An evaluation of the National Public Health Leadership Institute--1991-2006: part II. Strengthening public health leadership networks, systems, and infrastructure.

Context: The year-long National Public Health Leadership Institute's (PHLI) goals are to develop the capacity of individual leaders and networks of leaders so that both can lead improvements in public health systems, infrastructure, and population health.

Objective: To evaluate PHLI's impact on networks, systems, and infrastructure.

Participants: Senior leaders from government, health care, associations, and other organizations who graduated from PHLI between 1992 and 2006.

Intervention: Retreats; readings, conference calls, and webinars; personal assessments, feedback, and coaching; and action learning projects.

Methods: A cross-sectional survey sent in 2007 to all leaders from the program's first 15 cohorts. Between 1992 and 2006, PHLI graduated 806 leaders. Of the 646 graduates located, 393 (61%) responded, for an overall response rate of 49% (393/806). Telephone interviews of 35 key informants were also conducted.

Results: Graduates fostered changes in systems, policies, organizations, and programs and frequently described these changes as resulting from their work as or with networks. Many graduates formed an informal national network of "thought leaders" and volunteered with professional associations to help in creating methods for improving systems and infrastructure. At the state level, graduates worked as informal networks and with associations to restructure services, reorganize agencies, catalyze new laws, and develop programs. Locally, graduates developed coalitions, fostered new laws, and improved programs, among other changes.

Conclusion: The Centers for Disease Control and Prevention's multiyear sponsorship of a national program fostered national networks among "thought leaders" who helped to lead the development and diffusion of numerous innovations. Public health leadership development program sponsors should foster collaborative leadership by engaging leaders in systems thinking, team leadership, dialogue, conflict resolution, and negotiation, recommend using networks for sustained personal and system development, and link leaders to networks and associations. Networks provide the collective creativity and broad support needed to enact system and infrastructure changes.