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Boundary Spanning Leadership

Promising Practices for Public Health

Fick-Cooper, Lynn, MBA; Williams, Andrea, MAEd; Moffatt, Sharon, MS, BSN, RN; Baker, Edward L., MD, MPH, MSc

Section Editor(s): Baker, Edward L. MD, MPH, MSc; Column Editor

Journal of Public Health Management and Practice: May/June 2019 - Volume 25 - Issue 3 - p 288–290
doi: 10.1097/PHH.0000000000001004
The Management Moment
Free

Center for Creative Leadership, Greensboro, North Carolina (Mss Fick-Cooper, Williams, and Moffatt and Dr Baker); and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Baker).

Correspondence: Edward L. Baker, MD, MPH, MSc, 25 Vassal Lane, Cambridge, MA 02138 (edwardlbaker@gmail.com).

The authors declare no conflicts of interest.

The complexities of solving challenges to improve population health necessitate that public health practitioners work with partners from multiple sectors.1 As public health leaders increase their involvement in multisectoral collaboration toward the goal of building healthy communities, they often encounter a range of obstacles and barriers. Typically, working with other groups and organizations presents challenges resulting from different assumptions and guiding principles and a lack of understanding of the expertise and regulatory or other barriers of the partner. Although multisectoral collaborations are common in public health practice, many fail to reach their full potential. In this column, we outline a promising practice—boundary spanning leadership (BSL)—that offers a research-based and field-tested conceptual framework along with practical tools that have recently been enthusiastically adopted by a few public health agencies.

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What Is Boundary Spanning Leadership?

BSL is a conceptual framework along with a set of practical tools developed by the Center for Creative Leadership (CCL) and driven by a range of research conducted over the past 10 years.2 , 3 BSL is the capability to create direction, alignment, and commitment across boundaries in service of a higher vision or goal4 by engaging in 3 strategies (managing boundaries, forging common ground, and discovering new frontiers) and 6 practices with specific tactics for each practice.

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Managing boundaries

This strategy taps into the power of differentiation—the human need for autonomy, divergence, and uniqueness across group boundaries.

  • 1. Buffering: This first practice is designed to help an organization define the boundaries that exist between the groups involved (eg, what each group brings to the work, what is in scope and out of scope) in order to create an outcome of safety among all participants. By formally exploring this practice, leaders are better positioned to move ahead and work with others. A tool that often helps in this practice is the creation of a team charter.
  • 2. Reflecting: This second BSL practice is designed to provide a process by which an organization “looks across” the boundaries between its groups to exchange knowledge and seek to understand others' perspectives. At this stage, the BSL model suggests “putting on others' shoes” to better understand how the other group might think and operate, which fosters intergroup respect. A key tactic in this practice is the art and discipline of asking powerful questions that foster a deeper level of inquiry and promote open dialogue to surface unstated assumptions and implicit beliefs.
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Forging common ground

This strategy taps into the power of integration—the human need for unity, belonging, and connection across group boundaries.

  • 3. Connecting: In this third BSL practice, participants are invited to “step outside” of their respective groups into a third space to suspend group differences and form new networks and deeper relationships, which enable intergroup trust.
  • 4. Mobilizing: The fourth practice, Mobilizing, is designed to create a new tone and structures for interaction between groups—creating an identity for the shared space in which they will do their work together, which creates a sense of community. Tactics that may help at this stage include creation of a set of shared values and beliefs, a unifying image, and establishment of a cross-functional team.
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Discovering new frontiers

This strategy taps into the power of integration and differentiation simultaneously—the juncture where boundaries collide and intersect.

  • 5. Weaving: Weaving, the fifth practice, is designed to foster the creation of innovative ideas and new solutions and advance interdependence. Useful tactics include implementation of “low hanging fruit” and use of after-action reviews to assess success of the BSL practices and tactics.
  • 6. Transforming: The final BSL practice, Transforming, is designed to nurture a process of “reimagination,” in which new collaborators aim to “bust silos” by asking challenging questions and fostering open inquiry through dialogue. At this stage, exploration of “alternative futures” is central to encourage a unified approach and to continue to target old boundaries that have limited effective BSL in the past.
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Boundary Spanning Leadership in Practice

As part of the ASTHO Leadership Institute, a new leader development program for state health officials led by CCL and ASTHO,4 we recently worked with state health agency leaders to explore the use of the BSL framework in public health practice. Our experiences in New Hampshire (NH) and Montana lead us to conclude that broader use of the BSL model in public health practice is to be encouraged.

  • 1. New Hampshire: To address the need to improve the NH child welfare system, an Interagency Task Force was recently formed including the NH Division of Public Health, the NH Division of Child and Family Services, the NH Attorney General office, and other stakeholders. To provide tools for this process, on-site training by CCL staff in the use of the BSL methods took place in April and August 2018. As a result, an enhanced partnership between the NH Division of Public Health and the NH Division of Child and Family Services was fostered by the use of these practices. Furthermore, NH state agencies have incorporated BSL practices into other child health initiatives and have received substantial new federal funding for BSL practice implementation.
  • 2. Montana: The state health official, Director of Public Health and Human Services, has authority over a large department that includes public health, Medicaid, child and family services, senior, long-term care, and disability services, and addictive and mental health services. BSL practices were used to focus on coordination and collaboration of department-wide grant applications in areas such as substance abuse. As a result, a cross-department leadership team skilled in BSL has been successful in receiving several grant awards that support multiple divisions working together and now continues working to apply BSL practices to complex challenges of addiction, mental health, and child welfare in Montana.
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Lessons Learned

BSL tools and practices represent a promising new way of behaving in public health. One benefit of the BSL approach is that it provides a research-based set of nested practices with proven utility. Furthermore, having a set of concrete tactics listed for each of the 6 BSL practices provides a toolset that public health teams can use as they reach across boundaries to work with other organizations.

The concepts of managing boundaries, forging common ground, and discovering new frontiers may appear familiar to other collaborative work of public health. Yet, key to the success of the BSL approach is intentionally taking the time at the beginning formation of the partnership to focus on understanding and managing the boundaries of each partner.

Use of the BSL mind-set and toolset requires a commitment to spending time in a learning mode to achieve a deep understanding of the practices and tactics and then immediately applying practices with a partner to achieve shared goal. This learning is best achieved by partners learning together in a workshop, reading materials,2 , 3 and ongoing support through active coaching from someone familiar with the BSL model and its use in public health.

Assessment of organizational readiness to use BSL involves asking a few questions:

  • What is the opportunity or challenge being addressed?
  • Who are the partners and what level of commitment exists?
  • What will success look like and how will it be measured?
  • What are major obstacles to success?
  • What is the resource commitment from partners?
  • Have opportunities to impact policy been identified?
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Conclusion

The BSL set of strategies, practices, and tactics provides a rich resource for public health agencies seeking to improve their organizational ability to work across organizational boundaries to improve health in the populations that they serve. Recent promising experiences in 2 public health agencies has led to an early sense of promise with respect to using BSL tools in other public health settings. Lessons learned to date can guide further exploration of these promising public health leadership practices.

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References

1. Fraser M, Castrucci B, Harper E. Public health leadership and management in the era of Public Health 3.0. J Public Health Manag. 2017;23(1):90–92.
2. Ernst C, Chrobot-Mason D. Boundary Spanning Leadership: Six Practices for Solving Problems, Driving Innovation and Transforming Organizations. New York, NY: McGraw Hill; 2011.
3. Lee L, Horth D, Ernst C. Boundary Spanning in Action—Tactics for Transforming Today's Borders Into Tomorrow's Frontiers. Greensboro, NC: Center for Creative Leadership; 2014.
4. Fraser M. Starting out right: what are the essential elements of new state and territorial health official onboarding and transition. J Public Health Manag Pract. 2018;24:590–595.
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