DOMINICK DEPAOLA: Well, it's a pleasure to be here. You know, you hear this phrase all the time. For me, it really is a pleasure because any time Wendy invites me to do anything, how can you ever resist? She works harder than any person I've ever met in my life, and I think she probably has an incredible e-mail bill, that's all I can say. All I could tell you is I download everything she sends and I think we've felled a few trees here in Washington state as a consequence. You heard a really wonderful introduction about the past and it's really a great prelude to the future. I'm going to talk to you about leadership and the public good. I actually have three themes I'm going to talk to you about.

I'm going to talk to you a little bit about leadership per se, and I don't want us to get bogged down to, you know, attributes of leaders and I'm going to put some of this up here, but, because it's important, but we have to make sure we understand what leadership is really all about. I'm going to talk about the public good, then I'm going to talk about community health models where you integrate the two together, because that's ultimately what I'm here for, and what all of you are here for. I should also tell you that as Ann Drum and Martha said earlier, it's always nice to be in a place where you come across old friends, and Ann Drum is an old friend/colleague of mine. We were at the medical college of Virginia. I can't even tell you how many years ago it was, but it's great. I haven't seen her in a long time. So I thank you for, all of you, for the opportunity again.

When I was preparing for this talk, I decided, you know, I need to look to see what people write about leadership. And you know, if you go to like the Harvard business journal, you would get so bogged down in the context of leadership that I'm not sure you'd understand exactly what the theme is supposed to be. So I go to the library, and then I go to Borders, and I go to Barnes and Nobles, and I look at what's on the shelf. And there are volumes of leadership things on the shelf. And they're all fantastic. And people have 21 ways to do this, seven ways to do that.

There are, you know, 15 lists that you have to be able to do in order to be a leader. I mean, and I'm thinking, you know, this is not what leadership is really about. It's about people. And it's about making change and making things happen, as you'll hear me iterate a few times. So I may be a little repetitive a few times in this talk, but I think it's important. Then I look around, and I say, "Gee, who is actually, what do they write about?" Well, you know, they write about great leaders like JFK, they write about Martin Luther King. They even write about Attila the Hun. There's actually a leadership about how Attila led the group. There's obviously Caesar, there are leaders like Tony Soprano. If you watch the Sopranos. There's actually a book, Leadership According to the Soprano Way. And it's fascinating because they have a goal that is unwavering. And that's another piece of leadership. It's vision, and unwavering. And they're unwavering goal is to make a boatload of money. They don't use the word boatload, as you might suspect. They use a different word, but they, a boatload of money, and that's, that's what drives them. And they do everything to make sure that nothing impedes their, their getting to their goal. Then I decided, you know, it's great to have all of this context, but I've had two experiences in my life to watch things evolve in two different dimensions.

One is in the airline industry. And I lived in Texas for a long time. And I watched Southwest Airlines grow from nothing, okay, to an institution that has changed the way airlines and airline travel is perceived in this country, and in fact, it's going to change the way airlines function. It's doing it right now in all these markets, and they've been phenomenal. The leadership there has been incredible. So I'm going to borrow very heavily from Southwest Airlines. When you hear my conversations today and there is a wonderful book written by the Freiburgs who, it's called "Nuts--The Southwest Airlines Story."  And it's a wonderful material in there. Then the other thing is when I was a dean in one of the schools I was at, I attended the Disney Institute. And I did it twice, and I wound up sending six faculty members to this. And they had an organizational development program that was fantastic. And the difference with versus any other place they've ever been is they used the park as the living laboratory. So you could get first-hand experiences of how Disney created fun. And that was their mission in life. To create fun. What a great concept, you know? I liked that. So you'll hear me talk about Herb Calora, who was the CEO of Southwest Airlines, and about the Disney mystique, if you will.

So let's go through the material that I have for you today, and again, this is all on, in your packets, I believe. You heard a very important conversation earlier, and that is that leadership is a process and it's not a product. That's a very important thing to keep in mind. Like you'll see in the next slide, I'm going to, or next couple of slides, I want to reinforce that. And also, leaders emerge at every level. And maybe the best example I can remember is I read a book many years ago, I'm sure you all know, it's called "In Search of Excellency" by Tom Peters. And Tom Peters had a fantastic analysis of all the business community and why they were successful, the most important companies, and there's two, particular things that stuck in my mind. One is every company that was really successful had what he perceived to be a maniac in the company, driving it to excellence. And to high expectations and to performance. And you know?  Every time I've ever seen a program whether it's maternal child health, or any other program, education program, there is a maniac if it's really great that's driving it somewhere. And it doesn't have to be at the top level. It could be at any level in the organization. So it's really important to kind of put things in the right context and to borrow, actually, from people who've done some really great studies of things like this. So if you look at the summary thoughts, and by the way, it's an interesting way to start the talk. I'm giving you a summary before I actually give you the material, so if you want to leave, you can do that right after this.

The true test of leadership is to ask, "Are those who would participate in leadership equipped to serve the common good?" Because that's what we're about here. And leadership is the practice of helping people envision a better world. And participating creating that. So it's a shared vision and a shared experience. And also it's about creating a caring culture. I mean, creating a caring culture. People are what matter, and that's what comes first, and in fact, you know, you've seen some other interesting examples where people talking about leadership, and they talk about a customer, whether it's a patient in your office, or a recipient of the maternal and child health things that you are providing, and you think that, "Gee, those people, these people come first." But you know, in the Disney world, and in the Southwest Airlines world, that's not true. Who come first are the people who work for them. This is really an important point because if those people are happy, and those people understand the vision, and they buy in to the philosophy, the customers are going to be really happy. Okay. And not the other way around. So it's a really an important thing to think bout. And leadership is about exceeding expectations. So I'm going to give you a little anecdote here. In the Disney institute, they had this interesting conversation.

They said, if you drive to Disney, of course, they get 30 something visitors a year, just in Orlando. I have no idea how many they must get in California. When you drive in there, it's very common for people to forget where they parked their car. Because the place is huge. But if you just remembered something about the time that you got there, they actually will find your car because they park you by grids. That's why they park you in certain places. And listen to this. Up to 1200 people a year, (inaudible), 1200 people a year, actually leave their car running in the parking lot. And the reason is, remember their mission is to create fun, their reason is because when kids are in the car, and they see the Magic Kingdom, they open the door, and then dad has to get out with Mom and grab the kid and the car is running. It's unbelievable. You say, this can't be true. They say, absolutely true. So then what happens is, you don't think about it. You go in, you go, the kid, you can't stop the kid, once they're going there, you know?  So you go in there, and you say, "Gee, I'm leaving now, I don't have my car keys."  So they go over to you, and they say, "What time did you come in?"  And you tell them, "Oh, I don't know. 9:00 in the morning."

Now it's 11:00 at night because you can't get the kids away. And they said, "Fine."  And they give you the car keys, and when you get to your car, they even give you a full tank in gas. They exceed people's expectations. That's the business of leadership also. It's exceeding people's expectations, so they have a 60% return of people who come to the park. Wouldn't you love that to happen in the patients and the community that you serve?  That you have that kind of unbelievable participation. And they spend huge monies doing it. And then finally, influencing change in the business of leadership. Now sometimes when you influence change, you get some unintended consequences. There's a great Gary Larson cartoon that says, "Well, thank God we made it out in time because now we still got a problem."  Okay?  So, you know you have to be continuously aware of the environment in which you operate. And be sure that you can adjust your behaviors. Now I thought because I actually read the material before I came here of the leadership conferences you have before, we just kind of refocus on two definitions of leadership.

One is from Gary Wills' book, and I also use Gary Wills' material here quite frequently. A fantastic book called certain trumpets, the call of leaders. And he defines a leader as one who mobilizes others towards a goal shared by leader and follower and he spends a lot of time in his book about followership because he thinks it's just as important as leadership provided that you agree on the common goal. Then there's another one by Rust where leadership is a dynamic relationship. You see some changes in the words here based on mutual influence and common purpose between leaders and collaborators. You see he doesn't use "followers" he uses "collaborators" in which both are moved to higher levels of motivation and moral development as they effect real, intended change. And actually, Rust is actually someone who you've actually utilized in your past materials that I've seen and this is, these are too important but similar definitions. So if you boil them down to this, you get to the situation where the ingredients for a successful, and effective leadership are you have to have a shared goal that both the leader and the follower are willing to pursue. But remember we talked, and you heard before Dr. Shapiro talk about process. It's really important because you have to agree on a variety of things. Not just a goal. You have to agree on the process of establishing the goal. You have to agree on the common goal itself, and the context of the common goal. I mean, you have to do it in the context of your own mission, your own goals of your own institution, your own, basically wherewithal. And, of course, the environment, which, if you can't do things that are way out of line from the environment, you also have to understand the dimensions of the environment, and then finally you have to agree on success issues, or intent to change.

Now, there is an organization in Washington, D. C., called Research America. You're going to see a fair amount of slides I have here from Research America because they actually survey the public. And they tried to get people, tried to understand what drive the public and therefore, what would ultimately drive Congress to fund biomedical and medical research. Now, this has, in my view, direct applications to all the things that you do because this is a common good, as we talked about before. If the U. S. is to be established as a leader in medical and health research, it would translate directly into what you do because you have the wherewithal to create new prevention programs, new interventions, and these are the kinds of things you can use in your own practices, and in trying to advocate for children and pediatric health. So one of the things that they've done is they did a survey in 2004 and they said, should the U. S. be a world leader in medical and health research, and look at this--60% said they really agree with that. 31%, somewhat. I mean, that's 90% agreement on a really important goal. And they've even done, I didn't, I didn't take the slide with me, but they've even done a follow-up and they said, "Would you be willing to pay for this?"  Would you be willing to pay for it?  And they said they would. And you've probably seen this. This is.

Now they've gotten to the point where research America also has an agreement with Parade Magazine. Parade Magazine is the most widely read magazine in the United States, believe it or not, and the biggest distributor. Because I think it's distributed in every newspaper on Sunday. And every couple of months, they're going to have a poll in there that Research America has put together. So it should help advocate what we believe, I think, are all the common good things that are important. In the same context, and this is one they did from Parade, with Parade, they said, you know, 88% of the people that they surveyed thought it was important to eliminate health disparities. So this gives legitimacy from the public respect, this is the things that the we're all trying to do as well as context. And motivation. So let's just keep those things in mind as we go along. Now, again, I don't want us to get bogged down in long lists of attributes and things, but I think it's important to at least recognize some of these things. In order to achieve the common good, once you have agreed on what it is, you have to have the ability to move multiple constituencies, to be flexible and tolerant of disparate positions, and be savvy about the political and social landscape.

But I want to tell you a personal story I had. I was living in Texas in San Antonio, and we decided that we needed to go down to the Colonias, which are on the border of Texas and Mexico, and if you've ever been to the Colonias, they are not like third world countries, they're like fourth world countries if there is such a thing. The poverty, the health care disparities, are off the charts. Even I remember Texas Tech University Medical School had a branch in one of the towns down there and they couldn't even get a handle on the prevalence of disease it was so significant. They couldn't get vaccines to the people as quickly as they needed them. It was just an extraordinary place. And so I went down there to try to do some things with the dental school. I was the dean of the San Antonio Dental School, to try to help their oral health status, because they had terrible problems, as you might suspect. And I went down there with two other people. One was a fella named Lars Folkey, and Lars is a former Chairman of the Periodontics at the University of Minnesota, and he is a Swede, okay. And also Lathe Heldin. Lathe was on a sabbatical with us, also a Swede. So we had two Swedes and an Italian from Brooklyn in South Texas, trying to convince them that we could help them. And I'll never forget this because we sat in a little circle and the leaders really challenged us then. And what they didn't want is for us to tinker with the people. They wanted us to do real, intended change if we were going to do anything, and they wanted intervention because they had serious public health problems that had to be addressed. So we assured them that would happen. And it did. But it was an incredible experience, and if you weren't savvy about that before you walked in the door, you sure as hell got savvy when you left. It was an interesting experience. So you have to create these coalitions, which is what we had to do there, and in other places I've been and you have to nurture a fantastic amount of cultural competency, and of course, cultural discipline in order to actually to be successful.

And then, of course, you know, leaders really have to be somewhat of a maniac. You have to be willing to push envelopes and move things forward. And not just be willing to settle for what I would consider to be the status quo. And, of course, you have to have sustained resolve. Now, in the paper I wrote that Wendy had, was kind enough to send out, I illustrated, for me, and this is strictly my own interpretation, by the way, of leadership styles. And their pursuit. And really the styles are based on goals. They were not based just on any other dimension and when I look at leadership people I've come to know, there's a few categories here that are of particular interest.

The arrogant style is the worst style, in my view, of this entire group because it's the one that says, like if they were going to south Texas, that our goals are the right ones for you. And we'll help you. You don't have to worry about it. We'll take care of you. You get little external input. It's the worst thing that you could do. You'll never get buy-in, and you'll never understand the community and how it functions, nor will you ever get people to trust you under that kind of circumstance. And if you fail, you fail miserably. The other one that I really think is interesting are regressive leaders. Where you set the goals really low and change basically is never going to happen because you really never intended it to happen but you're trying to meet somebody's perception. Gee, you guys should be doing something for the community. And here, when you're in an institution like that, it's depressing because you know intuitively nothing's happening and you actually wind up believing that the leaders had some kind of charisma bypass, okay?  Because they can't stimulate and excite people for anything.

And then, finally, the other one I particular think is important is the one that's a visionary leadership style that you'll see people pushing the agenda all the time. There's like incredible movement in the institution. You can palpate this sense of excitement. It's amazing. And there, it's not just all good. Because there's a lot of anxiety that creates in amongst the faculty. Amongst the constituents of the institution, no matter what it is. But, you know something's going to happen there. Either the dean is going to get fired, okay?  Or the maniac is going to get fired, or some cool thing is going to happen. So, it's important to think about these things. I have a colleague who I'm probably, Ann may know Joe Witherman. Joe Witherman is a colleague of ours from the Medical College of Virginia. He and his wife just wrote this interesting book. And I promised myself I wasn't going to do some of these lists of things, but this is particularly important because of the context you heard earlier. They actually studied companies. He's a behavioral psychologist, and he's worked, actually, in the community, but he's studying companies now. And basically, he said, he and his wife came to the conclusion that you need eight steps to rapid change. And if you look at these, this is a given that you have to have the passion and commitment to go forward. Is that you first have to have a Clarion call. That you have to do something special. Whether it's increase your performance of the company, if it's Southwest Airlines, or whatever. And then you have to help people give them a compass and a road map to help them get to where they have, that's where the process becomes very important.

But I love this next one. It's unleash your change ninjas. Okay?  Because it means you can't do everything yourself. It's impossible. If you're going to be a leader, you're going to have to figure out who is on your wave length and who's going to be the ambassadors out there who can make things happens. And in companies, this is really critical. In academic institutions, it's vital. I guarantee you, in the community, it's important. And if you look around, you'll know who your change ninjas are. The people you can trust and who you've trusted in the community and amongst the patient population. You also have to shake up the status quo, as we've talked about before, sing from the same songbook, and focus your workforce. And ultimately, you have to let go of the present. Shaking up the status quo is important because what you have to do is you have to also do your own thing. You don't want people to impose on you the vision that they have. You want them to be a player in the vision that all of you have together. So I have a wonderful little illustration here which kind of, I think, demonstrates, why you have to do your own thing. It says if Ben Franklin had tried to be a general, and George Washington tried to be an inventor, we'd probably be living in a British colony without electricity. And this is a very important concept. I mean, it's kind of humorous, but because it tells you, you also have to do things within your own self. And your own context and your own skills and attributes, in spite of the long list of attributes that one can put on.

So I have three places where I'm going to ask you to think about questions. And here's the kind of questions you should think about, in my view. And Wendy and I've talked about this a lot. What kind of leadership do you practice?  Is it simple, sort of non-transformable leadership that you just want to do things at a low level and things might work out, and you might be okay, and if it doesn't, so what?  Or, do you want transformable leadership?  Does the leadership exhibit move both you and the collaborators, or the followers, to a higher level of moral development?  Do you need to take public need and social responsibility more seriously?  And then, who's on the team. You have the appropriate mix?  Remember, you have a huge mix of skills and attributes to really make things happen, especially when you're dealing with the issues that maternal and child health are dealing with. And is there tension to the cross-sectoring part?  So now I'm going to switch from leadership per se to the common good. And they're all interspersed here as you could imagine, and hopefully at the end we'll be able to put the two together.

So what are some common good things that people might agree on?  Well, I think this is a list and you could make this list as long or as short as you want, but increasing access to care, and effective use of access are really important things that are common good. Eliminating all oral health disparities would certainly be in that category. Engaging the community, expanding the community capacity for enhancing the wellness of its pediatric population is really important. Later, when I share with you a model, a community-oriented health model, I'm going to talk a little bit about community capacity. Because one of the places that people don't think a lot about, but the capacity of the community to help itself is really important. You could also make them more global, improve public schools. And as you're going to see in a second, I'm going to give you an illustration why you want to think about that as a common good. Because if you're relating this back to what you're doing, and you see some of these illustrations I'm going to share with you, you'll think, "Gee, how am I going to deal with this population if this is the level of education they're at."  And, you know, working towards a unified health system, I mean, there's obviously a lot of things here.

Once again, Research America did this study, and this is a wonderful thing because it's a common good. They said they asked if preventable diseases and injuries in the country is a major health problem, or a minor health problem. It's nice to know that 54% thought it was a major health problem. This gives you legitimacy to attack these kind of issues, and of course, in oral diseases, carries, and periodontal disease, gingivitis, in particular, these are controllable diseases with controllable risk factors. So this is a good thing. And we have a public paradox when it comes to this. We have scientific and technological advances at an absolute all-time high. But we have pediatric oral health care in a crisis. In fact, in the state of Massachusetts, they actually did a study and in the year 2000 and they proclaimed in a crisis, the state legislature actually did. Of course, they still didn't fund the things they needed to fund, but at least they know it's a crisis. There's a high prevalence of disease. There's limited access to care, limited use of access and there's also one other bullet I should have put on here. There is essentially a lack of practitioners. I mean, there's only 3500, I think pediatric dentists in the entire United States. This is a problem. And commitment is a problem. And, of course, the biggest paradox here is the perceived value of oral health is really problematic. It's still considered to be in many places, an elective kind of thing, unrelated to overall health status, which is really unfortunate.

The surgeon general of the United States has issued two reports. One in 2000 I'm sure you know about, one in 2003, the call to action. And if you look at this, it kind of coincides with a little paradox we just put out there, change of perceptions of oral health. Well, this is not, by the way, an easy job. I mean, this would probably require a $200 million budget that you give to (inaudible) the advertising firm in New York, and you let them figure out how the hell to change the perceptions of the public. It is really not an easy task, and probably have to do it for 10 years in a row before you get any measurable change. It's really difficult, although there are some places, and you'll see on my next slide where we're making some progress here. And some of the other things are build a science base that you can accelerate transfer, that means you are, you get training programs, and science programs which have the potential to effect larger segments of the population. For example, if Forsythe were working on a vaccine for dental cavities. And the faster we can get that onto the market, if ever, the faster it would help enormous populations both in this country as well as worldwide. And, of course, increasing the work force capacity. But one of the things I was also struck with when I look at this list, and you should probably be struck with it as well, is there's nothing in here about innovation. There's nothing in here about creativity. There's nothing in here about leadership. I mean, really there's not. It's just statements of things that need to be done.

Then you look at Research America in 2003, they did this interesting survey, and they asked people, is oral health important to your overall health?  And, of course, this is a very important theme. And look at this. 77% said it's very and 20% said it's somewhat. So it's 97% people believe that these things are linked, and they are, obviously, for a variety of different reasons. But you have to put this in perspective. Because if they made the same illustration and they had 15 other diseases along the way, you'd have to find out where this sit in that category, okay?  How important this would be to the American public. That's where the (inaudible) paradox still resides. It's a matter of perspective. However, when you think about those issues, and you think about the paradox, what, there's another interesting illustration of why leadership and the common good come together, because an effective leader not only needs all these attributes, and you know, integrity, and ethical behaviors, I mean all these wonderful things that you and I can write down and he needs to be a listener, he needs, to, he or she needs to be a person who can create these community coalition centers, but they also need legitimacy.

The person who is the leader has to have legitimacy. It cannot be somebody who's appointed, because it's the least offensive person you could put in that role. That has happened in the United States, in deanships, and in presidencies all over the country. And the moral contract that universities and health profession schools have with society suffers greatly because of that. You have very few advocates at the highest levels of higher education, willing to speak out on the issues that you are concerned about, and that I'm concerned about. And that's a really an American tragedy. Because if universities aren't willing to get up and make noise, who is?  Derek Bauk, the former president of Harvard made a fantastic commentary about this on numerous occasions, so it's something to think about. Legitimacy. And obviously, that goes along with public trust. I mean, I have been fortunate to be a leader of a campus in  Dallas, and I remember going to the state legislature, and they asked me what are you doing to help the people in Dallas and in Texas? And they didn't want to know about oral health. They knew we were doing that. They wanted to know are you improving the public schools. Are you going to help us do that?  Are you going to help us get people out of poverty?  Are you going to figure out a way?  I mean, you know, they said, you guys are the academic people. We're just legislators. You need to give us some guidance. Very few people spoke out on these issues. It was interesting. So, you have to, you know, you can talk about all these different issues, but you ultimately have to come to the conclusion that, you know, you're going to either address the moral dilemma and those issues or you're not. And sometimes you have enormous obstacles that face you.

Now I'm a golfer. Well, it's a, that's probably not true. I play golf, okay?  And you could look at a golf course like this and you could look at obstacles as frightful things you see when you take your eyes off the goal that you set. If the goal is the public good, and that's what we've been talking about here, you have to make that your raison d'etre. You have to not let it go. You know, in a different context, if you remember James Carville did this with Bill Clinton in the election campaign, he said, "It's the economy, stupid."  So everything they did dealt with that as the mantra for getting Bill Clinton elected. They never wavered from that, ever, ever. But we have some interesting dilemmas that I thought of to show you before where sometimes you see these obstacles, and they are daunting, and particularly when they relate to what I would perceive to be a public good that really is integrated with what you are doing.

I'm sure all of you are familiar with Jay Leno. Jay Leno does this interesting thing where he wanders through the streets and he talks to people. And let me share with you some of the questions, some of the answers he got on exams that were posed to students. He asked them to talk about water. H2O is hot water, and CO2 is cold water. Water is composed of two gins. Oxygen and Hydrogen. Oxygen is pure gin and hydrogen is water and gin. A vacuum is a large empty space where the pope lives. The place where people speak Gaelic is San Francisco. For a nosebleed, put the nose much lower than the heart until the heart stops. That might be actually useful to some people. And pyramids were built--why?  For shade. Why else would you build those huge things, you know?  So when you look at this and you say to yourself, "Oh, my God. We have a lot of work to do here. And we're trying to change the oral health of the public. How about their common sense," you know?  Unbelievable. So it gives us, it gives us an environmental context in which to operate. So, you know, ultimately, when it comes to the common good, and leadership, you have to gain support and excitement from the community. And you have to exhibit this caring and compassion and really have to be passionate with the shared vision. You can't just do it in a half-assed, or half-hearted way. It just doesn't work. And you really have to engage the consumer in advocacy. And in my view, this is one of the greatest faults we've had in leadership. We don't think about the consumer as a change agent that they really are, but they are.

And I'll give you another little anecdote. In dental education in particular, and in dental practice, I should say, as I'm sure all of you know, a number of years ago, there was a case where there was a transmission of AIDS from a dentist to a patient in a Florida practitioner. And actually, at that time, dentists were not utilizing universal precautions, gloves, masks, whatever. And actually the American Dental Association president went on 20/20 and got totally hammered trying to defend this stupid practice, frankly, and the truth of the matter is, within one year, one year, the consumer demand was so outrageous to get them to change they went from five percent of the people wearing gloves to 95%. Driven by the consumer. Consumer power is unbelievable. We don't take advantage of it. And this is where the rubber meets the sky. This is where, not the road, because you have a vision. All right?  And you've got to figure out how you're going to get there, and it's where reality and vision come together. And this is interesting, because here's some legitimacy to that. Once again, Research America. Which of the following do you feel should have the most influence on how government medical research funds are spent?  And look at this. Patients came out higher than scientists and scientists included physicians and health care professionals. And even Congress. So the consumer can be the most powerful advocate you have because in this context, the patient is the consumer.

So the thesis that you've seen in my paper, which I still think is true, that was also trumpeted by Gary Wills, is that effective leadership unfolds from the common good. See, the common good is where you have to have agreement. And then effective leadership unfolds that. So now we have the second question to ponder: Who should define our priorities?  Are you priorities connected to perceived in a real public values and need?  Is the parent public paradox (inaudible) help a failure of leadership?  And are health disparities in general a leadership failure per se, or a failure to create leadership in the public good. In other words, do we translate to the public the kinds of survey data that you see that would make us march on Washington for this?  And, in fact, there was a wonderful book written a few years ago by Jonathan Kozal, and it was savage inequities. And in this book, he talked about people and children and the, and I'm sure most of you know this, and the horrible conditions under which their oral health puts them. Terrible pain, terrible suffering, and really when you read this book, you say, Jesus, why aren't people marching on Washington?  You know?  And they're not. So something is amiss, and we have got to figure out how we change the passion into action there. And as partnering in the community the critical approach to actually improving these health outcomes that we're interested in.

So now I'm going to finish by sharing with you a couple of thoughts about community health model. And one of which appeared in JAMA that actually Wendy was kind to send to me, and probably sent to you as well. It was by Grohen and Pearson, and we took the liberty to actually excerpt their figure in this particular presentation. And this one is a model of physician-responsibility in relation to influences on health. And basically, it's pretty simple, actually. What it says is that physicians have a social contract and an obligation to be advocates for a public health agenda. But they have limitations. And the limitations are exhibited in the way these circles are characterized. And if the blue circles, for example, talked about things for a physicians have direct, direct contact and have direct influence. For example, individual patient care. They should have the highest quality care they can render. In access to care, they should actually be advocating for better insurance programs for uninsured care, for geographic distribution of services within the environment in which they practice. They should make sure that signage is appropriate so they can read. So transportation services might be available. And then socio-economic influences can include public policy about cigarette smoking, for example, or helmet-wearing in terms of motorcycles. But they don't have control over many variables. For example, they don't really have control over income disparities. They don't have control over housing and education as we already alluded to, and also in the global perspective, they don't really have control over the distribution of resources. But, the thing that's interesting about this model is that you can, this model can, these circles can expand and contract as we learn more about things and they become more under physician control. But a couple of years ago, Lars Folkey and I actually proposed this model at Association and Health Centers, and basically, it's very busy-looking. It's not nearly as busy as the ones they originally had in here, which I was advised to take out. But I think it's important in context and you have to understand the way this is written now.

This is just a schematic framework that all the arrows that should be in here connecting everything are not in here because it's too hard to read. But basically, if you look at it, you have three dimensions of the community-oriented Hale model. It's communications, it's understanding determinants of health, and it's understanding what health outcomes are. So I chose to actually focus on just two of these for a brief moment, and that is in communications it demonstrates the kinds of necessities that you have to have and the kinds of prerequisites you have to have to make anything happen and to have agreement on the common good. Even if it's a health determinant. For example, if you're in an environment with a health profession school, all that (inaudible) is continuing education programs, you have to help people understand that the education program has to have some material in it, content that will actually help them address some of these issues that are community-based. And we've seen time and time again that that's been a failure in dental education, although it's getting better, I must tell you that. There's no question about it. And I'm sure it's probably true in medicine as well. Also, the K to 12 partnership issue is an important issue for people to think about. And older community health education promotion issues are important on the one side.

On the other side, this issue of community empowerment is really what drives this model in my view. Because there have been some wonderful studies done where they've actually done some work on community needs and community capacity and if you, and in fact, at the university at Northwestern University in Chicago, there is a professor, and I cannot remember his name now. Who actually writes about community empowerment by understanding community capacity. You can, you can have all of the needs you want. You can do surveys of all the needs you want, but if you don't understand the community's role in meeting those needs, and the capacity they have to change, you'll never, ever get to first base. And so you really have to think a lot about these things. And it includes, by the way, understanding the infrastructure of the community, the churches, the schools, the safety issues, the environment issues, whether or not drugs are a big problem, whether housing's a problem, whether or not there's people are scared walking down the street, etcetera. You've got to understand this whole area, and also their willingness to participate and share in self-care models, which are important. You can't do everything yourself. You can't be everything to everyone. They have to play, have players in this. The consumer does. And then, you know, the determinants of health are huge. I mean, they're heredity, socio-environment, housing, transportation, literacy, health literacy, I mean, huge, huge things to think about. You have to put those in context. And then ultimately, you know, it's all designed to meet the common good and the common good here are these intended health outcomes. And if you notice, the ones that are up here, they're fairly substantial. And they can be anything you want. I mean they can be one of these or they can be 15 of these. But if you're going to have a community-oriented health model, you have to look at it in a big picture framework. And so sometimes this gets daunting when you look at all these things and you say, "My gosh. Maybe somebody else should do that."  Well, there is nobody else. You know?  You're the somebody else, and we're the somebody else. And we have to work together to move in that direction. So once again, and this is repetitive, I know, based on an understanding that the public good is worth pursuing, you have to understand how to move the community. What kind of capacity they have. You have to be willing to deal with them and be persistent and stick to the goal. Now, this is one of my favorite slides. We're coming to the end of this talk. This is actually a place in Colorado. Gold Hill, Colorado. This sign appears on the entrance into town. It says, "Gold Hill. Established in 1859. Elevation of 8463. Population of 118 for a total of 10,404."  This is a great bottom line slide, you know? 

So what's the bottom line of all of this discussion we had. Well, I told you I'm going to borrow heavily on Southwest Airlines. I love the (inaudible) I'm going to talk to you about now because this is practical leadership. I have five minutes. Thank you. I will be done in four and a half. You have to make work fun. This is directly from Southwest Airlines. You have to use celebrations to create relationships. And, by the way, I've experienced this is my own institutions. We have celebrations for everything and it really gets people to be on the same team. And really because the vision in our place is to be the best we can be, among other things, in the areas in which we function. And people have to want to buy into that. Because you could also be almost the best. Well, we don't like to be almost the best. Equip people to make decisions and become a risk doctor. Help people recover from mistakes. I cannot tell you in all the places I've worked how many times that's never happened. Where people make a mistake and basically you're labeled a failure. Or, they don't give you the wherewithal to recover, and then hold the reins loosely. I mean, it has always been my view, and I've actually said this in other contexts that people want to be the best. There is no question. I've never been in any academic institution where I've met a faculty member, I've never been in a community setting where they didn't want the best for the community. But, sometimes it totally thwarted by the way the institution, the framework functions, okay? 

They, my view is, you have to agree on the common mission, you have to make sure you got the maniac and the change ninjas out there, and then you have to let people alone and let them do what they're good at, and they'll do it. Guaranteed. Guaranteed they'll do it. Stamp out bureaucracy. Here's my other great Tom Peters philosophy. He said, in "Search of Excellence," in addition to the maniac, you have to get the bureaucrats out of the way of the productive people. Okay?  That is really important because otherwise they're stymied. Deal with people, not positions. Train for skill, but hire for spunk, enthusiasm, and look for creative unconventional ways to tell your story. And make sure that good is never good enough. Apply the Disney principle here all the time. Good is never good enough. Two quick anecdotes before I share with you a couple of things that we end with. Good is never good enough. Disney decided to create Epcot one time in their life, if you remember, okay?  But they didn't really think about what people wanted when they did that. They thought, gee, if this is good for the kids, it's got to be great for adults, so they created the adult version of Disney. And it was a failure.

I mean, Epcot first opened, it almost went under and they came very close, learned this at the Disney institute to essentially scrapping it. They decided before we do that, let's do a survey, find out what the heck is it that people come to Disney for. Okay?  Remember their philosophy was to create fun and expectations. And succeed people's expectations. So they actually did a survey, and what do you think the number one reason people come to Disney for? Want to take the chance?  To see Mickey Mouse. To see Mickey Mouse. Okay? And they didn't have Mickey Mouse in Epcot. Think about that. They didn't have Mickey Mouse in Epcot. You know what they did?  They put the characters in Epcot, and the rest is history. Okay?  Because then the parents could go over there with the kids. Because the kids were dragging the parents away from Epcot. Unbelievable. I mean, think about simple. But it tells you that you have to really understand the community that you're dealing with. So, that's very important. Oops, I've got to go back. Well, this is great. Use unconventional methods to tell your story. Southwest Airlines, this is fabulous, okay?  They were always number one in customer satisfaction.

Northwest Airlines came out with a survey that said they were number one in customer satisfaction. And this is how they responded. These articles appeared in the Wall Street Journal, the New York Times, the Los Angeles Times, after lengthy deliberation at the highest executive levels and extensive consultation of the legal department, we have arrived at an official corporate response of Northwest Airlines' claim to be number one in customer satisfaction: Liar, liar, pants on fire!  Okay?  That's cool, you know?  Last series of questions to ponder. Can you define your customers?  Do you perceive leadership as a position of power?  Do you believe the Lone Ranger is an appropriate leadership metaphor?  You remember the Lone Ranger. First, rides in, up this little hill, horse, Silver, rears up, rides down, does good deed, runs out of town, and they said, "Who was that masked man?"  Well, they found a silver bullet and say, "That's the Lone Ranger."  Is that a good metaphor for leadership today?  Do you believe leaders are servants by nature, and do you believe you've heard this question before, that people are born leaders. And there are clearly people who are clearly not born leaders, but they aspire to leadership.

Dave Nash believes those are the people who are not moral people, like Caesar, and Attila the Hun, but who knows?  And this is Tony Soprano. I have to give you something from Sopranos also illustrated, re-illustrated in the book "Nuts" I told you about before. Is that you have to make vision the boss. Vision if you keep the vision in front of you, all the time, all the obstacles, all of the distractions, all the controversies, they melt away, because you know that's what you have to get at, and you got to be relentless about it. And then, I started off by saying this, and I believe it. If you remember when the United States women's soccer team won the World Cup?  Leadership's all about people and making things happen in the long term. That's what we're all about. And I'm going to end with my famous, one of the most interesting quotes, I think I've ever seen, and it's Dante's. There's a special place in hell reserved for the morally indifferent and the safely neutral. And with that, I hope and I know that the people in this room don't fit in this category. I know you'll make the great difference. Thank you very much for your (inaudible).