Erica Brown, the Milbank Memorial Fund

October 13, 2020


The process of developing a strategic vision brings team members and other important stakeholders together to connect day-to-day work to a larger mission and set of goals. During a crisis like COVID-19, maintaining this sense of purpose and direction is critical as multiple competing priorities can easily deplete staff time and resources. As part of the Public Sector Leadership Consortium’s Leadership Forward podcast series, I recently spoke with LaQuandra Nesbitt, MD, MPH, director of the District of Columbia Department of Health, and Suzanne Bierman, JD, MPH, administrator of the Division of Health Care Financing and Policy for the Nevada Department of Health and Human Services, to discuss how they have remained focused on a long-term vision throughout COVID-19 and used strategic communications and other approaches to advance that vision.

This blog post, the third in a series that explores the Consortium’s Framework for Public Sector Leadership, examines how the framework’s “Setting and Managing Strategic Direction” domain applies in practice. The core competencies in this framework include vision and purpose, communication, planning for action, and balancing political and strategic agility. Through the Public Sector Leadership Consortium, the Center for Health Care Strategies is partnering with the Milbank Memorial Fund and the National Association of Medicaid Directors to strengthen the capacity of public sector leaders, particularly those in state government.

Q: Despite having training as a physician, Dr. Nesbitt, and as a lawyer, Ms. Bierman, you have both chosen to be public servants. How do you connect your day-to-day work to a larger vision and purpose?

I’m able to have these moments of victory over time because I’m improving the system. So that aligns the mission and the purpose I have to make sure that people — regardless of their place and station in life, regardless of their race, ethnicity, ability, gender, income, where they live — can all have access to the same resources to improve or maintain their health.

A: L. Nesbitt: Many people who go into the practice of clinical medicine are really driven to make a difference in people’s lives. As you go through your clinical training, it quickly becomes apparent that some people have more opportunities to do that than others. I don’t have the satisfaction anymore of being able to see a patient in the clinical environment, but I’m able to have these moments of victory over time because I’m improving the system. So that aligns the mission and the purpose I have to make sure that people — regardless of their place and station in life, regardless of their race, ethnicity, ability, gender, income, where they live — can all have access to the same resources to improve or maintain their health.

A: S. Bierman: I agree with Dr. Nesbitt and say it’s important to keep your eye on the mission. Medicaid, one of the state’s largest insurers, now covers close to 25 percent of the population, so it’s important to look at the big picture on a daily basis. I try to allocate our resources and time to make sure that we’re really focused on our strategic priorities, knowing at the end of the day, that’s all that really matters for the populations that count on these programs for their health care services.

Q: Can you discuss a communication challenge that you’ve faced as a public health official responsible for leading through a global pandemic?

A: L. Nesbitt: The biggest challenge my colleagues and I face is communicating the information that we need to with integrity and empathy, because people are being impacted in tremendous ways. These are unprecedented times and we’re asking people to make sacrifices that many people find challenging. Although we’re speaking often from the public health perspective, sometimes it comes across as if we are not empathetic to the other things that are consequences of this pandemic. It has been a challenge to ensure folks that we understand — we are human, too, and we are experiencing this pandemic just like everyone else.

Q: What do you think are the most important policy or programmatic changes that should come out of COVID-19?

I want to catalyze some of the gains that we’ve seen in telehealth expansions through COVID-19 and work collectively to keep that momentum going and push for additional flexibility related to telehealth policy.

A: L. Nesbitt: There are a lot of adaptations that we’ve put in place during the public health emergency. We’ve been able to look at access to care and telehealth regulations which are real opportunities for us to improve health outcomes. We’ve also focused on the diversity of the workforce, and I mean diversity in two different ways. First, the workforce shortages due to COVID-19 made us have a greater appreciation for how different members of the health care team administer certain types of procedures or certain types of tests. The other caveat for diversity is really looking at racial and ethnic diversity. We have different studies that have been put out about the impact or the outcomes related to racial concordance. The disparities that we’re seeing will have us looking at how we pipeline more people from racial and ethnic minority groups and to different healthcare professions across the continuum.

A: S. Bierman: Hopefully COVID-19 will highlight the critical importance of public health. More specifically, I’m hoping that this raises the level and awareness of just how important vaccinations are in Nevada. I really agree with Dr. Nesbitt about the role of telehealth. I want to catalyze some of the gains that we’ve seen in telehealth expansions through COVID-19 and work collectively to keep that momentum going and push for additional flexibility related to telehealth policy. We’ve seen it play a critical role in ensuring that patients continue to have continuity of care during COVID-19.

Q: What advice would you give to colleagues in other states who want to prioritize health equity in their long-term vision for health care and public health?

A: L. Nesbitt: I have found success by finding opportunities for alignment with cross-sector partners. I enter the conversations [with these partners] focused on finding out their priorities and leveraging the ones that are going to have the greatest impact on health outcomes. It’s not so much about winning the health argument with your colleagues and other sectors but working toward achieving a mutual goal.

A: S. Bierman: I suggest thinking about all of your issues from a health equity lens. That’s something that we’re trying to do with all of our policy decisions: everything from the requirements in our new managed care contracts to benefit enhancements we want to put forward. Including a health equity lens is a critical part of decision making. Additionally, make sure that you’re collecting data that could help inform these conversations and really do a lot of listening and community outreach to ensure that we have inclusive conversations and are being good community partners.


To hear more insights from this conversation, please listen to the accompanying podcast, which can be found on the Apple Podcast store, or wherever you download your podcasts.

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