Share Public Health Podcast Transcript: Don’t be perfect, be less wrong. An Interview with Michael Fraser.

Season 1 Episode 7

Laurie Walkner Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to public health topics, issues, and colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning into this series of interviews with public health leaders where we learn about different perspectives on current and emerging public health issues.

Brandon Grimm Hello, my name is Brandon Grimm and I am the associate dean of public health practice at UNC College of Public Health and part of the Midwestern Public Health Training Center. And I am here today with Dr. Mike Fraser, who is the executive director CEO of the Association of State and Territorial Health Officials. And as you know Mike, uh, the Public Health Training Center network is committed to building the capacity of the current and future public health workforce, and Midwestern Public Health Training Center, that’s region 7- Iowa, Nebraska, Missouri, and Kansas- and today we want to learn from you your expertise, your, uh, experiences about how we can build the workforce and then your experiences about some of the different leadership skills needed for our future and current public health workforce.

Dr. Mike Fraser Great, great to be here.

Grimm So, first before we start, I just- can you tell us a little bit about yourself- your history of public health, how you got to where you are –

Dr. Fraser Sure.

Grimm– and just give that brief history.

Dr. Fraser Yeah, yeah. Well you were around for some of it, which was great. Um, you know I started my public health journey in a different way, I did not go to MPH school. I actually have a, my graduate work was in sociology and I was doing medical sociology and HIV prevention. From that angle, which was actually really interesting, and, uh, some of the issues around equity that are now really current in public health were things that we were talking about in sociology for- for a long time, so that was fun. But I actually got my first public health job at NACCHO- county and city health official, so I’ve actually worked at NACCHO, I’ve worked at the federal government, and now I’m with STA, the State and Territorial Health Officials. I’ve really been in a unique, uh, career path where I’ve gotten to work with every level of governmental public health and have seen all that happen, and you know this really has really been quite great.

Grimm Yeah, that is awesome, yeah. You’ve seen the local level, the state level, the federal level, and seen the struggles and the opportunities that exist throughout your years in public health. So what- what excites you about public health right now?

Dr. Fraser I think we’re in a really neat time in public health because we’re taking very seriously this need to move upstream. It’s not being driven, necessarily by, um, public health people, which is interesting, it’s being driven by the people who pay for health care delivery. And I think, um, we have something to add to these conversations about moving health care from volume to value and really beginning to focus on the work of prevention, um, starting to see health plans, insurance companies, hospitals, get really engaged in prevention and thinking about: “How do we keep people healthy so we don’t have to pay for these downstream, uh, interventions and, and all the high-need medical stuff that we do?” And that excites me because I think public health has a huge role there and it’s never been as much in the spotlight. I think the other thing that really excites me, and it’s unfortunate that these things excite me, but we’ve had lots of really good examples of why we need public health- from infectious disease outbreaks, uh, recent measles to thinking about communities and what’s happening communities with the opioid crisis – thinking overseas with Ebola – I mean there’s just so many ways that Public Health is relevant today it’s you know it’s it’s really exciting it’s really fun and people in Washington want to talk about it they love talking about Public Health they just didn’t know it existed. So, we’ve got to make it visible.

Grimm Yeah, so on the other spectrum of that, what worries you right now about Public Health?

Dr. Fraser Well I’m really worried about two things: I’m worried about the very tactical work that we do in Washington which is advocacy, and I’m worried that we don’t have enough public health practitioners talking about the- the need for public health agencies and their work and really educating and informing policymakers and political leaders about public health and that, that worries me because I can only do so much, our team can only do so much advocacy, and if we’re not preparing public health practitioners to advocate with us I think we’re at a huge disadvantage because other groups are, and- and they win. So that worries me a little bit. I think that we’ve got a very compelling story to tell that’s not the issue the issue is preparing the folks that are watching this and the folks that work with them to be effective advocates and go in with the stories not tomes of data and be strategic about the messaging. So I think we can do a lot more there on policy and advocacy. We are really facing a fiscal crisis and FY 20 with the federal budget and a lot of people are like “Well that’s Washington, who cares?” Well you know 50, 60 percent of a state’s public health budget comes from the federal government so if you’re sitting in a state capitol thinking, “Well all I have to do is pay attention to what happens in my state or my community at the local level,” you know come- go to our website and see what’s going on so we’re you know we’re gonna have to really push for Public Health in this FY 20 budget, so that worries me very tactically. Big- on the bigger picture which is what I think you know we’re talking about today is the workforce: do we have the workforce we need to see the health improvement we want? And I think we do, but I think we need to start getting better about building the strategic skills of the public health workforce not just the technical skills and I’m really I’m excited to see the public health training centers working in that space we’re really interested in it our health officials are really interested in it so we can talk a lot about that this morning.

Grimm Well thank you, that’s a great transition because I agree with you. I think it’s gonna take great leaders to address these wicked problems that are coming our way in public health and specifically I want to talk a little bit about systems-thinking, persuasive communication, and change management.

Dr. Fraser Great.

Grimm So, I’m going to start first with the system’s thinking. How would you define systems thinking? Because systems thinking has been around for decades, as long as I’ve been in public health .People have been talking about systems thinking. What is the system’s thinking and-

Dr. Fraser Right

Grimm – we just throw it out, but I don’t think people actually understand what we mean by what we say “systems thinking.”

Dr. Fraser Yeah I think people know what it is intuitively when you talk about it but they don’t really have that perspective necessarily and they work in the work they do which is weird, so. To me systems thinking is really about looking at the big picture that contributes to the specific technical problem you’re trying to solve, and there’s a couple really good examples of that- that- that I use. One of the things happening in our country right now, and I’m sure folks in- in this region are working on or even in their own families or in their communities, is the opioid crisis. And the solutions that we’ve offered from most of the- the public health leadership has been around overdose prevention thinking about how do we get in a lock zone into the hands of responders and others to save lives- super important, no problems there. How do we make better faster prescription drug monitoring programs so that the physicians don’t prescribe as many opioids or the prescribers don’t prescribe as many opioids? How do we, you know, clamp down on the supply side? And those are very- and how do we expand access to medicine that assists treatment or MAT or medically-assisted or medicine-assisted treatment? Those are all very symptomatic approaches to a very big systems problem which is “Why do people become addicted in the first place, and what’s going on in communities?” And you have to start looking at there’s a lot more to this very large problem than the one, you know, drug take-back day that I’m responsible for and put those pieces together that to me that systems thinking these- these issues pop up, and we try and solve the- the tip of the iceberg. There’s a great systems thinking graphic that has this iceberg and what the problem we’re trying to solve is the tip that pokes out above the water but underneath that are all these factors and mindsets and behaviors and events and attitudes that create these conditions, you know we- thinking about systems means where these things are connected in ways that I think we’re getting to understand in public health when we think about multi sector partnerships and we think about community engagement and we think about authentic conversations about needs, stuff pops up, but systems thinking is a way to rationalize that and to- and to begin to be less wrong in our solutions which is I think a really big insight in system thinking which is we don’t you know. Part of it is not getting it perfect it’s being less wrong, right? And you know that’s not something that lots of people are used to thinking about.

Grimm Absolutely, especially in public health. Yeah right, yes. You talked about this a little bit earlier when you talk about advocacy and having public health professionals really be out there and share those stories. So persuasive communication, what- what do you think are some of the skills of persuasive communication that our practitioners really need right now?

Dr. Fraser Yeah, yeah, so you know persuasive communication is an interesting skill in terms of strategic skill and it’s one that I think is hard to quantify especially you know in terms of how would you teach that and what I’ve done when I start thinking about persuasive communication is look in the business literature and there is a whole heap of you know research in the management- management business schools around persuasive communication and it doesn’t mean manipulative communication or like you know one of the Dale Carnegie you know don’t sweat the small stuff communication. This is really about being effective storytellers and that ties back to advocacy it ties back to how do you bring people along and tell a story that they understand? And the days of just read the data and of course you’ll make the right decision I mean that that’s over that doesn’t happen we know this so really being- thinking about storytelling effectively and there’s a great I don’t know if this can be added to the to the ancillary material but there’s a great piece by Soledad O’Brien who just came out in the Journal of Public Health Management Practice, she was doing some work with some public health folks at de Beaumont and us, and she came to speak at our meeting and she’s a very effective communicator and journalist- you know for those of you who aren’t familiar with her she’s been on TV a lot and she talks about the need for stories like we’ve got to be better about how we tell our story and in public health because the work we do is so important why wouldn’t we? And so I think persuasive communication, although I always mix that up with pervasive communication, persuasive communication is super important and it’s a it’s a skill you’re not taught necessarily in your epidemiology course you’re taught how to present the table and find what’s significant and analyze that and use the scientific method and all that goes into that, but the next step is okay so how do we take that and actually turn it into communication that people can receive?

Grimm Absolutely. I totally agree with you. I think we are not teaching that into our future public health professionals. We teach them how to show the data and show the results but yeah to really be able to tell the story of what that means to the lay audience or your or your elected officials-

Dr. Fraser Yeah they don’t speak for themselves.

Grimm -exactly right. So, public health is ever-changing you talked about all the changes that are happening even in the next year, so change management is another skill that we want to make sure that our public health practitioners are able to have those skills of change management.

Dr. Fraser Right.

Grimm So, talk a little bit about that, you know, what do you- what do you see is that the next change is coming up or that some of the skills also in change management that are practitioners really need to be aware of.

Dr. Fraser Yeah, so I think when you’re looking at change management again there’s a great body of knowledge around this in the management literature and in business school literature but we haven’t really taken it into governmental Public Health so when we talk about change management in public health we hit two barriers right away. The first barrier is the natural human inclination to not want to change because we know that when things change we often lose something. So, change efforts that involve people which is pretty much everyone, have to really begin to address that issue of loss and understand what our people fear and what is actual reality and how do you have that conversation, right? So, leaders have to be ready to explain that and leaders have to be clear about the gains and be honest about the losses. The second piece around change in government in particular is that those are systems designed to not change so you’ve got organizational barriers to change in governmental public health and you’ve got people barriers which are just part of the work that we do. So, you can deal with the people and then you have to deal with your organization in your Culture. What are you doing to promote change within your organization? How is change perceived by people in your organization? Are there structures that prevent change? Are there collective bargaining agreements or ways that you’re organized that that sort of codify you know this the stability, or are there opportunities to maybe be a little more flexible and begin to introduce different ways of thinking and doing? Because we know that when you have different ways of thinking and doing work improves people are more productive. So, change, you know, it’s so trite to say change is the only constant but it is you know and- and I there’s this there’s an image I like to use my talk about change, which looks at the size of cell phones over time and how they went from really big to really small and now they’re getting really big again? And I, you know, I think that- that just goes to show all this stuff you know Evolves-

Grimm yeah

Dr. Fraser -and sometimes we go back to where we were you know people why do we change in the first place? But it’s not the same, so I think change management is extremely important and we have to get folks who are open to doing things differently in public health, or we’re not going to see any improvement.

Grimm Yeah, I totally agree with you there, too. I think innovation creativity is not something that has been in public health-

Dr. Fraser Right.

Grimm – for a long time. Your example about the cell phones-

Dr. Fraser yeah

Grimm -Apple tells us what we want. They told us we wanted a small phone and now they’re telling us we want a big phone.

Dr. Fraser Right.

GrimmWe should be able to do that in public health to tell people this is what you need and want with great stories with persuasive communication with systems thinking all those skills I think if we could do that better we would we could see some really great health outcomes for our communities.

Dr. Fraser Yeah and you know there’s more than three you know there’s every three important ones but I think that entire way of thinking which is the strategic skills matter as much as the technical skills in public health and our and our faculty and our practicum supervisors and our Dean’s and our health officials and everybody involved in the public health enterprise used to embrace that in a way and think a little bit about opportunities that you’re offering and others to say let’s take this seriously and again to address those skills in addition to the- the technical competencies we want anybody with advanced training in public health.

Grimm Absolutely, yeah. So, thank you for your insights. Do you have any final advice, any final insights, that you’d like to give the audience watching?

Dr. Fraser Yeah, I mean the the work of Public Health is so important and you’re not in this for the money. I know that. I don’t even know who you are, but you are mission driven, highly engaged practitioners that know your communities and want to make a difference and so we’re all in this together and I’m really appreciative of the time you spent listening to me and sharing, you know, that- your day with us- to get to know what it means to be a more strategic leader.

Grimm Dr. Fraser, thank you so much for your time today. Thank you- all of you- for, for watching and viewing this it’s been a pleasure thank you.

Dr. Fraser Thank you.

Laurie Walkner Thank you for joining us today. We hope you tune in for the next episode of Share Public Health. Special thanks to Katie Brandert, Brandon Grimm, Roger Hileman, Melissa Richlen, Hannah Shultz, and Laurie Walkner.

Funding for this webinar is provided by the Health Resources and Services Administration. Please see the podcast notes for an evaluation and transcript.

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