Why Public Health Systems Rise or Fall on Leadership
By Jordan C Kabins, Ph.D., MBA
Introduction
Leadership development represents a critical yet frequently underestimated mechanism for strengthening public health systems. In high-risk environments characterized by chronic workforce strain and complex behavioral demands, effective leadership determines policy adherence, fatigue management, and the overall safety of patients and communities.
The Employer Perspective
From an organizational perspective, leadership development enables public health and healthcare employers to manage workforce behavior, fatigue, and alignment with institutional goals. Leaders function as the essential link between policy and practice. In the absence of strong leadership, even well-designed policies are likely to fail during implementation.
Effective leaders help:
Manage workforce fatigue and psychological overload.
Reinforce consistent behavioral expectations.
Align organizational goals, values, and day-to-day practice.
Reduce policy drift following crisis events and negative results
Inadequate leadership results in organizational misalignment, employee disengagement, and diminished accountability, all of which elevate risk within the system.
The Employee Perspective
From the employee perspective, leadership shapes the organizational climate. Public health professionals and nurses rely on leaders to model and promote the following:
Fairness and accountability
Teamwork and trust
A culture of resilience, rather than mere endurance
Motivation, coaching, and psychological support
When leaders do not foster these conditions, employees are more likely to disengage, experience moral fatigue, and withdraw from organizational expectations.
Field Evidence: Masking Behavior in the Post-COVID Era
Recent research conducted in Southern Nevada hospitals highlights a significant leadership gap. After the COVID-19 pandemic, many nurses knowingly violated established flu-season masking policies that required masking when caring for patients, even if the nurse declined the influenza vaccine (Kabins, 2026).
This behavior did not represent simple noncompliance. Instead, it reflected pandemic-induced fatigue, apathy, and psychological withdrawal resulting from prolonged exposure to personal protective equipment shortages, inconsistent guidance, and sustained crisis conditions. As a result, nurses not only violated employer policies but also unintentionally breached professional and ethical commitments, thereby increasing the risk to patients and colleagues (Kabins, 20216).
When psychological fatigue and erosion of the psychological contract are not addressed, the consequences are predictable:
Increased policy violations
Higher infection risk
Presenteeism and absenteeism
Declining quality of care
Leadership, Psychological Contracts, and Organizational Impact
Leadership development is central to restoring the psychological contract between employees and institutions. Leaders who recognize workforce strain, reinforce organizational purpose, and support recovery foster improved behavior, stronger compliance, and healthier systems.
The resulting impact is substantial:
Improved staffing stability
Reduced presenteeism and absenteeism
Safer care delivery
Stronger organizational performance
Ultimately, investment in leadership development constitutes not only a workforce strategy but also a public health intervention that simultaneously strengthens outcomes, ethical standards, and organizational performance.
Reference:
Kabins, J. (2026). The Challenges and Experiences of Mask Compliance among Nurses in Southern Nevada during COVID-19.
