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

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

  1. a population health leadership philosophy,1
  2. transforming self and interpersonal relationships,
  3. transforming teams and collaboratives, and
  4. 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 lean leadership philosophy that promotes scientific reasoning, PDSA problem-solving, leader standard work, and alignment to purpose and values. Starting with self, leader standard work is developing people to solve problems and improve performance.

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. Based on Hess and Ludwig’s book Humility is the New Smart,2 NewSmart behaviors are (a) Quieting Ego (intellectual humility and mindfulness), (b) Managing Self (thinking and emotions), (c) Reflective Listening (listening to understand and empathize), and (d) Otherness (connecting and relating to others).

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 (scientific reasoning). Strategic intelligence is (a) having foresight, (b) building a shared vision, (c) building effective partnerships, and (d) motivating and inspiring people.3

The bottom right triangle is transforming teams and collaboratives. At center is lean thinking—a core PHL practice that operationalizes daily scientific reasoning: (a) PDSA problem-solving, (b) validated learning, and (c) A3 reporting. PDSA problem-solving is finding and solving problems using reasoning, planning, prediction, experimentation, learning, and improvement. Validate learning are PDSA cycles with a purposeful goal. A3 reporting is using A3 paper to summarize, collaborate, and communicate around a complex problem.

At 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.4 The CAM has led to tremendous success in tobacco control policy achievements in San Francisco (see

At center of the top triangle is population health data science (PHDS) is the art and science of transforming data into actionable knowledge to improve health. Actionable knowledge is knowledge that influences, informs, or optimizes decision making. PHDS supports decision quality. PHDS has five analytic domains: (1) description: measuring the burden of risk factors and outcomes; (2) prediction: early targeting of prevention and response strategies; (3) explanation: testing causal pathways for designing prevention strategies, and discovering and testing new causal pathways; (4) simulation: modeling processes for epidemiologic and decision insights; and (5) optimization: optimizing decision-making, priority-setting, and resource allocation.

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”5 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, Garcia BA. We will be the best at getting better! An introduction to population health lean.; 2017. Available from


  1. At the San Francisco Department of Public Health, Population Health Division we use population health lean. ^
  2. Hess E. Humility is the New Smart: Rethinking human excellence in the smart machine age. Oakland, CA: Berrett-Koehler Publishers, a BK Business Book; 2017. ^
  3. Maccoby M, Norman CL, Norman CJ, Margolies R. Transforming health care leadership: A systems guide to improve patient care, decrease costs, and improve population health. 1st ed. Jossey-Bass; 2013. ^
  4. 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. ^
  5. 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, ) ^


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