Leading Systems Change: A Conversation with Kris Risley and Christina Welter

We all do better when those who are facing structural barriers to health can thrive. The public health workforce has an important role in dismantling those barriers and advancing health equity. In this conversation with Kris Risley, DrPH, CPCC, and Christina Welter, DrPH, MPH, we discuss how this can be accomplished using a systems change lens.

Risley and Welter are two of the editors of Leading Systems Change in Public Health: A Field Guide for Practitioners. The book provides an inclusive process and framework with tools for implementing change that leads to transformation. Leading Systems Change translates academic and practice experiences into a roadmap that is approachable and easy to use, regardless of where readers or their institutions are on the journey to change.

We discussed how systems change relates to the work of the Consortium and the practical guidance the book offers members of the Consortium and others who share its vision.

Below are excerpts from our conversation.

Let’s start off with something relatively simple. What is systems change?

Christina Welter: Systems change is a process to address problems that seem intractable; you’ve tried and tried, and still, they remain a problem. It’s a holistic approach that acknowledges that the problems are complex: there is no single solution and no one expert can solve the problem; multiple leaders are needed. The problems change and shift over time and in different environments and contexts.

How does systems change — and the book — relate to the efforts of the National Consortium to achieve health equity through public health workforce development?

CW: Systems change work involves bringing together a diverse group of partners to explore and ask questions to understand complex problems more deeply and to examine the structures, systems, and processes that are influencing the situation — and reinforcing it in both positive and negative ways. We also need to understand the power structures embedded within our systems and how these can obstruct transformational systems. These conversations and work  helps us to unpack, understand, and unlearn previously baked in perspectives that may inhibit systems change, and instead open up new ideas or approaches that others have tried. 

Kris Risley: Clearly, the Consortium is tackling a complex problem that others have been trying to address for years — decades even! Through the Consortium’s work to develop its Common Agenda, members have begun to develop a deeper, shared understanding of the problem and are discovering new pathways and approaches to advance change.

To achieve systems change, we need to look at ourselves differently and we need to look at organizations and communities differently. We need to be open to identifying and understanding diverse perspectives regarding the challenges we are trying to overcome. 

What are some of the practical skills that the book can help readers develop?

KR: It’s been my experience that practitioners understand the importance of health equity, but they don’t necessarily have the concrete tools they need to help them achieve it. The book provides practical strategies for using a health equity framework to address issues in your health department at the personal, interpersonal, and organizational levels to create change within health departments and then, ultimately, in communities.

What do people need to be prepared for as they undertake systems change in public health, something that seems challenging — and BIG?

CW: In the book, we emphasize the value of having diverse relationships that provide the space for brave conversations that help to uncover the root causes of an issue. And you need to invest time and effort upfront to create that space. To achieve true systems change, you need to really get a cross-sectoral variety of perspectives, including those with lived experience. Once you’ve created the space for conversations, relationships, and trust, you need to be able to unpack those issues, and only then can you move forward to generative conversations. The book helps the reader to take these big steps.

For example, in her chapter on interpersonal leadership, Patricia Moten Marshall uses a framework called Creative Interchange — the process through which we learn, change, and perform to our highest potential. This framework, which Pat uses in her coaching and training work, provides an asset-focused and constructive approach to overcome the unproductive debate, division, and polarization in interpersonal interaction that often occurs as we begin the systems change process. In Kris’ and Renée Branch Canady’s chapter on personal leadership, they explain how to define what’s important to you — what your vision is — so that you can engage others in achieving a shared vision. Both of these are ideas based on Jim Kouze and Barry Posner’s research regarding exemplary practices of leadership.

KR: People who work in public health understand the importance of cross-sector partnerships. They know that they can’t achieve their goals alone, and they often bring partners together for a project or program. However, they may be lacking in the skills to develop a common agenda and engage in collective work while also offering their own unique contributions. They have been trained to be technical experts, to be experts in public health content and program planning and other critical public health skills, but they may be lacking in the skills to lead systems change.

Fortunately, we are starting to see these types of skills being taught in public health programs, including the DrPH Program at the University of Illinois at Chicago, where Christina teaches; in training centers, such as the regional public health training centers; and in workforce development centers, including the National Maternal and Child Health Workforce Development Center at the University of North Carolina at Chapel Hill.

CW: Collectively, we need to get better at opening up, asking, and really understanding the perspectives of different partners — and then synthesizing these perspectives to find the leverage pieces to identify a shared vision.

We collaborate on delivering vaccines or on testing or we collaborate on a chronic disease grant, but that’s not systems change. We need to back up to see what the systemic issues are. 

Systems change must be completed in partnership, from start to finish, with community members and individuals or organizations in other sectors and disciplines.

KR: Systems thinkers look at the underlying causes of the challenges we face, including how our assumptions and values contribute to problems and solutions. When we take the time to do systems work, we can find small — and often unanticipated — openings for change that can lead to even greater change.

A number of Consortium members authored or co-authored essays for the book and bring their expertise to the work of the Consortium: Dorothy Cilenti of the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Lili Farhang and Solange Gould of Human Impact Partners, Jeannine Herrick of Jeannine Herrick Leadership Coaching and Consulting and Adjunct Faculty of Public Health Leadership at the Gillings School of Global Public Health, Cynthia D. Lamberth of the Kentucky Population Health Leadership Institute, and Jonathan Webb of the Association of Women’s Health Obstetric and Neonatal Nurses.

To purchase a copy of Leading Systems Change in Public Health: A Field Guide for Practitioners, visit Springer Publishing’s website. 

Kristina Y. Risley, DrPH, CPCC, has a sincere interest in the intersection of human and public health workforce development. She is an Executive and Leadership Coach with Kris Risley Coaching, where — since being certified with the Co-Active Coaching Institute in 2004 — she works with public health professionals and others committed to making the world a better, more equitable place for all. Dr. Risley earned her DrPH in Maternal and Child Health from the University of Alabama at Birmingham, her Master of Science degree in Developmental Psychology from Illinois State University, and her Bachelor of Arts degree from Purdue University.

Christina R. Welter, DrPH, MPH is a policy practitioner, visionary leader, and practice-based researcher passionate about and deeply committed to helping organizations and communities facilitate equity-centered systems change. She is a Clinical Assistant Professor in the Health Policy and Administration Division at the University of Illinois Chicago, School of Public Health where she also serves as the Director of the Doctor in Public Health Leadership Program and the Associate Director of the Policy, Practice, and Prevention Research Center. Dr. Welter’s scholarship focuses on collaborative learning and evidence building to co-create and impact racial and economic justice-focused policy and systems change.