LMI Strategy Paper

Strengthening the Healthcare and Education Systems of Resource-Limited Countries through

Training in Leadership and Management:

The Leadership and Management Initiative (LMI)

of I-TECH

Strategy PaperDraft – March 3, 2011

Table of Contents

i. Executive Summary..........................................................................................................................................2

I. Background...................................................................................................................................................3

Figure 1. The WHO Health System Framework.......................................................................................3

II. Leadership and Management Initiative (LMI)..................................................................................................7

A. Leadership Development Framework.....................................................................................................8

B. Partnership Model and Training Approach.................................................................................................9

III. LMI Strategy & Activities...............................................................................................................................11

A. Objectives.................................................................................................................................................11

Objective 1: External partners...................................................................................................................11

Objective 2: Deepen network capacity......................................................................................................12

Objective 3: University-based support......................................................................................................12

B. I-TECH LMI Logic Model............................................................................................................................13

C. Menu of Services......................................................................................................................................15

D. Current Activities......................................................................................................................................16

IV. Collaboration/Partnership...........................................................................................................................19

V. Evaluation Plan.............................................................................................................................................19

References.........................................................................................................................................................20

Appendix A: Organizational Background..........................................................................................................21

Appendix B. MSH Leading and Managing Framework......................................................................................23

Appendix C: MSH Leading and Managing for Results Model.............................................................................24

Appendix D: Framework for Training................................................................................................................25

LMI Strategy Paper, 3/3/2011 Page 2

i. Executive Summary

The I-TECH Leadership and Management Initiative (LMI) is an umbrella initiative that supports the development of strong public health leaders and managers in the developing world. LMI furthers I-TECH’s ability to realize its mission, principles, and strategic planning goals at the organizational level, while supporting the I-TECH network and external partners to achieve broader health objectives. LMI addresses a very real need for increased capacity in these areas.

This initiative is built upon the premise that good leadership and management can be learned and must be taught alongside required technical competencies as an essential component of health systems strengthening [8]. I-TECH’s unique approach to leadership, management, and supervision is shared through its network and to its partners in a variety of ways. In every case, LMI activities are tailored to the context. Methodologies include distance learning, individual’s skill assessments, workshops, curriculum enhancements and personal action plans. LMI objectives are:1. Work with external partners to integrate leadership and management capacity strengthening into

existing systems;2. Deepen leadership and management expert technical capacity within the I-TECH network; and3. Support the development of a leadership and management approach (institute) at the University of

Washington.

This paper provides the background and rationale that led to the creation of LMI and describes the initiative.

I. Background

National governments and the nonprofit sector are increasingly acknowledging the need for strengthened leadership and management capacity in the field of global health. The World Health Organization (WHO) places leadership & governance as one of the six building blocks of a well-functioning health system in its Health Systems Strategy Framework for Action [1]. WHO published this framework in 2007 to promote a common understanding of what constitutes health systems strengthening (See Figure 1).

The building blocks represent the six discrete functions that make up an effective health system:1. Service Delivery2. Health Workforce3. Information4. Medical Products, Vaccines & Technologies

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About I-TECH

The International Training and Education Center for Health (I-TECH) is a collaboration between the University of Washington and the University of California, San Francisco. It is a center in the University of Washington's Department of Global Health and has offices throughout Africa, Asia, and the Caribbean.

I-TECH's mission as a global network is to work with local partners to develop skilled health care workers and strong national health systems in resource-limited countries. I-TECH promotes local ownership to sustain effective health systems.

5. Financing6. Leadership/Governance

Figure 1. The WHO Health System Framework

These building blocks serve three purposes. They: 1) Define desirable attributes of health systems; 2) Define WHO priorities; and 3) Identify gaps in WHO support [1].

According to WHO, leadership and governance is more than just one of the six building blocks of a well-functioning health system. Leadership and governance is the central component of health systems strengthening around which the five other building blocks revolve (See Figure 2).

The International Training and Education Center for Heath (I-TECH) subscribes to this approach to health systems strengthening. In accordance with WHO, I-TECH believes that leadership is an essential component of health systems strengthening. Consequently, activities to build leadership and management capacity are integrated directly into I-TECH health systems strengthening activities. Within leadership and governance WHO defines six priorities:1. Develop health sector policies and

frameworks2. Regulatory framework3. Accountability4. Generate and interpret intelligence5. Build coalitions6. Work with external partners

I-TECH is already engaged in many of these activities both internally and externally through our international partners.

The United States President’s Emergency Plan for AIDS Relief (PEPFAR) has also identified health systems strengthening and country

LMI Strategy Paper, 3/3/2011 Page 4Figure 2. WHO Health System Building Blocks

ownership as core programmatic strategies in its latest Five-Year Plan [2]. Along with its partners, PEPFAR has helped to build widespread recognition of the critical need for health systems strengthening as a core component of global health initiatives. This focus has resulted in concrete improvements in health delivery systems in many PEPFAR countries. Building on this success, PEPFAR is transitioning its focus to country ownership with an explicit goal of expanding technical assistance and mentorship of professionals at all levels of national health systems [2].

A recent study conducted by I-TECH’s home institution, the University of Washington Department of Global Health, echoes the need for increased efforts to build leadership and management capacity. The study interviewed 25 leaders in the field of global health – including William Foege, Helene Gayle, Peter Piot, Mark Dybul, and others – about current and future jobs in global health and the competencies and skills required by professionals to be effective in the field. Analysis of these interviews indicated a substantial need for stronger management skills, greater leadership/strategic thinking, and more finely tuned policy/political skills as a complement to competency in specific areas of technical expertise. This emphasis creates an opportunity for I-TECH to expand its efforts to support capacity strengthening in leadership and management.

I-TECH is a coordinated network of resources dedicated to supporting global health initiatives. At the University of Washington, I-TECH collaborates with other Department of Global Health centers and projects to provide education, resources, and training to global health partners. At the University of California - San Francisco, I-TECH collaborates with numerous centers to support projects throughout the larger I-TECH network. With access to a wealth of institutional resources and a global network of trained clinical mentors who regularly interface with leaders in health policy, I-TECH is well placed to advance a strong leadership and management program both within its 11 country offices and their broader constituencies.

Why Strengthen Capacity in Leadership and Management?

High-performing organizations are those that have, at all levels, individuals who commit to and practice values-based leadership and management. The results of successful leadership and management are improved service, performance, and outcomes. Effective leadership and management skills improve

employees’ job performance as well as business/organizational outcomes.

A wealth of evidence, primarily from the business sector, exists to support the connection between high-performance management practices and highly profitable companies or organizations. Leading this field of study is organizational behavior scholar, John Pfeffer. In his book, The Human Equation: Building Profits by Putting People First, Pfeffer references a large base of evidence to document the profitability of investing in leadership and management [3]. Pfeffer discusses one award-winning study of 968 firms from all major industries that found that, "a one standard deviation increase in use of [high performance management] practices is associated with a 7% decrease in turnover and an $18,000 increase in stock market value per employee.” Another study referenced by Pfeffer of 702 firms came to an even stronger conclusion that “a one standard deviation improvement in the human resources system was associated with an increase in shareholder wealth of $41,000 per employee or about a 14

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“Training is an essential component of high-performance work systems because these systems rely on front-line employee skill and initiative to identify and resolve problems, to initiate changes in work methods, and to take responsibility for quality. All of this requires a skilled and motivated work force that has the knowledge and capability to perform the requisite tasks.”

John Pfeffer

percent market value premium.” A third study of the five-year survival rate of 136 non-financial companies demonstrated that with other factors such as size, industry, and even profits held constant, both the value placed on human resources and the way the organization rewarded people were significantly related to the probability of survival [3].

Many of Pfeffer’s ideas were reinforced in a 2003 Forbes’ McKinsey Quarterly report [4]. McKinsey research shows that companies that regularly earn spots on the best places to work lists “combine low-powered tangible incentives with a culture that reflects the presiding values of customer service, fairness, empathy for employee concerns and open access to company information.”

One of the key practices of high-performance management is leadership and management skills development through training. In his book, Pfeffer recommends extensive leadership and management training as one of the seven essential practices of successful organizations.

In 2009 [5], Menasha Packaging trained 300 managers in order to improve their personal job satisfaction as well as the performance of their direct reports. The course focused on effective leadership, supervision and coaching. Courses were implemented during a 3-month period in 20 two-day classroom training sessions. In-class work was supplemented with extensive reinforcement from human resources managers. The impact of training on key job metrics was measured. The detailed participant evaluation data predicted high job impact and business results, while 91.8 % of employees said they felt the training would have significant impact on job satisfaction — meaning improved morale and potentially increased engagement.

While this example and Pfeffer’s work refer primarily to the business community, it is easy to see how these programs and findings apply to complex health systems. The values of training and the need for successful organizational practices are not limited to for-profit enterprises.

A recently published article in Human Resources for Health describes how a leadership development program successfully contributed to improved health system outcomes in Egypt [6]. In 2007, WHO representatives working in Egypt recognized that the broad goal of health systems strengthening depends not only on resources, but also on how those resources are managed – especially at the local level. WHO worked with Management Sciences for Health (MSH) to implement the Leadership Development Program (LDP), a skills development and training program for health care workers, including doctors, nurses, and midwives, at all levels.

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Global Health Case Studies

As part of its effort to develop the leadership and management skills of health professionals worldwide, I-TECH is developing a collection of global health case studies. Each case, written by an I-TECH staff member, documents a situation in which a key leadership or management skill was employed to address an existing challenge to improving health systems. The cases, which are drawn from a variety of settings and written by international staff members, illustrate how leadership and management skills can be applied in a variety of contexts in a culturally appropriate and effective manner. Case studies not only help training participants to better understand leadership and management practices, they help participants to think creatively about how they can alter and adjust these practices to be effective in their particular work environment. I-TECH has found case studies to be a highly effective tool for teaching leadership and management skills.

The program trained existing teams to use the Leading and Managing Practices Model (See Appendix B) to identify and set goals. At the end of the first year, 8 of 10 health teams had achieved 95% or more of their desired results and three districts increased the number of new family planning visits by 36%, 68% and 20% respectively. The majority of health teams also selected a new challenge without prompting, illustrating that the LDP was not only effective but also sustainable. After the program, participants convened a meeting to discuss how to continue without outside funding. Health system indicators continued to improve without outside funding and a qualitative evaluation showed significant success. One author notes “The LDP has scaled up with local resources because it uses a simple process of working with teams over time to focus on real health results, developing leaders at all levels of the health system and enabling local health managers to own the development process” [6]. This is a concrete example of Pfeffer’s theories at work in

the global health arena.

Another well-documented program related to HIV interventions in the developing world provides evidence that investing even a limited amount of resources to leadership training can have an impact. An article in Human Resources for Health [7] describes a program in Zimbabwe aimed at responding more effectively to the HIV/AIDS epidemic by reinforcing a critical competence-based training institution and producing public health leaders. The program used HIV/AIDS program-specific funds to support a local education institution to train public health leaders in leadership and HIV-related content.

The Center for Disease Control (CDC) committed approximately US $400,000/year to this program, or approximately 5% of its annual budget for Zimbabwe. The results proved that an investment of a modest proportion of new HIV/AIDS resources in targeted public health leadership training programs can assist in building capacity to lead and manage national HIV and other public health programs [7].

I-TECH’s leadership and management strengthening efforts are in direct response to the many substantive studies and articles that point to the need for and effectiveness of leadership and management training to improve health outcomes in developing countries.

II. Leadership and Management Initiative (LMI)

The I-TECH Leadership and Management Initiative (LMI) is an umbrella initiative that supports excellence in leadership and management within the I-TECH network and with partners. The goal of LMI is to strengthen global health systems in order to improve health outcomes for all. LMI furthers I-TECH’s ability to realize its mission, principles, and strategic planning goals at the organizational level, while supporting the I-TECH

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“My supervisor and myself have different values. I cannot change her values and I have realized that. What I can change is myself and how I interact with her. This workshop has helped me realize how I need to be open to understanding different type(s) of viewpoints and how I need to first understand where they are coming from.”

LIH Namibia Participant

Leadership

SupervisionManagement

Figure 3. Essential Skill Sets

network and external partners to achieve broader health objectives. I-TECH has committed to supporting leadership and management development by instilling a culture that recognizes the importance of these competencies and by offering multiple opportunities for growth.

LMI is founded upon several core principles:1. There are three essential skill sets: Leadership, Management, and Supervision (see Figure 3).2. These skill sets can be learned, taught and nurtured.3. They are necessary components of effective health system strengthening,4. Leadership should be encouraged at all levels of an organization.5. Leadership is founded upon personal practice.

A. Leadership Development Framework

I-TECH’s Leadership Development Framework empowers healthcare leaders to design their own path to effective leadership based on greater self-awareness and informed by proven leadership theories (Figure 4).

The I-TECH Leadership Development Framework draws upon a wealth of key resources from a variety of disciplines. At its essence, the I-TECH Framework fosters self-awareness. It uses a specific collection of carefully selected leadership messages as prompts to help participants craft their own leadership theory and application strategies. The I-TECH Framework encourages participants to begin their leadership development process by first looking inward and then focusing on external practices and relationships. The I-TECH Framework requires participants to focus on self-awareness using specific tools, including the Leadership Practices Inventory, or LPI, (http://www.lpionline.com/), to identify existing leadership strengths and begin a process of self-reflection.

Building upon self-awareness is self-development through I-TECH-supported training and learning opportunities covering a variety of practical skills. Training topics include project management, human resources management, supervision, teambuilding, communication, negotiation, time management, financial management, and advocacy, among others. The I-TECH Framework draws largely on the work of well-known thinkers such as Stephen Covey and Parker Palmer and pulls from the strong resource materials created by Management Sciences for Health, including the Leading and Managing Framework (See Appendix B) and Leading and Managing for Results Model [9] (See Appendix C).

These tools ultimately influence a process of self-determination through which participants apply tools to their own work environments and develop a personalized approach to continuing leadership development.

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Self-Awareness Knowing Who You Are

Assessments i.e., LPISelf-Reflection

Cultivate Wisdom

Self-Development Exposure to Selected

TheoriesMSH Framework

Leadership ChallengeValues-Based Leadership

Self-Determination Roadmap to Desired

BehaviorIndividualized Theory of Action

Personal Mission StatementProfessional Development Plan

Figure 4. I-TECH Leadership Development Framework

The I-TECH Leadership Development Framework is inherently flexible and adjusts to the needs of specific partners and the realities of cultural contexts. As it is deeply grounded in a reflective, values-based approach to leadership and management, the I-TECH Framework can be translated across cultures to fit unique cultural contexts.

By practicing internally the skills we hope to build around us, we are pursuing the development of mutually reinforcing and collaborative systems that will reduce friction and improve efficiency in an effort to strengthen health service delivery and ultimately improve overall health outcomes.

B. Partnership Model and Training Approach

In order to integrate leadership and management into health systems strengthening, I-TECH employs its partnership model (See Figure 5). This model illustrates the process through which I-TECH delivers the Leadership and Management Initiative.

I-TECH applies its proven partnership approach to the delivery of leadership and management training. The partnership approach supports I-TECH's commitment to the goals of PEPFAR and the Global Health Initiative. I-TECH works with host country partners to initiate new programs to build the capacity of the health workforce and then transfers the ownership and leadership of these programs to the partners. Within I-TECH, this requires leaders who implement this process effectively. Leaders must employ a vision of change and lead staff to implement the transition. For our partners, a successful handover requires that we build the leadership skills of the host country institution receiving the project. Through this approach, I-TECH builds sustainability of projects and has a lasting impact on the health workforce in countries where we work.

The Leaders in Health (LIH) course offered in Namibia is an example of this partnership approach in action (See inset box on page 11). I-TECH was approached by various Ministries in Namibia for assistance building leadership and management capacity. I-TECH conducted a needs assessment, worked to developed an appropriate partnership structure, identified presenters, delivered the technical services through a three-part series, evaluated the results, and is now preparing participants to lead the second series to be delivered next year.

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Figure 5. The I-TECH Partnership Model

This successful project illustrates how I-TECH’s six step partnership model will build leadership and management capacity through a long-term, sustainable and locally-owned process.

In addition, I-TECH utilizes a training framework that consists of six levels. The I-TECH Framework for Training (See Appendix E) is adapted from the AIDS Education and Training Centers (AETCs) and outlines multiple stages that result in the transfer of learning from classroom to job site. The first five levels reflect a progressive degree of independence, responsibility, and mastery among learners in relation to a particular set of skills, knowledge, and attitudes. Level 1 and 2 trainings typically occur in a classroom setting, and are used to impart large bodies of knowledge to learners. Level 3 and 4 trainings focus on the application of new skills and knowledge to a learner's own work setting or one similar to it. Level 5 training involves establishing systems to support learners who primarily work independently, but may occasionally require assistance with complex situations. Level 6 refers to systems strengthening, which encompasses efforts to improve or streamline organizational systems, processes, and routines to ensure transfer of learning in a supportive environment.

I-TECH believes that in order for leadership and management training to effectively strengthen health systems, capacity strengthening needs to be supported at multiple levels. In-service, or on-the-job, training provides an opportunity for participants to learn new skills and immediately apply them to the context in which they work. Trainings utilize practical real-world examples from the specific context in which they are held and allow participants to practice in real-time the leadership and management skills they are being asked to integrate into their daily work in the health system. By using examples, such as case studies that reflect relevant scenarios and practical issues, I-TECH believes there is a higher likelihood that new competencies will be put into practice and will result in higher performing health systems that contribute to improved health outcomes.

I-TECH uses this multi-level approach to integrate leadership and management training into its regular capacity building programs. In this way, I-TECH delivers leadership and management training in a manner that is relevant, appropriate, and applicable to the local context. I-TECH integrates values-based leadership with evidence-based management practices then enables these techniques to be adapted to the particular national or local context. I-TECH utilizes workshops held on-site, within the local work environment and among regular work teams to

ensure that skills are relevant and applicable to the specific context. Used together, these approaches aim to increase leadership and management capacity both within I-TECH and among external partners as a means to improve overall health outcomes.

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Leadership Initiative for Rural Kenya

Last year, I-TECH collaborated with UCSF’s Family AIDS Care and Education Services (FACES) project in the Kisumu and Nyanza provincial offices of the Ministries of Medial Services and of Public Health and Sanitation to develop and deliver a 5-day leadership and management training to 28 provincial and district health managers working in the western region of Kenya. The course is part of a larger, ongoing initiative that includes regular workshops, individual and team practical assignments, and mentoring. Participants reported high satisfaction with this workshop, and many gained a greater appreciation for team building and the contributions of all members. One participant said, “[This training] has helped me understand that everyone is important, and realize that everyone can contribute to successful performance if we support each other.”

“The workshop really impacted me on the personal level. It made realize that I needed to listen to people better and understand where they are coming from. .”

LIH Namibia Participant

III. LMI Strategy & Activities

LMI activities are guided by I-TECH’s unique approach to leadership and management and supported through a library of carefully selected resources and intentionally designed training materials.

A. Objectives

Using this model, I-TECH has prioritized three main objectives for the Leadership and Management Initiative:

1) Work with external partners to integrate leadership and management capacity strengthening into existing systems;

2) Deepen leadership and management expert technical capacity within the I-TECH network; and3) Support the development of a leadership and management approach (institute) at the University of

Washington.

Objective 1: External partners

In order to build strong health systems, I-TECH works in direct partnership with external organizations. These partners may include Ministries of Health, other government Ministries, universities, and non-governmental organizations (NGOs). I-TECH engages in direct partnerships at the request of the partner organization and works collaboratively to develop an appropriate and effective plan to incorporate leadership and management training into existing or new capacity building initiatives. Work with external organizations aims to integrate leadership and management training into existing health systems strengthening programs according to the I-TECH partnership model (Figure 4). The ultimate goal is to strengthen public health leadership in the countries where we work.

Work with external partners begins with a comprehensive needs assessment. Based on this assessment, I-TECH and the partner organization decide upon the most appropriate structure for strengthening leadership and management capacity. Once this structure is identified, technical experts and appropriate resources are identified – whenever possible, experts and resources come from within I-TECH or from within local partner organizations. These parties then deliver the agreed upon technical assistance through the selected program, workshop, or training. The work is followed up by an evaluation to solicit both participant self-reported satisfaction as well as long-term impacts on health systems. These evaluations are used to inform the continued development of leadership and management skills led by the partner organization either with or without continuing I-TECH support.

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Leaders in Health Educational Series in Namibia

In March 2010, I-TECH held the first of the three part Leaders in Health educational series. The series, designed to further strengthen health care systems in Namibia through effective mentoring of health leaders, managers, and teachers, brought together leaders from collaborative Namibian institutions, including the Ministry of Health and Social Services, the Ministry of Defense, the University of Namibia, and I-TECH. In workshops participants studied and discussed the nuances of leadership and management and practiced team building and communications skills. The series is complemented by a new distance-based course called "Global Program Management and Evaluation," which is being offered through the UW (see inset box on page 13). The series concluded with a final face-to-face workshop in June 2010. The series is being repeated in 2011.

Ultimately, the development of leadership and management skills among external partners contributes both directly to health systems strengthening as well as indirectly to the continuing development of leadership and management skills in the health sector. The Leaders in Health Educational Series in Namibia described in the inset box on page 11 presents an example of highly effective leadership and management capacity strengthening with external partners. Several other countries are considering replicating this successful model.

Objective 2: Deepen network capacity

While simultaneously building the capacity of external partners, I-TECH aims to build its own internal leadership and management skills. The I-TECH network consists of all I-TECH offices located in Seattle and San Francisco and throughout the 16 I-TECH country offices. The leadership and management capacity of the I-TECH network will be deepened through a variety of activities described below in the Menu of Services on page 15.

Similar to work with external partners, the process of developing leadership and management activities is driven by country offices, according to their identified needs and using the delivery method most appropriate for the cultural and work climate. The first LMI Workshop described in the inset box on this page describes an example of efforts to deepen network capacity. The synchronous distance learning Global Program Management and Evaluation course described in the inset box on page 13 is another example of I-TECH’s work to deepen the capacity of its network. The Current Activities Table (included below in section III. D.) illustrates the variety of ways LMI activities are currently being implemented in our country offices.

Objective 3: University-based support

As a member of the University of Washington community, I-TECH benefits from strong university initiatives and is invested in the success of other university efforts. Thus, I-TECH contributes to the University of Washington’s overall leadership and management efforts. Recognizing the tremendous need for leadership and management strengthening in the field of global health and possessing a rich collection of resources dedicated to global health work, the University of Washington is well placed to take a leadership role in designing and implementing leadership and management development as an essential component of health systems strengthening.

I-TECH plays an integral role in this effort and will help to ensure the success of the University of Washington on this front. For example, I-TECH supports and contributes to the University-wide Leadership, Policy, and Management Technical Working Group. I-TECH also relies on and connects the larger University community to its work both internally and externally to further leadership and management development. Shared vision is one of our operating principles and I-TECH aims to support a shared vision of leadership and management development within the Department of Global Health and the larger University of Washington community.

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Principles into Practices: LMI Workshop I

In March 2010, the first official workshop of I-TECH’s LMI took place in Seattle, WA. Deputy Directors, Unit Directors, Country Program Managers and other managers from I-TECH Country Offices and headquarters came together to share experiences, learn skills and contribute to the development of the next phase of the Initiative. Participants were asked to envision future benefits of the LMI and work backwards to identify key actions taken. This valuable feedback is being used to develop the strategy and inform the direction of the LMI. As such the LMI is growing directly from the identified needs and suggestions of participants. Furthermore, this workshop serves as the nucleus of leadership and management change practices, which are then integrated into the health systems strengthening programs at the country level.

I-TECH staff were involved in the development of a new track within the University of Washington School of Public Health’s Department of Global Health (DGH), known as the Leadership, Policy, and Management (LPM) track. The LPM track is designed to build the capacity of mid-career professionals to incorporate leadership and management development into their public health education. Students in the track gain concrete skills, which they can later apply in practice in their respective countries and organizations. I-TECH Executive Director, Dr. Ann Downer, teaches one of the required courses for the LPM track, Global Program Management and Evaluation (see inset box on this page).

Through the Leaders in Health program, I-TECH taps into university expertise in areas such as health policy, communication, and adult learning and metacognition. UW professors developed the curricula and lead the training activities, sharing current trends and applying them to developing world realities. This program is offered to I-TECH partners and universities in a variety of countries.

In addition to playing an integral role in the development of leadership and management competencies for global health professionals, I-TECH is also at the center of efforts to strengthen distance-learning opportunities offered by the UW DGH. The Global Program Management and Evaluation course referred to above was piloted this year as a distance-learning course offered to I-TECH staff located in offices around the world. Delivered synchronously to 8 classrooms around the globe, this course has inspired a high volume of interest in distance learning opportunities. The course has since been repeated to I-TECH staff in Uganda and an extension of the course delivered through monthly distance learning sessions is currently in development.

Both the LPM track and the distance learning initiatives fall within the scope of the target priorities set by the University of Washington’s outgoing President, Dr. Mark Emmert. Dr. Emmert has long supported the strengthening of global health programs and was behind the creation of the Department of Global Health. While participating in the Consortium of Universities for Global Health’s inaugural annual meeting in 2009 Dr. Emmert stated, “[Global Health] is a field that has incited more student interest and engagement in a relatively short period of time than virtually anything I’ve ever seen…Similarly, it fits our faculty’s strengths in many fields.” [10]

B. I-TECH LMI Logic Model

Goal: Strengthen global health systems to improve health outcomes for all Objectives: 1. Work with external partners to integrate leadership and management capacity strengthening into

existing systems2. Deepen leadership and management expert technical capacity within the I-TECH network3. Support the development of a leadership and management approach (institute) within the University of

Washington

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Global Classroom in Leadership & Management

In March 2010, I-TECH launched its first ten-week distance-learning course, Global Program Management and Evaluation. Taught by I-TECH’s Executive Director, Ann Downer, this course delivers weekly synchronous lessons to over 100 students located in 8 classrooms throughout the world. The unique delivery of this important training material allows country program teams to work collaboratively on class discussions and assignments. The course curriculum was designed in response to a global needs assessment and weekly feedback is integrated to continuously improve delivery and content. The result of this course is a new class of I-TECH staff members who now speak and understand a common language around leadership and management tools. This course is being repeated in 2011 – with 11 global classrooms.

Inputs Activities Output Outcome Impact DGH Faculty I-TECH Executive

Team I-TECH Country

Directors/ Country Program Managers

Content (I-TECH Curricula, MSH, FACES, other)

Case Studies

GH 521 Course LMI Workshops L/M Distance

Learning Series Integration into

Existing Programs Standardized

Curriculum and Multimedia Support Materials

Evaluation of training/activities

Staff/ Partners trained

Trainings completed

Staff/Partners receiving mentoring

Country-level initiatives established

Improved patient care Improved management

practices Program standards achieved

consistently Improved workplace

satisfaction Systems strengthened Ethical management

Sustainable programs

Improved health outcomes for patients

LMI Strategy Paper, 3/3/2011 Page 14

C. Menu of ServicesLMI-related activities include:

ACTIVITY DESCRIPTIONLeadership and Management Needs Assessment

The L/M Needs Assessment is a detailed survey to determine which leadership and management skills are most relevant to a unit, office, or program. Needs assessments form the basis for the integration of leadership and management skills development into ongoing program work. Data is used to design an approach as well as to develop specific workshop topics or training activities.

Self-Assessment, i.e., LPI 360° Assessment

Leadership assessment for individuals that includes self-assessment and input from colleagues, supervisees, supervisor, and partners; group feedback workshop to apply results. Recommend to be done with a work team or group of participants (pre-skill-building workshop). Can be done online or using paper.

LPI Refresher Training Refresher training to encourage ongoing application of leadership growth after taking LPI 360°. New members of team take the LPI, group brought back together to review results and chart course for next year. Suggested frequency: quarterly or annually.

Skills-Building Workshops

Skills-based workshops focusing on needs identified through needs assessment. Examples of topics include: leadership, management, supervision, workplace culture, influence without authority, top-middle-bottom, communication and team building

Leaders in Health Education Series

An educational series covering leadership competencies, management skills, communication & storytelling abilities, and policy skills. The blended-learning format uses two on-site skills-based workshops separated by distance learning sessions and assignments.

GH 521 – Global Program Management and Evaluation

Skills-building, graduate-level distance learning course that connects a classroom at the UW to classrooms around the world using Adobe Acrobat Connect Pro. Engages students in discussion and learning about leadership and management in complex global health environments. Utilizes lecture, discussion, case studies and other interactive exercises.

521 Alumni Support Sessions designed to bring group of participants back together to drill down into the topics more deeply and support ongoing leadership growth. Suggested frequency: Quarterly.

Global Program Management and Evaluation (based on 521 content)

Skills-building course about leadership and management in complex global health environments. Utilizes taped lectures from DGH 521, group discussion, case studies and other interactive exercises.

L/M Distance Learning Series

Monthly series of L/M topics; e.g., project management and conflict resolution.

L/M Topics Integrated into Existing In-Service/Meetings (Professional Dev’t)

L/M topics needed by a team or group are determined based on needs assessment and training on particular topics is integrated into existing meetings/trainings, e.g., clinical mentoring in-service, staff meetings, etc. Use case studies and existing lesson plans.

Curriculum Enhancement

L/M topics are integrated into existing pre-service and in-service curricula.

Technical Assistance/ Site Visits

TA as needed; can identify UW and I-TECH resources to meet identified needs.

Case Studies Developing cases from L/M experiences. Training/support for use of I-TECH template to develop and for integrating use of case studies in ongoing capacity development efforts.

Professional Development Planning

Support for developing the leadership and management capacity of staff. Includes library of resources, training on and materials for personal action plans.

Mentoring Supporting leaders and managers over time. Suggested timeframe: 2 years.Practicum Providing opportunities for L/M skill development by sending learners to work with

competent leaders/managers.

LMI Strategy Paper, 3/3/2011 Page 15

D. Current ActivitiesThe following table summarizes global and country-level leadership and management activities currently being planned or implemented throughout the I-TECH network:

Name Location or Focus Project Type Audience Delivery

Method Date Frequency of Activity

Funding Status ARCHI

Leadership & Mgmt Initiative (LMI) Workshop

I-TECH Global Network

Skills-based workshops focusing on needs identified through needs assessment

I-TECH Staff On-site

“Principles into Practice” March 2010

As neededPiP = core and country funds

A= Raleigh; R=Elaine; C=Ann; I=LMI Listserv, ET

GH 521 – Global Program Management and Evaluation

DGH MPH Students and I-TECH Global Network

Skills-building, graduate-level distance learning course that connects a classroom at the UW to classrooms around the world. Focuses on leadership & mgmt in complex global health environments. Utilizes lecture, discussion, case studies & other interactive exercises.

DGH MPH Students and I-TECH Global Network

Synchronous distance learning technology, small group discussion, individual assignments

Spring 2010; spring 2011

Annually UW / fully funded

A/R=Ann Downer; H= Anita Verna Crofts, Alison Ensminger

LPI 360-degree Assessment

COs and Units

Leadership assessment for individuals; input from colleagues and partners; group feedback available

I-TECH staff

Online or paper assessments; feedback workshops

ongoing tbd Country/Unit budgets A/R=Elaine

L/M Distance Learning Series

I-TECH Global Network

Monthly series of L/M topics; e.g., project management and conflict resolution.

I-TECH staff & partners

synchronous distance learning

Summer 2010 Annually tbd

A=Ann Downer; R=tbd; H= Anita, Elaine

Video – Interviews with GH Leaders

n/a

Taped interviews with GH leaders; answering the question “What 2 things have you learned about leadership?”

I-TECH Network, general audience

Video – posted on I-TECH Website, used in classroom settings

Production summer-fall 2010

After production, ongoing

Core / Funded

A=Ann; R=Tom Furtwangler

Case Studies I-TECH

Scenarios and in-depth case studies covering leadership and management issues

I-TECH Staff and Partners

Used within and outside of workshops

Under development; ongoing

Ongoing Core/country budgets

A=Ann; R=Elaine; H=Jenny Schechter, Anita

Technical Assistance

I-TECH Global Network (includes HQ, COs & Partners)

TA as needed; can identify UW and I-TECH resources to meet identified needs.

I-TECH Staff and Partners

On-site support ongoing As needed

Country budgets / funded according to need

tbd

L/M Training Materials Database

I-TECH Global Network (includes HQ, COs & Partners)

Gathering of materials from all activities

I-TECH Staff and Partners

multiple ongoing Ongoing Core A/R=Elaine; H= Jenny

Country Director Mentoring Project

I-TECH Global Network

New Country Directors matched with experienced Country Directors to provide a second source of consultation, coaching and support.

I-TECH Country Directors

Email/phone communication, in-person meetings

Ongoing

Monthly phone calls, two in-person visits during first year

Core/Country Budgets

A=Raleigh

Name Location or Focus Project Type Audience Delivery

Method Date Frequency of Activity

Funding Status ARCHI

COUNTRY PROGRAM ACTIVITIES

LMI Strategy Paper, 3/3/2011 Page 16

Professional Development Botswana

Formalizing a professional development program. Includes individualized needs assessment and action plan.

I-TECH Bots staff (incl. seconded staff)

Individuals with supervisors

Summer 2010 Ongoing

Funded –Country budget

A=Baz

Work-Life Balance Support

Botswana

Committee focused on supporting a more healthy balance. Examples include: Motswana & French lessons, photography lessons, etc.

I-TECH Bots staff (incl. seconded staff)

variousSpring 2010 launch

OngoingFunded –Country budget

A=Baz

Professional Development – 7 Habits of Highly Effective People

Botswana

Monthly lunch and learn sessions for 7 months (one habit covered each month). Facilitated by Ditsa and Jenny (LMI March ’10 participants).

I-TECH Botswana staff (including seconded staff)

Facilitated sessions

Spring-Fall 2010 once

Funded –Country budget

A=Baz; R=Ditsa & Jenny

Case Studies BotswanaDeveloped several case studies to share lessons learned in management and leadership.

I-TECH Network

Workshops, meetings, sessions, etc.

Spring 2010 Ongoing

Funded –Country budget

A=Baz

LPI 360-degree Online Assessment

Botswana

On-line Leadership assessment instrument providing a chance to self- assess and get input from those you work with.

I-TECH Botswana senior management

On-line assessment, on-site feedback workshop given by Ann Downer

Feb-March 2011

OnceFunded-Country Budget

A=Marrianne; R=Baz, Danielle, Jenny

LPI 360-degree Ethiopia

On-line Leadership assessment instrument providing a chance to self- assess and get input from those you work with.

I-TECH Senior Management, including 3 Regional Managers

On-line assessment; On-site feedback workshop

Summer ’10 =ass’mt; December 2010 Feedback workshop

onceFunded – Country budget

A/R=Elaine

L/M Needs Assessment Ethiopia

Survey to determine most relevant leadership and management skills for future workshop or training activity.

I-TECH-Ethiopia Senior and Mid-level Managers

Survey Summer 2010 annually

Funded – Country budget

A=Elaine; R=Jenny & Elaine, H=Matt, Wesen, Nega

Strategic Planning Session

Ethiopia4-day Strategic Planning Meeting to facilitate process for rolling out strategic objectives

I-TECH-Ethiopia Sr Managers, Raleigh, Ann, Tech Leads, Elaine, CPMs

Facilitated session

November 15-19, 2010

onceFunded – Country budget

A=Bill; R=??

LMI Workshop Ethiopia

2-day workshop, linked to LPI Feedback Workshop, focusing on teambuilding and communication skills.

I-TECH Senior Mgmt, including 3 Regional Managers

On-site workshop

December 15-16, 2010

OnceFunded – Country Budget

A=Elaine; R=Bill, Nega, Matt; H= Jenny

521 Alumni Session Ethiopia

Special session to bring 521 students together to drill down on topics and support ongoing development.

I-TECH Staff who participated in DGH 521

On-site session

Spring 2011 (tentative)

onceFunded – Country budget

A=Bill; R=Elaine

LPI Review Ethiopia Review of leadership development process

I-TECH Senior Mgmt, including 3 Reg’l Managers

On-site session

Spring 2011 (tentative)

Quarterly or by-annually

Funded – Country budget

A=Bill; R=Elaine

NameLocatio

n or Focus

Project Type AudienceDeliver

y Method

DateFrequen

cy of Activity

Funding Status ARCHI

HIV India 1-year residential clinical and Sr. Medical Didactic Yearly Year-long Funded – A=Jacob

LMI Strategy Paper, 3/3/2011 Page 17

Fellowship Programme

leadership program. Contains topics directly related to leadership and management

Officers and other physicians from throughout India

and experience-based curriculum and mentorship activities

beginning in October for 1 year

residential Country budget

Leaders in HealthUniversity of Namibia(LIH)

Namibia

An educational series covering leadership competencies, management skills, communication & storytelling abilities and policy skills.

MOH, Ministry of Defense, University of Namibia and I-TECH

On-site and distance learning

January -June 2010; March-June 2011

Annually (at least for 2 years)

UNAM grant / fully funded

A/R=Ann Downer; C- Erin Seiler & Ruth Levine; H=Aaron Katz, Anita Verna Crofts, Alison Ensminger

LMI Workshop Namibia

Skill-based workshop focusing on leadership, management, supervision, communication and team building

I-TECH Namibia supervisors

On-site workshop

October 25-29 2010

onceFunded - Country Budget

A=Sean Oslin; R=Richard & Elaine; H=Erin; I=Raleigh & Deqa

Leadership Training for Clinical Mentors

Namibia

In-Service training for CMs – 1st session included Understanding Leadership, LPI Results, Habit 5-Empathetic Communication

6 I-TECH-supported Clinical Mentors

During regular CM Meetings

July 2010 (1st), November 2010, etc.

Ongoing – every 4 months

Funded-Country Budget

A=Laura Brandt; R=Sean & Laura; H=Elaine

Leadership and Management Workshop

Peru

2-day workshop for Fogarty Scholars in Peru focusing on leadership, teambuilding, communication and managing change.

10-17 Peruvian Fogarty Scholars

On-site workshop

25-26 February 2011

Once

Fogarty Grant – Externally Funded

A=Patty Garcia & Ann Marie Kimball; R=Elaine, Liz and Matt

Leadership Presentation

South Africa

Presentation on Leadership and summary of March LMI Workshop

I-TECH South Africa staff

During staff meeting

Spring 2010 Once n/a A=Brian

LPI 360-degree

South Africa

On-line Leadership Assessment instrument providing a chance to self-assess and get input from those you work with

I-TECH Senior and Mid-level Managers (5-10 participants)

On-line assessment, On-site feedback workshop

Assessment Sept – Oct 2010, Workshop possibly Dec 2010

OnceFunded-Country Budget

A=Elaine; R=Harnik

Professional Development I Tanzania

Skill-building sessions on L/M Topics: teambuilding, professional development, & possibilities of organization (bottom, middle, top concepts).

All I-TECH Tanzania Staff

Facilitated discussion COP 2010 Regular n/a A=Tumaini;

R=Tumaini & Mary

Professional Development II

Tanzania

Skill-building sessions on L/M Topics: workplace culture, leadership concepts; and supervision.

I-TECH Tanzania managers & supervisors

Facilitated discussion COP 2010 Regular n/a A=Tumaini;

R=Tumaini & Mary

LMI Workshop Tanzania

Skill-based workshop focusing on Supervision, Communication/ Negotiation and Professional Development

All I-TECH Tanzania Staff

On-site workshop

Late-September 2010

OnceFunded-Country Budget

A=Alyson Shumays; R=Richard & Elaine

LPI 360-degree Tanzania

On-line Leadership Assessment instrument providing a chance to self-assess and get input from those you work with

I-TECH Senior Manager (3 – new, 4 – review)

On-line assessment, On-site feedback workshop

Fall 2010 OnceFunded-Country Budget

A=Elaine; R=Alyson

Leadership and Management Pilot Course

Tanzania

3-day content orientation for Tanzanian facilitators followed by comprehensive 5-day pilot course on leadership and management.

ZHRC Coordinators and HTI Principals

On-site workshop

February 2-11, 2011

OnceFunded-Country Budget

A=Lauren Dunnington; R=Alyson, Hilda, Elaine

GH 521 Uganda– Global Program Management and Evaluation

Uganda

Skills-building course about leadership and management in complex global health environments. Utilizes taped lectures, discussion, case studies and other interactive exercises.

IDCAP Staff Uganda

Taped lectures, small group discussion, individual assignments

Summer 2010 Annually UW / fully

fundedA=Ann Downer; R=Ann Micelli

LMI Strategy Paper, 3/3/2011 Page 18

IV. Collaboration/PartnershipCollaboration is currently built into LMI in the following ways:

The LMI Working Group – a HQ-based working group composed of representatives of all three divisions. Focused on supporting the LMI.

LPM Technical Working Group – a group dedicated to supporting the UW’s DGH leadership, policy & management activities and ensuring collaboration and coordination across units, organizations and other entities.

Global Program Management Division – LMI is a division priority and division staff support strengthening of leadership and management skills and programs across the Network.

Regular meetings between Ann Downer, Raleigh Watts, and Elaine Douglas to coordinate activities. LMI Listserv – a list of I-TECH staff across divisions interested in leadership and management activities within I-

TECH. GPM Division Buzz – providing updates to Country Directors, Unit Directors and the Executive Team. Within Country Offices, I-TECH HQ staff work with government and other partners to implement effective

leadership and management capacity strengthening projects/programs.

V. Evaluation PlanLMI is working with I-TECH’s Quality Improvement (QI) to develop a monitoring and evaluation plan and to support country efforts. An LMI TrainSmart Website is being developed to track leadership and management training efforts.

LMI Strategy Paper, 3/3/2011 Page 19

References1. World Health Organization (WHO). 2007. Everybody’s Business, Strengthening Health Systems to Improve Health

Outcomes: WHO’s Framework for Action. http://www.who.int/healthsystems/strategy/everybodys_business.pdf.

2. President’s Emergency Plan for AIDS Relief (PEPFAR). 2009. The U.S. President’s Emergency Plan for AIDS Relief: Five Year Strategy, December 2009. http://www.pepfar.gov/documents/organization/133035.pdf.

3. Pfeffer J and Veiga J, May 1999. Putting People First for Organizational Success, The Academy of Management Executive (1993-2005), Vol. 13, No. 2, Themes: Technology, Rewards, and Commitment (May, 1999), pp. 37-48, http://www.jstor.org/stable/4165538.

4. Lattal D, 2003. The Science of Success: Creating Great Places to Work. The Performance Management Magazine, February 28, 2033. http://www.pmezine.com/?q=node/8.

5. Daniels, Sharon. November 2009. Hard numbers: Measuring Leadership Development. http://www.clomedia.com/features/2009/November/2784/index.php

6. Mansour et al. 2010. Scaling up proven public health interventions through a locally owned and sustained leadership development programme in rural Upper Egypt, Human Resources for Health 2010, 8:1, http://www.human-resources-health.com/content/8/1/1.

7. Jones DS et al. August 2009. Increasing Leadership Capacity for HIV/AIDS Programs by Strengthening Public Health Epidemiology and Management Training in Zimbabwe. http://www.hrhresourcecenter.org/node/2741

8. O’Neil, Mary L. 2008. Human Resource Leadership: the Key to Improved Results in Health, Human Resources for Health 2008, 6:10. http://www.human-resources-health.com/content/6/1/10.

9. Management Sciences for Health. 2005. Managers Who Lead: A Handbook for Improving Health Services. Management Science for Health, Cambridge, MA.

10. Epstein J, 2009. Presidents Push for Global Health, Inside Higher Ed. http://www.insidehighered.com/news/2009/09/15/health.

LMI Strategy Paper, 3/3/2011 Page 20

Appendix A: Organizational Background

The International Training and Education Center for Health (I-TECH) is a collaboration between the University of Washington and the University of California, San Francisco. It is a center in the University of Washington's Department of Global Health and has offices throughout Africa, Asia, and the Caribbean. I-TECH has 600 worldwide staff who work in partnership with local ministries of health, universities, non-governmental organizations (NGOs), medical facilities, and other organizations to support the development of a skilled health work force and well-organized national health delivery systems. I-TECH activities occur primarily in the following technical areas:

• Health system strengthening• Health workforce development• Operations research and evaluation• Prevention, care, and treatment of infectious diseases

I-TECH receives funding from the Health Resources and Services Administration (HRSA), the United States Agency for International Development (USAID), the US Centers for Disease Control and Prevention (CDC), the US Department of Defense (DOD), and others. Most of I-TECH's project work is part of the President’s Emergency Plan for AIDS Relief (PEPFAR).

VisionI-TECH envisions a world in which all people have access to high quality, compassionate, and equitable health care.

MissionI-TECH is a global network that works with local partners to develop skilled health care workers and strong national health systems in resource-limited countries. I-TECH promotes local ownership to sustain effective health systems.

Operating PrinciplesHonoring a shared vision. We believe in the benefits of a network. We recognize the unique contribution of individual I-TECH offices while benefiting from our collective strengths.

Our vision and mission are future-oriented, while the operating principles guide us day-to-day. Our vision, mission, and principles are posted in each office. We use our long-term vision and mission to prevent us from becoming discouraged by short-term challenges. Each office strives to operate in accordance with the I-TECH standards.

Offering a rewarding work environment. We strive for high satisfaction and low turnover among staff. We offer regular opportunities for personal and professional growth and renewal. As a result of our trust and respect for one another, we take concerns or complaints directly to the source for

resolution. We value and promote the skill of good listening. We believe that each person's accomplishments benefit the entire group, and we take time to acknowledge and

celebrate them. We recognize the positive impact of personal time on productivity.

Acting with integrity. We recognize that our operating principles are ideals, and we strive to honor and achieve them. We encourage and model civility in our personal and professional interactions. We deal fairly and honorably with employees, donors, and partners. Conflicts are resolved in private. We believe trust is essential to a productive work environment. We seek to understand a problem from the other's perspective before making a judgment.

Producing high-quality work. We strive to deliver high quality work, on time and under budget. We employ people with technical ability and communication skills. We collaborate with universities and other organizational partners to improve our methods and outcomes. We recognize and reward innovative thinking. We believe that multidisciplinary approaches to complex challenges are the most sustainable.

LMI Strategy Paper, 3/3/2011 Page 21

We employ team-based management, and all members of a team are respected for the expertise and work they contribute.

Flexibility. Our mission is complex. We recognize that there are many ways to approach it. We make a genuine effort to learn from mistakes. We believe in working collaboratively with other organizational partners in order to achieve the best outcomes

for a community. We value and encourage the ability to respond to changing conditions and priorities in the workplace. We listen to our stakeholders and constituents.

An attitude of hope. We come to work with a belief that our job is to overcome challenges. We support staff renewal periods and personal growth plans because we recognize that hope is essential for

productivity and creativity. We expect employees to demonstrate a sense of personal responsibility toward the organization and the people

in it. We support one another personally and professionally. We accept that change takes time.

I-TECH’s strengths include:MULTIDISCIPLINARYAPPROACH

I-TECH combines the intellectual talents of leading clinicians, educators, researchers, and instructional designers to form multidisciplinary project teams. This results in innovative, comprehensive, and targeted capacity development activities that are tailored to the needs of individual countries.

ACADEMIC AFFILIATION

Supported by the University of Washington (UW) in Seattle and the University of California, San Francisco (UCSF), I-TECH offers its network of offices and partners access to technical specialists and new research in all areas of global health. I-TECH also links to the 11 university-affiliated AIDS Education and Training Centers in the United States.

LEADERSHIP The Principal Investigator for I-TECH is Dr. King K. Holmes, MD, PhD, Chair of the UW Department of Global Health. Dr. Holmes is one of the most influential infectious disease researchers and mentors of other scientists in the world.

GLOBAL PRESENCE I-TECH is a network of NGOs in 10 countries in southern and eastern Africa, Asia, South America, and the Caribbean region. Additionally, I-TECH implements projects in several countries where it does not maintain a formal presence, with support from its network. More than 85% of I-TECH employees are hired locally.

OVERSEAS PROJECTADMINISTRATION

I-TECH has extensive experience in overseas human resource management, risk mitigation, contract monitoring, NGO registration, auditing, and quality assurance. I-TECH builds the capacity of its overseas offices so they can independently manage funds and operate strong in-country programs. Among the skills transferred to local staff are strategic planning, funds development, management systems, report writing, and managing for results.

EMPHASIS ON QUALITYIMPROVEMENT

I-TECH applies the principles of quality improvement to all of its work. Throughout a project cycle, I-TECH leads staff and partners through facilitated reflection on areas for improvement, and helps to address these areas by finding appropriate, relevant solutions.

EXPERIENCE WITH DIVERSEDONORS AND PARTNERS

I-TECH has extensive experience working with United States government partners, including the Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), the Department of Defense, and the United States Agency for International Development (USAID). The goal of all these partnerships is the development of better human resources for health, and achievement of the President’s Emergency Plan for AIDS Relief (PEPFAR).

Appendix B. MSH Leading and Managing FrameworkPractices that enable work groups and organizations to face challenges and achieve results

LMI Strategy Paper, 3/3/2011 Page 22

Leading Managing

scanning identify client and stakeholder needs and priorities recognize trends, opportunities, and risks that affect

the organization look for best practices identify staff capacities and constraints know yourself, your staff, and your organization –

values, strengths, and weaknessesORGANIZATIONAL OUTCOMEManagers have up-to-date, valid knowledge of their clients, the organization, and its context; they know how their behavior affects others

focusing articulate the organization’s mission and strategy identify critical challenges link goals with the overall organizational strategy determine key priorities for action create a common picture of desired resultsORGANIZATIONAL OUTCOMEOrganization’s work is directed by well-defined mission, strategy, and priorities

aligning / mobilizing ensure congruence of values, mission, strategy,

structure, systems, and daily actions facilitate teamwork unite key stakeholders around an inspiring vision link goals with rewards and recognition enlist stakeholders to commit resourcesORGANIZATIONAL OUTCOMEInternal and external stakeholders understand and support the organization’s goals and have mobilized resources to reach these goals

inspiring match deeds to words demonstrate honesty in interactions show trust and confidence in staff, acknowledge the

contributions of others provide staff with challenges, feedback, and support be a model of creativity, innovation, and learning and

staff show commitment, even when setbacks occur

planning set short-term organizational goals and performance

objectives develop multi-year and annual plans allocate adequate resources (money, people, and

materials) anticipate and reduce risksORGANIZATIONAL OUTCOMEOrganization has defined results, assigned resources, and an operational plan

organizing ensure a structure that provides accountability and

delineates authority ensure that systems for human resource management,

finance, logistics, quality assurance, operations, information, and marketing effectively support the plan

strengthen work processes to implement the plan align staff capacities with planned activities ORGANIZATIONAL OUTCOMEOrganization has functional structures, systems, and processes for efficient operations; staff are organized and aware of job responsibilities and expectations

implementing integrate systems and coordinate work flow balance competing demands routinely use data for decision-making coordinate activities with other programs and sectors adjust plans and resources as circumstances changeORGANIZATIONAL OUTCOMEActivities are carried out efficiently, effectively , and responsively

monitoring and evaluating monitor and reflect on progress against plans provide feedback identify needed changes improve work processes, procedures, and tools ORGANIZATIONAL OUTCOMEOrganization continuously updates information about the status of achievements and results, and applies ongoing learning knowledge.

LMI Strategy Paper, 3/3/2011 Page 23

Appendix C: MSH Leading and Managing for Results Model

LMI Strategy Paper, 3/3/2011 Page 24

Appendix D: Framework for Training

LEVEL 1: Didactic Training Role of Learner: Learners in passive role. Location: Classroom setting in any location (training facility, health care facility, etc.). Methods: One-way communication from trainer to learner, though might include Q&A from participants;

includes specific learning objectives. Examples: Lectures, presentations.

LEVEL 2: Skills-building Workshops Location: Classroom setting in any location (training facility, health care facility, etc.). Methods: Participatory training methods (must include a method other than lecture plus Q&A); includes specific

learning objectives. Role of Learner: Trainer leads sessions, but learners are actively involved; two-way knowledge exchanges

between trainers and learners. Examples: Case presentations, role-playing, small group work, simulated patients.

LEVEL 3: Practicum Location: Work setting similar to that in which the learner will apply new skills and knowledge (but not learner's

work site); trainer and learner are in same location (i.e., not communicating via phone or email). Methods: May include discussion, case presentations, demonstrations, grand rounds; patients may be present;

includes real-life resources, constraints, challenges; training can be one-on-one or in small groups (eight people or under); must include exchange of information and knowledge from trainer to learner that is related to topic of training (i.e., learner is not just observing at the site); includes specific learning objectives.

Role of Learner: Trainer leads sessions, but learners are actively involved; two-way knowledge exchanges between trainers and learners.

Examples: Preceptorship, clinical practicum, mini-residencies.

LEVEL 4: Onsite Mentoring Location: Learner's work site; trainer and learner are in same location (i.e., not communicating via phone or

email). Methods: May include discussion, case presentations, demonstrations, grand rounds, clinical vignettes; patients

may be present; includes real-life resources, constraints, and challenges; training can be one-on-one or in small groups (eight people or under); must include exchange of information and knowledge between trainer and learner; includes learning objectives.

Role of Learner: Learner is an active participant (not just recipient of information); learner is actively engaged in the work with the trainer present and/or observing; learning may be initiated by learner or by trainer.

Examples: Clinical mentoring, supportive supervision, onsite training in using new EMR system.

LEVEL 5: Distance Consultation Location: Trainer and learner are not in same location. Methods: Consultation with expert via telephone, email, instant messaging, video conferencing, etc. Role of Learner: Interaction is typically initiated by learner and is usually related to a specific patient, situation,

or challenge faced by the learner. Examples: Warmline, telephone, or email consultations, video-conferencing case discussion.

LEVEL 6: Systems Strengthening Location: Usually at the facility, organization, or site receiving assistance. Methods: In contrast to the previous levels, assistance is provided to address organizational and/or system

issues versus helping an individual master new skills and knowledge.

LMI Strategy Paper, 3/3/2011 Page 25

Examples: Strengthening national training networks; curricula enhancement in pre-service training institutions; strengthening health care facility record-keeping systems; addressing patient flow issues; developing systems to track medication defaulters; introducing systems to avoid pharmacy stock-outs.

LMI Strategy Paper, 3/3/2011 Page 26