Leadership Principles and Practices for
Health System Transformation
W. Henry Mosley, MD, MPH
Johns Hopkins University
Dr. Schoenrich
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W. Henry Mosley, MD, MPH
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To change others, we may have to
change ourselves first
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Section A
Where Do Leaders Operate?
Where Do Leaders Operate?
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What Is Difficult? Impossible? Beyond
Imagination?
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The Present Health System Is Perfectly
Designed to Produce the Present Results
! If we want the same
results, let us keep
the present system
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If We Want New Results, We Need to
Redesign Our Health Production System
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Leadership and Management Should
Complement Each Other
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Core Leadership Disciplines
! Personal Mastery
! Mental Models
! Systems Thinking
! Shared Vision
! Team Learning
Source: Senge, P. (2006). The Fifth Discipline.‫‏‬
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The STAR Framework: Strategic Thinking,
Action, and Reflection
Strategic Thinking, Action, and Reflection
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Personal Mastery: STAR Question
! How can we live more creative and purposeful lives?
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Personal Mastery, Examples
! Nelson Mandela
! Mother Theresa
! Martin Luther King Jr.
! CNN “Heroes”
! And many more …
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Mental Models: STAR Question
! How can we continuously open our minds to new ideas?
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Our Best Thinking Got Us Here
! The problems that
we face cannot be
solved by the same
level of thinking that
created them.
- Albert Einstein
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Leadership the Old Way: The “Blueprint”
Strategy
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Mental Models Sustaining the Blueprint
Strategy
! ! ! ! ! ! Professionals know it all
Evidence-based research has the answers
Predesigned projects are mandatory
Ministries of Health are the health system
Short-term technical assistance is enough
Evaluation requires outside expertise
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The “Blueprint” Strategy: A Fundamental
Flaw
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Nigeria – Immunization Case Study
Source:http://apps.who.int/immunization_monitoring/data/data_AFR/en/index.html
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Nigeria – Immunization Case Study
Source:http://apps.who.int/immunization_monitoring/data/data_AFR/en/index.html
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Source: Nigerian Demographic and Health Survey (DHS), 2008.
State Eki7 Osun Imo Anambra Abuja Lagos Cross Rivers Edo Oyo Ebonyi Abia Delta Plateau Kwara Kogi Ondo Rivers Akwa Ibom Enugu Ogun Benue Kaduna Adamawa Nasarawa Gombe Bayelsa Niger Taraba Yobe Zamfara 90 Kano Kebbi Borno Sokoto Kas7na Bauchi Jigawa Coverage (%) Nigeria—Immunization Coverage by State
DPT3 coverage by states, DHS 2008 100 Why is this happening?
80 70 60 50 40 30 20 10 0 22
Reasons for No- or Under-immunization:
Definition of Categories*
Immunization systems
Family characteristics
! Access and vaccine service
availability
! Education level (of mom and
dad)
! Use of all opportunities
! Family size
! Cost and service quality
! Income, occupation
! Health worker knowledge
! Ethnicity/language group
Communication/information
Parental attitude/knowledge
! Media messages regarding
vaccinations
! Perceived benefit of vaccines
! Perceived disease threat
! Community involvement in EPI
! Group pressure for or against
vaccinations
! Trust in health service provider
*From New Generation Vaccines, 3rd edition
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Reasons for Being Unvaccinated
% based on total reasons abstracted from 12 articles on unvaccinated
children according to definitions in New Generation Vaccines, 3rd ed.
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To Change the Way We Act, We Must First
Change the Way We Think
! A first step is to change our “mental model” of what
constitutes the “health system” of a country
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