Leadership is getting results in a way that buildstrust—A Public Health Accreditation UpdateTomás J. Aragón, M.D., Dr.P.H.Health Officer, City & County of San FranciscoDirector, Population Health Division, SFDPHKaren Pierce, Public Health Accreditation Coordinator20 August 2013

Introduction and review

The San Francisco Health Commission has identified three strategicpriorities for the Department of Public Health which aligns with thenationally recognized “Triple Aim” (Figure 1).

Figure 1: The Public Health Triple Aim

1. Public Health Accreditation (Health)

2. Integrated Delivery System (Care)

3. Financial & Operational Efficiency (Cost)

The purpose of public health accredition is to create a high per-forming learning organization that is responsive and accountable toour community stakeholders. We will be evaluated on public healthservices using 12 domains:

No. Domain Description

1 Assess Conduct and disseminate assessments on population health status2 Investigate Investigate health problems and environmental health hazards3 Inform & Educate Inform and educate about public health issues and functions4 Community Engagement Engage the community to identify and address health problems5 Policies & Plans Develop public health policies and plans6 Public Health Laws Enforce public health laws7 Access to Care Promote strategies to improve access to health care services8 Workforce Ensure competent workforce and professional growth9 Quality Improvement Ensure continuous improvement of performance and quality

10 Evidence-Based Practices Contribute to and apply the evidence base of public health11 Administration & Management Maintain administrative and management capacity12 Governance Maintain capacity to engage the public health governing entity

Public health accreditation consists of seven steps:

1. Pre-application

2. Application

3. Documentation

4. Site Visit

leadership is getting results in a way that builds trust 2

5. Accreditation Decision6. Reports7. Reaccreditation

We are currently in the pre-application step. The application processbegins once we submit a completed application form and requiredsupporting material (see Table ). This material includes, but is notlimited to, three prerequisite documents, updated in the last 5 years:

Table 1: Accreditation TimelineStep Date

Prerequisites December 2013

Application December 2013

Documentation September 2014

PHAB Site Visit January 2015

Accreditation March 2015

1. Community Health Assessment (CHA) and Profile;2. Community Health Improvement Plan (CHIP),3. Public Health Strategic Plan (focus of this update)

The Community Health Assessment and Profile, and the CommunityHealth Improvement Plan have been completed and have been pre-sented to the San Francisco Health Commission. In this update, wefocus on our strategic planning.

Because public health accreditation involves the evaluation ofpublic health (not medical) services, the effort is being lead by theOffice of Policy and Planning,1 and the Population Health Division.2 1 Director, Colleen Chawla, MPA

2 Director, Tomás Aragón, MD, DrPH

Figure 2: The Baldrige Criteria forPerformance Excellence

Population Health Division Strategic Plan

As part of accreditation, the Population Health Division is undergingan extensive reorganization. To guide the reorganization, accredita-tion, and strategic planning we are adapting the Baldrige Criteria for

leadership is getting results in a way that builds trust 3

Performance Excellence as our overarching framework (Figure 2).3 3 http://www.nist.gov/baldrige/

Baldrige is a national award program in existence since 1987, andits goal is to guide businesses, non-profits, education and healthagencies to become innovative, high performing, and continuouslyimproving organizations. The Baldrige Criteria build on core valuesand concepts which are embedded in systematic processes (Criteria1–6) yielding performance results (Criterion 7) (Figure 3).

Figure 3: The Baldrige Criteria, CoreValues and Concepts, and Results. Corevalues and concepts include Visionaryleadership, Patient-focused excellence,Organizational and personal learning,Valuing workforce members andpartners, Agility, Focus on the future,Managing for innovation, Managementby fact, Societal responsibility, Focuson results and creating value, Systemsperspective

The six of seven Baldridge Criteria are grouped into the Leader-ship Triad (leadership, strategic planning, customer focus) and theResults Triad (workforce focus, operations focus, and results). TheLeadership and Results Triads anchor the Baldrige Criteria, ener-gizing us to focus on leadership development and results-basedmodels. Therefore, our initial primary focus is on the following Cri-teria:

Criterion 1 Leadership using Authentic Transformation Leadership4 4 John J. Sosik and Dongil (Don) Jung.Full Range Leadership Development:Pathways for People, Profit and Planet.Psychology Press, 1 edition, 9 2009.ISBN 9781848728066

Criterion 7 Results using Results-Based Accountability5

5 Mark Friedman. Trying Hard Is NotGood Enough. BookSurge Publishing, 5

2009. ISBN 9781439237861

For leadership, we are using the authentic transformational leader-ship model. For results, we are adapting the Results-Based Account-ability (RBA) model where “results” are always defined in terms ofhaving measurable impacts on community health and well-being, orclient health and well-being. The RBA framework is very popularwith public sector and non-profit agencies.

leadership is getting results in a way that builds trust 4

Our overarching goal is to create an organizational culture andsystem of processes to support creativity, innovation, and discovery,and to drive service excellence, continuous quality improvement, andresults-based performance. To achieve this we are implementing thefollowing:

1. Strategic planning retreat on September 24–25, 2013 using RBA todevelop Action Plan for high-priority, citywide health initiatives.

(a) Community Health Improvement Plan6 6 In partnership with San FranciscoHealth Improvement Partnership(SFHIP)(b) African American health

(c) HIV Prevention(d) Public housing(e) Children’s health

2. PHD Leaderhip Academy (Fall 2013: Directors, Year 2+: staff)3. RBA/Equity & Quality Improvement Training Academy (2013)

Summary

For public health accreditation, we are adapting the Baldrige Cri-teria for Performance Excellence. The Baldrige Criteria starts withLeadership (“Driver”) and ends with Results (“Destination”). Forour leadership foundation (Criterion 1) we are adopting the authen-tic transformational leadership model which is evidence-based withvalidated assessment and development tools.

For our results foundation (Criterion 2) we are adopting theResults-Based Accountability framework. RBA is used extensivelyaround the world. In California, RBA is used by Marin, Alameda,San Mateo, Contra Costa, and Los Angeles Counties. LAC PublicHealth as agreed to mentor us.

References

Mark Friedman. Trying Hard Is Not Good Enough. BookSurge Pub-lishing, 5 2009. ISBN 9781439237861.

Roger Gill. Theory and Practice of Leadership. SAGE Publications Ltd,second edition edition, 1 2012. ISBN 9781849200240.

John J Sosik. Leading with Character: Stories of Valor and Virtue and thePrinciples They Teach (PB). Information Age Publishing, 7 2006. ISBN9781593115418.

John J. Sosik and Dongil (Don) Jung. Full Range Leadership Devel-opment: Pathways for People, Profit and Planet. Psychology Press, 1

edition, 9 2009. ISBN 9781848728066.

leadership is getting results in a way that builds trust 5

Appendix A—Results-Based Accountability

Results-Based Accountability (RBA) is “a disciplined way of thinkingand taking action that can be used to improve the quality of life incommunities . . . ” RBA was popularized by Mark Friedman’s bookTrying Hard in Not Good Enough. RBA (also called Outcomes-BasedAccountability) is used by public sector and non-profit agencieswhose missions include addressing complex social challenges usingcollaborative partnerships.

RBA “starts with ends and works backwards, step by step, tomeans. For communities, the ends are conditions of well-being forchildren, adults, families and the community as a whole . . . For pro-grams, the ends are how customers are better off when the programworks the way it should . . . ”

Figure 4: RBA for Community Resultsusing Partnership Shared Accountabil-ity to Improve Community Health andWell-being (Source: Friedman book)

For communities (Figure 4), we ask the following seven questions:

1. What are the quality of life conditions we want for the children,adults and families who live in our community?

2. What would these conditions look like if we could see them?

3. How can we measure these conditions?

4. How are we doing on the most important of these measures? And,what is the story behind the curve?

5. Who are the partners that have a role to play in doing better?

6. What works to do better, including no-cost and low-cost ideas?

7. What do we propose to do?

For programs (Figure 5), we ask the following seven questions:

1. Who are our customers?

2. How can we measure if our customers are better off?

3. How can we measure if we are delivering services well?

4. How are we doing on the most important of these measures? And,what is the story behind the curve?

5. Who are the partners that have a role to play in doing better?

6. What works to do better, including no-cost and low-cost ideas?

7. What do we propose to do?

Figure 5: RBA for Program Perfor-mance using Program Direct Account-ability to Improve Customer (Client)Health and Well-being (Source: Fried-man book)

Notice that questions 4 through 7 are identical; only the first threequestions differ depending on whether the focus is population account-ability for outcomes in a community population, or program accountabilityfor program performance for outcomes in a customer population. In ei-ther case, the term “Results” always applies to improving well-beingoutcomes in communities or customers (“Is anyone better off?”).Figure 6 depicts the connection between population (shared) account-ability and program performance (direct) accountability.

leadership is getting results in a way that builds trust 6

Results-Based Accountability is a powerful, community-centered,data-driven, continuous quality improvement method with the fol-lowing special features:

Figure 6: In the RBA framework,Program Performance and DirectAccountability contribute to PopulationResults and Shared Accountability(Source: Friedman book)

• Designed for public sector and non-profit agencies who are mis-sion and results driven

• Designed for engaging and empowering community stakeholdersto tackle complex social problems

• Focused on Results, which is defined as improving communityand/or client well-being

• Starts with ENDS (results), and uses data and community voice, todevelop and implement MEANS (strategy and action plan)

• Distinguishes between shared accountability with partners vs.direct accountability for our program performance

• Contains comprehensive approach to selecting community out-come indicators and program performance measures

• Built on the empirical sciences of epidemiology and quality im-provement

• All the materials are free for use by governments and non-profits

RBA complements emerging and powerful approaches such asCollective Impact that has been popularized by inspiring colleaguesat FSG (http://www.fsg.org/).

Appendix B—Authentic Transformational Leadership

For leadership development there are many good models,7 programs, 7 Roger Gill. Theory and Practice ofLeadership. SAGE Publications Ltd,second edition edition, 1 2012. ISBN9781849200240

and consultants—and it can be very confusing! From our experiencesat the SFDPH, we have come to appreciate that relationships play ahuge and central role! In contrast to individual development, for or-ganizational development, learning, and performance improvement,a leadership development model should have the following strengths:

• Emphasis on relationships

• Based on extensive research

• Available validated tools for assessment and development

• Inclusion of method for spread throughout the organization

• Implementable and sustainable at low costs

• Practical and common sense to implement

Based on these criteria, we are adapting—as our core foundation—authentic transformational leadership (ATL).8 ATL is an extension of 8 John J. Sosik and Dongil (Don) Jung.

Full Range Leadership Development:Pathways for People, Profit and Planet.Psychology Press, 1 edition, 9 2009.ISBN 9781848728066

transformational leadership.

leadership is getting results in a way that builds trust 7

Transformational leadership

Transformational leaders are those who transform their followers into becom-ing leaders themselves.

From mindgarden.com: “Transformational leadership is a lead-ership approach that is defined as leadership that creates valuableand positive change in the followers. A transformational leader fo-cuses on ‘transforming’ others to help each other, to look out for eachother, to be encouraging and harmonious, and to look out for theorganization as a whole. In this leadership, the leader enhances themotivation, morale and performance of his follower group.”

“Transformational leaders are those who stimulate and inspirefollowers to both achieve extraordinary outcomes and, in the process,develop their own leadership capacity. Transformational leaders helpfollowers grow and develop into leaders by responding to individualfollowers’ needs by empowering them and by aligning the objectivesand goals of the individual followers, the leader, the group, and thelarger organization. . . . ”

We can identify transformational leaders by what they do (behav-iors) and who they are (character strengths). Here is our summary ofwhat transformational leaders do:

1. Be an exemplary role model (Idealized Influence)

2. Motivate through inspiration (Inspirational Motivation)

3. Promote innovative thinking (Intellectual Stimulation)

4. Mentor and coach your staff (Individualized Consideration)

Transformational leadership is critical for health organizations!The work of health professionals is knowledge-based and requireshigh educational attainment, experience, problem-solving, creativity,and innovation. The work of health professionals is also trust-basedand requires high ethical/moral standards and behaviors. Also,health professionals train and practice within mentor-mentee rela-tionships. Given all the above, extrinsic motivation (via contingentrewards) is insufficient—we need the 4 Is of transformational leader-ship

Authentic leadership—Role of character strengths

Now that we know “what they do,” we must learn what ideal char-acter strengths define “who they are.” When our TL behaviors alignwith our character strengths and our character strengths are vir-tuous, then we are authentic transformational leaders.9 “Virtues 9 John J Sosik. Leading with Character:

Stories of Valor and Virtue and the Princi-ples They Teach (PB). Information AgePublishing, 7 2006. ISBN 9781593115418

are core characteristics universally valued by moral philosophersand religious thinkers as exemplars of good character. . . . Character

leadership is getting results in a way that builds trust 8

strengths are positive traits or psychological processes or mechanismsfor displaying the virtues. For example, love of learning is a characterstrength that reflects the virtue of wisdom.”

Peterson and Seligman10 (pioneers in positive psychology) have 10 Christopher Peterson and MartinSeligman. Character Strengths andVirtues: A Handbook and Classification.Oxford University Press, 1st edition,2004.

identified 24 character strengths, clustered within six virtues, that areassociated with positive personal qualities and beneficial outcomes.These “Virtues in Action” are the foundation of authentic transforma-tional leadership (Table 2):

Virtue Character strengths

Wisdom & knowledge Creativity, curiosity, open-mindedness, love of learning, and perspectiveCourage Bravery, persistence, integrity, and vitalityHumanity Love, kindness, and social intelligenceJustice Citizenship, fairness, and leadershipTemperance Forgiveness and mercy, humility/modesty, prudence, and self-regulation/controlTranscendence Appreciation of beauty and excellence, gratitude, hope, humor, and spirituality

Table 2: Virtues In Action Model

Authentic leadership is measured by the following domains:

• Self Awareness: To what degree is the leader aware of his or herstrengths, limitations, how others see him or her and how theleader impacts others?

• Transparency: To what degree does the leader reinforce a level ofopenness with others that provides them with an opportunity tobe forthcoming with their ideas, challenges and opinions?

• Ethical/Moral: To what degree does the leader set a high standardfor moral and ethical conduct?

• Balanced Processing: To what degree does the leader solicit suf-ficient opinions and viewpoints prior to making important deci-sions?

360 evaluations and leadership development To date, we have been verydissatisfied with the leadership 360 evaluations we have evaluated.Fortunately, the Full Range Leadership Development model11 has 11 John J. Sosik and Dongil (Don) Jung.

Full Range Leadership Development:Pathways for People, Profit and Planet.Psychology Press, 1 edition, 9 2009.ISBN 9781848728066

been extensively studied with the Multifactor Leadership Question-naire. MLQ is used for 360 evaluations and leadership developmentplans. The short form has only 45 items and takes 15 minutes to com-plete! The MLQ and the Authentic Leadership Questionnaire areboth available at http://www.mindgarden.com.

Appendix C—Attachments (6)

OUR MISSION

OUR VISION

Drawing upon community wisdom and science, we support, develop, implement evidence-based policies, practices, and partnerships that protect and promote health, prevent disease and injury, and create sustainable environments and resilient communities.

To be a community-centered leader in public health practice and innovation.

POPULATION HEALTH DIVISION SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

TRANSFORMING PUBLIC HEALTH IN SAN FRANCISCO

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GOAL 4: Lead public health systems efforts to ensure healthy people and healthy places OBJECTIVES: • 4.1 Establish community-centered approaches that address the social determinants of health and increase

population well-being. • 4.2 Sustain and improve the infrastructure and capacity to support core public health functions, including

legally mandated public health activities. 5. Sustainable funding and maximize collective resources

GOAL 5: Increase administrative, financial and human resources efficiencies within the division. OBJECTIVES: • 5.1 Establish a centralized business office for the division. • 5.2 Appropriately address the human resource issues regarding civil service and contract employees. • 5.3 Establish a centralized grants management and development system for the division.

6. Learning organization with a culture of trust and innovation.

GOAL 6: Build a division-wide learning environment that supports public health efforts. OBJECTIVE: • 6.1 Establish a division-wide Workforce Development program.

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GOAL 1 : Build an integrated information and knowledge management infrastructure that enables us to monitor health, to inform and guide activities, and to improve staff and systems performance. OBJECTIVES: • 1.1.Build a strong, highly functional information technology (IT) and technical assistance infrastructure in

alignment with Department of Public Health IT strategy. • 1.2 Establish a highly functional, integrated infectious disease system to collect and report data, and to deliver

and monitor public health actions.

2. Assessment and research aligned with our vision and priorities

GOAL 2: Integrate, innovate, improve, and expand efforts in community and environmental assessments, research, and translation. OBJECTIVES: • 2.1 Create an action plan that supports division priorities. • 2.2 Build cross-section interdisciplinary teams to improve health outcomes and programmatic activities.

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GOAL 3: Conduct effective policy & planning that achieves collective impact to improve health and well-being for all San Franciscans. OBJECTIVES: • 3.1 Establish a division-wide Performance Management, Equity & Quality Improvement Program. • 3.2 Establish systems and partnerships to achieve and maintain Public Health Accreditation. • 3.3 Develop a prioritized legislative agenda and strategic implementation plan to address health status and

inequities.

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ealt

h O

ffic

er, V

. 201

3-07

-31

Life

Cou

rse

Proc

esse

s

* Fo

r a

spec

ifie

d po

pula

tion

, the

"po

pula

tion

hea

lth"

app

roac

h is

a s

yste

ms

fram

ewor

k fo

r st

udyi

ng a

nd im

prov

ing

the

dist

ribu

tion

of

heal

th a

nd q

ualit

y of

life

sta

tes

(wel

l-bei

ng, h

ealt

h an

d fu

ncti

on, m

orta

lity,

dis

ease

, and

inju

ry)

and

thei

r de

term

inan

ts (s

ocio

econ

omic

, env

iron

men

tal,

life

cour

se p

roce

ss, b

ehav

iora

l, re

silie

nce,

etc

.) th

roug

hco

llabo

rati

ve, s

usta

inab

le, i

mpa

ctfu

l sol

utio

ns (e

.g.,

colle

ctiv

e im

pact

, hea

lth

in a

ll po

licie

s).

IHI

Mod

el a

dapt

ed f

rom

Sto

to, M

. A. P

opul

atio

n H

ealt

h in

the

Aff

orda

ble

Care

Act

Era

, Aca

dem

y H

ealt

h, 2

013

2St

rate

gic

Plan

ning

6O

pera

tion

sFo

cus

3Cu

stom

erFo

cus

5W

orkf

orce

Focu

s

Lead

ersh

ip

+

E

xecu

tion

->

Re

sult

s

Infl

uenc

ed b

y CH

ALL

ENGE

S an

d O

PPO

RTU

NIT

IES

Guid

ed b

y ST

RATE

GY a

nd A

CTIO

N P

LAN

S

4M

easu

rem

ent,

Ana

lysi

s, a

nd K

nowl

edge

Man

agem

ent

Supp

orte

d by

VA

LUES

:Vi

sion

ary

lead

ersh

ip *

Cus

tom

er-d

rive

n ex

celle

nce

Org

aniz

atio

nal a

nd p

erso

nal l

earn

ing

* Va

luin

g wo

rkfo

rce

and

part

ners

Agi

lity

* Fo

cus

on t

he f

utur

e *

Man

agin

g fo

r in

nova

tion

Man

agem

ent

by f

act

* So

ciet

al r

espo

nsib

ility

Focu

s on

res

ults

and

cre

atin

g va

lue

* Sy

stem

s pe

rspe

ctiv

e

1LE

AD

ERSH

IP7

RESU

LTS

Clie

nt H

ealt

h &

Wel

l-bei

ng (R

esul

t)Pr

ogra

m P

erfo

rman

ce (E

ffor

t)

Com

Hea

lth

goal

sEf

fect

ive

stra

tegi

esPr

ogra

mro

les

Perf

orm

ance

goal

sPe

rfor

man

cem

easu

res

Perf

orm

ance

stan

dard

s

Goal 1

Stra

tegy

1Ro

le 1

Stra

tegy

2

Stra

tegy

3

Goal 1

Goal 2

Goal 3

Role

2

Role

3

Mea

sure

1

Mea

sure

6

Mea

sure

5

Mea

sure

4

Mea

sure

3

Mea

sure

2

Stan

dard

1

Stan

dard

6

Stan

dard

5

Stan

dard

4

Stan

dard

3

Stan

dard

2(n

one)

Perf

orm

ance

Exc

elle

nce

Usi

ng B

aldr

ige

Crit

eria

& R

esul

ts-B

ased

Acc

ount

abili

tyPo

pula

tion

Hea

lth

Div

isio

n, S

FDPH

Bald

rige

Cri

teri

a fo

r Pe

rfor

man

ce E

xcel

lenc

eRe

sult

s-Ba

sed

Acc

ount

abili

ty:

A P

opul

atio

n H

ealt

h A

ppro

ach

Shar

edA

ccou

ntab

ility

Publ

ic H

ealt

hM

issi

on &

Vis

ion

Dir

ect

Acc

ount

abili

ty

1. Ba

ldri

ge P

erfo

rman

ce E

xcel

lenc

e Pr

ogra

m. 2

013.

201

3–20

14 H

ealt

h Ca

re C

rite

ria

for

Perf

orm

ance

Exc

elle

nce.

Ga

ithe

rsbu

rg, M

D: U

.S. D

epar

tmen

t of

Com

mer

ce, N

atio

nal I

nsti

tute

of

Stan

dard

s an

d Te

chno

logy

. htt

p://

www.

nist

.gov

/bal

drig

e.2.

Ins

ight

to

Perf

orm

ance

Exc

elle

nce

2013

-201

4: U

nder

stan

ding

the

Int

egra

ted

Man

agem

ent

Syst

em a

nd t

he B

aldr

ige

Crit

eria

, by

Mar

k Bl

azey

, ASQ

Qua

lity

Pres

s, 2

013

3. T

ryin

g H

ard

is N

ot G

ood

Enou

gh: H

ow t

o Pr

oduc

e M

easu

rabl

e Im

prov

emen

ts f

or C

usto

mer

s an

d Co

mm

unit

ies,

by

Mar

k Fr

iedm

an, T

raff

ord

Publ

ishi

ng, 2

005

4. Q

ualit

y Im

prov

emen

t Ex

peri

ence

in a

Hig

h-Pe

rfor

min

g Lo

cal H

ealt

h D

epar

tmen

t, b

y Je

ffre

y D

. Gun

zenh

ause

r, e

t al

. J P

ublic

Hea

lth

Man

agem

ent

Prac

tice

, 201

0, 1

6(1)

, 39–

48

3, 4

1, 2

Tom

ás J

. Ara

gón,

MD

, DrP

HH

ealt

h O

ffic

er, V

. 201

3-07

-30

"Lea

ders

hip

is g

etti

ng r

esul

ts in

a w

ay t

hat

insp

ires

tru

st."

Com

mun

ity

Hea

lth

& W

ell-b

eing

(Res

ult)

Colle

ctiv

e Pe

rfor

man

ce (E

ffor

t)

Indi

cato

rs

Goal 2

THEM

ES &

PRA

CTIC

ES>>

Vis

ion

(des

ired

fut

ure

stat

e)>>

Pur

pose

(why

)>>

Val

ues

(why

)>>

Str

ateg

y (h

ow)

>> E

mpo

werm

ent

(who

)>>

Eng

agem

ent

(who

)

Full

Rang

e Le

ader

ship

Dev

elop

men

t M

odel

TRA

NSF

ORM

ATI

ON

AL

LEA

DER

SHIP

>> B

e an

exe

mpl

ary

role

mod

el (i

deal

ized

infl

uenc

e)>>

Mot

ivat

e th

roug

h in

spir

atio

n (in

spir

atio

nal m

otiv

atio

n)>>

Pro

mot

e in

nova

tive

thi

nkin

g (in

telle

ctua

l sti

mul

atio

n)>>

Coa

ch a

nd m

ento

r st

aff

(indi

vidu

aliz

ed c

onsi

dera

tin)

TRA

NSA

CTIO

NA

L LE

AD

ERSH

IP>>

Con

ting

ent

Rewa

rd

CORR

ECTI

VE L

EAD

ERSH

IP>>

Man

agem

ent-

By-E

xcep

tion

(MBE

) --

Act

ive

>> M

anag

emen

t-By

-Exc

epti

on (M

BE) -

- Pa

ssiv

e

MU

LTIP

LE I

NTE

LLIG

ENCE

S>>

Cog

niti

ve>>

Em

otio

nal

>> B

ehav

iora

l-

- -

- -

- -

- -

>> E

thic

al /

Mor

al>>

Soc

ial

>> C

ultu

ral

>> S

piri

tual

RESU

LTS-

BASE

D A

CCO

UN

TABI

LITY

A

Pop

ulat

ion

Hea

lth

App

roac

h-

Com

mun

ity

Hea

lth

& Cl

ient

Hea

lth

- Co

llect

ive

& Pr

ogra

m P

erfo

rman

ce-

Shar

ed &

Dir

ect

Acc

ount

abili

ty

[Pu

rpos

e]

The

Lead

ersh

ip C

heat

shee

t --

Res

ults

-Bas

ed, A

uthe

ntic

Tra

nsfo

rmat

iona

l Lea

ders

hip

(RB-

ATL

)

RELA

TIO

NSH

IPS

[Peo

ple]

"Tra

nsfo

rmat

iona

l lea

ders

are

tho

sewh

o tr

ansf

orm

the

ir f

ollo

wers

into

beco

min

g le

ader

s th

emse

lves

."

"Lea

ders

hip

is g

etti

ng r

esul

tsin

a w

ay t

hat

insp

ires

tru

st."

"Whe

n 'w

hat

you

do'

alig

ns w

ith

'who

you

are

'yo

u ar

e an

aut

hent

ic le

ader

."

+LE

ADER

SHIP

EXEC

UTI

ON

RESU

LTS

Wha

t yo

u D

O[P

roce

ss]

Virt

ues

in A

ctio

n M

odel

:1

Crea

tivi

ty, c

urio

sity

, ope

n-m

inde

dnes

s, lo

ve o

f le

arni

ng, a

nd p

ersp

ecti

ve2

Brav

ery,

per

sist

ence

, int

egri

ty, a

nd v

ital

ity

3 Lo

ve, k

indn

ess,

and

soc

ial i

ntel

ligen

ce4

Citi

zens

hip,

and

fai

rnes

s5

Forg

iven

ess

and

mer

cy, p

rude

nce,

hum

ility

/mod

esty

, and

sel

f-re

gula

tion

/con

trol

6 A

ppre

ciat

ion

of b

eaut

y an

d ex

celle

nce,

gra

titu

de, h

ope,

hum

or, a

nd s

piri

tual

ity

CHA

RACT

ER S

TREN

GTH

S>>

Wis

dom

& K

nowl

edge

(1)

>> C

oura

ge (2

)>>

Hum

anit

y (3

)>>

Jus

tice

(4)

>> T

empe

ranc

e (5

)>>

Tra

nsce

nden

ce (6

)

LEA

DER

[Per

sona

l]W

ho y

ou A

RE[P

erso

nal]

MA

NA

GEM

ENT

>> T

eam

bui

ldin

g &

perf

orm

ance

>> M

ulti

-Cri

teri

a D

ecis

ion

Mak

ing

>> S

trat

egic

Pro

ject

Man

agem

ent

>> E

quit

y &

Qua

lity

Impr

ovem

ent

>> P

erfo

rman

ce m

anag

emen

t sy

stem

s

Tom

ás J

. Ara

gón,

MD

, DrP

H, H

ealt

h O

ffic

er, V

. 201

3-08

-14

San

Fran

cisc

o D

epar

tmen

t of

Pub

lic H

ealt

h

Bibl

iogr

aphy

:-

The

Theo

ry a

nd P

ract

ice

of L

eade

rshi

p. b

y Ro

ger

Gill,

SA

GE P

ublic

atio

ns (2

012)

, 2nd

Ed.

- Tr

ansf

orm

atio

nal L

eade

rshi

p, b

y Ro

nald

Rig

gio

& Be

rnar

d Ba

ss, P

sych

olog

y Pr

ess

(201

2), 2

nd E

d.-

Full

Rang

e Le

ader

ship

Dev

elop

men

t: P

athw

ays

for

Peop

le, P

rofi

t, a

nd P

lane

t, b

y Jo

hn S

osik

, Psy

chol

ogy

Pres

s (2

012)

"Lea

ders

hip

is s

howi

ng t

he w

ay, a

nd h

elpi

ng o

r in

duci

ng o

ther

sto

pur

sue

it. T

his

enta

ils e

nvis

ioni

ng a

des

irab

le f

utur

e, p

rom

otin

ga

clea

r pu

rpos

e or

mis

sion

, sup

port

ive

valu

es a

nd in

telli

gent

stra

tegi

es, a

nd e

mpo

weri

ng a

nd e

ngag

ing

all t

hose

con

cern

ed."