Matching public health administration leadership to changes in societal, political, and economic contexts

The political, socio-ecological, and policy environments surrounding healthcare in America continue to change. The Affordable Care Act is a symbol and product of such change. Two models of society within the policy sciences that are useful for understanding these changes are the market and polis models.

The market model envisions societal welfare as the aggregate of individuals' situations, wherein individuals are rational decision-makers maximizing their own self-interest. The polis model views society as individuals who are socially and materially dependent; people often have a private, self-interested side and a side concerned about the public interest.

For those in healthcare, the transition to patient-centered medical homes provides an example of these competing models. Note the transition in language from “consumer, provider, and payer” to “patient, personal physician, and insurer.”

Given increasing costs, access issues for the under/uninsured, difficulties of governments to afford to assist those in need of and/or entitled to care, and shifts in politics, the market model is of questionable use. The polis model changes the way policymakers and administrators approach, understand, and respond to the needs of today's communities.

This recontextualization of public health policy and administration in the polis model requires a change in public health leadership, a progression from transactional and/or exchange approaches to a leadership approach involving the collective management of meaning. In the polis model, leadership is less a matter of rewarding or facilitating individuals. Leadership is a matter of sensemaking situations, creating compelling visions of the future, relating within and across organizations, and inventing new ways of getting people and organizations to work together.

This presentation outlines the contextual appropriateness of utilizing the polis model of society in light of societal, political, and economic contexts and presents an effective leadership model for health administrators to employ in the midst of current contexts.