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Doctor of Education in Leadership (Ed.D.)

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Karen Westberg, Thomas Fish, Sarah Noonan


This qualitative study explored the experiences of executive level leaders within the health insurance industry throughout the United States since the passing of the Patient Protection and Affordable Care Act (PPACA) approximately a decade ago. Fifteen leaders, including five Chief Executive Officers, five Chief Financial Officers, and five Chief Medical Officers, including three women, participated in this study. Most of the participants in this study were highly educated Caucasian males, and more than half worked for a non-profit health plan. The study addressed five primary themes: (1) health care reform, (2) education and lifelong learning, (3) leadership, (4) quality, and (5) the role of the customer. The primary modes of analysis applied through the study involved the use of Northouse’s (2019) adaptive leadership theory, Lincoln’s (1989) discourse, myth, ritual, taxonomy, Kramer & Enomoto’s (2007) ethical leadership theory, Bridges & Bridges’ (2016) transition model, and Bolman and Deal’s (2017) reframing organizations theory. The study sought to address these research questions: What knowledge, skills, and dispositions have health care leaders been using during these changes? How do clinical, administrative, and financial executives describe their leadership experience? How do current leadership practices compare to the literature? What types of decisions are health care leaders making?

Health care is a complex industry and continues to be a frequent topic of discussion and a point of contention throughout the United States. Cost, quality, and a lack of overall satisfaction remain the driving forces behind the overall frustration (An et al., 2013; Ungar & O'Donnell, 2015). The Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Acts passed in March 2010 served as a catalyst for change designed to address these concerns by expanding health insurance coverage to an additional 32 million individuals and tax credits for individuals, families, and small businesses to ensure the insurance was affordable. It also focused on shifting the health care delivery system from treatment and disease management to prevention and reduce costs and efficiency while improving quality and satisfaction. The New York Times stated it was “the most expansive social legislation enacted in decades” (Levey, 2010, September 9, p. 1). According to CNN it was a centerpiece of the 2012 presidential election campaign (Cohen, 2012, June 29).

In response to health care reform, the findings in this study indicate that Chief Executive, Financial, and Medical Officers have transformed their organizations through new visions and strategies. They shared information, built trust, and aligned their organizations. The leaders have started to see results and their key performance indicators demonstrated reductions in costs, improved outcomes in targeted areas, and improvements in the consumer’s experience.

The future is uncertain, and it is clear new that models evolved from these major changes which led to new ways to deliver health care, new and different players in the industry, new rules, and new roles and responsibilities. This is just the beginning of a major change which is expected to continue for at least the next five to ten years. Recommendations include health industry leaders need to: (1) develop and implement strategies for sustainable changes, confirm roles, responsibilities, and accountabilities are clear, and share key milestones and provide updates quickly and often, (2) seek alignment and agreement regarding the new organizational goals and measurements as well as how they are going to report their results, (3) engage employees and collaborate with stakeholders, (4) partner with educational institutions and those who provide care to their members throughout their communities, (5) develop and implement succession plans, (6) a bigger culture shift must occur before we will see higher outcomes, lower costs, and improved consumer satisfaction, (7) ensure that Chief Medical Officer have a reporting line to the Board of Directors and attend the Board of Directors meetings, and (8) have the Chief Executive Officer, Chief Financial Officer, and Chief Medical Officer provide their staff with a leadership compass, so the next generation of leaders can be effective at guiding their organization successfully through the complex health insurance rapids.


health insurance leadership, adaptive leadership, executive leadership, health care reform, change management, lifelong learner

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Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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