137: From Local to Global: How Crisis Response Shapes Our World, with Heidi Steinecker

When crisis hits, what separates exceptional leaders from the rest? 

Dr. Heidi Steinecker draws from her remarkable career as Deputy Director of the California Department of Public Health and US Citizen Diplomat to reveal the unexpected qualities that define crisis leadership.

"What will do the least amount of harm?" 

This guiding question frames her approach to crisis management: She acknowledges that perfect solutions rarely exist, but strategic thinking can minimize suffering. Rather than merely reacting, she advocates for a proactive stance that combines data-driven decision-making with boots-on-the-ground intelligence gathering.

Heidi challenges conventional wisdom about crisis response. Being too calm during congressional testimony once drew criticism, yet she argues that compartmentalizing emotions while remaining focused is precisely what effective leaders must do. This emotional intelligence extends to recognizing when teams need mandatory breaks, a lesson learned during marathon pandemic response efforts when staff worked seven days a week for months.

The conversation explores how relationship-building before crises creates the foundation for an effective response and how trust and cultural understanding outweigh technological solutions. Her unique global perspective bridges lessons from remote villages to state-level pandemic management. And she finds hope in the next generation of leaders entering the workforce, who bring fresh enthusiasm and innovative approaches to complex problems. Their creativity and comfort with new tools promise more responsive, effective crisis management for the future.

Dr. Heidi W. Steinecker is a distinguished public health leader with over two decades of experience in healthcare delivery systems and public health policy. 

She has held several key leadership roles, including serving as a US Citizen Diplomat for US Department of State, Deputy Director at the California Department of Public Health and Principal at Resultant Consulting, where she advises government leaders on innovative ways to improve healthcare system strengthening, disease surveillance infrastructure, data modernization, and proactive analytic systems for preventative interventions in population health. Her work spans pandemic preparedness, quality and safety systems, and global health security, including epidemiological fieldwork in Uganda’s border of DRC and Rwanda. With a proven ability to align strategy, policy, and operations, Dr. Steinecker is committed to building resilient health systems and disease mitigation platforms to improve local and global health. Her expertise lies in integrating data-driven systems with people-centered processes to drive transformational change across all levels of healthcare and public health infrastructure.

You can learn more about her on LinkedIn. 

Go to https://betterhelp.com/resilience or click Notes on Resilience during sign up for 10% off your first month of therapy with my sponsor BetterHelp.

Chapters

• 0:00 What Will Do Least Harm?
• 2:53 Meet Dr. Heidi Stenecker
• 5:41 Leadership During Crisis
• 8:13 Data, Analytics, and Boots on Ground
• 13:19 Building Trust Before Crisis Hits
• 18:52 Balancing Urgency with Reflection
• 23:11 The Emotional Recovery After Crisis
• 31:45 The Next Generation Brings Hope

Transcript

Heidi Steinecker: 1:15

What is going to do the least amount of harm? That's always the question. What will do the least amount of harm? What has the best strategy to help the most amount of people and lay the groundwork for not just creating a band-aid on something? But how can we actually iterate and make something that's more of a systematic potential change or throughput for patient?

Manya Chylinski: 1:40

Hello and welcome to Notes on Resilience. I'm your host, manja Chilinski. My guest today is Dr Heidi Stenecker. She is a distinguished public health leader with decades of experience in healthcare delivery systems and public health policy, and she has served as a US citizen diplomat for the US Department of State and the Deputy Director of the California Department of Public Health, and she's a principal at Resultant Consulting. We had a wonderful conversation about a difficult topic, which is crisis management and how to lead when a crisis is occurring. I think you're really going to learn a lot, heidi. I'm so glad that we got this chance to talk today. Thank you for being here.

Heidi Steinecker: 2:25

Absolutely. I'm excited for the conversation.

Manya Chylinski: 2:29

All right, To get us started. What is one thing that you've done in any area of your life that you never thought?

Heidi Steinecker: 2:38

you would do so many to choose from, however, I would say getting to be able to do citizen diplomacy for sure, being able to meet with heads of state, ambassadors, ministries of health, whole cabinets. Sometimes I met with the entire parliament of Kosovo once when they were trying to design a new healthcare system. That piece of the puzzle was not on my bingo card growing up.

Manya Chylinski: 3:07

Yes, I probably didn't know many people's bingo card, but that's so cool. I imagine you have so many stories connected to those experiences.

Heidi Steinecker: 3:17

Yes, many stories connected to those experiences, yes, and both domestic and abroad, just experiences in that space where, when you think of healthcare as a rural student growing up in a rural area, which is where I grew up in rural California I was more really focused on access to care than later on in my career I was more focused on quality of care. And then I fell in love with this kind of juxtaposition where the intersection of healthcare and government meet, and understanding how whatever happens in one little corner of the world has its way of working, its way over to another corner of the world and so all things that happen locally end up global and all things that are global impact local communities.

Heidi Steinecker: 4:00

And seeing that there is that really important intersection between diplomacy relationships, data sharing, all of those things keep all of us safe.

Manya Chylinski: 4:11

Yes, wow, that's so amazing and I just love the sound of the work that you do and, like you said, the local piece and this global piece, and I'm a little envious of the kinds of experiences you've had. Well, thank you for sharing that. And today we're talking about crisis management and proactive strategies during a crisis, because I know you, in your public health role, have dealt with some big crises that I think we would all recognize. Just to get us started, how would you define what strong leadership is during a crisis?

Heidi Steinecker: 4:57

Well, I can perfectly define that as something I was actually accused of once of being too calm and collected by a senator during a hearing debriefing on a crisis.

Heidi Steinecker: 5:11

And I was accused of being too calm, collected and, you know, really rational with my approach of how we were going to go through something, rather than showing up to the testimony unhinged. And so when I was accused of looking on, feeling for the thousands who were dying, not only did I make it clear to that senator that I had lost a family member to COVID during the pandemic in a facility that I was, it was partially all of my responsibility for the entire state. So of course, I had personal feelings and fears and things. But when you are a leader, you need to compartmentalize. You need to be able to focus on your team. You need to focus on what you can do, not what you can't do, and constantly get your team to be motivated, inspired to just get up one more day and do one more task, one more purpose-driven mission, piece of the puzzle that they have a piece of and that's your job as a leader during a crisis.

Manya Chylinski: 6:10

Right Interesting that there was criticism of your being a strong leader. I imagine there would have been criticism had you come in in a panic and overly or not overly, but emotional about the situation.

Heidi Steinecker: 6:27

Of course, in my mind. My immediate thing that was running through my mind was I don't think you would ask a male leader the same question.

Manya Chylinski: 6:35

I refrained. I am fairly certain you are correct Exactly. I think we may have uncovered part of the challenge here, which is probably not a surprise to most of our female listeners. What is the first thing to look for in a leader's response when a crisis hits? Whether you're male or female, and whether you're asking the questions for some other reason or not, what is the first thing we should be looking for in leadership?

Heidi Steinecker: 7:10

So the first thing I look to is visibility of what the scope of the issue and the potential forecasting of the problem can be.

Heidi Steinecker: 7:19

I look at it as a chess match, right? Not as what is currently occurring at the time, but in addition to that, what are going to be the downstream effects that we need to be looking for in the next hours, days, weeks, et cetera. And with that, to have visibility, I need as much real-time data as possible, and real-time quantitative data is already kind of difficult to get sometimes because you don't have in a health situation. You need real-time understanding of where the bed capacity is, different acuity levels, different things, different types of facilities that you may need to evacuate or repopulate or transfer patients that are really critical and non-ambulatory, as well as which locations can you maybe be able to bolster and shelter in place. And those are all very kind of quick decisions you have to make based off of the information you have at the time, and so a leader needs to be comfortable making difficult decisions with the information you have at the time and then constantly being able to iterate and communicate the why between those shifts. Wow.

Manya Chylinski: 8:23

As you were describing that, I was thinking that one also has to have a lot of presence of mind to understand okay, this is what's happening in the moment and it's important, but I have to be thinking one, two, 12 steps down the line of what could be happening and you can't predict the future, so you have to make some guesses.

Heidi Steinecker: 8:46

I would say educated guesses right or estimates right. Luckily, when we're dealing with science, it's often a math equation right, so you can run different estimates based off of math and modules. I also like to work with fantastic data scientists who can run algorithms and risk algorithms based off of where we think that there are different weights of kind of root causes that could cause different scenarios to happen. So there's a lot that we can do now with predictive analytics. There's a lot of things that we can do for quicker decision-making based off of mathematical models.

Heidi Steinecker: 9:25

And in addition to that, I would like to say, because I think it's so important I'm a mixed method research person the fact that you can run risk models. You can be able to have an idea of where you think you're going to have highest risk locations to be able to intercede or mitigate quickly. But nothing replaces that qualitative data from being boots on the ground, getting that intel from your teams on the ground, flying in or driving in or whatever yourself to get to that location as well, to interview and understand the nuances and the context of what's creating those, those maybe quantitative measures that you're looking at. So you can't just look at one piece of the puzzle. You do have to be able to be able to get more local context and community and cultural context of what's happening in that particular area that you're trying to mitigate Right, and you mentioned your research background and that you like to work with data scientists.

Manya Chylinski: 10:27

If we're average company leader and suddenly dealing with something you never expected, you probably don't have access to that data scientist. So then that boots on the ground. Experience becomes much more important.

Heidi Steinecker: 10:41

Absolutely. I mean, I even spent last summer living in Uganda, in rural Uganda, on the border of the DRC in Rwanda, in the Bwindi impenetrable forest. That is the location is what epidemiologists like to call a hot zone in the world. It's a location where you have multiple different types of diseases, everything from HIV, malaria, dengue, cholera, monkeypox, ebola, you name it. It's going to come out of this region, for multiple reasons, of great biodiversity. However, you don't always have all of the same tools in the toolbox to be able to mitigate in these high-risk locations. So you have to be really creative, really collaborative, building trust with the local community and the cultures that are at play there If you're going to have any kind of protection of your healthcare facilities, to be able to, as these diseases are coming into your facility, to be able to quickly cohort and contain that you don't have mass outbreaks.

Manya Chylinski: 11:44

Right, and one thing you said there really sticks with me, which is building trust in the community and doing that before. You need to reach out before the crisis hits and you need to figure out what's going on in the ground or you need help, and I think that's a lesson that's transferable across industries, across locations. It's all about building those relationships across industries across locations.

Heidi Steinecker: 12:09

It's all about building those relationships Absolutely, and I think that is the key that is missing so often. And people want to build really cool tools. They want to do mobile applications, they want to be able to have more modern surveillance tools, and that's fantastic and absolutely agree with that. But you have to start with the people first. You have to start with the relationship building first. You have to build that trust so that you can be able to have focus groups and communities that want to use this. You do have staff who want to be able to buy in and be able to have real-time information at their fingertips. You do have to be able to have partnerships to be able to understand how different data sits in our play and be willing to have data sharing agreements for using access to data in a good way.

Heidi Steinecker: 12:59

For example, even in California, when I was serving CDPA, the Department of Public Health, we were starting to figure out that, oh, in all of our risk data algorithms, it didn't account for. Hmm, all of these child care centers that were around skilled nursing facilities and all of the health care workers working in skilled nursing facilities are around childbearing age. So we started to reach out to our friends in social services and say hey, you have all the data of outbreaks in child care centers. Would you be willing to share it with us? And this is the goal that we have in mind. Because we have this hunch of correlation here and, sure enough, because we had an established relationship, they shared that data into our risk algorithm and we were able to definitely see that there was within a five mile radius of a skilled nursing facility. If there was an outbreak in a local childcare facility that there would be an outbreak in that skilled nursing facility following a few days later.

Manya Chylinski: 14:27

Well, and, as you mentioned, it's so important to have built those relationships and be asking the people on the ground what they care about and what matters to them. I think there is often or perhaps not often, there's sometimes a desire to we know X, we're going to do this because it's the right way to do it. Usually, I think those don't end up to really be the best ways.

Heidi Steinecker: 14:52

Absolutely completely agree, and each community is going to be very, very different, right, and we have a lot of rural communities in the US that will be drastically impacted by the passing of the Big, beautiful Bill and the cuts of Medicaid, because a lot of our healthcare facilities in rural locations are dependent on that payer mix, are dependent on that payer mix, and I see that there's a lot of things that I learned in working in rural Uganda as far as these relationships and consolidations and creative ways that they can help each other could be ways that we can start to look at. How can we prepare ourselves to make sure that we maintain access to care in our rural communities here, right?

Manya Chylinski: 15:34

Because that which, by the way, I refer to it as the big ugly bill but that itself is creating a crisis that will need to be responded to.

Heidi Steinecker: 15:45

Absolutely.

Manya Chylinski: 15:46

Absolutely so. When we're thinking about a crisis, I know when I talk about it I'm often thinking of an incident that happens at a moment in time, versus something ongoing, like COVID, which lasted for a while, and the impact we're about to see on our rural communities, which is going to last for a while. As a leader, how does someone balance the urgency of that response with the need to really kind of listen and reflect and take a moment before making some of those big decisions?

Heidi Steinecker: 16:20

It's a great question because you don't want to be having analysis, paralysis, right? You don't want to also be waiting, because sometimes, then again, the information is shifting constantly and there are certain things like wildfires, earthquakes, anthrax, outbreaks, things that come across the border. We've had multiple different issues of crisis. It's even something as simple as, oh, there was a utility breakdown in a hospital and they don't have water for 48 hours, right? So it can be something small and very, very localized or something really spread. So it can be something small and very, very localized or something really spread.

Heidi Steinecker: 16:57

But regardless, it's taking that time to think through okay, what is going to do the least amount of harm? That's always the question. What will do the least amount of harm? What has the best strategy to help the most amount of people and lay the groundwork for not just creating a bandaid on something? But how can we actually iterate and make something that's more of a systematic potential change or throughput for patients, because it's a whole continuum, right? I know a lot of people think of hospitals when they think of, oh, a healthcare crisis or that, and they forget that there's actually 38 different types of healthcare facilities in the.

Heidi Steinecker: 17:38

US, and they're all licensed and regulated differently. They all serve a different niche of our healthcare delivery system and some of them are less seen as healthcare, but more of different types of centers to provide care for individuals who are vulnerable and unable to care for themselves.

Manya Chylinski: 17:58

Right. You said something that was so interesting to me what's going to do the least amount of harm, as a civilian, when something goes wrong? And looking to leaders like yourself and others who are managing the response, I think there's an expectation that there's somehow a single right answer that's going to protect everyone. And then it's hard as a civilian to be watching this and realize that the best answer, the best response, isn't necessarily one that is going to protect everyone.

Heidi Steinecker: 18:36

And that's unfortunately the case sometimes, especially if something is wide, widespread right, you are hoping to be able to protect those who are the most vulnerable to whatever that particular situation is. Right, and so if it's an infectious disease, you're able to know often what the pathogen attacks, how it transmits and who is more susceptible to it, right? So you kind of have that information. If it's a natural disaster, you are looking at the radius of that natural disaster. If it's an earthquake, of course you're looking at, you know, seismic radius to see what are the different types of licensed facilities or facilities that have people in them that can't just up and move right, people who, for whatever reason, whether they live on their on their self, by themselves, or they're living in a facility, they can't just ambulate and just move to another location easily, right? So that's what you're targeting in that case. When it's wildfires and or hurricanes, we have sometimes a path trajectory that we can tell based off of wind, but that can also constantly shift.

Manya Chylinski: 19:43

Yes, the other thing, speaking of constantly shifting in a crisis and we saw this a lot during COVID, for sure is we learn things, and so the response today is shaped by what happened yesterday and again. As a civilian out in the world, it can be so hard to understand that something you said was true last week actually isn't true this week and because, or this, what was true an hour ago isn't true now and when you're involved in a crisis and you're in a leadership position, how do you manage that? That information can be changing really quickly and it can be very difficult for people to understand that that is happening.

Heidi Steinecker: 20:34

Absolutely. Communication is the number one factor in moving a population toward the information they need to be able to make decisions for themselves. And that is one area that unfortunately, I would say during the pandemic was a lesson learned for all of us who work in science and leadership, because it was taken for granted. I think throughout the 80s and 90s like 70s, 80s and 90s you just had these kind of campaigns that you know. Yeah, of course, everyone gets vaccinated, everyone washes their hands, everyone does this. You know, infectious disease kind of fell away as a priority at that time period in the US and we had more on chronic disease. Because of all of the efforts in the 40s, 50s and 60s, we had cured or contained most of infectious diseases. So, other than AIDS, that came up in, you know, 80s and 90s and we then again found ways to mitigate for that, and so there wasn't a new novel pathogen in a while. That had been one of those things that an average American citizen would have been concerned with and we hadn't updated any of our approaches for how we communicate around infectious disease in years either. It was oh, you just go and do it right, you just go do what you're supposed to do right, and we needed to put more of an emphasis on the why and explaining quickly how and why this is shifting in real time. And it didn't help that we had conflicting messages coming out from the federal government versus whatever state government you were working with, right? So you had a lot of conflict there when it came to information. But you know, it's interesting, when I was in Uganda last summer and we did a vaccination clinic in a village on the DRC border and this is a location where they do not have a written language, so you actually have to go out there, stand in their city center in scrubs and then that lets everyone know that today's the day for vaccines and it travels by word of mouth and they will walk miles barefoot to get to you to get all of their shots. And so we did HIV testing, screening, treatment and vaccinations for kids and we vaccinated over a hundred families that day, just all day long.

Heidi Steinecker: 23:00

And one of the nurses came up to me and said yeah, so you're from America, right? And I said yeah. She says is it true what I heard in the news, that there's Americans who who wouldn't want these diseases that save your life? And I said yeah, it is true, and she goes. But why haven't they seen someone die of polio? Haven't they seen how, how deadly you know you can die of this, this and this? And I said sadly, no, they hadn't. They hadn't seen it in decades.

Heidi Steinecker: 23:30

And then the next question she had was so telling. She said but you must have elders who had, Didn't you have your elders talk to everyone about experiencing what measles, mumps, rubella was or all of these things? And I thought you know what we didn't For decades? We just told people go do it. This is what you do. We never did share those stories of our grandparents or people from other generations who had witnessed and experienced or lived a life in a wheelchair from polio. Like we never did a great job of explaining and carrying that information on, so people thought it was eradicated and no longer needed.

Manya Chylinski: 24:10

Right, and when you think about vaccines, for most of us, most vaccines were already existing when we got to the point where we needed to get them, or we learned about them, so we didn't go through that process of watching them be tested and having to deal with. What does that mean? And so, wow, that's so telling, though that it's something that people here weren't thinking about in the same way, and how grateful they were clearly for the opportunity to get this. Wow, thank you for sharing that. So, in a crisis situation, and whether it's something that plays out over a long time or it's kind of instantaneous how do you move from being reactive and trying to deal with okay, this is happening now, to that recovery piece of okay, now we've got to deal with this for the long term and the immediate crisis is over, or it's slowing down and we need to think about the future?

Heidi Steinecker: 25:12

So I think there's a step in between that reactive and response. That I'd like to try to insert is how can we be proactive in ending the heights of the issue sooner? So first you're reacting right with the information you have. Once you get enough information, you can start to take pieces of the puzzle and be like, okay, so we think this is going here or we think that it's going to now have a downstream effect to these locations where people hear what can we do to bolster them and provide them resources to mitigate in advance, to end it sooner, whether that is natural disaster or infectious disease? And then when you move past, when you get a handle of kind of stopping the progression or slowing it, then that recovery piece I think there's a big piece with crisis management that people forget is the emotional piece.

Heidi Steinecker: 26:12

So many, whether you are the responders or people who are mitigating the situation, or you're the heroes who are the active service players in that piece of the crisis, or you're the victim or citizen who was impacted, and sometimes you're both. Sometimes you're both a or citizen who was impacted, and sometimes you're both. Sometimes you're both a respondent and a victim. There is this emotional piece to it that people have to grapple with because in the moment, many responders particularly are trained to be able to be calm, cool, collected, handle things, help people, move things along. They're very focused on fixing and mitigating the situation at the moment.

Heidi Steinecker: 26:56

After the fact, when there's a moment of pause and you see the level of devastation to whomever it is, that's when a lot of folks who are responding sometimes go could I have saved more people? I mean, I always call it like the Schindler's list moment where you know at the end of Schindler's list where he's crying and says I could have saved more. It is that feeling that many different folks in either leadership or government positions or response or crisis management positions have, that moment of what could we have done more right? And that's good, because you iterate on these after actions. You purposely are looking at after action reports, thinking how you could do it differently and focused on that. But also I think it's important that there needs to also be some self-recovery as well, for folks to be able to truly kind of be as present as they need to be during the next stage.

Manya Chylinski: 27:51

Yes, and I think it's easy to overlook that or decide it's not important in the moment In terms of we got to continue the response. We have to keep helping people. I don't need to take a break, unless you are in a formal. If you are a first responder or you're in a crisis management firm, then they often have those steps of you have to step away and take a break after X amount of days. What have you? If you're not in an organization that requires you to step away? I think it's hard for people to step away until they have to.

Heidi Steinecker: 28:27

Yeah, absolutely Absolutely. We started to have to institute during the pandemic because, you know, all of us were service oriented leaders and we realized that it had been months since no one had taken an hour or so or a day off, Like it was seven days a week, in every single weekend. You were missing. Every holiday, you were missing every birthday, everything Right. And it wasn't until, as we neared the holidays, they said okay, we're going to start mandating All right, this person's going to take a Saturday off, this person's going to take a Sunday off, this person's going to take a Monday off. Like, and rotated around to force people off their like, don't even pick up your state phone, like you. You are, you are off and you have have. You have someone who is handling your duties for that day and have a whole process for how you are going to offload your authority, whether it was your decision making authority or whether it was your staff or whatever project a piece of the puzzle you were put on I'm.

Manya Chylinski: 29:24

That was very important and I'm sure that it wasn't enough for the amount of work that folks were putting in, but at least it was something, a little chance to get a break. Heidi, we're coming up to the end of our time and I want to talk to you forever, but I promised my listeners that we're going to go about half an hour, so can you tell us a little bit about yourself and the work you do and how folks can reach you?

Heidi Steinecker: 29:51

Absolutely Well. Folks can always reach me on LinkedIn. I am very present there and always happy to have a conversation whenever people direct message me and say hey, heard your podcast and would love to connect, and so I'm always happy to do that. A little bit about me I grew up in rural California and spent my first part of my career in health on the healthcare side everything from operations, regulatory quality and safety.

Heidi Steinecker: 30:18

Did a brief stint over abroad, in Germany, working with them as they were bringing in all their Syrian refugees and needing a process for surging their healthcare systems. During that time, came back and served with Governor Brown and Governor Newsom as the deputy and authority over healthcare system for public health and stayed in that role throughout until after we had the vaccine rollout in 2021. And since then I have both been serving as a US citizen diplomat for Department of State, as well as a consultant who's worked with many different states and countries, and just love to see where I can help different governments to be able to think through complex problems and trying to be able to put data and policy and operations together to where they can be able to work on their crisis management.

Manya Chylinski: 31:07

Wow, wow, that's so amazing. Thank you for sharing. And, as the final wrap-up question what is giving you hope these days?

Heidi Steinecker: 31:17

What's giving me hope is the next generation. I see the next generation of leaders or starting or workforce starting to enter and they're not deterred by whatever else is going on. And they're not deterred by whatever else is going on. And having that fresh level of enthusiasm is important to infuse into a workforce, and also creative about how they can be able to use different tools that we didn't grow up with right To be able to infuse into our government systems. Wow.

Manya Chylinski: 31:48

Well, thank you so much, Heidi. It was such a pleasure to talk to you today. I really appreciate you making the time. Thank you so much for having me. It was great talking with you. Thank you, and thank you to our listeners for listening to this episode of Notes on Resilience. We will catch you next time.