By George T. Roberts, Jr., MHA, FACHE, NACCHO President and Chief Executive Officer of the Northeast Texas Public Health District
Rex D. Archer, MD, MPH serves as the Director of Health for the City of Kansas City (KCHD), MO, and is also a past president of the National Association of County and City Health Officials (NACCHO). In 2017, KCHD was awarded the Samuel J. Crumbine Consumer Protection Award for Excellence in Food Protection for demonstrating unsurpassed achievement in providing outstanding food protection services to their community. Under Dr. Archer’s leadership, in 2018, KCHD earned NACCHO’s Local Health Department of the Year Award. In the same year, Dr. Archer was awarded the Maurice “Mo” Mullet Lifetime of Service Award. KCHD has won several Model Practices Awards, showcasing their exemplary and replicable local public health programs. With the direction of Dr. Archer, KCHD became an accredited health department by the Public Health Accreditation Board and has been one of the first 13 LHD’s to be reaccredited.
Dr. Archer exemplifies the meaning of a true transformational leader. His guidance helps the department address the root causes of health inequities and diseases and promotes the health and wellbeing of his community. Below, he shares some of the ways he uses leadership to mobilize staff and stakeholders to communicate the core values of the department and discusses some of the most important decisions he’s had to make as leader of KCMO.
What are some of the most important decisions you make as leader of your department?
Recruiting and hiring the very best people for the job is very important to me. I use a book of philosophy and approach called “Hiring the Best” by Martin Yate. You’ve got to bring the best talent in. It’s comparable to being the head coach of a major sports team—half your job is recruiting, and the other half is coaching what you recruit.
Other important decisions include, building vital relationships with the community so that you can mobilize when needed. Additionally, receiving accreditation and maintaining it is just as important.
I like to use the Eisenhower Matrix, also known as the Urgent-Important Time Matrix. I believe the biggest challenge for leadership in public health is increasing your time for those things that are important but not urgent because otherwise it’s easy to get trapped doing urgent things—some of which are important, but some are not. The accreditation and reaccreditation standards help you keep and invest time in the important and not urgent areas.
In what ways do you encourage your staff to communicate the core values of your organization? How do you ensure your organization and its activities are aligned with your core values?
We have used Patrick Lencioni’s book The Advantage and many of his other books, which have guided our decision in having a playbook. Our playbook includes us answering a series of questions—the first one is, “Why do we exist?” As a health department, we exist because collective action is needed to share the conditions where our residents can be healthy. Secondly, “How do we behave?” We behave with compassion, focus on prevention, and have a deep awareness of the sufferings of others, coupled with a passion to prevent it. Through our dedication and innovation, we strive for health equity for all.
The third question is, “What do we do?” We promote, preserve, and protect the health of Kansas City residents and visitors. We strive to prevent illness and injuries, improve health services, enforce public health laws, and support policy development to build a healthier community.
The last question there is, “How will we succeed?” The answer is within our strategic plan—by strengthening the impacts of our programs and services, increasing stakeholder awareness in support of our mission and activities, and that stakeholders are, enriching and supporting community partnerships, weighing policy and advocacy development, and developing and sustaining a high-performing organization. We also believe in integrating and supporting diversity, inclusion, and equity in the work we do with the community and using data and evidence-based practices as tools to drive decision-making. That’s our general playbook.
Just like a football team has offensive, defensive, and special teams playbooks, we have different playbooks that examines the effects of social determinants of health, prevention methods from communicable diseases, environmental threats, and violence, and one that focuses on how to save money and reduce costs.
Throughout your years serving in the public health field, what is one mistake or misstep you have witnessed leaders making more often than others?
One of my favorite quotes is from the inventor of the artificial heart, Dr. Robert Jarvik, and that quote is “Leaders are visionaries with a poorly developed sense of fear and no concept of the odds against them. They make the impossible happen.” One of the mistakes I see is health leaders not lowering their sense of fear.
A parallel example of that would be Colin Powell’s, 40/70 rule, which states leaders should make decisions when they’ve obtained between 40 and 70 percent of the information they need and if you make a decision before you’re 40 percent certain, you’ve decided too soon—but if you wait until you are 70 percent certain, you’ve waited too late.
I think most public health leaders operate under a 95/105 rule, where they’ve got to be 95 percent certain or more before they make a decision. I try to operate in a 50/80 rule, depending on how serious the decision is, how difficult will it be to correct a wrong decision, and how many people might be harmed or hurt because the decision was not made or delayed.
I like to ask myself, “What’s my track record been recently? Do I have a bit of political capital, or am I skating on its edge right now? Should I be a little more cautious?” Leaders have to be ready to lose their jobs and in doing so, it’s important not to overextend yourself financially, and be sure to have enough of a nest egg for at least six months in case you’re told your services are no longer needed. Certain individuals in the community can sense your fear, and if you’re not afraid of losing your job, it’s easier to keep it.
The last thing is understanding that what you can do the first six months of the job may be different than what you can do two years later when you’ve built more trust and a positive reputation. Sometimes, starting slower can be more beneficial. Occasionally, you can build more resistance by pushing too much too soon. I’m comfortable in knowing that if I don’t get something done this year, I’ll get it next year because by laying more groundwork. I can come back to it during the next issue or crisis, which can give me a bit more leverage, so I keep those things on the shelf and ready. Just because I didn’t get it done the first time doesn’t mean the timing won’t be right later.
How can transformational leaders influence partners and other stakeholders in their communities?
Working in that upper-right quadrant in the matrix—the important but not urgent issues—is critical when influencing partners. Having a relationship with someone and discovering what they need or what they’re interested in, may not be in your top three or even your top ten priorities, but it may be in your top 50. If you can help them get that done, then you’ve not only done something in your top 50, but you’ve also developed a relationship with them that you might be able to count on the next time when need them to consider one of your top 10 issues. Getting people to see that even if their top priority doesn’t get resolved, that working together on any shared issue will allow for their top ten priorities to move closer to resolve. That tactic moves those issues forward.
When we worked to get our Healthy Homes Rental Inspection Program launched last year, there had not been any tenants’ rights activity in our city for many years. We started seeing many issues and started building the case, but before taking it to our city council, we worked with several community-organizing groups that we’ve partnered with in the past, educated them on the issue, and got their support so that when we went in with council for the ordinance, they were prepared. At that time, we had difficulty getting it passed by the council. But the community-organizing groups decided to do an initiative petition. They took it to the voters with an even stronger ordinance than what we were proposing. Eventually, it was passed by 57 percent.
Now, we have about $2 million coming in each year to do rental home inspections to keep kids from going to the emergency room because of asthma, mold in their apartments, and other issues. Also, the City Council has unanimously voted to strengthen the ordinances.
Leaders should be developing relationships and working with folks to make a difference. We’ve developed a relationship with our chamber of commerce. They often support what we do. While sometimes they decide to stay neutral, it is enough to move an issue forward.
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To share your story of transformational leadership or to recommend a leader to be highlighted, please contact Taylarr Lopez, NACCHO Communications Specialist, at [email protected].