For more than 30 years, Dr. Joan Reede worked to increase the diversity of voices and viewpoints heard at Harvard Medical School (HMS) and at its affiliate teaching hospitals and institutes. Reede, HMS's inaugural dean for Diversity and Community Partnership, as well as a professor and physician, conceived and launched more than 20 programs to improve the recruitment, retention, and promotion of individuals from racial and ethnic groups historically underrepresented in medicine (UiMs). These efforts have substantially diversified physician faculty at HMS and built pipelines for UiM talent into academic medicine and biosciences. Reede helped embed the promotion of diversity, equity, and inclusion (DEI) not only into Harvard Medical School's mission and community values, but also into the DEI agenda in academic medicine nationally. To do so, she found allies and formed enduring coalitions based on shared ownership. She bootstrapped and hustled for resources when few readily existed. And she persuaded skeptics by building programs using data-driven approaches. She also overcame discriminatory behaviors and other obstacles synonymous with being Black and female in American society. Strong core values and sense of purpose were keys to her resilience, as well as to her leadership in the ongoing effort to give historically marginalized groups greater voice in medicine and science.
On February 1, 2020, Jessie Gaeta, the chief medical officer for Boston Health Care for the Homeless Program (BHCHP), received news that a student in Boston had tested positive for the novel coronavirus virus that causes COVID-19 disease. Since mid-January, Gaeta had been following reports of the mysterious virus that had been sickening people in China. Gaeta was concerned. Having worked for BHCHP for 18 years, she understood how vulnerable people experiencing homelessness were to infectious diseases. She knew that the nonprofit program, as the primary medical provider for Boston's homeless population, would have to lead the city's response for that marginalized community. She also knew that BHCHP, as the homeless community's key medical advocate, not only needed to alert local government, shelters, hospitals, and other partners in the city's homeless support network, but do so in a way that spurred action in time to prevent illness and death. The case study details how BHCHP's nine-person incident command team quickly reorganized the program and built a detailed response, including drastically reducing traditional primary care services, ramping up telehealth, and redeploying and managing staff. It describes how the team worked with partners and quickly designed, staffed, and made operational three small alternative sites for homeless patients, despite numerous challenges. The case then ends with an unwelcome discovery: BHCHP's first universal testing event at a large city shelter revealed that one-third of nearly 400 people there had contracted COVID-19, that most of the infected individuals did not report symptoms, and that other large city shelters were likely experiencing similar outbreaks. To understand how BHCHP and its partners subsequently popped up within a few days a 500-bed field hospital, which BHCHP managed and staffed for the next two months, see Boston Health Care for the Homeless (B): Disaster Medicine and the COVID-19 Pandemic.
Jessie Gaeta, the chief medical officer for Boston Health Care for the Homeless Program (BHCHP), learned on April 7, 2020 that the City of Boston needed BHCHP to design and staff in 48 hours one half of Boston Hope, a 1,000-bed field hospital for patients infected with COVID-19. The mysterious new coronavirus spreading around the world was now running rampant within BHCHP's highly vulnerable patient population: people experiencing homelessness in Boston. A nonprofit community health center, BHCHP for 35 years had been the primary care provider for Boston's homeless community. Over the preceding month, BHCHP's nine-person incident command team, spearheaded by Gaeta and CEO Barry Bock, had spent long hours reorganizing the program. (See Boston Health Care for the Homeless (A): Preparing for the COVID-19 Pandemic.) BHCHP leaders now confronted the most urgent challenge of their long medical careers. Without previous experience in large-scale disaster medicine, Gaeta and her colleagues had in short order to design and implement a disaster medicine model for COVID-19 that served the unique needs of people experiencing homelessness. This case study recounts the decisive actions BHCHP leaders took to uncover unexpectedly widespread COVID-19 infection among Boston's homeless community in early April 2020. It details how they overcame their exhaustion to quickly design, staff, and operate the newly erected Boston Hope field hospital for the city's homeless COVID-19 patients. It then shows how they adjusted their disaster medicine model when faced with on-the-ground realities at Boston Hope regarding patients' psychological needs, limited English capabilities, substance use disorders, staff stress and burnout, and other issues.
Deeply disturbed by the consequences of underinvestment in critical infrastructure in the United States over the last half century, highly successful former investment banker Suneel Kamlani set out to address the problem by launching an innovative infrastructure bank model that he honed as a 2016 Harvard Advanced Leadership Fellow. To implement his social innovation, Kamlani, an unaffiliated private citizen, needed to convince states to pass new legislation permitting its establishment, despite his lack of legislative knowhow and institutional power. This case study chronicles Kamlani's development of his solution for infrastructure underinvestment and his relentless efforts to build a robust multi-stakeholder coalition using advanced leadership practices to try to pass infrastructure bank legislation in his home state of Connecticut. It shows how he worked with elected state officials and other stakeholders to champion the effort and how he tried-both successfully and unsuccessfully--to overcome entrenched interests. It provides background for an in-depth discussion regarding 1) the degree to which Kamlani's skill set, his chosen solution pathway, and his targeted societal problem aligned to tackle the infrastructure underinvestment issue, and 2) the strategies and advanced leadership skills that individuals without legislative expertise or formalized institutional power in state government can employ to build coalitions and pass new legislation. The case study opens on June 3, 2019 with Kamlani on the cusp of a major legislative victory for his Connecticut Infrastructure Bank (CIB) initiative. It concludes with the Governor's unexpected withdrawal shortly thereafter of support for the CIB bill and the CIB coalition's relaunch of the legislative effort in early 2020.
The 8.9 magnitude earthquake that struck Japan on March 11, 2011, unleashed a 30-foot tsunami along Japan's Pacific Coast that damaged nuclear reactors at the Fukushima Daiichi Nuclear complex. The crippled reactors leaked radiation into the sea and atmosphere, contaminating the local environment and sending a radioactive plume across the Pacific Ocean toward North America some 5,000 miles away. Washington State Governor Christine Gregoire soon asked State Secretary of Health Mary Selecky for the State Department of Health's action plan for the crisis, directing the seasoned health officer to "handle it!" Although the health risks posed to west coast communities by the incoming radiation was low, the public's anxiety about possible health consequences was high. Round-the-clock news coverage of the Fukushima nuclear disaster and its fallout inadvertently stoked what Selecky described as "an epidemic of fear" as residents sought to protect themselves from potential radiation contamination in water, shellfish, and dairy products. Nearly three weeks into the crisis, Selecky received an unexpected phone call from Governor Gregoire, whom New York Times reporters had just contacted for comment on radiation found in a Washington State milk sample. "What milk sample?" Selecky replied, hearing the news for the first time. What should Selecky do? How should she and her staff respond to the March 11 disaster? How should she proceed following revelations of radiation in a Washington State milk sample? How should she and her department handle the public's concerns about contaminated debris washing up on Washington's shores and other disaster-related issues in months and years to come?
Three months into her job as secretary of health for Washington State in 1999-a position which had been vacant for nearly a year following the previous secretary's resignation-Mary Selecky read a newspaper story that the state's largest and most influential health jurisdiction, Public Health Seattle King County, reported three unconnected people in the county had been infected with salmonella, a common foodborne bacteria that makes people sick and can lead to severe illness and even death in some instances if untreated. While Department of Health epidemiologists had already serotyped the bacteria, which they traced to fruit smoothies from a Seattle chain, this was the first time that Selecky had heard anything about the outbreak. Clearly, she mused, no one in the state working on the matter thought the state secretary of health needed to know about it. Selecky, who had previously run a poorly resourced, rural county health district in Washington State, did not yet understand how state-level public health laboratories and other resources interacted with Public Health Seattle King County, health labs in other states, or federal agencies and resources. She was not even sure of her role vis à vis the State Department of Health's own epidemiology team when it came to routine foodborne outbreaks. However, Selecky did know that foodborne pathogens could sicken and kill, and had no respect for man-made borders. What if anything should Selecky do? What does she need to know? What is her role in what staff consider routine communicable disease investigations. How should she go about discovering it? How does one decide what is and what is not routine?
Dr. Jonathan Woodson faced more formidable challenges than most in his storied medical, public health, and military career, starting with multiple rotations in combat zones around the world. He subsequently took on ever more complicated assignments, including reforming the country's bloated Military Health System (MHS) in his role as assistant secretary of defense for health affairs at the U.S. Department of Defense from 2010 to 2016. As the director of Boston University's Institute for Health System Innovation and Policy starting in 2016, he devised a National Digital Health Strategy (NDHS) to harness the myriad disparate health care innovations taking place around the country, with the goal of making the U.S. health care system more efficient, patient-centered, safe, and equitable for all Americans. How did Woodson-who was also a major general in the U.S. Army Reserves and a skilled vascular surgeon-approach such complicated problems? In-depth research and analysis, careful stakeholder review, strategic coalition building, and clear, insightful communication were some of the critical leadership skills Woodson employed to achieve his missions.
A deep sense of foreboding filled Dr. Jim O'Connell and his team at Boston Health Care for the Homeless Program (BHCHP) in October 2014. The Boston mayor's office had just announced the closure of the 64-year-old bridge that provided the only passage to the island in Boston Harbor housing the city's largest homeless shelter. It did not have a long-term contingency shelter plan in place and the city's other shelters were full. With winter fast approaching, O'Connell, who at the time had been providing health care to Boston's homeless population for over a quarter century, feared some of the city's dispossessed would die on the streets from cold. BHCHP would be hard pressed to provide them the medical care they needed. To implement his solution-reopening the Boston Night Center-O'Connell had to overcome the disinterest of BHCHP's traditional allies in the homeless service provider community, who for a number of years had been channeling their energies away from sheltering toward permanent housing solutions. The Boston Night Center's reopening helped achieve an unprecedented feat for the City of Boston: Not a single homeless person died from the elements that winter, the harshest in the city's recorded history. How did O'Connell work with stakeholders to accomplish his goal? What could he do to maintain support for the Boston Night Center and the reestablishment of homeless services on the island?
As administrator for the U.S. Environmental Protection Agency (2013-2017), Gina McCarthy faced a daunting challenge: to write a technically airtight and legally defensible regulation, the Clean Power Plan, to reduce carbon pollution from existing power plants. The task required deep understanding of current trends in the electric power sector and how regional markets operate to ensure that EPA actions to curb carbon pollution would not threaten energy reliability or affordability. The initiative, officially launched in 2013, was key to U.S. action and leadership on climate change during the Obama administration's second term. McCarthy could count on industry and other players to resist proposed changes. Extensive and thoughtful stakeholder outreach and communication were hallmarks of EPA's approach under McCarthy. The strategies used provide a prominent example for leaders mandated to craft complex regulations in a contentious environment.
Center for Health Communication at the Harvard T.H. Chan School of Public Health Director Jay Winsten spearheaded a national mass media campaign, the Harvard Alcohol Project, also known as the Designated Driver Campaign, to rapidly diffuse the "designated driver" into the American lexicon and culture. The campaign broke new ground in the process, most notably by harnessing on an unprecedented scale the Hollywood entertainment community's power to disseminate messages and facilitate social learning. Writers incorporated the campaign's designated driver message into the scripts of more than 160 prime-time television episodes during four television seasons. The campaign persuaded large numbers of Americans to adopt the practice of choosing a designated driver-i.e., a member of a social group who agrees to stay sober in order to safely drive others in the group who have been drinking alcohol. The campaign provided a model for a generation of advocates seeking to mobilize the power of Hollywood to advance social causes, and convinced funding organizations that media advocacy campaigns were worth supporting.
Years before Harvard University Professor Howard Koh was appointed by President Barack Obama as the 14th U.S. Assistant Secretary for Health (2009-2014) for the U.S. Department of Health and Human Services (HHS), where he went on to address a vast portfolio of health challenges, he played a leading role in two highly impactful coalition-based public health campaigns focused on tobacco control and organ donation. The tobacco tax and organ donation campaigns illustrate how public health advocates can effectively build and rally coalitions of diverse groups around a results-focused health mission. They underscore the perseverance and other leadership traits that public health leaders like Koh harness to push through innovative strategies in the face of powerful entrenched groups committed to preserving the status quo. And while the campaigns also demonstrate the difficulties of sustaining public health initiatives due to changing political and economic circumstances, leaders like Koh must surmount disappointments to find new ways to continue the mission over the course of a long career.
After a successful career as a superintendent of some of the nation's largest urban school districts, Carol Johnson elected to complete a Fellowship at Harvard's Advanced Leadership Initiative (2014). There, she hoped to gain perspective and knowledge surrounding how new superintendents of urban school districts could be better trained and supported in this challenging and dynamic role. Following her ALI Fellowship, Johnson created the Leadership for America's Urban Schools (LAUS), a proposed program that would provide mentorship, training, and networking for new urban school leaders.
The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." For many Americans, the World Health Organization's definition of true health seems unattainable, given the multitude of complex problems plaguing the U.S. health system. The United States over the last 50 years has focused most of its health resources on providing medical care for individuals after they fall ill. It has placed far less emphasis on the non-medical determinants of health and the prevention of disease for the lives of its citizens. The result: an infamously expensive "sick care system" that does not perform as well as other wealthy countries across key measures. Americans of all socioeconomic stripes experience poorer health outcomes than their rich country peers. Such trends undermine U.S. international competitiveness. This background note digs deeper into these trends and their origins, the barriers hindering change, and past and current reforms, including the 2010 Affordable Care Act. If fully implemented, the controversial act will help the United States push beyond its myopic sick care focus towards the WHO's true health vision by creating a health system that integrates medical care with public health and prevention for all Americans.
If you want to create change in public education but are not a school principal or other traditional public education leader, what do you need to do? This long, integrated background note examines the inspiring models and stories of individuals who are improving outcomes for low-income students through innovative social ventures. It shows how small innovations that start outside the traditional public education establishment get off the ground and overcome obstacles; how, if properly set up and tended, they can scale to multiple sites to move inside the "school building" for greater impact. They demonstrate the advanced leadership skills, tools, and principles that courageous education innovators everywhere can use to guide their thinking from outside the school building in.
A swelling current account deficit, ballooning interest rates, and a plunging currency: These were just some of the worrisome trends in India that Krishna 'Kittu' Kolluri contemplated on his 20-hour return flight from Mumbai to Silicon Valley in September 2013. The U.S-based general partner co-leading India investments at New Enterprise Associates (NEA) reflected on how the American venture capital firm just 18 months earlier had set aside US$200 million of its US$2.6 billion world fund for investments in the sub-continent. Now Kolluri was mulling over whether to recommend changes to NEA's India strategy at the VC firm's quarterly general partner meeting in Washington, DC in October and the potential for missing out on lucrative investment opportunities in India if NEA played it too safe. This case closely examines how a venture capital firm creates and implements a strategy to invest outside the United States. It presents U.S. venture capital firm NEA's response to globalization and a contracting U.S. venture capital industry via an innovative global fund strategy that emphasizes agility in investment decision-making across and within geographies and sectors. The case focuses specifically on NEA's activities in India to illustrate the various elements of this strategy. It asks students to analyze the advantages and challenges of investing in an emerging market located half a world away both logistically and culturally, through a large, U.S.-based, multi-country venture fund. Students evaluate NEA's global fund strategy and determine the best investment strategy to follow in India given the country's deteriorating macro-economic situation at the time. They examine NEA's decision-making processes, communication channels, and incentive systems for its India practice. They gain a deeper understanding of what a U.S. venture capital firm like NEA expects from portfolio companies in emerging markets and what those portfolio companies receive in return.
This is an MIT Sloan Management Review article. Multinational corporations are under growing pressure to make sure that their contractors and subcontractors in China meet environmental standards in their operations. Yet traditional approaches to ensuring environmental, health and safety compliance, such as checklist audits, have proved problematic. The authors conducted research over a one-and-a-half-year period with leading multinational buyers (mostly in the apparel and footwear industries) as well as with NGOs and industry groups active in China. Based on their research, the authors report that rather than simply monitoring Chinese suppliers'compliance with local environmental, health and safety (EHS) standards, leading companies are giving suppliers tools and incentives to independently improve environmental performance. They are helping suppliers use energy, water and materials more efficiently and reaching deeper into their supply chains to where the greatest environmental damage occurs. At the same time, they are overcoming their traditional reluctance as competitors to cooperate in monitoring and fixing problems at common suppliers.<BR> <BR>The authors describe innovative approaches that companies such as Nike are taking. More generally, the authors' recommendations include working closely with suppliers and providing incentives for identifying, disclosing and addressing problems; establishing collaborative relationships with NGOs and industry groups; and finding ways both to learn from suppliers'best practices and to facilitate learning among suppliers.<BR>
When Chris Chen founded VanceInfo Technologies in Beijing in 1995, the firm had 25 employees and one low-end IT services outsourcing project for a U.S. multinational. By August 2008, through a combination of organic growth and acquisitions, VanceInfo employed more than 4,800 people, had numerous Fortune 100 clients, and enjoyed revenues exceeding $80 million over the preceding 12 months. Although small compared to more sophisticated Indian rivals, VanceInfo was well placed to capture an expected explosion in demand for China-based offshore IT services. At the same time, rapid growth was straining the firm's management personnel, systems, and resources. Headcount was slated to quintuple to 20,000 in four to five years' time to keep pace with aggressive revenue targets. Old ad-hoc ways no longer could accommodate current or future needs. To succeed, management had to implement new financial, operational, and internal management systems, especially in the critical area of human resources where VanceInfo faced some of its greatest challenges. These included introducing effective processes for rapidly expanding, training, managing, and retaining its workforce. Moreover, in its quest to grow its workforce to 20,000 within five years, move into higher-margin business lines requiring new expertise, and beat out domestic and international rivals, management had to strike a balance between quick gains via acquisitions and potentially slower growth through organic expansion. The case helps students think through the complexities involved in managing a fast growing company. Specifically, it asks students to analyze whether VanceInfo's current strategy of growing organically and through selective strategic acquisitions will allow it to achieve its goals. It also asks them to analyze the company's human resource challenges and its efforts to meet them.