Big Pharma and Global Health


The increasing importance of the pharmaceutical industry in global health and development

Posted by Debbie Koh

Take a moment to think about the last time you bought some medication. Maybe you went to your local Duane Reade/CVS/RiteAid to pick up an over-the-counter drug. You might have debated over a brand name versus a generic, or what was covered by your insurance, but the whole process probably didn’t cause you too much anxiety. You probably don’t stop to think if your provider was able to prescribe that medication in the first place, if it was stored properly, or if those meds might even be a useless or possibly harmful counterfeit.

Now, place yourself in another setting. You know you need some medication and you walk into a pharmacy.  The shelves are pretty dusty and filled will medications, labeled and unlabeled. You describe what’s wrong to the guy behind the counter. He listens, and cuts off some tablets from a larger foil-wrapped strip. “Take these twice a day for one week,” he says. Are you thinking about some of those questions now?

For pharmaceutical companies, the developing world is an untapped market that is poised for growth. Recent developments, such as a landmark decision by India’s Supreme Court to reject a patent application for a cancer drug made by Novartis, seem to be protecting generic manufacturer’s ability to continue making low cost drugs available to this market. Other companies are trying to make their products available at competitive prices (the latest example: two name-brand HPV vaccines are now available for less than $5 per dose).

Creating a reliable pharmaceutical regulatory and distribution system hasn’t been a particularly trendy or popular priority in global health and development. But, as the focus around international aid shifts increasingly toward ownership and sustainability, it’s increasingly important to ensure that people can access high-quality, affordable medicines outside of donor-funded supply chains.

Debbie graduated from Wagner in 2010 with her MPA in Health Policy and Management, International Health. She returned to her native California in 2011 and currently works for Venture Strategies Innovations. Follow her on Twitter at @thedebkoh or connect via LinkedIn. All views expressed are her own.


What if we just gave them money?


Cash payments as a baseline measure for program performance

Posted by Debbie Koh

What if every nonprofit that focused on poverty alleviation had to prove they could do more for the poor with a dollar than the poor could do for themselves? – from “Want to Help People? Just Give Them Money”

The idea of giving people money (or cash transfers) isn’t new. I gave some examples of cash transfer programs in Mexico and India in my last blog post. But what I found thought provoking about this quote, from a Harvard Business Review blog I read last week, was the idea of using cash transfers as a baseline measure for program performance.

Is the money spent on the programs we hope will help people more effective than giving that same amount of money directly to them? How do we know that providing a health intervention is more useful than providing a cash payment to someone instead?

The short answer is, we don’t know.

It’s easy to think of examples that could tip the scales either way. A large-scale vaccination program that involves provider training, medical supplies, and community education confers important health benefits to beneficiaries and contributes to a public good when a large population is immunized.

On the other hand, the entire cost of implementing and administering program (i.e. including direct and indirect costs) utilized as a direct cash payment could potentially provide greater benefits to the recipients. The payment might allow a parent to pay their child’s school fees, for example. This more educated child might experience long-term benefits (higher income, better health outcomes, for example) that exceed what they would’ve received via the health program.

Of course, a cash transfer system would still end up needing staff, monitoring, evaluation and other administration costs that would cut into the total payment amount. But, I think this idea is still useful as a thought experiment, and challenges students and practitioners to think critically about how effective we are in our hoped for or current public service careers with the resources that we have.

Debbie graduated from Wagner in 2010 with her MPA in Health Policy and Management, International Health. She returned to her native California in 2011 and currently works for Venture Strategies Innovations. Follow her on Twitter at @thedebkoh or connect via LinkedIn. All views expressed are her own.


Seeking Measurable Program Impact


Will Pay for Performance Strategies Improve Impact?
Is Further Innovation Needed?

Posted by Debbie Koh

A few years ago, someone who wanted to give money to a nonprofit would likely head to Charity Navigator’s website, check that the organization’s program expenses amounted to at least 90%, and give it a green light. If the majority of the nonprofit’s money was going straight to programs, it must be an effective organization making a significant impact on the population it served… right?

Donors (whether individuals, governments or other entities) have become more sophisticated in their approach. “Measurable impact” is funders’ new mantra, especially as many have tightened their purse strings in the continued economic uncertainty. It’s no longer sufficient for a nonprofit to point to their program ratio as evidence of their ability to reduce hunger or increase access to health care. Nonprofits must be able to specify the indicators they will measure to demonstrate the larger impact they hope to achieve.

Tying funding directly to outcomes is one way donors are trying to get the most bang for their buck. The popularity of pay-for-performance (P4P) programs, for example, is on the rise – especially in healthcare. Linking compensation to physicians or hospitals in the U.S. is hoped to achieve targets that range from reducing readmission rates to improving patient satisfaction survey scores (see Wagner professor Jan Blustein’s post on P4P in NYC’s public hospitals here). In resource-poor settings where governments seek to increase the utilization of certain health services, a P4P scheme might provide monetary incentives to providers who enroll a target number of patients in a vaccination program, for example.

Social impact bonds (SIBs), another “pay for success” model, are structured so that private investors supply the initial capital for a program, and receive a return on their investment from the government only when the program achieves previously specified targets or outcomes. Goldman Sachs provided a nearly $10 million loan to New York City to help reduce recidivism rates at Rikers Island. A rate reduction of 10 percent will earn back Goldman’s investment; but a rate increase will lose Goldman up to $2.4 million (read more about the program here). New York State recently announced potential funding for up to $100 million in SIBs over the next five years (press release here). Development impact bonds (DIBs) apply the SIB model to international development programs, where donors or host-country governments will be responsible for repaying private investors if the agreed upon targets are met.

Finally, direct cash payments may be the most radical example of connecting aid to social change. Perhaps most well known, the Government of Mexico pays cash to target families through the Oportunidades program when families fulfill certain conditions, such as enrolling their children in school or taking their children to regular health exams. India is experimenting with making direct payments into recipients’ bank accounts; if it goes well, they may expand such payments to replace fuel and food distribution that may be more easily misdirected away from its intended recipients. After all, is there a better way to claim impact than putting money directly into the hands of beneficiaries?

The tools mentioned above may not work in all circumstances; more evidence and testing is certainly required. Achieving social change is a highly complex problem; improving health, for example will require a multitude of approaches whether in the United States or abroad. As someone who works in the traditional “fund a program” model, I welcome innovation in this area. I believe that the more methods we have available, the greater chance of success we have.

Debbie graduated from Wagner in 2010 with her MPA in Health Policy and Management, International Health. She returned to her native California in 2011 and currently works forVenture Strategies Innovations. Follow her on Twitter at @thedebkoh or connect viaLinkedIn. All views expressed are her own.


How Much are Three Letters Worth?


Posted by Debbie Koh

Pursuing a graduate degree is a huge undertaking. At Wagner, getting a Masters of Public Administration typically means an investment of two years’ time (nights studying at Bobst Library you’ll never get back), tuition (roughly $40,000 per year), and any lost wages if you’re not working (opportunity cost).

It’s reasonable to question whether such a significant investment is worth it, especially when considering a public service career. So what convinced me that getting those three letters behind my name was worth the time and resources? I’d say the following areas: networking, experience and skills.

- Networking: No, I don’t mean the jaded, using-other-people’s-connections-to get-ahead kind of networking. I’m talking about being brought into a group of students and alumni who are joined by the desire to use their careers to achieve some sort of social impact. That shared motivation is what drove my day-to-day conversations with other students, helped me conduct information interviews with alumni, and encouraged me to connect with prospective and new students. Sometimes this kind of networking opened doors to career opportunities and sometimes it didn’t, but it helped me decide what made sense to keep pursuing and what to leave behind.

- Experience: Wagner offers a unique opportunity to build up one’s work experience. Being in New York meant that I had access to a huge array of institutions, organizations, and companies. If I wanted to work for a non-profit with US headquarters and overseas offices, or a small consulting firm with local and national clients, I could (and did). Capstone, which remains the highlight of my Wagner experience, provided me with solid experience that I could reference in job interviews and lessons learned that I apply in my current job. Finally, it was inspiring to learn from from the variety of backgrounds that were captured even in a specific program like Health Policy and Management, and from the larger student body.

- Skills: Probably the easiest, most obvious reason the go to graduate school, but it’s still worth noting. Economics, statistics, and finance skills are critical to have but difficult to get outside the classroom. In addition, taking time to become knowledgeable and stay current about one’s field – whether hospital management or international development – often falls prey to the daily demands of the workplace. Graduate school provides the opportunity to study the history, theory and recent developments in one’s practice area. I believe that this is a key component to producing high-quality work in any field.

The affordability and utility of an MPA or any graduate degree will always be a personal choice. It’s impossible to know how my career might be different or whether I would’ve had the same opportunities without attending Wagner. Certainly, no program is perfect – but for me, it was worth it.

Debbie graduated from Wagner in 2010 with her MPA in Health Policy and Management, International Health. She returned to her native California in 2011 and currently works for Venture Strategies Innovations. Follow her on Twitter at @thedebkoh or connect via LinkedIn. All views expressed are her own.


What’s Trending in Global Health


Posted by Debbie Koh

Trends are a part of our lives. Fashion, YouTube videos, Twitter hashtags – they all come and go. International health and development is not immune to these cycles either. On January 30, Bill Gates announced the commitment of pharmaceutical companies, public and private donors in the “London Declaration” to eliminate neglected tropical diseases (NTDs) by 2020. This overdue focus certainly should be celebrated – you know it’s bad if the fact that nobody pays attention to this group of diseases has been worked into their name.

Two days later, the New York Times ran an op-ed by Paul Farmer,“Why the Global Fund Matters,”in which he essentially pleads for the continued existence of the formerly behemoth funding mechanism. Before the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Presidents Emergency Plan for AIDS Relief (PEPFAR) in the early 2000s, development assistance for HIV/AIDS was less than $1 billion. By 2005, more than $3 billion was being spent to fight HIV/AIDS. Throw TB and malaria into the mix (and the establishment of the President’s Malaria Initiative) and the total amount of development assistance for health by mid-decade was more than $17 billion. Between 2001 and 2008, the total development assistance for health more than doubled.[i]

So what’s the problem? By 2008 and 2009, development assistance for HIV/AIDS and TB slowed while areas like maternal, newborn and child health enjoyed rapid growth. This is in no doubt aided by the rapidly approaching 2015 deadline for achieving the Millennium Development Goals, including Goal 5 – reducing the maternal mortality ratio by three quarters.As someone working in maternal health, I already get the sense of needing to strike while the iron is hot, before the attention and funding moves on, if it hasn’t started to already.

Agriculture and food security, social franchising, and mobile health technology are just a few areas gathering momentum. I am not arguing for any one over the other, and reality is that the total amount of funding for HIV/AIDS still remains high, even if growth is slowing. I’m as guilty of following the herd as anyone else:  I jumped from HIV/AIDS work to maternal health and eagerly track what’s new and upcoming in the field. I do worry, though, that these recent developments are indicative of shortening attention spans in a field that requires sustained commitment and focus.

The fight against HIV/AIDS continues to be a drawn out, difficult battle with “wins” that are very different from what we envisioned a decade ago. Truly reducing maternal mortality in the world will require a long-term and complex combination of health interventions, economic growth, political will, education and empowerment. NTDs are low hanging fruit now, but who will be there to address the social, environmental, and other unanticipated factors that will inevitably thwart these new efforts?

Paul Farmer’s plea serves as a reminder that achieving true, lasting impact in global health is a long haul. Lives are at stake in our work. Let’s not forget our commitment to them.


[i]Institute for Health Metrics and Evaluation. Financing Global Health 2011: Continued Growth as MDG Deadline Approaches. Seattle, WA: IHME, 2011.

Debbie graduated from Wagner in 2010 with her MPA in Health Policy and Management, International Health. She returned to her native California in 2011 and currently works for Venture Strategies Innovations. Follow her on Twitter at @thedebkoh or connect via LinkedIn. All views expressed are her own.


Working for the Federal Government


Posted by Debbie Koh

Welcome to 2012! Moving forward, I will alternate my posts between more career development-focused entries and more general musings on the public service field (similar to last month’s “The Business of Non-Profits”).So, let’s get started.

A Non-Official Guide to Possibly Working for the Federal Government

I’ve talked to enough people curious about how to crack into this area, so here’s my quick and dirty primer for Wagner students looking to work for the federal government. My disclaimer: I am not an expert. This is based on my personal views and experience at the US Agency for International Development (USAID) and only the tip of a very large iceberg. While at Wagner I did attend an excellent overview by someone who is an expert: Paul Binkley, Director of Career Development Services at the Trachtenberg School of Public Policy at George Washington University. His presentation, “U.S. Federal GovernmentCareer Opportunities,”is still available via Career Services.

1. Identify your agency: for many people with a desire to work in international health and/or development, USAID is the logical first step. But other “domestic” agencies, like the Centers for Disease Control and the U.S. Department of Health and Human Services, also do internationally focused work.(HHS recently developed its own Global Health Strategy). Or, consider smaller agencies like the Millennium Challenge Corporation.

Lesson learned: government agencies are huge and may do work in your area of interest, despite first impressions. Start with the big names, but don’t overlook less obvious opportunities.

2. Do you really want to work for the government: getting a job working directly for the government (known in DC parlance as a “direct hire” position) is harder than it sounds.There is a whole science and strategy to applying to usajobs.gov or avuecentral.com that I won’t even attempt to broach. The best-case scenario is to identify some sort of fellowship or program that will narrow down the application pool of thousands; eligibility is typically based on current enrollment in a graduate program. Below are a few starting points:

  1. Presidential Management Fellows (PMF): though still highly competitive, PMF is a two-year fellowship that allows for appointment into a government position upon completion. I came across PMFs at USAID who completed their two years there and others who began working there after completing their fellowships at other agencies. Check in with Career Services for instructions on the application process, as schools are only allowed to nominate a certain number of applicants. You may only apply during your final academic year.
  2. Student Temporary Employment Program and Student Career Experience Program (STEP/SCEP): I knew a USAID summer intern who returned to her masters program in the fall, returned to USAID as a SCEP intern and then converted to a position at the Agency. I know the least about these programs because I wasn’t eligible, but USAID details its own STEP/SCEP opportunities.
  3. Other fellowships/internships: this is where you have license to use creative Internet searches and your networks. For example, the USAID Indonesia Mission is recruiting interns in Health, Education, Democratic Governance, and Economic Growth (application deadline February 2012) but the announcement didn’t make the main website. A good start for those thinking about international health is the Global Health Fellows Program. Eligibility requirements may vary.

Lesson learned: current Wagner students should take advantage of their status and look for opportunities now. Don’t wait until after graduation!

3. So you don’t really want to work for the government: recent grads haven’t missed the boat. A better strategy may be to identify some of the many organizations and companies (“contractors”) that won government contracts and are looking to hire. I won’t mention any specific contractors but to start, here’s a list of 2011’s Top 100 Contractorsvia Washington Technology and one of many international development coalitions. Again, start big but try to identify smaller companies where competition may be less fierce. Many people jump between contract and direct hire work; it’s all about getting your foot in the door at first.

A not-so-recent grad with at least a couple years of experience, including work in developing countries, and a willingness to be based overseas may also consider a direct hire option at USAID called the Development Leadership Initiative (DLI). This initiative is meant to double USAID’s Foreign Service workforce. I saw new batches of DLIs coming in fast and furious, but the program is scheduled to end this year.

Lesson learned: decide whether one’s best option is to work direct hire or contract and proceed from there.

My advice is to pursue several strategies at once. I failed at one of PMF’s many elimination rounds and received rejections or no responses from multiple internships. When I landed an internship and got to Washington D.C., I attended workshops and presentations, volunteered at conferences and talked to as many people as I could about how they got where they were. Eventually, I transitioned into a contract position. It just took some perseverance.

Debbie graduated from Wagner in 2010 with her MPA in Health Policy and Management, International Health. She returned to her native California in 2011 and currently works for Venture Strategies Innovations. Follow her on Twitter at @thedebkoh or connect via LinkedIn. All views expressed are her own.


Let’s Meet to Meet


Posted by Jacob Victory

The routine is the same every morning. I enter my office. I walk in, put my large coffee, banana and yogurt (creamy, please) on my desk, hike off my hiking boots (I walk to work) and look for that button under my desk that officially starts the day: the “on” button on the computer. I guzzle a few sips of the piping hot coffee as I wait for the computer to boot up. Once the computer’s ready (it’s temperamental), I search not for new emails, not for documents, but I search for my schedule as I know they’ll be something (or, a lot of things these days) on my calendar that makes me wince. There is always one (or three) meetings staring back at me that garners the “I-don’t-want-to-meet-just-to-meet-anymore” sentiment.

In a time of doing more with less, with job cuts eating into staff productivity, with the excessive amount of presentations executives must present to other executives, most meetings don’t make sense anymore. I’ve reported to “Ms. Healthcare” for awhile now. She is brilliant, fun and very driven. Yet, she is obsessed with meetings—so much so that she proposes pre-meeting meetings to meet about what to meet about. She also requests that I prepare documents for these pre-meetings and send them to her 24 hours prior our meeting. Here’s how one typical meeting rolls:

First 10 meetings: I wait outside her door for her to wrap up her last meeting.

First “official” 5 minutes of the meeting: “What are we meeting about again?” she asks with her arms folded.

Next 10 minutes: I’m trying to walk her through the rationale of why I was asked to prepare a document for this meeting and guide her on what was in the document. It is clear she has not read it.

Next 20 minutes: We spend only 5 minutes talking about the relevant items and the next 15 trying to undo everything we discussed in the last 30.

Last 15 minutes: We discuss alternatives to what we think trying to do, only to nix all of the options in every second that follows.

Last 30 seconds: “I’m late for my next meeting,” I’m told, as I collect my pad and walk out of there with a bewildered look that leaves me confused on my next steps.

Amusingly, I’ve noticed that my meetings are scheduled only on Mondays and Fridays, which leaves me anxious on Sundays and exclaiming TGIF! on most Friday afternoons.  I will bet you cash-money that if you ask a fellow executive, you’ll get a similar response on what a typical meeting feels like. You may ask, “Why don’t you just refocus your boss and do a better job managing up?” Well, our response will be that the executives are not listening to their staff and are so immersed in meetings that they don’t realize this pattern of unproductive busy-ness that most take so much pride in.

Here’s how I’ve learned to focus the meetings that I lead:

  1. Send out the documents prior to the meeting and require people to read them before the meeting.
  2. Do not bring copies of the documents to the meetings. For the non-readers, they will quickly learn that you mean business!
  3. Send an agenda prior to the meeting. Keep it less than 4 bullets.
  4. With the agenda, send out the question you need to answer with the meeting members before the meeting ends. This will focus the meeting.
  5. Respect people’s time—you get extra brownie points for ending the meeting earlier than planned.
  6. Thank people for their work and make sure there are next steps, with accountable folks and deadlines.
  7. Set up the next meeting immediately, following the timelines given at the meeting.
  8. Presto. Here’s another cash-money bet: You’ll end the meeting in less than 40 minutes.

Now, I’m not espousing that we don’t connect with our fellow workers, and that we don’t mingle, schmooz and banter around. But we’re all busy and we’re all drowning in governmental regulations, expenditure reduction initiatives, staff shortages and changing policies due to the new health reform projects. To keep the ship afloat, let’s meet more efficiently!

Here’s another quick solution to reduce meeting time and keep things focused: conference calls. There is no better way to get a one hour meeting condensed into a 10 minute discussion that is pointed, productive and empowering. Chat away!

Jacob Victory, an NYU-Wagner alum, is the Vice President of Performance Management Projects at the Visiting Nurse Service of New York. Jacob spends his days getting excited about initiatives that aim to reform and restructure health care.  He’s held strategic planning, clinical operations and performance improvement roles at academic medical centers, in home health care and at medical schools. Jacob also exercises the right side of his brain. Besides drawing flow charts and crunching numbers all day, he makes a mean pot of stew and does abstract paintings, often interpreting faces he finds intriguing.


The Business of Nonprofits


Posted by Debbie Koh

The Wall Street Journal recently ran a special section on philanthropy and charitable giving. I recommend reading the entire report (available here), but the article that first caught my eye was Should Philanthropies Operate Like a Business?

The “yes” side argues that nonprofits should adopt more business practices in order to create social returns on one’s philanthropic investment. More specifically, the authors argue that data collection and measurement are necessary for nonprofits to generate impact. The argument against this kind of business approach hinges more on a market-gap argument; that nonprofits serve a population that government and business don’t. The author of this “no” side worries that a dramatic shift toward a businesslike mentality will end up leaving the underserved, well, underserved.

I’m inclined to fall somewhere in the middle. It is critical, though inherently difficult, to find ways to measure and evaluate impacts in health, welfare and other social issues. Such efforts must be undertaken with great care. Ill-defined criteria may be useless at best or end up subverting the intended effects at worst.

Achieving specific indicators, like serving x many people food, doesn’t address what might be a systemic problem that requires policy change achieved by sustained advocacy efforts. A hyper-focus on hitting specific benchmarks, like enrolling y number of children participating in an after school program, can be detrimental to the quality of service provision if resources are spent on recruitment efforts rather than curriculum development.

But, I don’t think the debate here is really about the application of “business thinking” to the social sector. The authors are essentially arguing about the role of the philanthropist: how much say should an individual or institution get when it comes to how their money is spent? I think this concern reflects an often-voiced uneasiness or ambiguity the larger public holds about nonprofits and social service organizations: they recognize the importance of the work but struggle to see how their donation really leads to change. They’re trying to figure out how exactly you hold the whole nonprofit, social impact sector accountable for the money they receive.

This issue can be frustrating even to me, a practitioner in this field. (I think this is why featuring child sponsorships or individual loan needs have become such a popular fundraising strategy. That individual connection, the feeling that one’s money will meet a person’s specific need, is powerful.) Like measurement, instituting such accountability can be a double-edged sword. Meeting current donor requirements, whether government or private, is already an arduous task for many organizations. Additional requirements may push some organizations beyond their current capacity or simply take away resources from achieving those desired returns. More money might be needed to hire extra staff or to create an IT system to track all those new indicators, for instance.

There are no clear answers here but these are issues that we should continue to grapple with, whether we are on the giving or receiving end. Overall, I’m happy that this kind of discussion is moving beyond the classroom and into a larger forum. Please feel free to share your thoughts.

Debbie graduated from Wagner in 2010 with her MPA in Healh Policy and Management, International Health She returned to her native California in 2011 and
currently works for Venture Strategies Innovations (www.vsinnovations.org), a US-based nonprofit organization committed to improving women’s health in developing countries.  All views expressed  in this post are her own.


My Time at Wagner


Posted by Debbie Koh

Though it’s hard to tell with near 80° weather here in Southern California, fall is well underway – which means application season is in full swing. I’ve been talking to several prospectiveHealth Policy and Management students over the past few weeks, and they typically want to know the same things about my time at Wagner: my favorite or most valuable experiences, and some of the challenges I faced.

I’ll detail what I usually tell people below, but I’d love for readers to add anything you think prospective students should know in the comments section, especially insights from current students or recent graduates.

1)     Favorite or most valuable experience:

Of course this is a difficult question to answer, but my capstone project is probably the highlight of my Wagner experience. I was an International specialization and enrolled in a summer capstone session, so my group of four and I traveled to India to document best practices of a school lunch program for our client, the Global Alliance for Improved Nutrition (our final product is available here).

This was an invaluable opportunity for me because I hadhad limited work and international field experience prior to graduate school. My capstone brought together what I learned in the classroom, from project management skills to international development theory to successful group work. I often cited examples from the project during job interviews, including my current employer.

2)     Challenges:

Being an International specialization in the HPAM program was sometimes an identity crisis for me. I knew I had an interest in global health specifically, so I applied to HPAM instead of the Public and Non-Profit Management program. Few of my January 2008 “spring start” cohort were also International specializations and I sometimes felt like my lack of desire to work in hospital administration or my limited passion for domestic health policy created a barrier between me and others in the program.

Eventually, I embraced being an HPAM-International student and sought to better represent this portion of the student body through my involvement with the Wagner Health Network (WHN). Though starting in the spring presented its own challenges, my extra semester allowed me to serve as both International Events Chair and Co-President of WHN. During my tenure I tried to plan events that bridged the International with the Policy, Management, and Finance specializations and to strengthen ties with other student organizations focused on international issues.

It’s been less than two years since I graduated, but I know things can change quickly. If you have an experience to share that might illustrate another aspect of Wagner that prospective students should know about or any additional words to share, please leave a comment and I would be happy to pass them along.


“My Boss, Ms. Healthcare: Leadership in Action”


Posted by Jacob Victory

I embrace the theory that leadership is an action-step. And I also think that bosses are an interesting species. It is sometimes hard not to notice themes when colleagues and friends who work in pharmaceutical firms, nursing homes, home health care agencies, hospitals, health care law or managed care organizations describe their bosses. “I need a leader, not a boss!” proclaims one close friend. “She’s a busy regulatory expert who can’t operationalize anything,” says one colleague. Another quips, “I can’t find him. He’s always focused on preparing board documents and is not interested in the day-to-day details.” Yet another smirks, “My boss is so overwhelmed putting out fires and worrying about reimbursement cuts that she rarely provides any direction—so I make the decisions that she needs to make for me!”

One synthesized it succinctly: “Healthcare has too many busy leaders who are focused on changing regulations or survival.” Indeed, healthcare insurance coverage, utilization, care delivery and reimbursement structures are evolving (I won’t use the word “changing”). As a service industry, healthcare is solely about people helping people. What help do our leaders need to manage their people, who can then help others to make this industry churn?

Since most of us work in the health care industry, let’s for a moment assume that we all share the same boss. We’ll call her “Ms. Healthcare” (I say “Ms” strictly based on personal experience, as I’ve had 11 bosses in my career thus far and nine have been women). Ms. Healthcare walks into her office every morning and faces: 1) Clinical staff shortages; 2) Changing regulations; 3) Chronically ill patients who need more coordinated care; 4) Reimbursement that increasingly does not cover expenditures; 5) An inquisitive board who seeks solutions; and 6) Management staff who fear self-implosion if they receive another project to manage—without resources. Let’s also assume that Ms. Healthcare has developed a short-attention span, is anxious, doesn’t espouse project management, and is continually faced with the same six issues I list above.  And with phone calls and meetings that clog her calendar all day, it can seem like it’s an endless cycle. (Luckily, patients continue to be served.)

Ms. Healthcare, being of awesome power and might, feels she can conquer everything. She is bright, hard-working and dedicated. Indeed, Ms. Healthcare has a lot to offer. She is continually chipping away at ensuring efficiencies, new care models, staff development and patient care. I’ve learned a lot from Ms. Healthcare, too. She’s taught me to think at a high-level, that building relationships are key and to have high expectations of myself and others. But let’s consider some easy leadership tips I’ve learned in my own experiences leading people, programs and projects and what I’ve observed in the experiences of others that she can follow to make her day even more productive. If I was her coach, I’d advise her to:

1.  Go to your computer. Find the delete key. Cancel 50% of your meetings. You don’t need them.

2.  Get a pen. Make a list. Prioritize your objectives. Do we really need all those projects completed simultaneously?

3.  Grab the phone. Call your direct reports. Check-in. Do you know how much a “How’s it going?” can re-energize your staff? And how much thinking has been done on staff development and succession planning?

4.  Find a clinician. Ask him what he needs. Are you prepared for what he might say?

5. Call a politician. Invite them to take a tango lesson with you. Could you dare your government to seek your input?

Now, you may think that the five points above are droll or too simplistic. My next five blog postings will address each respective tip in a bit more detail.  Blog postings thereafter will address the other healthcare issues that Ms. Healthcare faces. Leadership is indeed a verb, an action-step. I firmly believe that it can be easy only if its simplest tasks are mastered.

Jacob Victory, an NYU-Wagner alum, is the Vice President of Performance Management Projects at the Visiting Nurse Service of New York. Jacob spends his days getting excited about initiatives that aim to reform and restructure health care.  He’s held strategic planning, clinical operations and performance improvement roles at academic medical centers, in home health care and at medical schools. Jacob also exercises the right side of his brain. Besides drawing flow charts and crunching numbers all day, he makes a mean pot of stew and does abstract paintings, often interpreting faces he finds intriguing.