COMMENTARY
The University of Illinois at Chicago School of Public Health Doctor of Public Health Program: An Innovative Approach to Doctoral-Level Practice Leadership Development The University of Illinois at Chicago, School of Public Health, Doctor of Public Health degree is designed to build leadership skills and an ability to contribute to the evidence base of practice. The competency-based, distance-format, doctorallevel program for midcareer professionals features an action learning approach in which students apply leadership principles from the virtual classroom to realworld problems at their work sites. Students demonstrate mastery of the competencies and readiness to advance to the dissertation stage through completing a portfolio by using a process of systematic reflection. The practice-oriented dissertation demonstrates the ability to contribute to the evidence base of public health practice in an area of emphasis. Preliminary evaluation data indicate that the program is meeting its intended purposes. (Am J Public Health. 2015;105:S55–S59. doi:10.2105/ AJPH.2014.302331)
Patrick Lenihan, PhD, MUPP, Christina Welter, DrPH, MPH, Paul Brandt-Rauf, ScD, MD, DrPH, Babette Neuberger, JD, MPH, Eve Pinsker, PhD, Michael Petros, DrPH, MPH, and Kristine Risley, DrPH, MPH
FOR NEARLY A CENTURY, a succession of reports on public health authored by the Institute of Medicine and other authorities in the field has identified leadership as a key, but often neglected, ingredient to more effective public health practice.1---5 Leadership continues to be stressed for addressing the public health challenges of today, but the emphasis is more on driving change and collaboration at the community level and across sectors and less on establishing the authority of public health agencies to carry out core functions.6,7 But a recent Robert Wood Johnson Foundation report noted that lack of leadership skills was a “huge barrier” to cross-sector collaboration.6 In response to this call, a variety of short-duration leadership training programs have been formed both at the national and regional levels attempting to better equip current leaders and to build leadership skills among emerging public health managers.8,9 In addition, schools of public health have included more leadership training in their curricula, primarily at the Master of Public Health (MPH) level.1 Some have questioned whether leadership can be adequately covered in an MPH program, suggesting that doctoral preparation might be needed.2 Recognizing the need for a more comprehensive and rigorous approach to leadership development, a consensus has emerged that the focus of the Doctor of
Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health
Public Health (DrPH) degree should be leadership in public health practice and an array of competencies has been put forth by Association of Schools and Programs of Public Health for how this focus should be implemented.5,10---12 Several existing DrPH programs and most newly formed programs have adopted this focus.11,13 We describe the distinctive features and innovations of the University of Illinois at Chicago, School of Public Health (UICSPH), Doctor of Public Health in Leadership Program implemented in an effort to offer public health professional leadership education at the doctoral level to meet the dynamic needs of public health practice.
THE UIC-SPH DOCTOR OF PUBLIC HEALTH PROGRAM In 2005, the UIC-SPH revised its longstanding DrPH program to adopt a practice leadership focus within a competency framework.14 Six competencies (see the box on page e2) guide a highly structured curriculum, consisting of nine core courses and a focused area of emphasis leading to the completion of a portfolio and a dissertation. The UIC competencies, though consistent with those developed later by Association of Schools and Programs of Public Health, provide a distinctive emphasis for the UIC-SPH program.
Several other features add to the program’s distinctiveness. Although online course offerings are becoming more common at the doctoral level, UIC is one of only four fully distance-format DrPH programs nationally.15 This feature, initiated in 2010, allows the program to tap into a broader and more diverse pool of students. Beyond that, a distance format keeps students connected to their work settings, where leadership principles covered in the virtual classroom can be tested and shared. This real-time feedback reinforces the practice relevance of the content-oriented and theoretical material. A required, annual three-day, in-person summer institute helps reinforce a learning community by bringing students to campus, where they can interact with each other and faculty, face to face. A portfolio documents mastery of the six program competencies attained through a student’s professional career and academic achievements, including the DrPH program. The portfolio, which replaces the customary preliminary and qualifying examinations, is primarily used to gauge adaptive leadership development and readiness to advance to the dissertation stage. The portfolio is developed in stages, using tools of systematic reflection, as a student identifies, assesses, and presents in an integrated narrative an individual leadership vision along with evidence reflecting the application
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The UIC-SPH Doctor of Public Health (DrPH) Program and Association of Schools and Programs of Public Health (ASPPH) Competencies UIC-SPH DrPH Competencies
ASPPH DrPH Competencies
1. Gain in-depth understanding of core areas of public health practice, research, and theory
1. Advocacy: influence decision-making regarding policies and practices that advance public
including the legal basis for public health, public health as a system, and the ecological
health.
model. 2. Analyze issues and problems using needs or resource assessments, critical evaluation,
2. Communication: assess and use communication strategies across diverse audiences to
applied research methodology, and statistical methods. 3. Synthesize information from multiple sources to develop strategies for addressing problems
inform and influence policy actions. 3. Community or cultural orientation: communicate and interact with people across diverse
in an area of emphasis that contributes to the evidence base of practice and public health
communities and cultures.
scholarship. 4. Demonstrate leadership in designing and implementing policies, strategies, and interventions.
4. Critical analysis: synthesize and apply evidence-based research, theory, and health-related data sources.
5. Assess communication strategies and use communication skills across diverse audiences to inform or influence program and policy decisions.
5. Leadership: create and communicate a shared vision; inspire trust and motivate others; use evidence-based strategies to enhance essential public health services.
6. Demonstrate a vision and philosophy for leadership that includes systems thinking and ethical principles.
6. Management: provide fiscally responsible strategic and operational guidance. 7. Professionalism and ethics: identify and analyze an ethical issue; balance claims of personal liberty with population responsibility; act on ethical concepts of social justice and human rights.
14
Source. University of Illinois at Chicago, School of Public Health ; ASPH Doctor of Public Health (DrPH) Core Competency Model.10 Note. SPH = School of Public Health; UIC = University of Illinois at Chicago.
of each competency. Competency attainment is judged by a faculty committee that uses Bloom’s taxonomy to assess levels of attainment.16 Another pillar of the DrPH program at UIC is the use of research methods to contribute to the evidence base of public health practice through a practice-based dissertation, which generates two publishable papers. Approaches include a sophisticated use of data in problem-solving, the appraisal of evidence for application, the studied adaptation of evidencebased interventions under realworld conditions, and, more traditionally, the direct contribution to the evidence base through practice research. The orientation toward research reflects a call for public health research to be more grounded in practice.17 While drawing from the same methods toolbox as the Doctor of Philosophy (PhD),
DrPH students focus on different research issues and apply alternative research designs. (A list of dissertations is available in Table A, available as a supplement to the online version of this article at http//www.ajph.org). Students enter and progress through the program as a cohort until the dissertation stage. The cohort model, together with the requirement that students maintain their employment status, helps to create a peer-based learning community and reinforce principles of experiential learning most effective for professional leadership development.18 Advising, too, is structured around the cohort model. Students are initially advised by a faculty advisor in group sessions, where students learn to apply tools of systematic reflection for portfolio development. Peer support at this stage is an essential part of the advising process, with individual
S56 | Commentary | Peer Reviewed | Lenihan et al.
attention given as needed. As students move to complete the portfolio and on to the dissertation, an individual core faculty advisor is assigned.
INNOVATION IN PROGRAM DESIGN Begg et al. noted that a relevant public health definition of innovation goes beyond the novel to demonstrate utility and sustainability.19 The DrPH program at UIC has attempted to innovate in the aspects noted previously, but three interrelated elements stand out concerning how leadership is defined and operationalized in doctoral-level education relevant to public health practice.
Adaptive Leadership Creating a focus for public health leadership development has been elusive because leadership is multidimensional and
broad, having been defined over a century, largely focusing on the personal traits of the individual leader or positional leadership of those in formal roles of authority in keeping with an industrial-era notion of leadership as an extension of management.20---23 A more recent paradigm of leadership stresses a shared or collaborative approach to leadership also being called for now in public health.2,23 This paradigm recognizes that a different approach to leadership is required to address adaptive challenges of a very turbulent public health environment, which defy leadership based on technical expertise or authority.24 The UIC-SPH program has operationalized adaptive leadership around six skill dimensions: systems thinking, change management, innovation and creativity, communication, partnership development, and conflict management, which collectively
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contribute to adaptive leadership capacity. In aligning with national public health leadership needs, UIC-SPH emphasizes adaptive leadership, for its strong organizational change and meta-leadership applications, with less weight given to personal leadership development.24 Dimensions of adaptive leadership are reflected most explicitly in core curriculum courses and are reinforced in other aspects of the program, including the portfolio and the dissertation.
DrPH program, as core faculty form an action-learning management group, which routinely meets to diagnose program problems and explore solutions by using principles of action learning. This process has effectively documented key program concepts reflected in a theory of change model (Figure A, available as a supplement to this article at http://www.ajph.org) for both how the program functions and its impact on the leadership development.
Role of Action Learning A key element of the UIC-SPH program, which creates a nexus among leadership development, a practice orientation, and scholarship, is action learning. Action learning is an iterative and empirical group problem-solving process that is rooted in action science and has been adopted as a leadership tool by business organizations, government agencies, and leadership development programs for more than 50 years.25,26 Action learning is particularly well suited for professional education for public health leadership because of its emphasis on “adaptive flexibility” and the use of systematic reflection in problem solving grounded in an experiential learning approach, which resonates with midcareer students and their practice environments.27 Although action learning has been recognized for its relevance to public health leadership development, it has not been fully operationalized as a tool for public health leadership practice.28 Action learning is integrated into the DrPH core curriculum providing students, using applied leadership skills, the opportunity to solve real-world adaptive challenges arising in their work setting. An action-learning approach is also used in development of the
Systematic Reflection and Leadership Reflection, as a meta-cognitive activity, enhances the ability of the learner to access and question tacit knowledge and assumptions, articulate and solidify new learning, and share and test that learning with others. Systematic reflection is a critical skill of high-level professional practice, especially useful in leadership situations.18 Reflection has been identified as one marker that distinguishes leadership from management.29 But, like in defining leadership, operationalizing systematic reflection as a leadership practice has been illusive, especially for public health.30 The DrPH program at UIC-SPH has attempted this in defining a six-step process, which is covered in several core courses, and applied by students in developing the leadership portfolio and extracting a researchable problem from a complex adaptive challenge in the early stages of the dissertation.
DEVELOPMENTAL EVALUATION The DrPH program at UIC-SPH has adopted a developmental evaluation approach, which is highly consistent with action learning and adaptive leadership, as it supports
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the process of innovation, often characterized as being in a state of continuous development and adaptation.31 Evaluation is being focused at several levels: on the curriculum, on student performance, and on program outcomes. Initial evaluation efforts have focused on achieving greater explicitness about program components, their intended workings, expected outcomes, and associated metrics, and several logic models have evolved that identify elements that will be incorporated into a more formal evaluation design, now that the program has reached a point at which a sufficient number of students have passed through all stages—from application to graduation. A variety of evaluation data sources are being assembled to include application materials, a comprehensive database that captures student status in completing key milestones, course evaluation questionnaires, and Summer Institute satisfaction surveys. Less structured information is also being more systematically collected and covers focus group--type data from students in the advising seminars and feedback sessions, and indirectly from unstructured interviews.
Preliminary Evaluation Results Preliminary information examined thus far suggests that the DrPH program is meeting its intended purposes at all levels. The program appears to have resonated with a market segment of midcareer public health professionals seeking doctoral-level leadership development. Enrollment has grown from eight students in 2006 to nearly 80 today. Applications, too, have increased, topping 125 for the 2014---2015 matriculating cohort of 14 students.
The program is attracting and admitting a highly diverse student body, representing multiple segments of the public health system and several demographic groups. Nearly 40% of the student body is from governmental public health agencies, with the largest segment from local public health (27.6%). Smaller represented segments (5%---12%) include professional associations, academia, for-profit entities, nonprofits, the military, and health care providers. Positions held include local health department directors, division-level managers at federal agencies, health care provider organization executives, and field grade military officers. Demographically, students are older (median age older than 40 years), largely female (63%), and ethnically diverse, with more than 40% of minority status. Course evaluations indicate that nearly all courses meet learning objectives (which are linked to the competencies) at a level of four or higher on a five-point scale. Students are demonstrating through their action learning projects that key action learning principles are being learned and applied, in 80% of the cases to address a real leadership issue at a student’s practice site. The projects are also of high quality with several selected for presentation at national professional meetings (e.g., American Public Health Association). As indicated in Figure 1, students make good progress toward attaining the degree, reaching key milestones at the predicted timeto-degree pace of approximately 4.5 years. Students tend to bog down in completing the portfolio and moving to the dissertation stage, the causes of which are now being explored by core faculty. These preliminary data also suggest that the distance format is no
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No. Students
COMMENTARY
65 60 55 50 45 40 35 30 25 20 15 10 5 0
Resident cohorts (≤ 2009) Distance cohorts (≥ 2010)
62
48
29 20
16
16
16
11 5
Portfolio part 1 approved by advisor
Portfolio part 2 approved by advisor
16
7
4
1
2
0
1
Portfolio part 3 Portfolio part 3 Dissertation proposal Dissertation under way Dissertation defense approved by advisor approved by committee scheduled
Total
Milestone
FIGURE 1—The University of Illinois at Chicago School of Public Health doctor of public health program milestones: 2005–2014.
less effective than a traditional classroom-based format. An examination of the 18 completed dissertations and nine under way shows that DrPH students are more likely to focus on issues involving the organization and delivery of public health services and to employ mixedmethod designs. The DrPH study designs often feature policy analysis, case study methods, evaluation, and action research. More than 80% of the dissertations address an adaptive challenge facing a public health organization (usually the student’s employer) as opposed to a more-narrow technical problem, characteristic of doctorate dissertations. These preliminary findings indicate that the practice research approach featured in the program for contributing to the evidence base of practice is effectively present in the curriculum and being learned by students. (A list of dissertations is provided in Table A.) On the academic side, one indicator that the program is resonating with more divisionally oriented faculty is the level of their participation in DrPH program activities, such as serving on dissertation committees. Divisional
faculty participation in this schoolwide degree is wholly voluntary, yet more than 30 UIC-SPH divisional faculty have agreed to participate on DrPH dissertation committees. Other faculty have tapped DrPH students as teaching assistants reflecting a recognition of the program’s rigor.
Enhancing Leadership Development Perhaps the ultimate measure of DrPH program success is how well prepared students and graduates are to assume new leadership positions in the public health system. Although a more definitive answer to this question must await the formal evaluation, preliminary anecdotal information looks very promising. If one considers job change as a marker of professional development, more than half of the graduates and another 20% of continuing students have advanced their careers, taking new high-level jobs. Several of those who made career changes have attributed the motivation for success in securing the new position to the DrPH experience. One student, promoted to head the science division at a premier national public health
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agency, was called to the agency director’s office to make a performance impact presentation, which she grounded in principles of adaptive leadership and systems thinking. She recalled that the director was highly complementary, noting, “that’s what every Center should be doing.” She went on, “Despite taking lots of courses, I was never exposed to this kind of thinking in my MPH program.” Another student at a large local health department used her action learning project from the core leadership seminar to develop an environmental health performance management system, for which she went on to lead implementation across California. This earned her a promotion to an executive-level position for environmental health. She reported, I started off seeing only the technical aspects of the issue, but in realizing that it was an adaptive challenge, I saw the role of organizational culture change that needed to be addressed.
She will continue this work for her dissertation. Even those students who have not made a career move report greater confidence in taking on leadership roles as a result of the DrPH program.
CONCLUSION In conclusion, although leadership continues to be emphasized as a critical element of effective public health practice, the nature of leadership has changed over the years, in turn requiring a shift in focus of leadership training. In response to calls to focus the DrPH degree on leadership in practice, the UIC-SPH has reoriented its DrPH degree program around adaptive leadership and has structured the program to feature experience-based leadership development, action learning, and systematic reflection as innovative distinctions. Developmental evaluation results indicate that this reorientation has been successful in meeting the public health leadership challenges of today. j
About the Authors All of the authors are with the School of Public Health, University of Illinois at Chicago. Correspondence should be sent to D. Patrick Lenihan, University of Illinois at Chicago, School of Public Health, 1603 W Taylor, m/c 923, Chicago, IL 60612 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This article was accepted September 13, 2014.
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Contributors P. Lenihan led the writing and research of the article. C. Welter, P. Brandt-Rauf, E. Pinsker, B. Neuberger, M. Petros, and K. Risley provided content, reviewed, or edited the article and abstract.
References 1. Fried LP, Begg B, Bayer R, Galena S. MPH education for the 21st century: motivation, rationale, and key principles for the new Columbia public health curriculum. Am J Public Health. 2014;104(1):23---30. 2. Fineberg HV, Green G, Ware J, Anderson B. Changing public health training needs: professional education and the paradigm of public health. Annu Rev Public Health. 1994;15:237---257. 3. Institute of Medicine (US), Committee for the Study of the Future of Public Health. The Future of Public Health. Washington, DC: National Academy Press; 1988. 4. Rowitz L. Public Health Leadership: Putting Principles Into Practice. 3rd ed. Burlington, MA: Jones and Bartlett; 2014. 5. Committee on Assuring the Health of the Public in the 21st Century. The Future of the Public’s Health in the 21st Century. Washington, DC: National Academy Press; 2003. 6. Time to Act: Investing in the Health of Our Children and Communities: Recommendations From the Robert Wood Johnson Foundation Commission to Build a Healthier America. 2014. Available at: http:// www.rwjf.org/en/research-publications/ find-rwjf-research/2014/01/ recommendations-from-the-rwjfcommission-to-build-a-healthier-am. html. Accessed on June 11, 2014. 7. Chehimi S, Cohen L. Towards a 21st Century Approach: Advancing a Vision for Prevention and Public Health. 2013. Available at: http://www. preventioninstitute.org/component/ jlibrary/article/id-342/127.html. Accessed on June 11, 2014. 8. Baker E, Umble K, Frederick S, Woltring C. A brief history of formal public health leadership development in the United States since 1988: lessons learned and future needs. Leadership Public Health. 2008;8:13---18. 9. Umble K, Diehl S, Gunn A, Haws S. Developing Leaders, Building Networks: An Evaluation of the National Public Health Leadership Institute—1991---2006. Chapel Hill, NC: North Carolina Institute for Public Health; 2007. Available at: http://phli.org/ evalreports. Accessed on June 17, 2014. 10. ASPH Doctor of Public Health (DrPH) Core Competency Model. Available at: https://apha.confex.com/apha/137am/ recordingredirect.cgi/id/30171. Accessed on June 18, 2014.
11. Lee JM, Furner S, Yager J, Hoffman D. A review of the status of the Doctor of Public Health degree and identification of future issues. Public Health Rep. 2009; 124(1):177---183.
27. Lissio A, Wilson K. Action learning in higher education: an investigation of its potential to develop professional capability. Stud Higher Educ. 2004: 29;469---488.
12. Curtis LM, Marx J. Untapped resources: exploring the need to invest in doctor of public health degree training and leadership development. Am J Public Health. 2008;98(9):1547---1549.
28. Dinkin D, Frederick S. Action-learning projects used in public health leadership institutes. Leadersh Health Serv. 2013; 26(1):7---19.
13. Trauth JM, Documét P, Hawk M, Blais N. Aligning a departmental DrPH program with the new ASPH competencies. Public Health Rep. 2011;126(2): 294---298. 14. University of Illinois at Chicago, School of Public Health, Doctor of Public Health Leadership Program Graduate Student Handbook 2013---2014. Available at: http://publichealth.uic.edu/media/ uicedu/sph/studenthandbooks/20132014/2013-2014,DrPH,Student, Handbook,final.pdf. Accessed on June 1, 2014.
29. Gosling J, Mintzberg H. The five minds of a manager. Harv Bus Rev. 2003;(11):54---63. 30. Rodgers C. Defining reflection: another look at John Dewey and reflective thinking. Teach Coll Rec. 2002;104(4): 842---866. 31. Patton MQ. Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use. New York, NY: Guilford Press; 2011.
15. Association of Schools and Programs of Public Health. Academic degree finder. Available at: http://www.aspph.org/ program-finder. Accessed on September 4, 2014. 16. Krathwohl D. A revision of Bloom’s taxonomy: an overview. Theory Into Practice. 2002;41(4):212---218. 17. Potter M, Quill B, Aglipay G, et al. Demonstrating Excellence in PracticeBased Research for Public Health. Washington, DC: Association of Schools of Public Health; 2006. 18. Schon D. Educating the Reflective Practitioner. San Francisco, CA: JosseyBass; 1990. 19. Begg MD, Galea S, Bayer R, Walker J, Fried L. MPH education for the 21st century: design of Columbia University’s new public health curriculum. Am J Public Health. 2014;104(1):30---36. 20. Northouse P. Leadership Theory and Practice. 3rd ed. Thousand Oaks, CA: Sage Publications; 2004. 21. MacGregor Burns J. Leadership. New York, NY: HarperCollins; 1978. 22. Kouzes J, Posner B. The Leadership Challenge. 3rd ed. San Francisco, CA: Jossey-Bass; 2002. 23. Rost JC. Leadership for the TwentyFirst Century. Westport, CT: Praeger; 1993. 24. Heifetz R, Grashow R, Linsky M. The Practice of Adaptive Leadership. Boston, MA: Harvard Business Press; 2009. 25. Marquardt M. Optimizing the Power of Action Learning. Boston, MA: DaviesBlack; 2004. 26. Argyris C, Putnam R, McLain-Smith D. Action Science. San Francisco, CA: Jossey Bass; 1985.
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The University of Illinois at Chicago School of Public Health Doctor of Public Health Program: An Innovative Approach to Doctoral-Level Practice Leadership Development The University of Illinois at Chicago, School of Public Health, Doctor of Public Health degree is designed to build leadership skills and an ability to contribute to the evidence base of practice. The competency-based, distance-format, doctorallevel program for midcareer professionals features an action learning approach in which students apply leadership principles from the virtual classroom to realworld problems at their work sites. Students demonstrate mastery of the competencies and readiness to advance to the dissertation stage through completing a portfolio by using a process of systematic reflection. The practice-oriented dissertation demonstrates the ability to contribute to the evidence base of public health practice in an area of emphasis. Preliminary evaluation data indicate that the program is meeting its intended purposes. (Am J Public Health. 2015;105:S55–S59. doi:10.2105/ AJPH.2014.302331)
Patrick Lenihan, PhD, MUPP, Christina Welter, DrPH, MPH, Paul Brandt-Rauf, ScD, MD, DrPH, Babette Neuberger, JD, MPH, Eve Pinsker, PhD, Michael Petros, DrPH, MPH, and Kristine Risley, DrPH, MPH
FOR NEARLY A CENTURY, a succession of reports on public health authored by the Institute of Medicine and other authorities in the field has identified leadership as a key, but often neglected, ingredient to more effective public health practice.1---5 Leadership continues to be stressed for addressing the public health challenges of today, but the emphasis is more on driving change and collaboration at the community level and across sectors and less on establishing the authority of public health agencies to carry out core functions.6,7 But a recent Robert Wood Johnson Foundation report noted that lack of leadership skills was a “huge barrier” to cross-sector collaboration.6 In response to this call, a variety of short-duration leadership training programs have been formed both at the national and regional levels attempting to better equip current leaders and to build leadership skills among emerging public health managers.8,9 In addition, schools of public health have included more leadership training in their curricula, primarily at the Master of Public Health (MPH) level.1 Some have questioned whether leadership can be adequately covered in an MPH program, suggesting that doctoral preparation might be needed.2 Recognizing the need for a more comprehensive and rigorous approach to leadership development, a consensus has emerged that the focus of the Doctor of
Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health
Public Health (DrPH) degree should be leadership in public health practice and an array of competencies has been put forth by Association of Schools and Programs of Public Health for how this focus should be implemented.5,10---12 Several existing DrPH programs and most newly formed programs have adopted this focus.11,13 We describe the distinctive features and innovations of the University of Illinois at Chicago, School of Public Health (UICSPH), Doctor of Public Health in Leadership Program implemented in an effort to offer public health professional leadership education at the doctoral level to meet the dynamic needs of public health practice.
THE UIC-SPH DOCTOR OF PUBLIC HEALTH PROGRAM In 2005, the UIC-SPH revised its longstanding DrPH program to adopt a practice leadership focus within a competency framework.14 Six competencies (see the box on page e2) guide a highly structured curriculum, consisting of nine core courses and a focused area of emphasis leading to the completion of a portfolio and a dissertation. The UIC competencies, though consistent with those developed later by Association of Schools and Programs of Public Health, provide a distinctive emphasis for the UIC-SPH program.
Several other features add to the program’s distinctiveness. Although online course offerings are becoming more common at the doctoral level, UIC is one of only four fully distance-format DrPH programs nationally.15 This feature, initiated in 2010, allows the program to tap into a broader and more diverse pool of students. Beyond that, a distance format keeps students connected to their work settings, where leadership principles covered in the virtual classroom can be tested and shared. This real-time feedback reinforces the practice relevance of the content-oriented and theoretical material. A required, annual three-day, in-person summer institute helps reinforce a learning community by bringing students to campus, where they can interact with each other and faculty, face to face. A portfolio documents mastery of the six program competencies attained through a student’s professional career and academic achievements, including the DrPH program. The portfolio, which replaces the customary preliminary and qualifying examinations, is primarily used to gauge adaptive leadership development and readiness to advance to the dissertation stage. The portfolio is developed in stages, using tools of systematic reflection, as a student identifies, assesses, and presents in an integrated narrative an individual leadership vision along with evidence reflecting the application
Lenihan et al. | Peer Reviewed | Commentary | S55
COMMENTARY
The UIC-SPH Doctor of Public Health (DrPH) Program and Association of Schools and Programs of Public Health (ASPPH) Competencies UIC-SPH DrPH Competencies
ASPPH DrPH Competencies
1. Gain in-depth understanding of core areas of public health practice, research, and theory
1. Advocacy: influence decision-making regarding policies and practices that advance public
including the legal basis for public health, public health as a system, and the ecological
health.
model. 2. Analyze issues and problems using needs or resource assessments, critical evaluation,
2. Communication: assess and use communication strategies across diverse audiences to
applied research methodology, and statistical methods. 3. Synthesize information from multiple sources to develop strategies for addressing problems
inform and influence policy actions. 3. Community or cultural orientation: communicate and interact with people across diverse
in an area of emphasis that contributes to the evidence base of practice and public health
communities and cultures.
scholarship. 4. Demonstrate leadership in designing and implementing policies, strategies, and interventions.
4. Critical analysis: synthesize and apply evidence-based research, theory, and health-related data sources.
5. Assess communication strategies and use communication skills across diverse audiences to inform or influence program and policy decisions.
5. Leadership: create and communicate a shared vision; inspire trust and motivate others; use evidence-based strategies to enhance essential public health services.
6. Demonstrate a vision and philosophy for leadership that includes systems thinking and ethical principles.
6. Management: provide fiscally responsible strategic and operational guidance. 7. Professionalism and ethics: identify and analyze an ethical issue; balance claims of personal liberty with population responsibility; act on ethical concepts of social justice and human rights.
14
Source. University of Illinois at Chicago, School of Public Health ; ASPH Doctor of Public Health (DrPH) Core Competency Model.10 Note. SPH = School of Public Health; UIC = University of Illinois at Chicago.
of each competency. Competency attainment is judged by a faculty committee that uses Bloom’s taxonomy to assess levels of attainment.16 Another pillar of the DrPH program at UIC is the use of research methods to contribute to the evidence base of public health practice through a practice-based dissertation, which generates two publishable papers. Approaches include a sophisticated use of data in problem-solving, the appraisal of evidence for application, the studied adaptation of evidencebased interventions under realworld conditions, and, more traditionally, the direct contribution to the evidence base through practice research. The orientation toward research reflects a call for public health research to be more grounded in practice.17 While drawing from the same methods toolbox as the Doctor of Philosophy (PhD),
DrPH students focus on different research issues and apply alternative research designs. (A list of dissertations is available in Table A, available as a supplement to the online version of this article at http//www.ajph.org). Students enter and progress through the program as a cohort until the dissertation stage. The cohort model, together with the requirement that students maintain their employment status, helps to create a peer-based learning community and reinforce principles of experiential learning most effective for professional leadership development.18 Advising, too, is structured around the cohort model. Students are initially advised by a faculty advisor in group sessions, where students learn to apply tools of systematic reflection for portfolio development. Peer support at this stage is an essential part of the advising process, with individual
S56 | Commentary | Peer Reviewed | Lenihan et al.
attention given as needed. As students move to complete the portfolio and on to the dissertation, an individual core faculty advisor is assigned.
INNOVATION IN PROGRAM DESIGN Begg et al. noted that a relevant public health definition of innovation goes beyond the novel to demonstrate utility and sustainability.19 The DrPH program at UIC has attempted to innovate in the aspects noted previously, but three interrelated elements stand out concerning how leadership is defined and operationalized in doctoral-level education relevant to public health practice.
Adaptive Leadership Creating a focus for public health leadership development has been elusive because leadership is multidimensional and
broad, having been defined over a century, largely focusing on the personal traits of the individual leader or positional leadership of those in formal roles of authority in keeping with an industrial-era notion of leadership as an extension of management.20---23 A more recent paradigm of leadership stresses a shared or collaborative approach to leadership also being called for now in public health.2,23 This paradigm recognizes that a different approach to leadership is required to address adaptive challenges of a very turbulent public health environment, which defy leadership based on technical expertise or authority.24 The UIC-SPH program has operationalized adaptive leadership around six skill dimensions: systems thinking, change management, innovation and creativity, communication, partnership development, and conflict management, which collectively
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contribute to adaptive leadership capacity. In aligning with national public health leadership needs, UIC-SPH emphasizes adaptive leadership, for its strong organizational change and meta-leadership applications, with less weight given to personal leadership development.24 Dimensions of adaptive leadership are reflected most explicitly in core curriculum courses and are reinforced in other aspects of the program, including the portfolio and the dissertation.
DrPH program, as core faculty form an action-learning management group, which routinely meets to diagnose program problems and explore solutions by using principles of action learning. This process has effectively documented key program concepts reflected in a theory of change model (Figure A, available as a supplement to this article at http://www.ajph.org) for both how the program functions and its impact on the leadership development.
Role of Action Learning A key element of the UIC-SPH program, which creates a nexus among leadership development, a practice orientation, and scholarship, is action learning. Action learning is an iterative and empirical group problem-solving process that is rooted in action science and has been adopted as a leadership tool by business organizations, government agencies, and leadership development programs for more than 50 years.25,26 Action learning is particularly well suited for professional education for public health leadership because of its emphasis on “adaptive flexibility” and the use of systematic reflection in problem solving grounded in an experiential learning approach, which resonates with midcareer students and their practice environments.27 Although action learning has been recognized for its relevance to public health leadership development, it has not been fully operationalized as a tool for public health leadership practice.28 Action learning is integrated into the DrPH core curriculum providing students, using applied leadership skills, the opportunity to solve real-world adaptive challenges arising in their work setting. An action-learning approach is also used in development of the
Systematic Reflection and Leadership Reflection, as a meta-cognitive activity, enhances the ability of the learner to access and question tacit knowledge and assumptions, articulate and solidify new learning, and share and test that learning with others. Systematic reflection is a critical skill of high-level professional practice, especially useful in leadership situations.18 Reflection has been identified as one marker that distinguishes leadership from management.29 But, like in defining leadership, operationalizing systematic reflection as a leadership practice has been illusive, especially for public health.30 The DrPH program at UIC-SPH has attempted this in defining a six-step process, which is covered in several core courses, and applied by students in developing the leadership portfolio and extracting a researchable problem from a complex adaptive challenge in the early stages of the dissertation.
DEVELOPMENTAL EVALUATION The DrPH program at UIC-SPH has adopted a developmental evaluation approach, which is highly consistent with action learning and adaptive leadership, as it supports
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the process of innovation, often characterized as being in a state of continuous development and adaptation.31 Evaluation is being focused at several levels: on the curriculum, on student performance, and on program outcomes. Initial evaluation efforts have focused on achieving greater explicitness about program components, their intended workings, expected outcomes, and associated metrics, and several logic models have evolved that identify elements that will be incorporated into a more formal evaluation design, now that the program has reached a point at which a sufficient number of students have passed through all stages—from application to graduation. A variety of evaluation data sources are being assembled to include application materials, a comprehensive database that captures student status in completing key milestones, course evaluation questionnaires, and Summer Institute satisfaction surveys. Less structured information is also being more systematically collected and covers focus group--type data from students in the advising seminars and feedback sessions, and indirectly from unstructured interviews.
Preliminary Evaluation Results Preliminary information examined thus far suggests that the DrPH program is meeting its intended purposes at all levels. The program appears to have resonated with a market segment of midcareer public health professionals seeking doctoral-level leadership development. Enrollment has grown from eight students in 2006 to nearly 80 today. Applications, too, have increased, topping 125 for the 2014---2015 matriculating cohort of 14 students.
The program is attracting and admitting a highly diverse student body, representing multiple segments of the public health system and several demographic groups. Nearly 40% of the student body is from governmental public health agencies, with the largest segment from local public health (27.6%). Smaller represented segments (5%---12%) include professional associations, academia, for-profit entities, nonprofits, the military, and health care providers. Positions held include local health department directors, division-level managers at federal agencies, health care provider organization executives, and field grade military officers. Demographically, students are older (median age older than 40 years), largely female (63%), and ethnically diverse, with more than 40% of minority status. Course evaluations indicate that nearly all courses meet learning objectives (which are linked to the competencies) at a level of four or higher on a five-point scale. Students are demonstrating through their action learning projects that key action learning principles are being learned and applied, in 80% of the cases to address a real leadership issue at a student’s practice site. The projects are also of high quality with several selected for presentation at national professional meetings (e.g., American Public Health Association). As indicated in Figure 1, students make good progress toward attaining the degree, reaching key milestones at the predicted timeto-degree pace of approximately 4.5 years. Students tend to bog down in completing the portfolio and moving to the dissertation stage, the causes of which are now being explored by core faculty. These preliminary data also suggest that the distance format is no
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No. Students
COMMENTARY
65 60 55 50 45 40 35 30 25 20 15 10 5 0
Resident cohorts (≤ 2009) Distance cohorts (≥ 2010)
62
48
29 20
16
16
16
11 5
Portfolio part 1 approved by advisor
Portfolio part 2 approved by advisor
16
7
4
1
2
0
1
Portfolio part 3 Portfolio part 3 Dissertation proposal Dissertation under way Dissertation defense approved by advisor approved by committee scheduled
Total
Milestone
FIGURE 1—The University of Illinois at Chicago School of Public Health doctor of public health program milestones: 2005–2014.
less effective than a traditional classroom-based format. An examination of the 18 completed dissertations and nine under way shows that DrPH students are more likely to focus on issues involving the organization and delivery of public health services and to employ mixedmethod designs. The DrPH study designs often feature policy analysis, case study methods, evaluation, and action research. More than 80% of the dissertations address an adaptive challenge facing a public health organization (usually the student’s employer) as opposed to a more-narrow technical problem, characteristic of doctorate dissertations. These preliminary findings indicate that the practice research approach featured in the program for contributing to the evidence base of practice is effectively present in the curriculum and being learned by students. (A list of dissertations is provided in Table A.) On the academic side, one indicator that the program is resonating with more divisionally oriented faculty is the level of their participation in DrPH program activities, such as serving on dissertation committees. Divisional
faculty participation in this schoolwide degree is wholly voluntary, yet more than 30 UIC-SPH divisional faculty have agreed to participate on DrPH dissertation committees. Other faculty have tapped DrPH students as teaching assistants reflecting a recognition of the program’s rigor.
Enhancing Leadership Development Perhaps the ultimate measure of DrPH program success is how well prepared students and graduates are to assume new leadership positions in the public health system. Although a more definitive answer to this question must await the formal evaluation, preliminary anecdotal information looks very promising. If one considers job change as a marker of professional development, more than half of the graduates and another 20% of continuing students have advanced their careers, taking new high-level jobs. Several of those who made career changes have attributed the motivation for success in securing the new position to the DrPH experience. One student, promoted to head the science division at a premier national public health
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agency, was called to the agency director’s office to make a performance impact presentation, which she grounded in principles of adaptive leadership and systems thinking. She recalled that the director was highly complementary, noting, “that’s what every Center should be doing.” She went on, “Despite taking lots of courses, I was never exposed to this kind of thinking in my MPH program.” Another student at a large local health department used her action learning project from the core leadership seminar to develop an environmental health performance management system, for which she went on to lead implementation across California. This earned her a promotion to an executive-level position for environmental health. She reported, I started off seeing only the technical aspects of the issue, but in realizing that it was an adaptive challenge, I saw the role of organizational culture change that needed to be addressed.
She will continue this work for her dissertation. Even those students who have not made a career move report greater confidence in taking on leadership roles as a result of the DrPH program.
CONCLUSION In conclusion, although leadership continues to be emphasized as a critical element of effective public health practice, the nature of leadership has changed over the years, in turn requiring a shift in focus of leadership training. In response to calls to focus the DrPH degree on leadership in practice, the UIC-SPH has reoriented its DrPH degree program around adaptive leadership and has structured the program to feature experience-based leadership development, action learning, and systematic reflection as innovative distinctions. Developmental evaluation results indicate that this reorientation has been successful in meeting the public health leadership challenges of today. j
About the Authors All of the authors are with the School of Public Health, University of Illinois at Chicago. Correspondence should be sent to D. Patrick Lenihan, University of Illinois at Chicago, School of Public Health, 1603 W Taylor, m/c 923, Chicago, IL 60612 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This article was accepted September 13, 2014.
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Contributors P. Lenihan led the writing and research of the article. C. Welter, P. Brandt-Rauf, E. Pinsker, B. Neuberger, M. Petros, and K. Risley provided content, reviewed, or edited the article and abstract.
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