1028: Leading Through Change: Adaptive Leadership in Public Health

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Monday, November 17, 2025. I'm John Sheehan, with news from the Association of State and Territorial Health Officials.

Today, we'll be discussing adaptive leadership in public health and how it can help build trust, strengthen community partnerships and drive meaningful change across systems. We have two guests from the Public Consulting Group, a founding member of ASTHO's Innovation Advisory Council. Itta Johnson is an associate manager.

ITTA JOHNSON: 

A part of the solution to today's problems. I think, though, isn't going to be just around the newest tool or the newest technology or the shiny thing, right? Really, it's going to be around the approach to leadership.

SHEEHAN: 

And Lillian Shirley is a senior public health advisor.

LILLIAN SHIRLEY: 

So, adaptive leadership moves away from the top-down leadership style, and instead, it gets guidance from those who are doing the work and experiencing the problem. It helps our science-based data land in a way that communities can see how it relates to what they're experiencing.

SHEEHAN: 

Drawing from real-world initiatives, they'll share practical insights on adaptive leadership, as well as leading with empathy, collaboration and purpose in today's complex public health landscape.

JOHNSON: 

I think that in public health, we often truly believe that leading all solutions with the science and the evidence is the most prominent thing. And while yes, I agree that is important, maybe instead of solely relying just on that, when you can bring in an adaptive leadership mindset, it pushes leaders to think also about how that wisdom is really sourced from our communities. So, if we start with the platform of our science, but then go into more of a curiosity and inquiry mindset, understanding how the communities actually interpret and relate to it, this is going to be more beneficial and advantageous. So, of course, that doesn't mean that we're just asking communities how they want us to fix the problem; rather, asking about their perspective on how the problem or the challenge is really understood and how they feel it. Right? How do they relate to the solutions that we can provide them? Does it make sense for their daily lives? This should really be able to help tailor your decision-making and then move forward with the programmatic or the technical issues, right? So, in looking at the landscape, our community engagement practices have absolutely improved over the past five years, right? But there really needs to be that follow-up step to the collection of input and drawing out from our communities, and really making sure that the priorities and the practices to help their families are relevant to them, so that we can get the best outcomes, and that adaptive leadership will allow us to flex in a way that is more responsive.

SHIRLEY: 

Adaptive leadership moves away from relying solely on the science as the reason to adopt health practices, but rather present the science and then ask, how could this work in your life? What's missing? And I don't think we can say this too often or repeat it enough, kind of go into inquiry, as opposed to didactic, understand what that guidance means to the community and how they would apply it, being honest and transparent with humility and working to achieve a solution together with those constraints. These are not new ideas, but these are ideas I think we have to remember, there isn't something new, maybe going back to that 'basics.' It's important to be honest about resource deficits, limitations, and challenges that public health agencies face, but also being forthright about what you can do allows people to manage expectations on how programs can deliver, and also how they may find solutions and offer it to us on how to deliver.

SHEEHAN: 

Itta says that public health leaders can begin applying adaptive leadership into their communication strategies.

JOHNSON: 

I actually worked in hospital administration for nearly a decade, and what I've seen working in that operations world is that traditionally, communication has fallen on the shoulders of the community health workers, the navigators, right? Those on the front line. However, as I mentioned earlier, everything rises and falls based on leadership. So, this task should really be shared by everyone within the agency, and it's the leadership's responsibility to really be able to relate, be among the community in a different way. We- we can't continue to delegate it solely to the community health workers and those delivering those services.

SHEEHAN: 

And collaboration with other public health agencies can definitely improve messaging to communities.

JOHNSON: 

To start, we really need to, you know, get to the balcony, so to speak, get the bird's eye view of the problem. And once we do that, the public health leaders really can continue to build those partners. Relationships with other agencies, like the social services, child welfare, and aging and disability services, those human services, right? To address common, complex problems like homelessness, substance abuse, the chronic disease, working together. If we do that, then we're breaking out of the silos of funding and programs, and that's something that's needed in these times, learning from these agencies about how they're approaching some of the same issues and problems from their purview, and then build on that where our knowledge and expertise can really, really help. I do think that this is especially relevant with the emergency and incident response strategies that oftentimes require resources from multiple parts of our safety net. And it doesn't just start with going to the meeting. We've all been to the meeting, right? You have to be informed with the strategic plans of other agencies so that we can pull those best ideas and so, when we're understanding their goals and priorities, we can align with our shared values and determine where everyone's capabilities and strengths can really complement theirs.

SHIRLEY: 

I just wanted to share, just this week, Oregon announced an initiative called Move Oregon Health Forward Pledge, and it's an initiative that has a concrete and accountable basic Health in All Policies approach. [It] has a plan across the varying sectors in the state, including, importantly, not just human services, but business partners for how to reach public health goals in that state. In addition, in Maine, MaineHealth has a system-wide initiative that forwards public health community outcomes. Again, working across sectors was a common goal. These are not things that we don't know and understand. For instance, Health in All policies is something that has been part and parcel of our public health practice, both academically and as we've done our community health improvement plans, et cetera, but this really puts a discipline around it and a shared commitment to focus on this, for leadership, to have that as a priority.

JOHNSON: 

I totally agree wholeheartedly, and these are excellent examples. I would also say that PCG has done many cross-sector initiatives to facilitate this type of shared problem-solving with representatives from behavioral health, substance use, and health plans. I've seen this and supported work in Maine, in California, Oregon, and in other states, nationally. And what this looked like was getting the frontline providers together, the managers, the directors in a room, mapping out the barriers, yes, with the sticky notes from you know, pre-2020 and brainstorming possible solutions to their thorniest problems, using a quality improvement process to really govern those conversations and have them centered around things that are as complex, from data sharing and data sharing agreements to the more common ones, such as just the resources that are limited and our coordination and care.

SHEEHAN: 

Here are some of Itta and Lillian's final thoughts.

JOHNSON: 

I think one of the things that we heard loud and clear at NACCHO this past summer is that we really do need to start working with our human services agencies, because our public health work comes out of the human services practice area here at Public Consulting Group. We are very familiar with that, and had seen time and time again that we are all working on the same problems, and if we come to the table with our mindset of that Health in All Policies and saying, how do you all work towards this problem? I think that we really, really can get far, especially in these times, and build up a resilience in relationships that can be sustained over the next several decades.

SHIRLEY: 

Yeah, and I would just add to that, you know, language changes, and it comes to different ideas and different, you know, things come and go. You know, as time goes on. But I think one of the things we need to remember in public health, as a profession, public health has always been about social justice, and it's our discipline and our work and our commitment to our communities that has helped make many, many outcomes for healthy communities. And we know, we know there's the little programmatic work that makes a big difference, and then there's also the overall system work that has made a difference, but we should stay optimistic, because we know that we're connected to the communities that we face, and we know that everyone wants health for their families, their children, and their communities, and that's our job.

SHEEHAN: 

Lillian Shirley is a Senior Public Health Advisor, and Itta Johnson is an associate manager, both of the Public Consulting Group, a founding member of ASTHO's Innovation Advisory Council. You can learn more about them at publicconsulting group.com or find the link in our show notes.

I'm John Sheehan, and this has been another edition of Public Health Review Morning Edition from the Association of State and Territorial Health Officials.