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What are the basic challenges facing Public Health and Healthcare and why is dialogue important for addressing these challenges?Minimum 200 WordSupport your discussion with research. Be sure to include references and intect citations.
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Leadership in Practice
Essentials for Public Health and Healthcare Leaders
Chapter 2: Moral Courage in Public Health Leadership
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Chapter 2 Objectives
• By the end of this chapter, the reader will be able to:
• Describe moral courage and how it fits into the larger field of ethics
• Explain how to engender moral courage in the workplace and equip people to practice it
• Describe how public health ethics differs from medical ethics
• Explain how ethics can be taught and modeled to equip students with the knowledge and skills to practice
moral courage
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Moral Courage
• Where there is power, there is ethics. With power there is a chance it can be abused. Ethics names those
abuses and names measures to avoid them.
• Moral Courage: The strength to do the right thing when there is a cost to doing so
• Morals: values influenced by the world around an individual(family, education, culture and religion)
• Values: include honesty and respect for others
• Ethics
• Focus on duty(Kantian Philosophy)
• Focus on outcomes(Consequentialism)
• Greatest good for the greatest number(Utilitarianism)
• Virtue ethics answers the question, what is a good person?
• Justice
• Retributive justice: rightful punishment
• Distributive justice: fair distribution of opportunities and goods
• Moral courage involves sense of duty to take action when there is a lack of morality, ethics, or justice
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Foundation of Moral Courage
• Courage, fear, and humility
• A Companion of Courage is Fear: Fear stems from humility—recognition that one’s perceptions may be flawed
• Courage is acting in spite of fear
• Acting in the face of fear is what makes an action courageous
• Noticing an injustice
• Leaders may wonder if they saw it clearly, if others know the whole story, or if were extenuating circumstances
• What is the right action to take?
• Do I as a Leader, have the kind of influence it will take to bring about he needed change?
• Wondering about their own effectiveness in dealing with the injustice
• Humility as a foundation
• Prevents impulse actions or self-righteousness
• Causes leaders to seek more information and perspective of others
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Using Evidence to Know the Right Thing to Do
• Morals and ethics guide leaders toward the right thing.
• Morals embedded and promoted through culture; ethics encoded by organizations
• Many learn what is considered right and wrong by observing parents or guardians
• Can morals be taught through formal education?
• Ethics courses
• Promotion of evidence-based actions
• Evidence-based actions
• Cost-benefit versus cost-effectiveness
• Epidemiology and biostatics used to rank important health issues, causes, and interventions
• Rarely link to an underlying ethical principle
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Ethics in Public Health
• Includes concepts of equity, human rights, and social justice
• Health justice—distribution of scarce resources plus remediation of forms of domination
• Racism as domination
• “Manifest destiny” and dehumanization of Africans
• Effects on health include stress, lack of health insurance, poor housing, lack of access to nutritious foods
• Research ethics
• Certification required for studies on human subjects
• Respect for persons
• Beneficence—acting for the benefit of others
• Justice—nonpreferential treatment
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Public Health Code of Ethics
The American Public Health Association Code of Ethics, 2019 Version
• Core values
• Professionalism and trust
• Health and safety
• Health justice and equity
• Interdependence and solidarity
• Human rights and civil liberties
• Inclusivity and engagement
• Guidance for analysis
• Is the action morally permissible and allowed by the law?
• Does the action show respect of individuals and communities?
• Does it incorporate reciprocity by offsetting the potential harms or losses?
• Will the action be effective?
• Is it a responsible use of scarce resources?
• Is the action proportional in scope to the issue it addresses?
• Is there accountability and transparency in how the action is carried out?
• Is there public participation in formulating the action?
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Environment for Moral Courage
• Factors that Public Health and Healthcare Leaders can attend to in the workplace include the following:
• Safety
• Physical and emotional
• Safety from sexual predation, from public shaming, macro- and microaggressions, from unfair practices, and
more
• Respect
• Leaders respect coworkers by honoring their time, trusting them, and keeping the workplace peaceful
• Listening is essential
• Community in the Workplace
• Familiar with each other’s strengths and struggles
• “have each other’s backs”
• Meaning
• Help each individual see how they contribute to a worthy goal
• Goal needs to be specific and credible
• Sense of meaning
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Elements for Courageous Decision-Making
1. Define the problem
2. Seek out relevant assistance, guidance, and support
3. Identify alternatives
4. Evaluate the alternatives
5. Make the decision
6. Implement the decision
7. Evaluate the decision
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Summary
• Moral courage is the strength to do the right thing when there is a cost to doing so
• A knowledge of ethics is not enough
• Knowledge must result in decisions and actions
• Leaders identify right actions
• Personal morals shaped by family, culture, and religion
• System of ethics that identify principles and practices for decision-making
• Courage to take action
• Degree to which leader cares about their work
• Whether workplace is supportive of acting ethically
• Courage to delegate
• Courage to listen to voices that express different perspectives
• Supporting systems that facilitate group decision-making
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Leadership in Practice
Essentials for Public Health and Healthcare Leaders
Chapter 1: Dialogue: A Foundational Skill for Effective Health
Leadership
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Chapter 1 Objectives
• By the end of this chapter, the reader will be able to:
• Provide public health and healthcare leaders with an understanding of the context in which dialogue is to be
practiced.
• Offer a conceptual foundation on which dialogue competency rests.
• Describe components of dialogue including skills of active listening and asking powerful questions.
• Summarize lessons learned by public health and healthcare leaders in the application of dialogue to practice.
• Explore future directions, including the benefits of mindfulness practice as a companion to dialogue.
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Fundamental Concepts
• Dialogue defined
• Greek: Dialogue comes from the Greek word DIA which means “through” and logos which refers to
“meaning”
• Participation in the emergence of meaning
• Practice of dialogue as participation in the “Emergence of Meaning” is based on two things…
• Expanded way of seeing the world
• New way of relating to each other and everything else
To effectively address challenges in the healthcare sector we must have a deeper dialogue.
• Dialogue as a framework
• The world is very largely interdependent; however, societies have become more independent
• Transition to awareness of a life as interbeing
• Requires participants to connect at the most authentic level possible-to themselves, to each other and to the
moment.
• Much conversation falls into discussion or debate(the comparison of perspectives)
• In dialogue the emphasis is on participation which suggest the discovery of something new.
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Dialogue as an Intentional Process
Skillful Interaction that leads to creative outcomes
• Thinking together
• Working with differences in perspective
• Listening deeply (to self and others)
• Participation in building trust and making meaning
• Dialogue is a crucial building block of creative leadership
• The foundation on which communication, change leadership, building and maintaining trust, systems
thinking, organizational learning, negotiation, problem solving, and decision making are built.
• Creation of a safe and respectful environment to foster:
• Listening to understand
• Asking powerful questions
• Being open to new and different ideas and perspectives
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Essential Conditions for Dialogue
• Openness
• Equality
• Empathy
• Equity
• Willingness to be influenced by perspectives of others
• Desire to change
• Attitude of humble inquiry
Dialogue competency requires being present to oneself and to others along with the intentional cultivation
of presence.
In doing so a leader can create the conditions needed for the practice of dialogue.
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Dialogue as a Core Leadership Skill
• Building mutually beneficial strategic partnerships and mobilization of community-wide efforts is central to the practice
of public health and healthcare.
• The response to covid-19 is an example.
• There are many groups that must come together to handle these crisis.
• Disconnect in language, vocabulary, and communication strategies.
• Parties tend to talk past each other and fail to converge to build much needed and mutually beneficial strategic partnerships.
• External challenges
• COVID-19 pandemic and threat of infectious disease
• Prevention of chronic disease, illness, and injury by occupational and environmental hazards
• Climate change
• Racism
• Emerging areas of emphasis
• Internal challenges
• Evolving composition of the public health workforce
• Transgenerational communication/collaboration challenge-Dialogue competency can play a strategic role in bridging the gap
between the “boomers, millennials and other generations that populate the workforce.
• Other concerns include the evolving way that information is created and shared.
• Public health leaders are challenged with managing attention and adapting messages to the many generations.
• Political polarization-Covid 9 responses, gun violence, reproductive health, etc.
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Evolution of Dialogue Competency
• The competency framework is greatly influence by Peter Senge and William Isaacs, who were greatly influenced by theoretical
physicist David Bohm.
• Bohm
• Suggested that Dialogue was “meaning passing through” A free flow of meaning between people. A method of improving team
learning.
• Dialogue, rather than discussion(the goal of discussion is often to make a point)
• Basic conditions needed for dialogue
• All participants must “suspend” their assumptions
• All participants must regard each other as colleagues
• There must be a “facilitator” who “holds the context” of dialogue
• Senge
• Dialogue as a central tool in the process of team learning
• Allows participants to observe their thinking as an active process
• Conflict is in thoughts, not individuals(Individuals can separate themselves from their thoughts and adopt a more creative and less
reactive stance toward their thoughts.
• Isaacs
• Book: Dialogue: The Art of Thinking Together.
• Balancing inquiry and advocacy while suspending assumptions-Allow ourselves to be influenced by shared perspectives.
• “David Kantor-Four player model”—movers, opposers, followers, and bystanders
• Individuals may modulate between these roles over the course of a conversation
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Stages of Dialogue
• Dialogue has evolved into a three- stage process:
• These stages can be viewed as a sequence in which each stage builds upon and reinforces the other.
• Connecting
• Sharing of life-changing stories
• Create space for connecting deeply and for dialogue to happen(trust, safety, security, etc)
• Fostered through skilled vulnerability(using vulnerability in the right way at the right time).
• Exploring
• Suspension of assumptions through internal listening, accepting differences, and further trust-building
• Inquiry to explore each others’ assumptions, reveal feelings, and build common ground
• Ability to think as a group in a way that leads to new shared assumptions and development of a new culture
• Discovering
• Interaction takes on new energy
• Participation in the emergence of meaning is very clearly experienced
• Listening FOR what has been generated
• New meaning and shared understanding
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Listening to Understand
There are many obstacles to effective dialogue:
Including; no one is really listening to what is being said; lack of mutual respect or low level of trust between
participants. Advocating and defending positions may dominate.
• Listen for content
• Focus on what is actually said, not what you imagine is being said.
• Focused attention and practice
• “Hear” what is not said(Nonverbally)
• Listen for meaning and intent
• Discern underlying meaning of what is being said and intent of speaker
• Step back and discern the underlying purpose of what is being said
• Listen for meaning while listening for content
• Listen for feelings and values
• Feelings introduces affect into the skill mix.
• Affect is where emotions and power live
• Understand at the affective level in order to know what to say and how to influence
• Listen to appreciate the underlying values of the speaker
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Practical Approaches to Better Listening
• Understand one’s natural conversation style(Difference between a telling style and asking style)
• Listen for specific words or phrases(practice reflective listening)
• Listen for embedded questions
• Maintain a posture of active inquiry and learning(avoid advocating for position, problem solving and
giving advice)
• Maintain an awareness of one’s own presence in the conversation(Develop the capacity to monitor the
quality of one’s own presence in real time) Nonverbal cues
• Deepen the level of listening: Why are you thinking this way or what leads you to conclude that?
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Tips for Effective Listening
• Be attentive
• Clarify
• Paraphrase
• Reflect
• Summarize
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Guiding Principles for Better Questions
“In the past, the leader was the person who came up with he right answers, in the future the leader will be the
person who comes up with the right questions.” Peter Drucker
Good questions helps us focus attention on what’s important
• Ask open-ended questions
• Be a good listener
• Avoid questions which are “statements in disguise”
• Make the process as conversational as possible
• Allow questions to surface deeply held assumptions
• Balance inquiry and advocacy to employ dialogue methods
• Practice practical tactics
• Keep questions short
• Use “what,” “how,” or “why” questions
• Ask one simple question at a time, rather than a string of questions
• Pace the asking and wait patiently for an answer
• Keep tone of voice soft
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Summary
• Dialogue techniques joined with the practice of mindfulness
• Dialogue is the art of creative interaction; mindfulness is art of presence and expanded awareness
• Powerful synergy that can inspire and inform change
• Leaders must practice connecting
• Awareness of reality and self
• Bring skills of dialogue to inspire a deepened awareness of reality
• Enables generation of new shared meaning as a foundation for new ways of living
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