MPH 508 Week 8 Leadership Reflection Example

Leadership Reflection: The Hospital Agreement I Let Lapse by Email, Reconsidered With What This Course Would Have Told Me to Do

Student Name

Chamberlain University

MPH 508: Leadership and Administration in Public Health Systems

Instructor Name

Month Day, Year

Leadership Reflection: The Hospital Agreement I Let Lapse by Email, Reconsidered With What This Course Would Have Told Me to Do

The Decision

The decision I want to examine was small and, at the time, felt like routine administration. In spring 2025, the emergency manager at the regional hospital, who had signed the hospital's closed dispensing agreement with the Merritt County Health Department in 2021, retired. Her successor emailed me to ask whether the agreement covered staff families and what the hospital would be expected to do. I replied the same day with the plan annex, the standing orders and a link to our training video. I offered to answer further questions. The successor did not reply, and in August 2025 the hospital declined to renew. The hospital had covered about 2,600 staff and household members, the largest single closed site in our network.

What I Did, Without Defense

I did not call the successor. I did not visit. I did not ask the health officer, who knows the hospital's chief executive, to make a call. I did not ask what the successor's concerns were, although the question about families clearly signaled one. I treated the email as a request for information when it was an invitation to a relationship. I can explain each of these, as I would have at the time: I had two exercises to run, the planner position was vacant, and the agreement was the hospital's to renew. But the explanation does not change the outcome. A twenty-minute meeting would very likely have kept the hospital.

Scarcity in the Picture

The decision was made under real constraints. In spring 2025 the program had one staff member instead of two, and the federal cooperative agreement had required two exercises that quarter. Time was scarce, and I spent it on deliverables the funder would check. A closed dispensing agreement does not appear in a quarterly report until it lapses. Scarcity explains why the email felt sufficient. It does not justify it, because the hospital agreement covered more people than any exercise I ran that quarter tested.

Course Material That Would Have Changed It

Three parts of this course would have changed what I did. The first is Crosby and Bryson's (2005) account of leadership across sectors, which I used in week 3. It treats partners' commitments as things leaders must keep alive through relationships and forums, not as contracts that sustain themselves. Read that way, the new emergency manager was a new partner, and the agreement needed to be rebuilt with her, not handed over.

The second is the research on closed dispensing networks. Rebmann et al. (2022) found that the planners they interviewed struggled most when a partner's contact moved on or a site lost interest, and that planners kept sites by staying in regular touch and knowing the people there. Had I known that a contact change is the most predictable point of failure, I would have treated the email as a warning.

The third is the budget and workforce work from weeks 5 and 6, which showed me that relationship work is real work with a cost in hours. I had not budgeted for it. I treated visits as optional because no line in any budget named them.

Week One, Tested

In week 1, my self-assessment scored me highly on collaboration and lowest on challenging the process, and I concluded that my real weakness was avoiding uninvited conversations that might end in a refusal. The hospital decision tests that conclusion and confirms it. The successor's email was, in fact, an invitation, and I still avoided the conversation, because a meeting with a new contact at a large institution could have produced a no in person. The week 1 finding was right, and the hospital shows how much it costs.

It also shows something I missed in week 1. The avoidance was not only personal. The program's structure, in which all partner relationships sat with one person, meant that my avoidance became the program's failure. A leader's habit is a program's risk when nobody else holds the relationship.

What I Would Do Now

Faced with the same email today, I would call within a day, ask what prompted the question about families and propose a visit with the health officer. At the visit, I would ask what the hospital needed from the agreement, show what other closed sites had done for staff families and leave with a date for a site walk-through. I would also make sure a second person at the health department had met the successor.

A Role Within Reach

The change I can make is within my current role. Since June I have been working through in-person visits to all nine sites, the newest contacts first, and I have asked the community health division manager to assign senior staff as second contacts for each site. I asked the hospital's emergency manager for a meeting in September 2026. She accepted. Whether the hospital rejoins or not, I will have had the conversation I avoided, and I will have learned whether the agreement's problem was the hospital's interest or my absence. I have also added a standing rule to my own calendar: any partner contact change gets a call within two working days and a visit within a month, with a second staff member present. The rule is simple, but it removes the choice I made badly in 2025, which was whether to make the call at all.

What the Lapse Cost

The cost of the decision can be counted. The hospital's withdrawal removed about 2,600 people from the closed dispensing network, close to a quarter of the people the network covered at the time. In an event, those people would join the public lines, at the sites whose setup was already too slow in the 2025 exercise. The lapse also cost something harder to measure: the hospital is the partner other organizations look to, and two long-term care administrators asked me later whether the hospital had "pulled out," which made their own renewals harder. National research on closed dispensing found that planners who had closed sites were far more likely to believe their jurisdiction could dispense within 48 hours (Rebmann et al., 2014), and the hospital was the site that most supported that belief in our county.

References

Crosby, B. C., & Bryson, J. M. (2005). A leadership framework for cross-sector collaboration. Public Management Review, 7(2), 177-201. https://doi.org/10.1080/14719030500090519

Rebmann, T., Foerst, K., Charney, R. L., Mazzara, R. L., & Sandcork, J. (2022). Challenges in managing, sustaining, and assessing closed point of dispensing sites: Findings from a qualitative study. PLOS ONE, 17(7), e0271037. https://doi.org/10.1371/journal.pone.0271037

Rebmann, T., Loux, T. M., Swick, Z., Reddick, D., Dolgin, H., Anthony, J., & Prasad, R. (2014). A national study examining closed points of dispensing (PODs): Existence, preparedness, exercise participation, and training provided. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 12(4), 208-216. https://doi.org/10.1089/bsp.2014.0014