Two types of leadership, transactional and transformational, might be easy to distinguish theoretically, but in practice, their differentiation sometimes proves more difficult. For instance, The Patient Protection and Affordable Care Act (ACA) might be sometimes viewed as transactional (if it is assumed that the Act only extends the status quo), but it might also be perceived as transformational. We argue that ACA should be seen as transformational leadership because it introduces qualitative changes in health care sphere, including extended coverage and better quality of care, and thus changes the existing situation and optimizes system benefits; it possesses some other qualities typical of transformational leadership as well (Robertson, Fernandez, and Porter 287), and has the potential for increasing both the effectiveness and efficiency of organizations (which is an important task, according to tables 10-13 of the Management Handout).
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ACA, a federal statute adopted as a law in 2010, does not simply extend the status quo established by Medicare and Medicaid health care and insurance programs but introduces new rules that should lead to major changes in the existing system. One of the transformations it leads to is the inclusion of a greater number of persons in health insurance coverage. For instance, according to ACA, the coverage of Medicaid is expanded to families and persons who have an income of up to 133% of the federal poverty level. This is not only a quantitative but also a qualitative change, for it recognizes the needs of people having the income of e.g. 101% of the federal poverty level, and admits that these people are, in fact, equal to those having the income of 99% of this level.
Another change related to the coverage is the new requirement for enterprises that employ 50 or more persons to supply insurance for their full-time workers or pay additional taxes to the government. This provides employed workers with greater opportunities for health insurance, thus optimizing system benefits, which is another trait of transformational leadership (Robertson, Fernandez, and Porter 287). Notably, this change is not an attempt to reconcile different groups of power; it favors those who have less power and provides them with an additional benefit, which is uncharacteristic of transactional leadership (Robertson, Fernandez, and Porter 287), and, in fact, contrast it, as table 7 in the Leadership Handout displays.
Besides, ACA offers a number of other transformations that change the rules and “habits” according to which health care institutions work. For instance, the advancement of the National Quality Strategy is lead to the creation of new quality and efficiency measures. These measures should result in higher safety for health care customers, greater access to health information for patients, and better opportunities for value-based purchasing. The ACA also directs additional funds to improve Comparative Clinical Effectiveness Research and find out the best methods for providing different groups of patients with health care services. This should allow specifying the means of delivering health care to various subpopulations of patients, thus developing “fresh approaches to long-standing problems” and optimizing system benefits, which are, again, traits of transformational leadership (Robertson, Fernandez, and Porter 287).
As can be seen, ACA should be viewed as an example of transformational leadership. It introduces some fundamental changes in the system, such as greater coverage of health insurance programs, additional requirements regarding the provision of employees with health insurance by their employers, and reforms aimed at establishing the new quality of health care services. Even though ACA has its limitations, it has the potential of introducing fundamental changes in the U.S. health care system.
Robertson, Tausha D., Claudia P. Fernandez, and Janet Porter. “Chapter 10: Leadership for Public Health.” Public Health Administration: Principles for Population-Based Management. 2nd ed. Ed. Lloyd F Novick, Cynthia B Morrow, and Glen P Mays. Sudbury, MA: Jones & Bartlett Publishers, 2008. 281-295. Print.