From know - do to how - why ITM colloquium, 2014 Dr Julie Balen - - PowerPoint PPT Presentation

From “know-do” to “how-why”…

ITM colloquium, 2014

Dr Julie Balen Lecturer, Global Health School of Health & Related Research (ScHARR) The University of Sheffield, UK

25 November 2014

SOCIAL SCIENTISTS ANONYMOUS…

Social scientists in global health research

Inter-disciplinary global health research: worthy goal; fuzzy concept?

Health economics Epidemiology

Sociology

Statistics

Geography Psychology Medicine

Anthropology

A complex landscape

Ethics

Management sciences

Political sciences

Law History

Inter-disciplinary global health research: worthy goal; fuzzy concept?

Health economics Epidemiology

Sociology

Statistics

Management sciences

Political sciences Geography Psychology Medicine

Anthropology

Law

A complex landscape – (a bit) more navigable?

Ethics

History

Health systems strengthening

Leadership is foundational element, but ill defined, under researched & poorly understood especially in complex, resource-poor settings

The Gambia, West Africa

Study design & setting

The study of leadership

• 1. Person: skills, abilities, personality, styles of

engagement and behaviours of individuals

• 2. Position: formal authority and responsibility in an
• rganization
• 3. Process: a set of dynamic activities and

interactions occurring among and between individuals, groups and organisations in a specific context

Leadership – a person, a position or a process?

Coercive Authoritative Affiliative Democratic Pace-setting Coaching Modus

• perandi

Demands immediate compliance Mobilises people toward a vision Creates harmony; Builds emotional bonds Forges consensus through participation Sets high standards for performance Develops people for the future Underlying emotional intelligence components Drive to achieve; Initiative; Self- control Self-confidence; Empathy; Change catalysts Empathy; Builds relationships Collaborates; Team leadership; Consults Conscientious; Drive to achieve; Initiative Develops

• thers;

Empathy; Self-aware The style in a phrase “Do what I tell you” “Come with me” “People come first” “What do you think?” “Do as I do, now” “Try this”

The study of leadership

A summary of the six key leadership styles explored in this study

Adapted from Goleman (2000)

Predominant leadership styles

Democratic: “Healthcare delivery entails dealing with life, and in dealing with life, certain issues that are coming up, you can’t predict them. So if they are unpredictable, then that means it’s no longer in your domain. If you do not reach out, reaching out doesn't mean you don’t know.” “I also conduct meetings... frequently call the staff and have a discussion, basically they will show you ways how to manage a facility. So I capitalise on what they say because I may not know exactly what is happening or may not know all, but sometimes their ideas are very good, I take them.” Pace-setting: “I use the religious aspect, whatever we do to help others no one can pay you, the payment will come after death. This is how I encourage people to strive.” Authoritative: “So it is context specific, I should think that a leader must always have a particular vision and wants that vision to be embraced by those around them so that we get to that goal.” “My leadership skills, I think I’m just born with it. I don't boast of it but I think I am privileged that God granted me certain things, which through my own innovations I am able to do them so I am a tough leader.”

A few brief conclusions

• Study of health leadership aids in constructing a

narrative of local agency

• Relocates focus from thinking primarily about

‘interventions’ & ‘innovations’… towards people- centered health systems comprised of local actors & their sense of ownership, authority & power

• Adding “human dimension” to dominant paradigms

in global health discourses

http://www.conferencemanager.dk/islc2014/about-the-conference.html

This work brings a new perspective to the study of leadership as an inter- subjective phenomenon that exists within a social & political reality & is shaped by particular, culturally determined ways of framing problems & solutions

A few brief conclusions (2)

• Brings to light the “rigour-relevance gap”
• Not same as “know-do gap” so well known in global health research/practice
• Focuses on the “why” rather than the “do” or “how”

Mind the gap(s), please…!

KNOWLEDGE ---- ACTION RIGROR ---- RELEVANCE

• 3. Assimilation
• 4. Adaptation
• 1. Acquisition
• 2. Application

Focus shifted to local level; Trans-disciplinarity is important; Inclusive participatory action research as tool for collaboration & reflection

• To close both gaps, research must adapt to ask the right

questions

• Reminder of a famous quote (Pablo Picasso):

“Computers are useless. They can only give you answers.”

• Refocus on people (rather than technology & innovation)

by addressing locally relevant questions/issues & through better engagement of/with local communities

4th quadrant: adaptation

Summary comments

Successful inter-disciplinary teams need disciplinary experts & cross-discipline “bridges” HPSR focused on geographical & financial access to medical technologies, innovations & service rather than on people – who form the core of health system Concept of leadership can add human dimension to dominant models of conceptualizing/researching health systems/policy HPSR needs to draw more on inter-disciplinarity; to be co- created/adapted at & by local level, through community participation & reflection in action (4th quadrant)

Future outlook - ScHARR

Building inter-disciplinary team for participatory action research

• n leadership & health systems strengthening in The Gambia &

Ghana – at the norming (i.e. “searching for funding”) stage… Team currently conducting research into (among other things):

• Lived-experience of health systems in urban informal settings of Northern

Nigeria (where the state is relatively absent) [Muhammad Saddiq]

• Real-life functioning of global health partnerships & their embeddedness

within national contexts, focusing on Ethiopia [Henock Taddese]

• Biomedical dominance & professionalization of health workers in Nigeria

through a case study of Global Fund HSS grant [Samuel Lassa]

• Impact of biomedical knowledge on evidence-informed health policy making,

focussing on malaria control in Senegal/Gambia [Maelle deSeze]

• Using cross-media data mining & analytics in Ebola control – dispelling myths

Acknowledgments

Imperial College Dr Lesong Conteh Prof Peter Smith Special thanks to all key informants who participated in this study Ethical clearance obtained from The Gambian Government/MRC Joint Ethics Committee and Imperial College London Ethics Committee MRC Gambia

• Prof. Umberto d’Alessandro (co-I)
• Prof. Tumani Corrah (co-I)

Dr Momodou Jasseh (co-I) Mr Serign Ceesay Mr Sulayman Janneh Ms Marie Rose Thorpe Mr Landing Bojeng MRC Drivers & Assistants The Gambia Government Dr Adama Demba (co-I) University of Oxford Dr Simukai Chigudu (student) I gratefully acknowledge funding from Imperial College London and the National Institute of Health Research, UK

References – further reading

1. Bennet, S., Agyepong, I.A., Kabir S., Hanson, K., Ssengooba, F., Gilson, L. Building the Field of Health Policy and Systems Research: An Agenda for Action. PLoS 2011;8(8) 2. Chigudu, S., Jasseh, M., d’Alessandro, U., Corrah, T., Demba, A., Balen, J. The role of leadership in people-centred health systems: a sub-national study in The Gambia Health Pol., Plan. 2014 3. Curry, L., Taylor, L., Chen, P.G.C., Bradley, E. Experiences of leadership in health care in sub-Saharan Africa. Human Resources for Health. 2012;10(1):33 4. Gilson, L., Hanson, K., Kabir S.,, Agyepong, I.A., Ssengooba, F., Bennet, S., 2011 Building the Field of Health Policy and Systems Research: Social Science Matters. PLoS Medicine 2011;8(8) 5. Goodwin, N. Leadership and the UK health service. Health Policy. 2000;51(1):49–60 6. Goodwin, N. 2010 Understanding Context and its Impact on The Leadership Challenges of Chief Executives in the English NHS. Monograph Series 7. Harman S., Rushton, S. Analyzing Leadership in Global Health Governance Global Health Governance. 2013;7(1):1-19 8. Hartley, J., Hinksman, B. 2003 Leadership Development: A Systematic Review of the Literature. The NHS Leadership Centre, UK 9. Huang Y.X. & Manderson, L. The social and economic context and determinants of schistosomiasis japonica, Acta

• Tropica. 2005;96(2):223-231
• 10. Patel, V.M., Warren, O., Humphris, P., Ahmed, K., Ashrafian, H., Rao, C., et al. What does leadership in surgery entail?

ANZ Journal of Surgery. 2010;80(12):876–83

• 11. Sheikh, K., Gilson, L., Agyepong, I.A., Hanson, K., Ssengooba, F. Building the Field of Health Policy and Systems

Research: Framing the Questions. PLoS Medicine. 2011;8(8):1–6

• 12. Siddiqi, S., Masud, T.I., Nishtar, S., Peters, D.H., Sabri, B., Bile, K.M., et al. Framework for assessing governance of the

health system in developing countries: gateway to good governance. Health Policy. 2009;90(1):13–25

• 13. Smith, P.C., Anell, A., Busse, R., Crivelli, L., Healy, J., Lindahl, A.K., et al. Leadership and governance in seven

developed health systems. Health Policy. 2012;106(1):37–49