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Practicing Management and Leadership: Vision, Strategy, Operations, and Tactics

Baker, Edward L. MD, MPH; Orton, Stephen N. PhD

Section Editor(s): Baker, Edward L. Column Editor

Journal of Public Health Management and Practice: September/October 2010 - Volume 16 - Issue 5 - p 470–471
doi: 10.1097/PHH.0b013e3181f5164b
The Management Moment

North Carolina Institute for Public Health, UNC Gillings School of Global Public Health, Chapel Hill.

Correspondence: Edward L. Baker, MD, MPH, North Carolina Institute for Public Health, UNC Gillings School of Global Public Health, Campus Box 8165, Chapel Hill, NC 27599 (

In the national Public Health Leadership Institute, which we manage, we are often asked to answer the question, “What is the difference between leadership and management?” Much has been written on the subject. For example, Warren Bennis, a noted “leadership guru,” stated that “leadership is doing the right thing, management is doing things right.”1 In his book, Leading Change, Kotter2 makes useful distinctions between what leaders and managers do: leaders develop vision and strategy, managers implement plans and execute budgets. Good leaders—at whatever level in an organization—achieve balance between leading and managing.

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A Leadership Case Study

We have found a useful distinction between the processes of leadership and management in a story from a researcher at the Institute for the Future. Once upon a time, a young congressman, interviewed on the subject of how one influences the future, stated that the processes can be summed up in 4 letters: VSOT, and he gave some examples.

Many elected officials, when asked to answer a question by a reporter, focus on giving the “right sound bite.” That is a tactical approach (T). Others establish a good press office so that when questions are asked, a press release can be provided: that is operations (O). Still others attempt to develop a strategy (S) so that the questions are answered in a way that supports a key message the official wants to deliver. This congressman, while acknowledging that tactics, operations, and strategy, are important, stated that he planned to focus on developing and articulating a vision (V). His vision would drive strategy, strategy would shape operations, and operations would implement tactics. In our view, this VSOT framework provides a useful tool in addressing the distinctions between the processes of leadership and management.

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Implications for Public Heath Organizations

In scientific and technical agencies such as public health organizations, tactical and operational approaches often dominate organizational thinking. These approaches often stem from the technical backgrounds of organizational leaders (eg, epidemiologists, nurses, physicians, and environmental health specialists). Indeed, for most of us in public health, early work experiences center on operations and tactics (eg, conducting research or providing clinical services). As a result, many of us are more comfortable focusing on operations and tactics than on shaping strategy and vision. Among other limitations, overreliance on operations and tactics may lead to what Senge3 describes as an “organizational learning disability” such as a reactive preoccupation with events.

The VSOT framework is one way for leaders to analyze their own leadership styles and adjust their approaches to include the entire spectrum from vision down to tactics. Are you able to identify your orientation with respect to these 4 areas?

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Definition of Terms


A vision is something you can see. In other words, a vision must be clearly “visualizable.” The leader must be able to create a mental picture that can be easily communicated to others. A simple test is that others can “see” the vision and also find it desirable. We all know of specific examples. John Kennedy: a man on the moon by the end of the decade. Bill Gates: a computer on every desk running Microsoft software. Bill Foege: a world free of smallpox. These are big ideas, clearly stated. Carl Larson calls them “ennobling goals.”4

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Strategies provide the logic for how the vision can be achieved along with a first level of detail on how the vision can be achieved.2 In public health practice, we speak of the core public health functions as assessment, policy development, and assurance of delivery of health services.5 These are strategies, designed to achieve the vision of “Healthy people in healthy communities.” Health protection, health promotion, and disease prevention are other examples.

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In public health, we have a range of programs that operationalize the strategies designed to promote the vision of healthy people in healthy communities. Much of our energy goes into developing and managing these programs (eg, immunization programs, cancer prevention programs, and environmental health programs).

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Tactics consist of very detailed actions, driven by specific timetables and operational plans. Tactics are linked to budgets and staffing roles and responsibilities. In sports, tactics are the most visible aspect of the game—the excellent pass or the 3-point shot at the end of the game. (We are from North Carolina and you might not be surprised that we are using this example.) Tactics tend to be more visible than operations, strategy, and vision to the external observer.

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Putting It All Together

All 4 areas must work together for a public health organization to effectively serve the public's health. Leadership means creating and communicating vision and strategy; management means translating that strategy into operations and tactics. Great leaders and great organizations integrate all 4 areas. Good leaders manage and good managers lead.

One implication of integrating all 4 areas is that “leadership” is not confined to the titled “leader” of the organization. Great organizations express leadership at all levels. Leaders, managers, and even frontline staff might help inform and then transmit vision and strategy. A second implication is that great organizations manage the connection from vision (eg, healthy people) all the way down to tactics (eg, press release contact lists, emergency radio protocols, and inspection data collection). In great organizations, frontline staff can explain the vision and know how their specific tactical role serves it.

To put the 4 areas to work for you as an individual leader (and we mean managers too), first become aware of your areas of strength and the strengths of your team members. We use various assessment tools that can assist in this process such as those created by our Public Health Leadership Institute partners at the Center for Creative Leadership. Following assessment, development programs can be designed to assist those with an operational/tactical orientation to function more as strategic thinkers and as visionary leaders. The development process may involve structured development programs, “develop-in-place” strategies, and/or executive coaching. Those who are more oriented toward strategy and vision can develop an enhanced awareness of the implications of this orientation for interactions with their team.

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The process of development should begin with a conceptual understanding of the 4 aspects of leading and managing: vision, strategy, operations, and tactics. Following this understanding, assessing individual strengths and orientation can be helpful to identify developmental needs and opportunities. Within the Public Health Leadership Institute program, we build upon the individual assessment process to shape developmental experiences and structure the executive coaching experience. To be effective, public health leader/managers must ensure that their organizations have integrated these 4 key areas:

  1. A compelling vision that all can see
  2. A few core strategies
  3. Efficient and effective operations
  4. Excellent tactical performance
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1. Bennis W, Nanus B. Leaders. New York, NY: Harper Collins; 1985.
2. Kotter JP. Leading Change. Boston, MA: Harvard Business School Press; 1996.
3. Senge P. The Fifth Discipline. New York, NY: Harper Collins; 1990.
4. LaFasto F, Carl L. When Teams Work Best. Thousand Oaks, CA: Sage; 2001.
5. Institute of Medicine. The Future of Public Health. Washington, DC: National Academies Press; 1988.
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