership and system wide distributed leadership skills, which some have more of than others.

Another point about my own experience is important here, because it has influenced me significantly. When I started in local government in 1990 (so I have been much more and longer a local government officer than an NHS one) as a new Principal Officer (as we were called then) I got sent to London or Manchester once a month for three years for a programme on skills for local government management and leadership. This ranged from technical skills (local government law) to the crucial skill of understanding the members and officers of the local authority [or even department within the local authority] I would find myself in, understanding the culture and knowing which styles of influencing and working work and which styles don’t. This was essentially a senior local government finishing school. It was the best programme I ever did. It’s a programme I wish someone had run for me as a new DPH and it’s a programme I know a lot of existing DsPH would find valuable.

It also helped me understand when to stop wasting my time in a role I would never fit and move on when needed. Not every public health leader or local government leader is right for every local authority. The issue of “person-organisation fit” was something we can easily conclude is more important in local government. But in reality it was important in the NHS, they just dealt with people who didn’t fit in different ways to local government.

Understanding leadership from the inside

The literature on leadership development is littered with reflections from people who have designed programmes have done so from “outside” the system they are looking at in one way or another , which means a particular view of what is needed or a particular solution is chosen without necessarily investigating it thoroughly from the inside out.

One of the common themes in conversation with DsPH is that a number of programmes for us seem to have been designed from “outside” the context DsPH are now in, so miss a number of issues. We need to understand the challenges from “the inside” to design effective development and programmes. Listening to DsPH in local government is going to be crucial to design effective programmes for them. Equally, helping people in local authorities and people in Public Health England learn about the other by immersing them in each other’s agencies is potentially very useful, and is happening in a number of areas with PHE people and local authority people shadowing each other. This kind of exchange can only be good.

But the issue of leadership style still needs to be addressed. There are many common areas where people across the system can do some similar work on leadership styles. But I can’t get away from the feedback I get that specific work around public health leaders in local government is still needed.

Some potential solutions from Occupational Psychology and Leadership research

So, onto the specific pieces of work. Again I stress this is “on the way”. The history of research on leadership had been typified by a range of paradigms, models and concepts which have changed, dialogued and developed over time. The “leaders are great men” theory, common in the early thirties, is one few people would seriously subscribe to now. But a bewildering array of models from trait theory, servant leadership, transformational, transaction and situational leadership to diversity leadership all exist, with varying challenges and problems. And all of them attract researchers and practitioners for different reasons. My own take after years of working on leadership is:

  1. Leadership is a set of influencing tools and mechanisms applied for a given purpose in a given context
  2. The ethical, interpersonal and intrapersonal aspects of leadership are as important as both the task and the situation/context
  3. Many models can be made to work, some are better than others, and the next model will be along in 5 minutes
  4. Be very suspicious of much but not all in airport bookshops, especially if it begins with “leadership secrets of Atila the Hun…” or some such stuff.
  5. Leaders exercise power, there is no getting away from it. That must be done ethically and connects public health leadership directly to the competence of ethical stewardship of self, resources and others.
  6. Leadership divorced from values is dangerous. Leadership without clearly understood and examined values is reckless.
  7. An effective style for the varied role of a DPH is emerging in the world of complex organisations, and I call it “adaptive strategic leadership”, about which a little more below.

Conceptualising Domains of public health and leadership – I have updated my 2011 work on Leadership and DsPH with thinking from conversations and discussions and learning events to reflect where I think some of the issues are, and you can find this here If it’s useful, use it. If not, discard. Your comments and views would be very elpful.

I have presented these challenges using the occupational psychology concepts of “person-role fit”, “person-organisation-fit”, and “person-system” fit. My own view is many of us DsPH have been struggling to redefine our competencies and skills to be effective when our role, organization and system has changed and the leadership programme currently available have not always been right for us.

Adaptive Strategic Leadership: Conceptualising Leadership Styles – An immense amount of work has been done in the world of leadership research across complex and distributed (geographically or organizationally) systems. After a great deal of reading and reviewing and listening and reflecting it seems to me that leadership style which is adaptive and strategic (see the powerpoint in the link below) is a style which works for the role of senior public health leader in England today. Again, I’ve used the three categories of “person-role fit”, “person-organisation-fit”, and “person-system” fit above as a first way into this challenge.

Based on this work I’ve put forward some hypotheses about DPH leadership styles where I have, I hope, colligated the evidence correctly, but of course have not had either the time or resources to write up the conversations and learning with peers I have done on this, or do some really thorough primary research on this. But for what it’s worth I offer where I have got to so far.

The self-learning powerpoint of this is here

The detailed slides with bibliography on this is here

And the video of my guest lecture on this is here


I stress that all of this work is essentially “on the way”. I’d love to know what you think. Equally, I’d love to know where you think you have a better way forward

I feel we need a bunch of us to work together on this. My own view is getting this right will move us forward.

5 thoughts on “Public Health Leadership: the conversation continues

  1. Hi Vicki, just bought your book on Kindle. Looking forward to reading. Tony

  2. I shall be ordering your book today 🙂

  3. Yes, agree completely. I owe you some emails.

  4. Hi Jim, also really enjoyed this and will include it as a resource for the clinical psychology course I teach on. The five year forward view makes public health its centrepiece and leadership in the coming months and years is going to be crucial.

  5. Hi Jim I enjoyed your discussion and the points made – and importantly agree with them. Have you looked at my book ‘Leading Health and Wellbeing’ which as written in part with my frustration at the leadership issues in public health. For me understanding the organisation is a crucial aspect hence the chapter on organisational structure and culture…

Comments are closed.

%d bloggers like this:
search previous next tag category expand menu location phone mail time cart zoom edit close