BRUCE SHAPIRO: Thank you, Colleen. It's a pleasure to be here. I needed some more rain, so I decided to come to Seattle. The title of our talk is looking back and as a leader, you know, looking back is only half of the story. And part of what we're here to do today is to reflect on what we did and to try to put that into a context so that we're better able to move forward. So without further, adieu. The idea of leadership training fits within the context of the reason for the existence of the Maternal and Child Health Bureau. This quote came from one of the grant guidances, and basically says that the mission for maternal and child health is to assure the continued improvement in the health, safety, and well-being of the MCH population. The first part of this says how they're going to do it, and the last part defines the population. But nevertheless, this is the fundamental mission and by the way, all these slides are in your packet, so for those of you over in the corner or are having trouble seeing, you can just follow along that way. The goals of the training program are to train the next generation of leaders in maternal and child health field to address the special needs of children, adolescents, and women, to foster interdisciplinary care, to change attitudes and practices to ensure the contemporary standards of care from corporate into practice patterns, and to emphasize a population focus, public health approach that extends beyond the patient-clinician level. There are a couple of fundamental beliefs that come out of this and one is that this appreciation of the broader issues of health care, and the acquisition of leadership skills will enable professionals to be more adequately prepared to deliver care and provide the leadership that would advance the mission of Maternal and Child Health Bureau.

The second is that the leaders will use the skills to achieve this mission. Now looking back in 1987, the concept of leadership was not clear to the training programs. We could not define it. We could not measure it. And we could not document that we were doing that. Very much the same questions that Wendy raised on her slides, so I thought that was kind of interesting. So it's not new, Wendy. And as a consequence, the (inaudible), which at that point, were still being called the UAPs, approached the Maternal and Child Health Bureau, the training directors, and this much credit goes to Mr. Cal Noblock from the University of North Carolina to convene a work group that would focus on this issue of leadership. And this, this meeting was held in Covington, Kentucky. And at the time, I was naive to geography. I'm still naïve to geography. Basically I know the west coast and the east coast and not very much in-between. Coming from New York originally, and I didn't realize that Covington Kentucky was right outside of Cincinnati. And said, where the heck is this meeting going to be?  But anyhow, Jim Papai and the Bureau invited a number of faculty that represented all the MCHB training activities, and this was the first conference that represented all of the training activities.

There is recognition that by everybody there, that leadership was central to all the training, but there was no preconceived model used to guide this conference. We were basically free to develop or define their own way. This conference extended over a two-year period. And basically, what did we learn?  First thing we learned is that we were all struggling with the concept. Nobody had a, knew all the answers. We knew leadership when we saw it. We were kind of like the Supreme Court and pornography. The training selection criteria that was associated with leadership could be defined. We got into this philosophical debate and spent a fair amount of time at the conference, actually, deciding whether we created leaders or we facilitated development of native talent for leadership. We felt that we could provide opportunities to develop skills and leadership domain, such as policy, communication, negotiation measurement, and we also decided to documenting our impact was very hard to do.

Now, just a couple of points to follow up and expand on this a little bit. First, leadership is not a job title. Leadership could be evidenced in many ways, teaching, research, administration, and in clinical domains. Leadership could also occur at different levels within our organization. You don't always have to be the boss to be a leader. And the other point that we made was that leadership was a process, not a product that, and this was a very fundamental consensus conclusion of the group. As to whether leaders are created or developed, we could define leadership criteria, but training to the criteria would not ensure that leaders would emerge. The culture, the setting, encouraged or impeded the expressions of leadership and leadership requires interdisciplinary skills, experience, and skills to think and work out outside the box, which wasn't the term that we used at that time, but that has become much more current. And, indeed, as we were working in 1987, sometimes there wasn't a box at all. We felt that leadership was dynamic. It evolves with experience so that when people finish their training, they may not necessarily be at the same stage of leadership as they are as they progressed. It changes with changing practices, settings, and demands. And probably the most humbling part of what we talked about is that we are training leaders who will be able to address problems and challenges that we cannot yet envision.

So, and then finally, the rigidly prescribed training of leadership will fail if we just train leadership like you train algebra. You won't meet your needs. I'm not going to focus on the training selection criteria. They're there and you can read that as well as I can. These were the criteria that we felt were likely to end up with people who were to become leaders. And again, the idea of whether they already had the talents coming in or whether we inculcated these skills. And finally, we focused on documenting our impact, and we found this was hard to do. First of all, there were too many variables for a clear effect to be demonstrated. You know, how does somebody take credit for somebody else's success 20 years down the road?  It becomes very difficult to do. When do correlations become proof, I mean, this whole issue in terms of, you know, well this is associated with leadership and in fact, had they trained in my program, or Roz's program, or Mary's program and you train leaders, well how do you know that these people because of our programs and not in spite of them?  And then the last point that I wanted to leave you with, which is, this is still an evolving process, and the purpose of what we're intending to do with this conference is to try to figure out where we go from here. Thank you.