Thoughts on Adaptive Leadership During the COVID-19 Pandemic

This article was originally posted on JPHMP Direct.

By Edward L. Baker MD, MPH; Robert Irwin, MA; and Gene Matthews, JD

As public health leaders around the globe work to provide leadership in these challenging times, each day will present new or recurring leadership challenges. Some lessons learned from prior outbreaks may serve as useful guideposts. However, the coronavirus outbreak has, in important respects, presented unprecedented challenges. Therefore, leaders will draw on wisdom from prior experiences while learning, in real time, lessons from today.

In this post, we suggest that, by focusing on a few elements of leadership practice, public health leaders, particularly those in state and local health agencies, may find ways to prioritize actions and thereby better serve those in our communities through a greater clarity of mission and purpose. We also suggest leaders should consider the practices of adaptive leadership as offered by Heifetz, Linsky, and colleagues as they deal with challenges that are not clear-cut or easy to identify. They offer a set of practices (below) which may be helpful including “maintaining disciplined attention.”

Adaptive Leadership – Leader Behaviors

  1. Get on the Balcony
  2. Identify the Adaptive Challenge
  3. Regulate Distress
  4. Maintain disciplined attention
  5. Give the Work Back to the People
  6. Protect Leadership Voices from Below

One aspect of adaptive public health leadership is for leaders to focus attention (their own and that of others) on 4 central elements of leadership practice in these times. Although these 4 areas may not include everything to be considered, we submit these as a starting point to be used to structure consideration of a range of issues. These elements are 1) situational awareness, 2) decision making, 3) communication, and 4) energy. In each area, we suggest that leaders should focus on asking the right questions rather than having all the answers*.

*Baker EL, Gilkey R. Asking Better Questions – A Core Leadership Skill. J Public Health Management and Practice. In press. 2020.

Situational Awareness
Public health epidemiologists are schooled in the techniques of monitoring case counts, risk factors and other aspects of monitoring the course of a disease outbreak. All of this is critical to the process of framing the response. In addition to the epidemiologic approach to situational awareness, there are other components of situational awareness.

First, monitoring the status of the public health system at the local, state and national levels is critical. For example, the state of laboratory capacity across the nation has received laser-like attention. Other aspects of the public health system that are central to this response includes public health agency informatics capacity and communication capacity, particularly at the local and state levels. Thus, situational awareness should include monitoring of key system status indicators, such as the 10 Essential Public Health Services, as a component of situational awareness.

Further, as public health and the healthcare system work together in these times, public health agencies will need to enhance awareness of the status of capacity in health care facilities. As capacity evolves over coming weeks, public health leaders will be called on to address conditions and concerns regarding health care delivery. Thus, a greater awareness of health care system capacity will be needed.

So, in these times, situational awareness for public health leaders may be enhanced by focusing on a few questions:

  • What is the status of the coronavirus epidemic from an epidemiologic perspective?
  • What is the state of the public health system’s capacity and capability to respond to the epidemic?
  • What is the capacity of the health care system (especially at the community level) to provide needed care?
  • In a state or local health agency, what are other state or local government agencies doing?

Decision Making

In times of stress, the process of sound decision making can suffer. A preoccupation with events may lead to a short-term focus and a reactive posture.

All too often the process of decision making may concentrate exclusively on data (which changes hourly) and recent events (another type of data). As a result, leaders fail to take a longer view and adopt a broader perspective incorporating not only data, information, and knowledge, but also cultivating wisdom.

So, how might public health leaders expand the decision-making process and make wiser decisions? A few questions may be of value:

  • How is our prevailing mindset interfering with our ability to both question our assumptions and encourage alternative perspectives?
  • In what ways are we fostering systems and procedures to better “look around corners” and anticipate events more effectively?
  • How are we encouraging a few wise individuals to serve as “participant observers” to “get on the balcony” and observe our decision-making processes and provide real time feedback?
  • How are we seeking to uncover what we don’t know and also identify what may be unknowable?

Communication has now become the central science/tool of public health practice (in contrast to the central role of epidemiology in the past). In these times particularly, local public health leaders serve as a credible and trusted voice to address the needs of the public for meaningful, empathetic, consistent, and factual communications. A few questions may be useful:

As I communicate with others (my staff, my colleagues, local elected officials, and the public), what do they really need to hear? This question contrasts with the frequent mindset which asks:

  • “What do I need to say?”
  • Am I then tailoring communication to meet the specific needs of the audience?
  • What is the strategic intent of our communication?
  • How is my communication helping to prepare others for what lies ahead?

Read more on JPHMP Direct.

A Message from NACCHO on Our COVID-19 Response

These are extraordinary times for public health. Not only are we at heightened concern for the communities we serve, but we’re also extending that concern to our families, friends, and neighbors, to local businesses and restaurants, and our hospitals and clinics. As we redouble our efforts in response to the COVID-19 pandemic, our work, expertise, and actions are needed more than ever. Our roles will be expanding in ways that will rapidly unfold, and NACCHO wants to emphasize that we’re here for our colleagues throughout the country, ready to respond to the best of our abilities.

NACCHO’s activation in this pandemic has been elevated to a Level 3 (highest) and a full Incident Command Structure (ICS) has been activated. At a Level 3, moderate to significant alteration of staff schedules should be expected; ICS staff may be prioritizing and spending significant amounts of time on COVID-19 related response activities.

We recognize that state and local public health agencies may be receiving COVID-19 updates at different times through other communication channels. Please know that we are collaborating with ASTHO, APHL, CSTE, and CDC to disseminate relevant and accurate information as quickly as possible to our members.

NACCHO has deployed a liaison to the Assistant Secretary for Preparedness and Response (ASPR) Secretary Operations Center (SOC) and is in constant contact with the CDC. If you issues that you need elevated, send an email to

We have also set up a dedicated COVID-19 Virtual Community, where best practices can be shared and LHDs can learn from each other about ways to respond. All LHO and Preparedness Coordinators have been sent log-in information, please contact them for access.

We need to hear from you. If you’re with a local health department, please submit your stories on this short form about your COVID-19 response efforts: This feedback is critical to our work to advocate on your behalf. (And yes! please submit it again as the situation changes.)

Other ways to keep in touch with NACCHO as we all work to address the pandemic include the following:

If there’s anything we can do, please don’t hesitate to reach out to us. We truly are all in it together, and our work matters more than ever – not only for our communities, but for the nation, and the world. Thank you for all you do.

Call for Nominations: 2020–2021 NACCHO Vice President

The National Association of County and City Health Officials (NACCHO) announces its Call for Nominations for the position of Vice President. Every year, NACCHO holds elections for positions on its Board of Directors; for the year 2020-2021, the open position is Vice President. The Vice President will serve a four-year term beginning as Vice-President, then President-elect, followed by President of NACCHO, and ending as Immediate Past-President. The term begins on July 1, 2020 and ends on June 30, 2024. The NACCHO Nominations Committee will identify and present a slate of well-qualified, experienced public health professionals that is diverse and best represents NACCHO’s membership.

Recently, the Board of Directors adopted a policy that will help to ensure the best candidates by requiring that the nominee have current or prior board experience. We hope you will seriously consider helping to lead your national association into the future and serve your profession by nominating a colleague and/or yourself, who meets the above described qualifications for Vice President. Public health is clearly in the spotlight and NACCHO needs a dedicated, qualified individual to help lead our Board and association, so that the spotlight shines brightly and favorably on local health departments across the country.

For more information, please visit and direct any questions to The call for nominations closes on April 3, 2020. Thank you in advance for your thoughtful consideration.

Metropolitan Board of Health Selects Dr. Michael C. Caldwell as Nashville’s Next Director of Health

News release from Nashville Metropolitan Public Health Department

NASHVILLE, Tenn., February 24, 2020 –Members of the Metropolitan Board of Health of Nashville/Davidson County voted at a specially called meeting last Thursday to approve a contract with Michael C. Caldwell MD MPH as Nashville’s Director of Health.  Dr. Caldwell is a Nashville resident, licensed to practice medicine in Tennessee.

“I am honored to welcome Dr. Caldwell as the Director of the Metropolitan Public Health Department,” said Board Chair, Alex Jahangir MD. “After a comprehensive national search, I am confident that Dr. Caldwell has the experience, commitment and vision needed for him to lead the Department to face the ever-changing public health needs of all of the residents of our great city.”

“Dr. Caldwell has extensive public health experience that will be important as we build a healthier Nashville for everybody,” Mayor Cooper said. “I look forward to working closely with him as our new Director of Health as we focus on the health and well-being of all Nashvillians.”   “I have known Dr. Caldwell for years,” said Dr. Stephanie Bailey, Senior Associate Dean for Public Health Practice, Meharry Medical College and former Director of Health. “He knows how to connect, he cares, and he has a history of success in facilitating the health of a community. I am filled with joy at his being named the Director of Health for my city and the ladies and gentlemen who make up the Metro Public Health Department.”

“Dr. Caldwell’s background and skills are outstanding and in his new role he will no doubt be an excellent leader who continues to improve the health and well-being of our community,” said Dr. Tim Jones, Chief Medical Officer at the Tennessee Department of Health. “The Tennessee Department of Health looks forward to a strong and effective relationship with Dr. Caldwell and his team in addressing our shared mission and goals.”

Board of Health members, with direction and support from Metro Human Resources, conducted the national search for Nashville’s next Director of Public Health. The search included input from community stakeholders as well as Health Department staff. Dr. Caldwell’s contract will be presented to Metro Council for final approval.

Dr. Caldwell’s public health experience includes serving 19 years as the Commissioner of Health for Dutchess County, New York. The Dutchess County Health Department serves a population of 300,000 with a budget of $40 million and 200 employees. Dr. Caldwell has also served as the President of NACCHO. Dr. Caldwell brings expertise on a wide range of public health issues including infectious diseases, vaccines, tobacco control, emergency preparedness and health equity. He is a recognized researcher with a focus on the clinical research of vaccines as well as Public Health Systems & Services Research.

Dr. Caldwell received an undergraduate degree from Columbia University, a medical degree from Mount Sinai School of Medicine, and a master’s degree from Harvard School of Public Health. He is a member of the Nashville Academy of Medicine, the Tennessee Medical Association, the American College of Preventive Medicine, the American Public Health Association, and he is a Fellow of the American College of Physicians.

“I am well acquainted with Dr. Caldwell and delighted that he has been named as Nashville’s new Director of Health,” said Dr. William Schaffner, Professor of Preventive Medicine and Infectious Diseases at Vanderbilt University School of Medicine and Medical Director, National Foundation for Infectious Diseases. “I look forward to working with him.”

“The Nashville Public Health Department is one of the finest Departments of Health in the country,” said Dr. Caldwell. “Our outstanding and innovative public health professionals work every day to improve the health of our entire community with a special focus on health equity.  I am honored to join their team.”

The Nashville Metro Public Health Department serves a population approaching 700,000 over 526 square miles with a staff of more than 500 employees and a budget of $69 million. The mission of the Metro Public Health Department (MPHD) is to protect, improve and sustain health and well-being for all people in Metropolitan Nashville. Nashville’s local health department provides and connects people to essential public health services, enforces health regulations and leads and supports collaborative efforts to create healthy conditions for everyone in Nashville.

Learn more about the Nashville Metro Public Health Department.


Registration for NACCHO 360, the Reimagined NACCHO Annual Conference, is Open!

Registration for NACCHO 360 has officially opened! Join us, July 7–9 in Denver for a conference that goes beyond informatics to also explore local health department information technology infrastructure and public health surveillance.

NACCHO 360 is not just any other NACCHO Annual conference—for the first time ever, NACCHO Annual convenes with PHIITS: Public Health Informatics, Information Technology, and Surveillance for a reimagined Public Health Informatics (PHI) conference. NACCHO 360 will empower cross-pollination, break down silos, and connect public health professionals and disciplines, while also preserving the pathways that respect the focus and interests of individual public health professions. This conference aims to explore how local health departments and public health stakeholders can extend beyond the status quo to reinvigorate the public health workforce; build and strengthen cross-sector partnerships, and innovate mechanisms for data- and information-sharing.

Conference Tracks

There are six conference tracks involved in fortifying the overall conference theme, Raising the Reach of Public Health. Tracks include:

  • Track 1: Emerging Trends in Public Health and Public Health Policy, is all about how local health departments are developing public health policies, plans, and laws to respond to emerging trends.
  • Track 2: Leadership and Workforce Development, focuses on assuring a competent workforce when contending with shrinking budgets and resources, staff reductions, increased workloads, and the ever-changing public health threats.
  • Track 3: Community Engagement and Health Linkages, spotlights local health departments and their vital leadership role in convening health agencies, stakeholder organizations, and individuals in the community to collaboratively identify community health priorities and more.
  • Track 4: Healthy Behaviors, aims to highlight data-driven approaches or initiatives to identify trends in behavioral health issues and collaborate with cross-sector stakeholders and community partners to respond.
  • Track 5: Equity and Social Justice, explores how creating health equity requires both mitigating inequitable health outcomes through conventional programs and services and acting on the political and economic systems and powers that establish and uphold social inequities.
  • Track 6: Applying Information and Technology to Improve Essential Public Health Services, showcases stakeholders’ efforts to collaborate, enhance existing infrastructure, and apply the necessary skills to improve the delivery of public health services. These varying tracks all have the main purpose of improving the health of the communities we serve.

Full descriptions of the conference tracks are available to view online.

Conference Attendees Get Discounted NACCHO Membership

Registering for NACCHO 360 makes you eligible for discounted individual NACCHO membership! Typically $125 per person, you can become a NACCHO member for just $75. Active membership makes you eligible for:

  • Discounted registration for the 2021 conference
  • Access to other NACCHO members
  • Complimentary access to NACCHO Exchange, Public Health Dispatch, publications, assessment tools, and archives
  • Advance notice about NACCHO funding opportunities
  • Reduced registration fees and scholarships to attend NACCHO conferences
  • Participation in one of our National Advisory Committee Workgroups
  • Recognition in our NACCHO annual awards program
  • Opportunities to receive grants from NACCHO to assist in emergency preparedness, food safety, and other programmatic work at the local level
  • Discounts and access to NACCHO Career Network job postings and services
  • Discounts on vital technological resources and tools you use in your daily work

Reserve Your Hotel Room

Reservations for the Sheraton Denver Downtown Hotel are now open. NACCHO has secured a block of rooms at the group rate of $199 plus applicable state and local taxes. A government per diem block has been reserved at the per diem rate of $195 (or prevailing government per diem) plus applicable state and local taxes. Reservations can be made until 5:00 PM EDT local time on June 12 or until the block is sold out—whichever comes first. Room block rates are for the dates of June 29–July 13. Make your room reservation today.

How to Register

The full conference registration fee includes admission to the opening reception, all regular conference sessions, and the exhibit hall. There are many registration options, including group and student options. Ready to register? Follow these steps!

  • Visit to view registration types.
  • Choose to register yourself or as a group.
  • Log in or create an account.
  • Fill in the requested information.

Want to add PHIITS sessions to your schedule? Be sure to select “NA-PHIITS Registration” under “Event Fees” when registering.

Join us in Raising the Reach of Public Health at NACCHO 360 on July 7–9 in the Mile-High City! Register before May 15 to take advantage of early-bird registration rates.

Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases

By Emily Yox, MPH Program Analyst, Global Health

Each month, NACCHO will bring you a new public health book, read and reviewed by NACCHO staff. We hope to provide a well-rounded reading list that you will find enjoyable as well as informative.

Vaccinated, by Paul Offit tells the incredible story of Maurice Hilleman, aptly named the father of modern vaccines. Despite his significant influence in the field of immunization, Hilleman is not as well-known as his impact would predict him to be. Vaccinated tells the story of Hilleman’s daughter, Jeryl getting the mumps as a child, and how that led to the development of the modern mumps vaccine, starting as a father’s determination to help his child. It goes on to discuss the numerous other vaccines that Hilleman played a role in developing, and covers with care, the recent anti-vaccination movement that is growing across the United States.

This is the second book by Paul Offit that I have recommended and likely won’t be the last. His ability to cover complex topics in a thoughtful and interesting way is unparalleled in my opinion.

Want to discuss this book and others? Head over to NACCHO’s Virtual Communities page and connect with peers.

Stronger Together: ASTHO and NACCHO Team Up for Public Health Advocacy

The work of public health is often invisible. It is only when there is a disaster or outbreak that the safety net of public health becomes apparent. In our daily lives, we rarely consider the safety of the food we eat, the air we breathe, or the water we drink. But our nation’s public health system is, at its core, a partnership between federal, state, and local governments.

That is why again ASTHO and the National Association of County and City Health Officials (NACCHO) will host a joint public health advocacy day to bring these messages to elected officials from across the country on Capitol Hill in Washington, D.C. this month. Along with members of the ), state and local public health leaders will educate policymakers about the need for increased federal funding for public health departments. This includes both support for key public health programs, but also for the broader governmental public health infrastructure—especially its workforce.

In our current moment that has us dealing with the novel coronavirus outbreak overseas, illnesses and death caused by vaping, or the recurrence of measles in communities across the country, we see just how important the work of our public health system is to the safety and security of our nation. However, it is also in these crises that we recognize the chronic underfunding of our governmental public health system. That is why we are joining together as one public health voice to illustrate the need for Congress to support strong public health workforce legislation and provide sustained, predictable, and increased funding for public health across the spectrum.

What’s in store for ASTHO and NACCHO members during this year’s Public Health on the Hill, and how is it different from year’s past?

ASTHO, NACCHO, members will have the opportunity to network, learn, and spread shared messages regarding the importance of governmental public health. We will host a joint breakfast, where members of Congress and their staff can meet informally with their public health officials before their official meetings. After that, public health leaders will embark on nearly 200 meetings with key members of Congress and their staff.

It is the perfect time to be here: right now, members of Congress are putting together the budget for the upcoming fiscal year—so we are sure they will want to learn more about preparedness and response efforts in their states and communities. By working in coalition, we can amplify our messages to new and veteran lawmakers alike.

What are some of your biggest policy and program priorities this year?

Our shared priority this year is encouraging Congress to increase funding for the entire public health system through the annual appropriations bill. While right now there is an intense focus on the preparedness and response efforts to coronavirus, it is important to remember that public health functions as an entire system, whether there is a well-known public health emergency or not.

. While we appreciate increased investments for emergency scenarios—and it is certainly needed as states and localities prepare for and respond to the novel coronavirus—that is a band aid. What is really needed is increased funding across all of public health so that it is ready and able when any challenge arises. These types of emergencies strain the entire public health system, and when we pull funding from one area to address another disease it doesn’t help achieve our goal of protecting and promoting the health of all Americans.

Workforce is the backbone of governmental public health, but it in the middle of a great shortage. Why is that such a critical problem, and how can Congress help?

Governmental public health was hit hard by the Great Recession, and while much of the rest of the public sector workforce has recov­ered or grown, local and state health departments have not. In fact, local and state health departments have lost nearly a quarter of their workforce since 2008, shedding over 50,000 jobs across the country. This deficiency is compounded by the age of the public health workforce — almost a quarter of health department staff are eligible for retirement. Between those who plan to retire or pursue jobs in the private sector, projections suggest that nearly half of the lo­cal and state health department workforce might leave in coming years. At the same time, competition with the private sector, low pay, and geographic challenges contribute to a difficulty recruiting new talent with key public health skills. Combined, these forces indicate a public health workforce crisis that must be ad­dressed.

While we face new public health challenges all the time, the nation is also positioned to make incredible progress in addressing long­standing public health problems. But health departments need the people to make a difference.

Why are these Hill Days so important to both organizations, and how can members get involved if they can’t make it to Capitol Hill?

Opportunities to engage with members of Congress and their staff in Washington, D.C. is one of the most important ways to build relationships with the federal delegation. By fostering a relationship with members of Congress, our members can build that bridge of trust so policymakers know who to call when they have questions, need additional information, or need to better understand the impact of federal policy proposals.

If ASTHO and NACCHO members are not able to come to Washington, D.C. we do encourage them to reach out to their delegation and invite members of Congress to meet with them at the state or local health department, go on a tour of the local  facility or just pick up the phone and call the health legislative assistants. Both ASTHO and NACCHO have advocacy toolkits which provide information on how best to schedule these types of interactions.