Public Health Leadership & Management: Cases and Context


Stuart A. Capper, Peter M. Ginter & Linda E. Swayne

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  • Back Matter
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  • About the Cover

    The cover artwork by Gustav Klimt (1862–1912) is Hygeia—the Greek goddess of health. It is part of a larger work titled Medicine that was painted between 1900 and 1907 and destroyed by fire in 1945. Images of Hygeia are frequently used to represent the profession of public health. For example, in 1970 a marble bust of Hygeia was installed outside the main entrance of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Klimt, in his extraordinary painting, portrays the Greek goddess with her traditional cup and snake—symbols that represent the waxing and waning of life and death. Born in Austria, Klimt became the foremost exponent of art nouveau in Vienna. His greatest works were portraits and landscapes of exotic sensibility, with symbolic themes and extravagent rhythms. Klimt was significantly influenced by the vibrant colors of Byzantine mosaics, clearly evident in his Hygeia.


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    During my career, I have been fortunate to work in a variety of senior positions with local, state, federal, and private health organizations. As I think back on my experiences, I recognize that there was little in my formal education that prepared me for the breadth and complexity of the leadership and management judgments I was called on to make.

    Throughout my medical education, with the guidance of faculty, I studied case after case and refined my ability to help individual patients through difficult clinical judgments. However, during my public health education, there was little if any opportunity to practice applying the powerful science I was learning to real world public health judgments. This book aids significantly the important process of filling a void in public health leadership and management education by providing cases that allow students a classroom experience somewhat akin to real life public health decision-making.

    The fifteen case studies in this book place the reader in a wide variety of real public health leadership situations, ranging—as one reviewer commented—from babies to bioterrorism. Each situation is presented to the student with the swirl of communications, conflicts, and conundrums that I have found accompany any difficult public health leadership judgement. The diversity of the organizational settings is quite wide. Students will find themselves grappling with issues from local, state, and federal public health agencies as well as private organizations that have substantial public health missions. The setting for these organizations is within many different geographic regions, both domestic and international.

    As I have moved around this country to assume various health leadership positions, I have been struck by the influence that local and organizational contexts can have on the decisions that are made. The case writers have done a very good job of placing the student in public health decisional situations that, to me, feel like the reality of my own professional life.

    As Professors Capper, Ginter, and Swayne mention in their preface for this book, the cases are not presented to illustrate correct or incorrect decision making. I believe this is as it should be. My experience suggests that few of the difficult decisions our public health leaders face in the future will have a clearly right answer. Instead, they will be called upon to make difficult judgments and to be ready and willing to explain and be accountable for the decisions they have made. Participating in discussions of the timely and complex cases in this book will give future, as well as current, leaders the opportunity to practice the essence of our profession.

    Having been a public health practitioner and now, as a public health academic, I am especially pleased to see the extensive collaboration that occurred between these two groups. The realism, relevance, and quality of this book are not because of either public health practice or public health academics. Rather, it is the collaboration that created the success.

    This book is both good education and a good read. It is my hope that it will substantially aid the research, writing, and teaching by the case method that needs to be established within the profession of public health.

    William L.Roper, MD, MPH, Dean, School of Public Health, The University of North Carolina at Chapel Hill


    Noted educators and business writers Warren Bennis and Burt Nanus stated, “Managers are people who do things right, and leaders are people who do the right thing.” This statement suggests that management is more about efficiency, whereas leadership is more about effectiveness. The often cited Institute of Medicine (IOM) study The Future of Public Health called for public health education to increase its emphasis on both managerial and leadership skills. The implications of the IOM study were that public health institutions need to be more effective in carrying out their mission and use their available resources much more efficiently.

    Over the past fourteen years, a variety of public health organizations have sought ways to respond. Federal agencies such as the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) have funded and worked within public health to develop management and leadership institutes at the national and regional levels. Many state and local public health systems have established public health leadership training programs within their jurisdictions. Schools of public health have worked with federal and foundation funding partners in addition to state and local public health agencies to establish and conduct leadership training through continuing education and certificate programs as well as degree-granting programs. It is our belief that case studies are a valuable tool to develop the management and leadership skills envisioned by the Institute of Medicine and that these skills will, in turn, make public health institutions more effective and efficient. Learning to apply independent critical analysis in the making of difficult public health judgments is the essence of professional public health practice. The dilemma is how to develop the ability to make good public health decisions without undo risk to the public's health. As educators, we believe it is important to incorporate these difficult decisions in the classroom for students to practice and develop the skills with full, frank, and critical discussion of the students' recommendations.

    Definitive answers to tomorrow's public health problems will not be found in the public health leadership programs of today. The complexity of national and international public health practice and the rapid changes in the context for public health leadership mean that there will be few situations where rote learning will provide solutions. Public health professionals must learn to apply an independent critical analysis and to make judgments that balance conflicting and completing interests, interests that may or may not accept the best public health science that, in a rapidly evolving situation, may or may not provide clear guidance.

    For more than 100 years professionals in medicine, law, and management have relied on case studies as a didactic method for education. Case studies are an ideal pedagogy to practice professional decision-making and leadership skills because they place the student in real situations—situations that actually were encountered by professionals—with all the information, conflicts, and confusions inherent in the difficult decisions that were faced. Cases do not reveal to the student what the professional decided or how the decision was made. The cases do provide students with the situation and opportunity to practice making tough professional judgments. The ensuing discussion offers a chance to present and defend the logic of a particular recommendation and listen to others who have different views. Thinking is the method of intelligent learning, and case studies help teach discussion participants how to think.

    This book is designed to overcome the lack of public health practice case studies. Each case provides a wide variety of public health leadership challenges based on actual events in public health practice. The cases were not written to illustrate correct or incorrect decision making; rather, the cases give students the chance, in a protected and collegial environment, to develop their public health management and leadership skills.

    Organization of the Book

    This book is divided into three parts. Part I contains four chapters that provide methods to improve public health management and leadership through case analysis and decision making. Chapter 1 includes a framework for case analysis, Chapter 2 presents a valuable list of sources for public health information, Chapter 3 provides guidance for making effective oral presentations, and Chapter 4 presents a brief primer on health care finance.

    Part II of the book provides descriptive information about the U.S. health care system and the U.S. public health system to provide the context for public health decision making. Although public health leaders have some control over the organizations they manage, they have little control over the forces outside their agencies that influence public health practice. The “rules” for successful public health leadership are defined outside public health organizations.

    Part III contains fifteen public health case studies that present a wide array of challenging and complex public health issues. The cases are based on field research conducted in a variety of public health agencies. Many have been coauthored by public health practitioners. The cases encompass all the core public health disciplines and engage the student in integrating these disciplines into management and leadership practice.


    Many people helped and encouraged us as we worked on this book. First, we would like to thank all the authors of the cases. Case writing is a difficult art requiring many hours of library research, personal interviews, and detailed analyses. The case contributors in this text represent some of the finest researchers anywhere. They have greatly enhanced the important body of public health case literature. In addition, we want to pay a special tribute to the authors of the chapters in this text. It has been a wonderful experience to work with each of them.

    We would like to provide special recognition to all the state and local public health leaders who have assisted us, including Don Williamson, Carole Samuelson, Max Michael, Clyde Barganier, Kathy Vincent, and Frances Kennamer of Alabama; Pat Cleaveland, Barak Wolff, Norty Kalishman, and Alex Valdez of New Mexico; Joe Hunt of Indiana; Jesse Greenblatt of New Hampshire; Joe Kimbrell of Louisiana; Gail Gannaway and Lewis Leslie of Arkansas; and Paul Wiesner of Georgia. At the federal level, we are indebted to Earl Fox and Ron Merrill of HRSA as well as Stephen Thacker, Andrew Dannenberg, and Edward Baker of CDC.

    Within the academic community, we have many outstanding colleagues who have contributed to our work in a variety of ways. They include Dean Eli Capilouto and Associate Dean Donna Petersen of UAB, Dean Ann Anderson of Tulane, and Dean Claude Lilly of UNC Charlotte as well as Professors Jack Duncan and Michael Maetz. We offer special thanks to Bill Roper for writing the forward to this book. Dr. Roper has been an important leader in public health and has always been supportive of our projects.

    Thanks to our collaborators at Sage Publications—Marquita Flemming, our editor, with whom we have had an enjoyable and productive relationship, and Rolf Janke, whose unfailing enthusiasm for our work is always motivational.

    We deeply appreciate the support and comradeship of all the individuals who have influenced and encouraged us. Most important, we want to recognize the patience, love, and support of our families. After all, they are what it is all about.

    Stuart A.Capper
    Peter M.Ginter
    Linda E.Swayne
  • About the Authors

    Stuart A. Capper, DrPH, is Professor of Health Care Organization and Policy and Co-Director of the MidSouth Program for Public Health Practice, University of Alabama at Birmingham (UAB). He has served as Associate Dean of the School of Public Health and Chairman of the Department of Health Care Organization and Policy. Before coming to UAB, he served as Senior Staff to the Chancellor of the Tulane Medical Center. He has been a lead investigator on projects concerning the implementation of strategic management in state health departments. He also has received federal funding for the development of case studies in public health practice. In addition, he serves on the faculty of the Preventive Medicine Residency Program of the Centers for Disease Control and works with colleagues at CDC on case research projects. His publications in the area of public health management have appeared in Public Health Reports, Public Productivity and Management Review, Health Services Management Review, Preventive Medicine, Academic Medicine, The European Journal of Public Health, and the Case Research Journal He is the recipient of the Phillip Cooper Award for the Outstanding Health Care Case Study and the UAB Faculty Award for Outstanding Public Health Service.

    Peter M. Ginter is Professor and Chair of the Department of Health Care Organization and Policy in the School of Public Health and Professor of Management in the Graduate School of Management at the University of Alabama at Birmingham. He is the author or coauthor of eleven books, including Strategic Management of Health Care Organizations (3d ed., with Jack Duncan and Linda Swayne, 1998), The Physician Strategist (1996, with Duncan and Swayne), and Strategic Issues in Health Care Management (1992, with Duncan and Swayne). He is also coeditor (with Duncan and Swayne) of The Handbook of Health Care Management (1998). He has published more than 100 articles, papers, and cases in management journals, with his work appearing in such publications as the California Management Review, Academy of Management Review, Academy of Management Executive, Business Horizons, Journal of Management Studies, Long Range Planning, Management International Review, Journal of Leadership Studies, Managerial Planning, Public Health Reports, Advances in Health Care Management, and the Journal of Case Research.

    Linda E. Swayne, PhD, is Professor and Chair of the Department of Marketing in the Belk College of Business Administration at The University of North Carolina at Charlotte. She serves as Editor of the Case Research Journal and has assisted public health practitioners in Alabama and New Mexico and at the Centers for Disease Control and Prevention with case research and writing. She has served on the Board of Directors of C. W. Williams Health Center and is on the Steering Committee for the Metrolina Health Initiative. Her consulting work has been with hospitals, pharmaceutical companies, the Mecklenburg County Medical Society (MCMS), Centers for Disease Control, and a variety of physician practices. She was presented the Friends of Medicine Award by MCMS in 1997. She has coauthored ten textbooks, more then twenty-five journal articles, and thirty-five case studies. She has served as president of three professional organizations. She cochairs the Strategic Thinking in Health Care Faculty Forum for AUPHA.

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