1. Leadership Development: A “New Science” A Leadership Development Framework to Prepare Community Clinic Leaders for the Future Conceptualized for: The Community Clinics Initiative A Joint Project of Tides and The California Endowment November, 2003 CCI Steering Committee Meeting Sacramento, CA

2. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Why Leadership Development? CCI already supports … The missions and effectiveness of individual clinics  Stronger regional and statewide networks Community engagement in pursuit of healthy communities and social justice Leadership Development will … Help to integrate and add value to all CCI investments in individual clinics Cultivate current and next generation leaders Help maintain and sustain the network of clinics as a strong system for positive change

3. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative An Overview of Sources: Current Theories of Leadership Experience and Findings: Community- based leadership initiatives Policy Link Report: Leadership for Policy Change CompassPoint Reports: What We Know About CCI Leaders — CEOs and Medical Directors

4. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Current Theories of Leadership In response to the tumultuous historical changes in the theory and practice of leadership it has become the current fashion to integrate what might be called the old “ yang ” model of leadership with the new “ yin ” model:

5. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Current Theories of Leadership YANG (Traditional)YIN (New) Hierarchy “ Flatness ” AuthorityConsent ManagerFacilitator Expert “ The People ” ConflictConsensus CompetitionCooperation IndividualTeam RationalIntuitive SpecializedHolistic Industrial AgeInformation Age NewtonianQuantum LinearNon-linear UnityDiversity

6. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Current Theories of Leadership Profound Changes over the past 30 years: 1970: Robert Greenleaf — the “ servant leader ” 1978: James MacGregor Burns new paradigm termed “ transforming leadership ” 1987: James McKnight (and many others) articulate collaboration theory — leadership is in many … not one 1990: Peter Senge contextualizes the leader in the learning organization and links personal mastery with systems theory 1994: Dan Goleman brings “ emotional intelligence ” into leadership theory and practice. 1993 and 2000: Robert Putnam, Francis Fukuyama: leadership and social capital 1999: Meg Wheatley: leadership and complexity 2000: Greg Markus: diversity is an asset for leadership Adapted from Greg Markus: Building Leadership

7. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Current Theories of Leadership What is good is not yin or yang … but the dynamic balance between the two … [An interpretation of Built to Last by James Collins and Jerry Porras & What Leaders Really DO by John P. Kotter] Managing the Organization : Preserve the Core Core Values Purpose Preserve continuity and stability Limit options to mission-centered Clarify “content” Cope with Complexity Planning, Organizing, Staffing Institutionalize leadership-centered culture Leading the Organization: Urge change/new strategies Impel constant movement towards goals Expand possibilities Set direction Cope with Change Enroll others in the vision Align people for empowerment

8. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Experience and Findings from Other Leadership Initiatives Kellogg National Fellowship Program-- 701 Fellows and 91 Advisors over 21 years: Recruit Broadly, Select Carefully Diversity Increases Effectiveness … & Challenges Seek Solutions to Unproductive Stress Encourage an Authentic Learning Community Experiential learning: Direct Experience is Best! Affirmation Enhances Leadership Effectiveness Encourage Inner Work of Leadership Leadership Development Cannot be Neutral — it derives from values Leadership Development Occurs Within a Context Mentors Matter

9. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Experience and Findings from Other Leadership Initiatives Robert Wood Johnson Community Health Leadership Program: The leadership award added credibility to the position of local leaders and the media generated helped to positively shift the community ’ s perception of local healthcare. Leadership Lessons from the Program: Be quiet and listen See beyond the obvious Network to build bridges Be willing to apply compassion, inspiration and support for others to change Be skilled at coping with constant change Be skilled at managing inherent conflict Know how to collaborate Constituency enables leadership

10. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Policy Link Report Overall recommendations about engaging leaders of color: Leaders of color are critically needed to advance a new agenda Support leaders who embody community needs and concerns Support leadership development efforts that are place based with potential longterm impact Support leadership development that links leadership development to actual policymaking Triple focus: support individual development of skills; build organizational capacity; and help build constituencies

11. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Policy Link Report Intervention Strategies for Improving Policy Leadership Design programs that are intentional about developing leaders of color Recruit leaders who are grounded in and accountable to their communities Link leadership development to actual policy goals in the community Support the development of cross-boundary relationships and networks Use mentoring to provide leaders of color with access, guidance, and support Provide a strong curriculum that offers real skills (data analysis, negotiation, diplomacy, advocacy); visibility, positioning and exposure Focus on the development of individuals, organizations and constituencies … not one over the other Connect emerging leaders to movement-building strategies Be prepared to make necessary budgetary allocations and longterm commitments

12. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative CompassPoint Report A Profile of Community Health Leadership in California CEOs: Very high job satisfaction … but countered by stress, fundraising, and anxiety about finances A large majority (70%) are white A large majority (70%) are 50 years or older Most were recruited from “ outside ” Clinic CEOs have been in their jobs longer than the national average (11 years on average) Less than 25% anticipate leaving the job within the next two years though retirement will be the next move for 35% Only half have identified one or more persons as potential successors

13. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative CompassPoint Report A Profile of Community Health Leadership in California Medical Directors: Very high job satisfaction … but feel challenged by the pressures of personnel management, limited resources, balancing duties, communicating effectively with the CEOs A large majority (61%) are white and male (67%) The largest age cohort (47%) are 30-49 years old (younger than their CEOs) Male Medical Directors earn more than their female counterparts and Medical Directors earn more than their CEOs Medical Directors have a short tenure — 3-5 years and fear that there are not interested physicians to replace them

14. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative CompassPoint Report Calls to Action: Clinic CEOs: Recognize succession planning as a necessary aspect of organizational leadership Develop future leaders Model a sustainable approach to leadership Clinic Boards of Directors: Recognize succession planning Take responsibility for board training Clinic Associations and Consortia: Build awareness among members about the emerging field of executive leadership services Consider board structural changes to mitigate competition and conflict among members Funders: Fund realistic infrastructure costs Fund executive access to leadership services Support executives through leadership transitions

15. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Most Consistent Learning's About Leadership The Inner person: Nurture the individual — Self-awareness, coaching, mentoring, emotional intelligence, inner life The Professional Person: Build Essential Skills through active learning: Finance, Media, People Management, Data & Policy Analysis The Team: The group learns to work together and unleashes more power and effectiveness using key skills: Planning, Timing, Enabling Others, Collaboration among diverse leaders The Community/Constituents: Communications and Relationship-Building Accountability For What? Strong Institutions with good outcomes for clients Positive public policy in support of healthy people and communities

16. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative

17. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Knowledge & Values That Will Define CCI ’ s Leadership Work Practical and applied more than theoretical Focused directly on progressive social change in healthcare Team-based and collaborative effectiveness more than personal skills Multiple developmental experiences over time (2 years) rather than a single major experience Experiential Participatory Network-based and focused on systems Open channels for leadership mobility within the clinic system Other ….

18. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Desired Outcomes for CCI ’ s Leadership Development Program A network of clinic leaders who are clearer about larger systemic goals and feel enabled to seek each other to work together Clinic-based leadership teams who have gained new ideas and insights about how to continue developing their clinic, their community, their networks and the system of care. Individual leaders — at multiple levels of clinic leadership with improved skills in leadership for effectiveness One or two collaborative initatives among clinics that grow out of the leadership experience A culture of leadership development within and among the clinics Other …

19. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative The beginnings of a Logic Model to Guide CCI ’ s Leadership Development

20. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Options for Structuring a leadership Program Choices to Make: Our options are either … or ….hybrid …

21. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Major questions/choices for building a leadership development component for CCI: What are the guiding principles that express CCI ’ s unique vision & role? What outcomes are most important from the leadership program? Any “ must-haves ” ? What is the ideal combination of components (e.g. personal development, professional skills, team development, systems and policy development, etc) Overall, what is the mandate?

22. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative Next Steps: Today ’ s discussion provides preference and direction Staff to use input to make some key decisions on focus, direction, and framework [Nov-December 2003] Program Design — Staff and Consultant(s) [Jan-April 2004] Roles (Steering Committee, other outside expertise, clinic leaders, others?) Get ready for implementation …

23. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative … the effectiveness of leadership is determined by the extent to which people take responsibility for participating in leadership — not because some leader has figured out how to “ share ” leadership but because leadership is a property of the relationships people form when they are doing something together … and is therefore affected by the quality and nature of those relationships … In such a world, leadership is developed by developing the whole community of people so that they can participate more effectively in the relationships of leadership. (Wilfred Drath)

24. Leadership Development: A “ New Science ” A Context of Theory and Practice for CCI November 2003 Prepared for: Community Clinics Initiative … Leadership has to do with how people are. You don ’ t teach people a different way of being, you create conditions so they can discover where their natural leadership comes from. … When you ask people about what it is like being part of a great team, what is most striking is the meaningfulness of the experience. People talk about being part of something larger than themselves, of being connected, of being generative … their experiences as part of truly great teams stand out as singular periods of life lived to the fullest. Some spend the rest of their lives looking for ways to recapture that spirit. (Peter Senge)