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The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
November 5, 2019
Reforming States Group Emerging Leaders Program State Health Policy Leadership
Christopher F. Koller, President
Back to President’s Blog: The View from Here
Peggy Welch and Elizabeth Roberts did not become public sector leaders so they could fail. But they did — like when Welch got gerrymandered out of her seat as an Indiana legislator, or Roberts took the fall for a botched health and social services eligibility and enrollment system implementation in Rhode Island.
Nor does it seem like they took on leadership roles to bask in their successes — like being part of team that is revitalizing human services delivery (Welch), or getting legislation passed that improved access to dental care and oversight of health insurers (Roberts).
So why did they become public sector leaders? Welch, a former Indiana state representative and administration policy official and now chief advocacy officer for the Indiana Department of Family and Social Services, and Roberts, a former state senator, lieutenant governor, and health and human services secretary in Rhode Island, explained their motivations and lessons to the Milbank Memorial Fund’s newest cohort of its Emerging Leaders Program (ELP) this month as the ELP kicked off its fourth year.
Welch and Roberts, both veterans of the Milbank Memorial Fund’s Reforming State Group, opened the first meeting of this year’s 13 program participants, who are state officials from both the executive and legislative branches who have been identified as likely to play a key role in their state’s future health policymaking. Hailing from Massachusetts, Alaska, and many states in between, this year’s cohort is notable for its ethnic and professional diversity; it includes Dominican and Somalian immigrants, an economist, and a farmer.
The ELP and the Reforming States Group both represent the priority the Milbank Memorial Fund has placed on identifying, informing, and inspiring state health policy leaders. We believe population health will only improve if competent, committed leaders, particularly at the state and community level, can develop and implement informed public policy.
Over the two days of its first meeting, this year’s ELP cohort received training in basic leadership skills like negotiation and leading by influence as well as authority. They had a chance to reflect on the role of personal values in leadership and articulate what values are important to them. Curriculum consultant Richard Callahan of the University of San Francisco emphasized the importance of developing the habit of learning — and unlearning — from experience and applying those lessons in future instances. Every event, from a poorly run meeting to a well-executed project rollout, is an opportunity for learning and improvement, if one remembers to reflect.
These habits of values-identification and reflection will carry forward throughout the yearlong program, says Fund program officer Michelle Alletto, who is a veteran of the Reforming States Group and the ELP. A former deputy secretary in Louisiana, Alletto explains why these activities were important for her: “Self-awareness is a vital part of leadership. As one rises up the ranks in state government, amassing more responsibility and bigger charges, it is critical to find time to reflect on your own capabilities and what drives you to do the work.”
A second theme of the year is helping ELP participants benefit from the experience of state health policy leaders who are outside of their particular environment, such as Welch, Roberts and Greg Moody, the former head of the Office of Healthcare Transformation in Ohio, who spoke to the cohort about managing up and across government. The second ELP meeting will also occur concurrently with the year-end meeting of the RSG leadership, so the two groups can interact.
In addition, every ELP participant is matched with a current or former member of the Reforming States Group in a mentor relationship for the year. Leadership can be lonely and asking for direction difficult. Drawing on her personal relationships, Alletto goes to great lengths to match people who are likely to work together well based on their experience and perspective. Past ELP participants report that the mentor relationship creates a safe and rewarding way to learn from someone who is familiar with the issues and dynamics in state health policymaking, yet detached from the particular histories, personalities, and dynamics of the situation.
Still, the question remains: In this era of extreme partisanship and a loss of confidence in government, why pursue a career in public sector leadership? Why deal in a world where priorities are not clear and needs always exceed resources; where governor’s offices are often either meddling or mindless; and legislative leadership is more interested in politics than policy? Why navigate bureaucracies where personnel and procurement policies seem to compete to be the most onerous, and the well-intentioned desire to collaborate across agencies, branches, or political parties can be naïve, if not professionally hazardous?
And why health care? Why work in an area so complex, where raw financial interests masquerade as patient concerns, patients lack the resources to navigate the system, and it’s so hard to know what’s in the public interest?
At the ELP meeting, Roberts and Welch gave participants their answers to these questions. Welch spoke to the satisfaction of bringing people of different views together, working with highly skilled and committed leaders, seeing a good bill passed, and the opportunity for continued professional growth. Roberts said she was driven by the hard work involved in becoming well-versed in an issue and serving as a resource for other legislators. She also described implementing the Affordable Care Act in Rhode Island, and the satisfaction that came with building the trust of many constituents as they participated in an ongoing public process she had designed.
As the ELP curriculum emphasizes, however, to answer this question you have to know what is important to you. Each ELP participant must answer the “Why do it?” question for themselves. As must we all in our professional lives.
Public sector work can provide a deep sense of purpose. In spite of its drawbacks — and sometimes because of them (good stuff, after all, does not come easily) — the former state officials on staff at the Fund, the Reforming States Group members, and anyone who has served in a leadership role in government knows that there is a satisfaction in public service that comes from knowing you are of use, that you are working with others on important issues for the greater good.
In her written biography, one member of this year’s program stated simply: “In my current role, I am finally able to help with statewide policy and systems approaches to prevent and treat the societal issues I saw (previously)…This is incredibly motivating to me.”
Making the most of policymakers’ aspirations to help make things better is what drives the Emerging Leaders Program and our work at the Fund.
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An endowed operating foundation that engages in nonpartisan analysis, collaboration, and communication, with an emphasis on state health policy.