This paper will focus on how effective Leadership can influence policy and change in the United States healthcare system. The implementation of new policy, program, and institutional change is often meant to improve the quality of the nation’s ever-changing healthcare system. Several journal articles and texts have been selected particularly with a focus on leadership strategies to improve the quality of healthcare, and leadership’s ability to influence implemented changes to the system. The question proposed is; does leadership encourage and influence both public and private initiatives that measure health outcomes, and organize systems to improve health services when new policies, programs, and institutional changes occur? The issues summarized in this paper are supported by scholarly journals and texts that offer several perspectives, including real life examples that will illustrate my argument that effective leadership can impact changes within the healthcare system.
Our great nation has had a significant history of leadership both transactional and transformational throughout its existence. I venture to say that leadership is not just about performing a job: It’s about making a difference. When considering changes to healthcare, whether it is institutional, program, or policy, the importance and ability for leadership to put systems in place that strategically fulfill the goals and measures identified are extremely important. For example, with the passage of the Affordable Care Act, the future of healthcare has become more defined as noted by Baldwin; The Circle Way: A Leader in Every Chair (2011), “To serve as effective leaders, we must understand the context for our leadership roles–namely, the changing health care system and particularly, the impact of the Patient Protection and Affordable Care Act that President Obama signed into law on March of 2010.
The Affordable Care Act resulted from months of intense Congressional action and serves as a reminder that fundamental legislative changes do not happen overnight. Congressional tinkering over the 75 years since President Roosevelt attempted to enact national health insurance has yielded little by way of major change in health care programs, except for the addition of Medicare and Medicaid by President Johnson and the addition of Medicare coverage for prescription medications by President George W. Bush“.
The new health care reform law is more than just a big change. It promises to be transformative as suggested by Baldwin, “that the old framework is disappearing because we don’t really know what the new normal will look like, and that uncertainty creates angst among consumers and health care providers in all fields, clearly leadership will play an important role in defining the path more clearly. Examples of the types of leadership needed are transformational and transactional leadership.” The success of health care reform will also depend on collaboration among regulators, insurers, and providers. Success hinges on an approach to regulation that is flexible enough, particularly on antitrust issues, to ensure that these groups can cooperate to pursue the goal of providing access to high quality health care at a cost the public can accept.
As noted by Linsky, Leadership on the Line: Staying Alive Though the Dangers of Leading (2012), “Transformational leaders are driven by a moral or ethical imperative. They forsake a transactional leadership style in pursuit of something that must be done in and of its own right. For the transformational leader, the pain of leadership is exceeded only by the pain of lost potential. Transactional leadership, on the other hand, reflects the political exchange of resources, and is dominated by the coalition that possesses the most resources as measured in the current paradigm. There is a huge price to be paid by the transformational leader. It takes immense courage to challenge the vested interests of the dominant coalition that is threatened by ideas that shift the paradigm. It is also painful to be rejected by those whom you would seek to lead“. Changing market demands in health care mean we need new models for delivering services in a more agile, responsive and effective way.
I believe that leaders have the ability to translate personal talent, skills, and qualities into action that can influence change. Leaders take a stand for what they believe in and work to convince others to think and act differently as new policies, program change, and health care systems are implemented. Given the implementation of new program and policy changes leaders are driven to find better ways of doing things, and take paths that others fear to tread. Leaders empower people by providing new pathways to success, implementing new procedures, and guidance that enable others to move forward with a clear vision building strong relationships and inspiring trust and confidence in the process.
As a healthcare professional, I realize that each of us has a responsibility to help other health care professionals understand organizational goals, new program policies, and the many contributions we can make to the health and well-being of our citizens and the nation. As mentioned by Hertsgaard, Healthcare; Living Through the Next Fifty Years (2011); “The effectiveness of new program implementation, or policy change can be undervalued by many health care professions that view health care decision making as only being made by a handful of individuals that may not particularly benefit the whole. If value is to be added, all affected by new program, or policy change should understand the benefits of inclusion of all healthcare disciplines as partners willing to assume leadership positions. If those affected choose to abdicate leadership roles, they give others power over our future as health care professionals”.
An example used to illustrate my argument that the ability of leadership to impact, new procedures, policies, can be noted in the passage of the Affordable Care Act, as noted by Heifetz; Leadership Without Easy Answers (2012), “While the Affordable Care Act offers the potential to positively impact health care, we have a lot of work to do as regulations are implemented at the national and state levels. Implementation of health care reform may offer yet another test of our political system as Democrats and Republicans play out their very different health care visions. The federal health care reform law does not create a new system but does fill gaps in our existing system. It is a product of both a fragmented political process, which compels compromise, and our fragmented health care system, which limits reformers’ options to move away from the status quo.
Strong leadership will be required to realize the potential and promise for health care reform“. I do believe that because of transformational and transactional leadership the passage of the Affordable Care Act was possible. Below illustrates several fundamental institutional, program, and policies changes leadership will have to strategically implement with the passage of the transformational Affordable Care Act as noted by Zimmerman, Leadership in an Evolving Health Care System (2012); “It provides for: * Significant innovation with a focus on improved patient outcomes achieved through integrated care systems; * Fundamental payment reform, including capitation and bundled payments; * Expansion of pay-for-performance, where payment will be linked to outcomes in outpatient care; * Refocusing the system on wellness and prevention; and * Levels of transparency and accountability never before demanded of our health care system or its providers”
Furthermore, Zimmerman argues that for fundamental changes to occur; implementation of new policy and program change should be carried out by all individual as the system thrives on continuous innovation–just like strong leaders do“. Despite the limitations of our current delivery system, I do believe that leaders in the private sector health care see opportunities for innovation and change as our health care system evolves. Fixing our broken health care system will require courageous and innovative leadership on all fronts. There will continue to be strong reasonable voices all along the political spectrum that disagree about what changes are necessary, how to fix what’s broken and how to pay for the fixes. As Heifetz suggests in Leadership on the line (2012), “the fact is that organizations don’t just change because of new systems, processes or new organization structures. They change because the people within the organization adapt and change too.
Only when the people within it have made their own personal transitions can an organization truly reap the benefits of change, and good leadership recognizes and attempt to improve on those ideas”. As I reflect on the state of today’s health care leadership, I find that those individuals who have had the greatest impact are the ones who have let go of the consequences of that leadership. That is, rather than play it safe by reacting to consensus opinion; they have chosen to passionately lead to a transcendent vision. In essence they have rejected the politics of transactional leadership, and taken a position in service of what to them is a moral or ethical imperative.
In his book, The Tipping Point, Malcolm Gladwell identifies three types of leaders who have disproportionate impact on influencing their peers. “These are people who are either well-connected, serve as mavens, or act as salesmen. * The first are individuals who act as communication nodes for the spreading of information. * Mavens are knowledgeable individuals who delight in sharing that knowledge with others without seeking personal gain. * Salesmen are in many ways the most important. These people have the capacity to emotionally influence their constituents. They have presence or charisma, and easily influence others through their capacity to express and elicit common emotions.”
In conclusion, it is the job of leaders to create that environments in which letting go of the consequences of leading to a transcendent vision can inspire their followers and allow them to reconnect to the meaning and purpose in their work. In a world of exponential change, where leaders must serve in the capacity of change agent, transformational leadership is paramount. It is a position of great risk, requiring courage and can only be successful when driven by the passion of a transcendent vision. It is imperative to find joy in the doing, to make the journey and destination the same.
1. Baldwin, C. and Linnea, A. The Circle Way: A Leader in Every Chair. San Francisco: Berritt- Koehler Publishers, 2010. 2. Gladwell M. The Tipping Point. How Little Things Can Make A Big Difference. Boston, Little Brown and Company, 2000. 3. Heifetz, R.A Leadership Without Easy Answers. Cambridge, Ma: The Belknap Press of Harvard University Press, 2012. 4. Heifetz, R.A and Linsky, A. Leadership on the Line: Staying Alive Though the Dangers of Leading. Boston: Harvard Business Review Press, 2012. 5. Hertsgaard, M. Healthcare: Living Through the Next Fifty Years. New York: Houghton
Mifflin Harcourt. 2011.
6. Zimmerman, C. Leadership in an Evolving Health Care System. New York: Free Press, 2011