Understanding Leadership Around the World: GHLI Study

Lauren Taylor, Ghana Delegation Facilitator, GHLI,

Leslie Curry, Senior Research Scientist, GHLI

Each year, GHLI hosts a conference convening delegates from several Sub-Saharan African countries. The conference offers a forum for health practitioners, policymakers and researchers to facilitate collaborative, contextually-driven solutions in strengthening health systems. Delegates bring with them not only content expertise to share, but, perhaps more importantly, experiences of leadership from which we all can learn.

With this thinking in mind, a GHLI research team sought to better understand what it’s like to be in leadership positions in diverse environments. The conference offered a unique opportunity to conduct extensive interviews with delegates from Ethiopia, Ghana, Liberia and Rwanda to learn the challenges and rewards of their roles in their particular health systems.

We distilled five themes that were common to the delegates’ shared experience: 1) having an aspirational, value-based vision for the future of their country’s health care system, 2) being self-aware and having the ability to identify and use complementary skills in others, 3) investing in and managing relationships, 4) using data in decision making and 5) sustaining a commitment to learning.

The findings may be surprising to some in the degree to which they align with progressive conceptions of Western leadership. The focus on humility, the acknowledgement of larger teams and systems, the value placed on relationships and explicit emphasis on continual learning are all tenets of what academics have termed “value-based” and “relational” leadership over the past ten years. In the West, discussions of leadership “traits” and “styles” have been replaced by a growing view that all have leadership potential; success in leadership roles comes from honing one’s natural leadership skills as well as developing empowered complements. David Berg, GHLI affiliate, has made important contributions in advancing and disseminating this revised conception of leadership. As we continue on this path, our findings suggest that we would do well to partner closely with our African peers, whose distinctive cultural and historical roots appear to encourage such liberal thinking about the makings of modern leadership. These GHLI study findings are published in Human Resources for Health and are available here.

Why Work in a Ghanaian Psychiatric Hospital?

By Helen Jack,

Yale 2012

Ghana’s 11 psychiatrists serve a population of more than 24 million, nearly twice that of New England. Stigma and misunderstanding of mental health adds to the burden on workers, and their efforts go largely underappreciated. In Ghana last summer, I faced the question “How can we motivate people to work in mental health care?” Data is needed to answer this question – a resource-efficient intervention cannot be designed until the problems at hand are dissected and truly understood.

I wanted to ensure that any data I collected for my senior thesis at Yale could be useful to a development project, that it would not just fill a paper that few beyond my professor would read. I approached GHLI and the Ghanaian delegation with this goal in mind.

Together, we designed a study of Ghana’s mental health workforce, aimed at exploring how staff in psychiatric hospitals can be recruited and retained. I spent summer 2011 at Ghana’s three psychiatric hospitals, interviewing staff members.

“One thing that motivates us to work is our colleagues,” said a psychiatric nurse. “Sometimes you are tired, but your colleague says, ‘my friend, let’s get up and do the work.'” Almost universally, positive interpersonal relationships and constructive feedback motivated staff. On the other hand, workers were regularly attacked by patients and not compensated for injuries, they felt that the stigma of mental health disorders extended to those who treated them, and they were frustrated with the poor hospital infrastructure, low salaries, and lack of professional development opportunities.

Following data collection, the members of the Ghanaian delegation helped me get my research findings to decision-makers in Ghana, providing them with information that could inspire and inform changes. Some of the data, for example, went to the Vice President, helping advocate for the passage of a new Mental Health Law, which would increase focus on workforce welfare. The opportunity to conduct research in global health comes with the responsibility of ensuring that information gets back to where it can be most useful.

HuffPost Blog: America's Mental Health Challenge

GHLI faculty director, Elizabeth H. Bradley, and program manager, Lauren Taylor, penned a blog for the Huffington Post which ran on October 13 addressing some of the mental health challenges we currently face in the United States.

America's Mental Health Challenge

Aurora victims this October are participating in activism and sharing their insights from the horrific shooting spree in Colorado. Several have come forward to take public stances on the trial of the accused, the way charity funds have been dispersed, and most notably, gun control reform. By and large, Americans are joining these brave souls in revitalizing large-scale conversations around these critical cultural issues. Unfortunately, mental health remains in the margins. As we have done for several decades now, Americans are again eschewing an opportunity to discuss the role that mental illness played in the making of this and other massacres.

After three months, mental health has been little more than a footnote in the biography of the accused, James Holmes. A few details of the struggles he faced in receiving consistent therapy at and after school have become available, but otherwise, his mental health has scarcely been a topic of discussion. Now a clearer picture is emerging to suggest that Mr. Holmes, like Jared Loughner and other aggressors like them, suffered from serious mentally illness.

The scale of this country's challenge with mental illness is formidable. One in four adults -- more than 57 million Americans -- experience a mental health disorder each year, and less than one third of them receive treatment in a given year. Even among people who have been diagnosed with serious mental illness, less than 40 percent receive treatment. And what is the most common reason Americans are not seeking treatment? Our 'rugged' individualism. A 2001 Harvard study by Ronald Kessler reported that "wanting to solve the problem on their own" was the most widespread motive for foregoing treatment among people suffering severe mental illness.

Details now coming to light in court regarding the history of Mr. Holmes' illness make the Aurora story particularly frustrating. Classmates, teachers, and family all have confessed that they knew this was a young man in distress. He had even sought and received some care from a psychiatrist at the University of Colorado, but the relationship was severed when Mr. Holmes withdrew from the University. Once he was no longer enrolled, it is unclear to what extent he sought or received further treatment.

This story belongs to a larger narrative about what it is to be mentally ill in America. Although rarely included in the public discourse regarding health reform, stories like Mr. Holmes' reflect the ways in which our faltering health care system is even more problematic when it comes to mental health. First, the stigma associated with pursuing mental health still compels people to hide their suffering from friends, family and medical professionals alike. Second, given the prevalence of mental health issues, needs often overwhelm the supply of practitioners and availability of insurance. Third, particularly for younger adults, continuity of care can be interrupted by changes in school and employment status. This fragmentation is a major problem as the National Institute of Medical Health estimates that about 8 percent of people 18-24 years old have a serious mental illness. Prison, ironically, may provide better mental health care for Mr. Holmes than he may have otherwise received, at no cost to him.

The mental illness Mr. Holmes was experiencing when he opened fire does not excuse his egregious crime. But it forces us to reconsider the questions that we typically ask about why such travesties happen. Too often, we look to one another and wonder, "How can evil like this exist in the world?" when the more appropriate question may be, "How can illness like this persist in our world?" Had Mr. Holmes been properly diagnosed and under close, continued care of a trained professional, the earlier signs of his mental illness may have catalyzed medical intervention. In order to make this hypothetical a reality, we must reinvigorate conversation about how we design and deliver mental health care in this country.

Source: huffingtonpost.com

Why We Do What We Do: Zack Cooper

Zack Cooper, Ph.D., assistant professor of public health and of economics at Yale University, was drawn to the field of health care economics during the first class he took at the London School of Economics taught by Professor Julian Le Grand. Former policy advisor to Tony Blair, Le Grand’s class combined academic rigor with policy relevance and showed the difference that good policy could make in peoples’ lives.

Dealing with emotionally-impactful decisions – putting a price on medical treatments or structuring policies that could literally save thousands of lives – brought humanity to the work of being an economist for Zack. “I like that health care combines theory with a hugely emotive and important topic – something we each touch in our lives,” he explains. “I really wanted my work to make a difference, so focusing on health care made sense.”

Zack feels strongly that public policy should be guided by evidence, not ideology. This belief shaped his desire to produce research that can directly influence policy and help address the challenges we face in the here and now. He remembers when Prime Minister David Cameron was regularly citing his work, which found that hospital competition reduced hospital death rates. “That made me quite optimistic because here was a politician citing academic evidence – I thought that was hugely positive; and I began to see that my work was shifting public opinion on an important topic.”

At Yale, Zack focuses on expanding his research into three areas: looking what has caused the price of hospital care in the U.S. to rise over the last decade; comparing hospital performance across the U.S., Canada, England and the Netherlands; and seeing whether good hospital management can improve patient outcomes.

Zack hopes that his work continues to have an impact on public policy to help save lives, and illustrates how we can get health care spending in the U.S. under control.

Summer in Beijing with the 10,000 Women Scholars

Sang Hee Park,

2012 GHLI Intern

As an intern for GHLI’s China program, I worked at Tsinghua University in Beijing this summer for the Goldman Sachs 10,000 Women: Yale-Tsinghua Certificate Program in International Healthcare Management. The program aims to provide training to 500 female health care administrators in China by March 2013.

While I performed various tasks that improved my learning in the health care field, I learned the most from simply interacting with numerous people and getting to know their on-going research, challenges and opinions regarding the Chinese health care system. Despite the language barrier, I formed great relationships with faculty and staff at Tsinghua University thanks in part to the large amount of time spent traveling and working together to conduct student selection interviews. I also interacted with the more than 50 students in the most recent class who completed lectures, project work and graduated this summer. Each of them is a distinguished health care administrator, recruited to the program because they serve rural and underserved urban communities in China. Additionally, I was invited to dinners with health care policy makers, such as senior staff from the national drug pricing agency, directors of maternal and child health departments in both Guizhou province and Guiyang city, and faculty from the Tsinghua School of Economics and Management. These conversations helped me gain greater insight into health care as well as prepare me for further research of the Chinese health care system.

Overall, the internship provided me with the scientific tools and leadership skills necessary to be a successful female health care administrator serving low-resource communities. I also learned how health care financing and delivery policies impact a population’s access to cost-effective, quality health care. Through this experience, I was able to immerse myself in a different country and learn a different culture and language, increasing my cultural sensitivity and respect for diversity, which are the fundamental necessities for work in a global setting.