Abstract
This is the question. Many health systems over the last 20 years have invested heavily in training doctors to help them to manage better their hybrid role, and now the same systems – even if some research has recently highlighted as best hospitals are run by doctors – are wondering if it’s paying back and if it’s still worth. My answer is yes to the latter, not enough to the former. To discuss this issue, I need to start from the following concept: if we have a great medical doctor, we need to let him/her practice as a physician or surgeon as much as possible. Anything less would mean denying access to great care to patients. We also know, thanks to evidence that’s emerged over the last 20 years, that great doctors often (if not always) place medical practice first above managerial responsibilities. So, a solution might be to identify a second-tier of physicians and, after a good appraisal of their potential, develop them as managers. So the top ones can focus 100% on clinical practice. But we know that in healthcare organizations there in an unwritten rule for which the managerial apex must correspond to clinical leadership. Further, doctors are legitimized by their peers to lead if they are recognized as clinical leaders. Therefore, managers have to be the great doctors. It’s up to us to support top physicians in their managerial roles in order to free as much of their time as possible for clinical practice. This involves training them in different fields, with the aim of making them charismatic leaders (those that provide vision, sense-making, problem-solving, coaching). Alongside them, we might need to develop instrumental leaders, those that act as organizational designers and operations managers. The latter group doesn’t need a medical background, as they act as project managers, as change agents. More than 100 years of organizational studies have taught us that organizations change when someone acts constantly to pursue – accordingly to a vision – new ways and continuous improvements. That makes the difference between good and great (healthcare) organizations, between those that are stuck in their “comfort bunker” and those that innovate and evolve. From this perspective we need co-management by these two types of leaders. And we should train them together on different aspects (from clinical governance issues to law and business management). Or, if we can’t do so, we should train them using the same approach and vocabulary, with the aim to create a common ground for decision-making based on a common language and on the alignment of vision on the future challenges and opportunities facing the management of healthcare organizations.
In the end, then, the question is this: what is written above can be a reasonable, actionable path? In which contexts? Why are we not researching anymore this issue – which is “the issue” – with more depth and resilience? Why the issue of governance of health organizations seems not to be a real key theme in the agenda of European and International scholars? Why we concentrate focus often on top management, and not enough on doctors as (in)effective middle managers in health organizations? Then, know what … HSMR would be happy to host this research, and to start a new fresh dialogue and debate on doctors-managers. Please, stay in touch.