Table II.

Themes guided by the Public Health Leadership Competency Framework and example quotes from interviews with state-level health department staff in the United States (2019)

Domain	Elements within domain	Example quotes
Leadership and communication	Effectively sharing information and responsibility at different organizational levels	‘I will continue to give the authority to the division directors to run their programs as they see fit. And allowing for a review of how things go is what I’m looking at. So they know what they’re doing and they know what my expectations are.’
	Sensitivity to communicate with diverse cultures	‘I think that there’s lots of leadership support to maintaining excellent relations with our communities and the programs that we’re administering, making sure we’re accommodating their needs’
Collaborative leadership	Providing an environment conducive to opinion sharing	‘Our leadership is very supportive, specifically up the commissioner’s level. We have an open-door policy with our commissioner so that’s the way. If we see something, we can always go discuss it.’
	Offer opportunities for collaborative learning and quality improvement	‘We try to have a very collaborative decision-making process. I don’t know the last time that I personally came forward and said, “As your manager, you will no longer do X, Y, Z.”’
	Modeling effective group process behaviors	‘We’re organized into teams and into structures that continue and promote effective work and building off each other.’
Leadership to adapt programs	Facilitating reassessment and adaptation	‘We have an office of public health and performance management, and one of their tasks is quality improvement, so they do participate in our program and the plan new study act, and they have a quality improvement coordinator who implements rapid improvement events in different departments within our agency.’
	Serving as a driving force for change	‘I would say [changes are managed most effectively when] it’s well thought out and we really consider the process and how we’re going to roll it out.’
	Identify and communicate new system structures as needs are identified and opportunity arises	‘I like to think that we’re pretty effective when we do make a change and go in a different direction that it affective in the terms of communicating it, of trying to get people on board.’
Leadership and organizational learning and development	Advocate for learning opportunities	‘We participate on national calls so we would frequently stay up to date on changing evidence and changing policy that came out of CDC. We’re literally looking at, if you will, what’s being put out on that national agenda and that national stage at that time.’
	Foster an environment of trust	‘I think that’s really helpful with having the consistency of, for example, staff meetings or one on ones [with upper management]. All of those opportunities to share really make it then more comfortable and then easy for addressing circumstances that arise.’ ‘I think that there’s lots of leadership support to maintaining excellent relations with our communities and the programs that we’re administering.’
Political leadership	Advocate and participate in public health policy initiatives	‘Depending upon the makeup of your legislature determines which policies are passed and which ones are promoted. So, fortunately here in [name of the State redacted] we’ve had leadership that has been more in tune with health related topics.’
	Understand and apply effective techniques for working with boards and governance structures	‘There are factors like overall we have a very conservative legislature, so we have to have a sense of receptivity to issues we work on. Probably most dramatically we’ve encountered those issues because we do a lot of public campaigning. A lot of social media work and TV ads and that kind of thing so we have to make sure to write up to the governor’s office before anything gets aired that they’re okay with it.’
	Building alliances, partnerships and coalitions regarding critical issues	‘We had actually more funded partners at the time and I think as it would sound, the community-based coalitions would focus on just a broad strategy to reach any tobacco users in the community that were interested in seeking out cessation classes and then the minority-based coalitions were tasked with serving minority communities specifically’
	Evaluate and determine appropriate actions regarding critical political issues	‘I think that particular program, we had a change in the leadership, and then the person that started is very focused on scalability, sustainability, and outcomes, and the program clearly had no outcomes. She was able to really gain a support of the bureau chief to kind of identify that as an issue, and they were able to shut that down.’