The Leading Population Health Framework: A transformation road map

Leading transformation

The Leading Population Health Framework (LPHF) is based on pursuing and acheiving essential population health goals:

  1. protecting and promoting equity and health,
  2. transforming people and place,
  3. ensuring a healthy planet, and
  4. achieving health equity.

Population health improvement requires a leadership philosophy and transformation (Figure 1):1

  1. transforming self and interpersonal relationships,
  2. transforming teams and collaboratives, and
  3. transforming organizations and communities.
The Leading Population Health Framework (LPHF) is based on a leadership philosophy and three necessary transformations.

Transforming self and interpersonal relationships requires competencies in thinking, deciding, connecting, and leading. Transforming teams and collaboratives requires competencies in building teams, solving problems, and achieving impact. Transforming organizations and communities requires designing healing and learning organizations, mobilizing and engaging communities, pursuing health equity, and deploying data science—the art and science of transforming data into actionable knowledge. Transforming complex social systems requires experimentation, learning, innovation, and continuous improvement. At the San Francisco Department of Public Health, Population Health Division we have adopted the population health lean leadership philosophy.1 For a holistic, integrated summary see Figures 2.

The Leading Population Health Framework (LPHF) is based on a leadership philosophy and three necessary transformations.

The LPHF (Figure 2) is nothing original: it is our synthesis of what we have learned from the ingenuity, grit, and resilience of communities, staff, and colleagues from around the world. At center is the population health lean leadership philosophy to promote and support

  1. values, mindset, skillset, and toolset,
  2. leadership behaviors,
  3. people development,
  4. scientific problem-solving,
  5. daily management, and
  6. leading change (especially leader standard work).

The bottom left triangle is transforming self and interpersonal relationships. At center is the core human cognitive-behavioral processes of deciding, acting, and learning. The heart represents the central role of emotions. Radical Transformational Leadership is being, designing, and leading change from the core universal values of humility, dignity, equity, and compassion to transform self, people, systems, and cultures towards equitable and sustainable results (Conscious Full-Spectrum Response [CFSR]).2

W. Edwards Deming’s System of Profound knowledge is the understanding of (a) systems (systems thinking), (b) people (human psychology), (c) variation (statistical thinking), and (d) theory of knowledge creation (i.e., PDSA).

Strategic intelligence is (a) having foresight, (b) building a shared vision, (c) building effective partnerships, and (d) motivating and inspiring people. At center is the lean leadership philosophy that promotes (a) values and principles (mindset), (b) behaviors, (e) people development, (d) scientific (PDSA) problem-solving, (c) daily management, and (f) leading change.

The bottom right triangle is transforming teams and collaboratives. At center is lean thinking. And, the top triangle is transforming organizations and communities. Pioneered in San Francisco, the Community Action Model (CAM) is a community-based participatory approach that changes social policy through youth leadership development and policy action.3

A NewSmart organization is designed for optimal learning, adaptation, innovation, and continuous improvement by using the following psychological concepts: (a) positivity (promote positive emotions, minimize negative emotions); (b) self-determination theory (promote intrinsic motivation by supporting innate human drives for autonomy, relatedness, and competence); and (c) psychological safety (feeling safe to speak freely; to experiment, fail, and learn; to seek and give constructive feedback; to challenge others’ thinking, including the “boss”).

At first, Figure 2 may seem overwhelmingly complex—it is! Instead, start with Figure 1. Try it on for size. When ready, return to Figure 2 and start with “transforming self and inter-personal relationships.” To “be the change you wish to see in the world”4 you must commit to lifelong learning, critical self-reflection, and transforming self and interpersonal relationships. Before designing and leading change, we must be open to changing self. Transformation is an iterative journey. While you do not need a road map to take a journey, sometimes it helps.

Peruse the full document (link below). Experiment. Ask questions. Give us feedback. How can we improve?

Read full document here:

Aragón TJ, Colfax G. We will be the best at getting better! An introduction to population health lean.; 2019. Available from


  1. At the San Francisco Department of Public Health, Population Health Division we use population health lean. ↩︎

  2. Sharma M. Radical transformational leadership: Strategic action for change agents. Berkeley, California: North Atlantic Books; 2017. ↩︎

  3. Hennessey-Lavery S,Smith ML,Esparza AA,Hrushow A,Moore M, Reed DF. The community action model: a community-driven model designed to address disparities in health. Am J Public Health. 2005;95(4):611–616. ↩︎

  4. Although this quote has been attributed to Mahatma Gandhi, what he actually said was “If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. … We need not wait to see what others do.” (source: NY Times, 2011, ) ↩︎

Tomás Aragón
Tomás Aragón
Health Officer, City & County of San Francisco; Director, Population Health Division

I exercise legal authority to protect and promote equity and health, and I direct core public health services.

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