A conduit for change
Health is the common thread linking all people. And without good health, it’s difficult to lead the lives we want and pursue the things we’re passionate about.
That fundamental belief is what drew Jeremy Lapedis, DrPH ’17, to the field of public health.
“I wanted to be a doctor, but then found myself being much more drawn to things that happened outside of the four walls of the clinics,” says Jeremy, adding that he was attracted to public health because it allowed him to focus on social justice issues and society-level issues. “Public health is the ability to improve the lives and health of folks from a systemic and structural viewpoint as opposed to just looking at individuals and all of their problems within one room.”
Today Jeremy is putting this idea into practice through his work at the Center for Healthcare Research and Transformation in Michigan. He’s working on the State Innovation Model, which is a federal grant to transform Michigan’s health care system. Jeremy’s work focuses on connecting health care and social services. For example, he’s examining the underlying causes that drive people to frequently visit emergency departments for primary health care needs. “A lot of the work entails getting together lots of different actors—stakeholders in the community, be they health systems, county government social service organizations, insurance companies—to develop plans for providing coordinated care for individuals whose needs are not being met by the current health system,” says Jeremy.
It’s the kind of work that graduates of the Doctor of Public Health Program are specifically trained to do.
Seeking management experience
Jeremy came to the Harvard T.H. Chan School of Public Health after working at an organization delivering HIV services in Boston. His work focused in part on connecting health care and social services—similar to the work being done in Michigan—because HIV can be particularly devastating for marginalized groups and those living in poverty.
Jeremy thought that in order to have the greatest impact he needed more management experience. “I thought the work we were doing was really good, and I wanted to get some ability to talk to insurance companies about what we were doing so they might reimburse us for it,” he recalls. “And I frankly did not have the knowledge, management skills, or clout to be able to [have that kind of impact].”
Jeremy was drawn to the Harvard DrPH Program specifically because it focuses on applied, hands-on work.
“I wasn’t interested in doing a PhD, which was a lot of research and not as applied,” Jeremy says. “The number one factor was that I was going to be doing work on issues and learning about them at the same time.”
Leading through empowerment
Jeremy began working in Michigan as part of his DELTA Doctoral Project. The DELTA Doctoral Project is the culmination of the DrPH Program; students complete field work with host organizations, with the specific goal of making a tangible difference—whether that be working to implement programmatic or policy changes, documenting the success of prior interventions, or developing strategies for effecting future change that have a high probability of adoption and implementation.
The project gave Jeremy the opportunity to apply the leadership lessons he had learned—particularly when it came to facilitating decision-making on difficult issues.
One such issue involves figuring out why some people in need of case management or medical services often “fall through the cracks.” The reasons are multi-faceted, but Jeremy said that in order to address the issue, it was important to bring multiple organizations to the table to find a common solution. Working alone, organizations could not fill the necessary gaps. But by working together, they are able to pool resources and strategies to help a greater number of people. The process is not always easy, but it is essential, says Jeremy.
“You can’t just solve a problem by thinking hard about it,” Jeremy says. “There’s a lot of personality dynamics involved, and you need to be able to respond to that. It’s best for a community to come together to able to talk about their problems and try to define the solutions for themselves, as opposed to for those solutions being handed down to them from the outside.”
As part of his DrPH studies, Jeremy had the opportunity to take classes at the Harvard Kennedy School, where he learned about something called a “holding environment,” which is a set of relationships between individuals that allow them to have difficult conversations with one another, yet continue to stay at the table together and keep working towards solutions to common problems. “Even though they may have different ideas about how best to approach and solve a given problem—or how to define the problem, there’s enough respect in the room and relationships there in order to keep them coming back to the table when there are a lot of forces that are driving them apart,” Jeremy says.
According to Jeremy, the DrPH Program has changed what he views as necessary to achieve his goals. Rather than leading from the top down, he realized that he could have much more of an impact by facilitating difficult discussions, and helping communities identify their own solutions to pressing issues.
It’s a strategy he’s putting into practice in Michigan, where’s he’s working with a group of a dozen different organizations to solve issues related to emergency department utilization.
“A traditional way of facilitating such a meeting would be [to say], ‘The data show that we have a lot of mental health issues and we have a lot of housing issues. How do we fix those mental health and housing issues? What are the best ways to do that? Or maybe even having a couple of proposed solutions—we need to find out some more money for affordable housing,’” Jeremy says. But an alternative—and often more successful approach—is to be deliberately inactive. “Another way is to sit back and say, what do you folks think the problem is? Then you sit around the table and you’re silent, and the whole group is silent. It’s uncomfortable for a couple minutes. Then people start to speak and start to define the problem for themselves and start to define the solutions for themselves.”
That flips the traditional power structure on its head, says Jeremy. And he’s seen success. While initially it may have been uncomfortable, he’s now seen the group become more comfortable speaking with one another and speaking on their own.
“I am not this person who is defining problems, but more the person who is a conduit to help define problems and come up with solutions,” Jeremy says. “This way, when people feel like they have issues that they’d like to bring up, they feel more comfortable.”
A broader focus
Working at the Center for Healthcare Research and Translation allowed Jeremy to return to his home state of Michigan. And he plans to continue working there through at least 2020—when the State Innovation Model project will end. But it’s likely he’ll stay in his home state beyond that—to continue focusing on fundamental issue of health care accessibility.
“Before I came to the DrPH, I was in HIV services; but now I’m working on [a different scale],” Jeremy says. “I still have a focus on giving voice to underserved and marginalized populations, but now it’s much broader.”