Introduction:In April 2009, the United States Centers for Disease Control and Prevention (CDC) learned that a novel and seemingly lethal strain of H1N1 was present in Mexico and was spreading into US border states. The majority of senior CDC leaders were trained in meta-leadership, a strategy for emergency preparedness and response developed at the Harvard University National Preparedness Leadership Initiative. This study reports on an analysis of senior leaders involved in that response. Methods: Senior CDC leaders involved in the H1N1 response between 22 April and 22 May 2009 were interviewed using a structured interview tool and a qualitative analysis of their responses. Results: Given the short time since the onset of the event, research still is in progress. However, preliminary interviews confirm that senior CDC leaders, including Acting Director, Dr. Rich Besser, were knowledgeable in the five dimensions of meta-leadership and were intentionally practicing and applying the strategy. A public opinion survey indicated an 83% approval rating for public health leaders managing the event. Conclusions:The five dimensions of meta-leadership are: (1) the leader; (2) situational awareness; (3) leading one's silo of responsibility; (4) leading up to one's boss; and (5) leading intra-agency and cross-agency connectivity. When adopted across the government and out to the private sector, metaleadership provides three important advantages: (1) a strategy of action designed to advance coordinated planning and response to major emergencies; (2) a conceptual framework and vocabulary that encourages intentional networking and cohesion to connect the purposes and work of different public and private stakeholders; and (3) a practice method that both instructs and guides multi-dimensional problemsolving. By deploying the skills and abilities of meta-leadership, positive outcomes were achieved during the early phase of the H1N1 outbreak in the US.
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