Coordination in the Face of Public Crisis:
Examining a Case Study of Dr. Helene Gayle
The case study referred to here comes from PricewaterhouseCoopers Endowment for the Business of Government. You can access their PDF free of charge: Managing Across Boundaries: A Case Study of Dr. Helene Gayle and the AIDS Epidemic.
Dr. Helene Gayle faced obstructive forces in the political, social, and economic arenas when she began to change the face of public policy on HIV/AIDS prevention, education, and treatment. She experienced a coordination crisis when confronted with the myriad organizations needed to combat the disease on all fronts: church groups, non-profits, government agencies, and the international community. She rose to the challenge by forging strong partnerships at all levels, crossing cultural and political boundaries to form alliances. Her strong diplomatic skills and her expert use of an administrator’s three main political resources brought her success. Dr. Gayle’s case reminds us of the complex political environment we face today, and how we can tap into our individual power to create change.
Dr. Gayle faced powerful social and cultural forces, including conceptions of gender and sexuality, and patterns of intravenous drug use. Stemming the spread of HIV involved addressing cultural ideas about who got it and how they got it, and a host of behavioral taboos. Preconceptions about risk behaviors floated in a sea of misinformation that only increased risk.
Within the social groups most deeply affected by HIV exists a trend towards low income. People with little or no access to health care and education due to poverty lacked the information about risk behaviors and the proper diagnoses. Government funding for research and prevention lies on the other side of the economic equation. Without strong advocates like Dr. Gayle in place, mandates remain unfunded, and cutting edge research remains undone.
Powerful political forces come into play also, and they create a coordination crisis. Cooper (1998) defines coordination crisis as “the difficulty of planning, coordinating, and operating the many organizations… involved in the same area of activity simultaneously (p. 94). Cooper proposes that our government has become more complex than a three-tiered top-down hierarchy of federal, state, and local spheres of influence. Now we have a complex network of interdependent agencies addressing public concerns such as health and transportation and income assistance. That these agencies operate independently, sometimes with competing agendas authority, and at different levels of society makes them incredibly hard to coordinate. Thus, the crisis comes when faced with serious health problems like the spread of HIV. How can all these groups be mobilized together, effectively?
Dr. Gayle rose to confront this crisis and coordinate more than just public agencies at the federal, state, and local level. She partnered with non-profits and community groups. She reached beyond the nation’s border to forge partnerships in Africa and abroad, recognizing the spread of HIV as a global epidemic affecting us all. Her tremendous interpersonal skills and genuine concern made these partnerships possible. Dr. Gayle also makes expert use of all the political resources available to her.
USING POLITICAL RESOURCES
The political resources available to public administrators like Dr. Gayle include professionalism, external support, and individual power (Starling, 2011, p. 83).
Max Weber believed bureaucracies would engender the development of specialists, career professionals with substantial expertise who excelled in their roles. They would have great knowledge of the details and requirements of their positions. Starling sees these career professionals possessing enough power to overcome stifling political pressure from above. They can devote attention to a given problem full-time, monopolize information, and break down problems into smaller achievable parts due to their specialization (ibid, p. 84). Dr. Gayle exemplifies this lifetime of dedication to a role as a provider of health services. Before spearheading public policy on HIV, she studied medicine, earned an MD and a Masters of Public Health, and worked her way up through the ranks of administration from Acting Special Assistant to Director at the Center for Disease Control (Riccucci, 2002, p. 9).
To implement her policy initiatives, Dr. Gayle built a network of external support. She reached beyond the boundaries of her department into the community, working one-on-one with churches and non-profits. She saw their importance in influencing public perception on health matters, and the dissemination of much needed education and information to local communities. She also created collaborations with other federal agencies like the National Institute of Health and the Department of Health and Human Services. She joined South African President Mbeki’s advisory panel on HIV/AIDS. Mbeki counted on Dr. Gayle to “keep everyone together so that programs could be moved forward” (ibid, p. 21). Such a widespread support network requires not only great knowledge but great diplomacy.
Great leaders exhibit great diplomacy. Dr. Gayle’s cross-cultural and international partnerships prove her a diplomat of the highest order. The Center for Creative Leadership breaks diplomacy down into components. Diplomatic leaders are trusted, culturally sensitive, tactful, and well-connected to a wide range of people who can help get things done (Campbell, 2004, p. 31-2). CCL studies further suggest a link between diplomacy and the emotional intelligence skills of impulse control, stress tolerance, a sense of humor, and composure (Ruderman, 2004, p. 6-10). This kind of individual power lends itself to effective results through influence rather than coercion. It builds consensus and connection.
The Political Environment
Nothing exemplifies the coordination crisis of complex, competing agencies more than the CDC’s conflict with the Red Cross. In 2011’s Managing the Public Sector, Starling describes how the CDC appealed to the federal government to impose HIV screenings at blood banks, but met resistance. Based on Randy Shilt’s exposé The Band Played On, Starling makes it clear the large blood banks associated with the Red Cross used their political connections and greater experience in the political arena to block the CDC’s efforts (p. 16).
Thrown into such a political arena, Dr. Gayle’s ability to forge relationships and coordinate efforts proved key to her success. The ability to connect with a wide range of people to get things done provides a competitive edge. These external alliances take administrators out of their desks and into homes, offices, and other countries to nurture their formation and growth. Once in place, this network of alliances provides key influence and manpower to fully implement needed policies.
People do want good public programs, and they want them at the local, state, and federal levels. The very complexity and interdependence of government that causes the coordination crisis provides the key resource to unlock it: many departments working on the same problem. Coordinating these units for effective results, however, requires public administrators who are “adaptable and capable of understanding government not as a simple overhead authoritative organization of institutions, but as a complex collection of different organizations” functioning in different ways (Cooper, 1998, p.119). Dr. Gayle’s success shows that she understands this complex network and possesses the diplomacy to connect the parts into a functioning apparatus that carries out policy goals.
The deepest resources a leader can tap live within. Personal qualities – self control, charisma, people skills, a sense of humor and confidence – form the foundation for connecting with other people for the common good. A genuine concern for other people and cultural sensitivity pave the way for strong partnerships.
Campbell, D. 2004. Nine keys to good leadership. In Wilcox, M. and Rush, S., Eds., The CCL Guide to Leadership in Action, pp. 29-33. Jossey Bass: San Francisco, CA.
Cooper, P. 1998. The intergovernmental policy structure and action. In Cooper, P., et al., Eds., Public Administration for the Twenty-First Century, pp. 94-121. Harcourt Bruce College Publishers: Fort Worth, TX.
Riccucci, N. Jan., 2002. Managing across boundaries: A case study of Dr. Helene Gayle and the AIDS epidemic. Special Report by PricewaterhouseCoopers Endowment for the Business of Government. Retrieved from http://www.businessofgovernment.org/sites/default/files/AIDSEpidemic.pdf
Ruderman, M., et al. 2004. Making the connection: Leadership skills and emotional intelligence. In Wilcox, M. and Rush, S., Eds., The CCL Guide to Leadership in Action, pp. 3-14. Jossey Bass: San Francisco, CA.
Starling, G. 2011. Managing the public sector. Boston, MA: Wadsworth, Cengage Learning.