Medical leadership: the case in the literature
Graham Dickson, PhD
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This look at three recent articles reveals the need for strong physician leadership. New models of physician involvement are required to engage physicians more in leadership roles, and robust physician leadership development efforts are vital.
KEY WORDS: physician leadership, expert leadership, health care reform, transformation
“Anyone can hold the helm when the sea is calm”— Ancient Philosopher
Recently, the concept of doctors moving into leadership roles has become a focal point in the literature. A primary reason for this focus is the ongoing challenge of health system reform, sometimes called transformation. The health care seas are not calm. Should physicians take the helm? Top
It is clear to physicians that transformation will take place with physician involvement or without it. Clearly, if physicians’ views, expertise, and intelligence are to influence the direction of reform, their participation as a partner is crucial. If they do not take the helm on their own, at least they should share it. Top
To do so, physicians must develop the skills of collaborative leadership: adopting a style that allows them to be, on one hand, the independent expert in medicine that they are and, on the other hand, the partner with a perspective, who must be included if reform is to be successful.
Recently, three articles have come to my attention that support this contention and highlight the rationale, challenges, and approaches that should be considered by physicians who are moving toward this expanded role. One article is from Australia, and the other two are from the United States, where major transformation is ongoing as a consequence of the Patient Protection and Affordable Care Act (“Obamacare”). Although both health care systems are contextually different from Canada’s, it is important to seek out lessons from other jurisdictions that may be relevant to the Canadian context. I present a short précis of each and encourage you to access them for your further edification. Top
The “expert” leader
Amanda Goodall and colleagues,1 in their article entitled “Expert leadership: doctors versus managers for the executive leadership of Australian mental health,” argue that physicians —experts in their specific medical field, in this case, psychiatry — are best positioned to lead institutions dedicated to that medical field. The expert leadership theory proposes the existence of a first-order requirement — that leaders should have expert knowledge in the core business of the organization they are to lead. Given two people with equal leadership and management experience, the one with expert knowledge will make the better leader. Top
The authors provide a number of examples from across the world to support this contention. Their argument in support of the expert leadership view is as follows. First, a psychiatrist executive is viewed as “first among equals,” because he or she originated from among the collegial group. Having been “one of us” signals credibility, which can extend a leader’s influence. However, it is important that the psychiatrist executive was/is a talented clinician and, ideally, also a researcher, in his or her prior career. An unaccomplished clinician who chooses the management route is unlikely to gain sufficient respect from physician colleagues. Top
Second, an expert leader, having grown out of the same environment, will be more able to understand the culture, values, incentives, and motivations of their psychiatrist colleagues and other core professionals.
Third, psychiatrist executives are uniquely placed to link clinical services with academic departments of psychiatry to provide a gateway for translational medicine, which is increasingly recognized as essential if health services are to improve. Top
Fourth, it is generally recognized that the success of any organization relies on the quality of its people. People who have excelled in their field of expertise (in medicine and beyond) can be expected to attract and hire others who are also outstanding in their field.
Finally, expert leaders can also signal various messages — about themselves and their organization — to their staff and outsiders. An accomplished clinician and researcher commands respect because of his or her proven track record.
Looking at the challenges
In the second article, Kathleen Sanford2 explores the challenges that physicians face when moving into leadership positions. She suggests that although physician leadership is widely considered to be essential for success in next-era health care systems, there is a message in this intent that elicits a variety of responses from health care insiders, ranging from antipathy to fear, from resignation to anticipation. Top
In this article, she articulates five questions that must be addressed to understand the role of physician leadership in health care transformation:
To answer the questions, she looks at some American health organizations that have embraced physician leadership development, including describing how dyad programs, i.e., pairing an administrator with a physician leader, at Palomar Health and Promedica are designed.
Also, she acknowledges that views among various groups in health care toward expanding physician leadership vary depending on personal experiences and biases, how leadership is defined, and how individuals believe their own career trajectories will be affected by possible shifts in power and influence. For example, most physicians would understand that moving into leadership will require major adjustments to relations between physicians and hospital executives. However, others might be surprised to hear that some consumers are bemused: “Haven’t doctors always been in charge?” Although all of these reactions to change are normal, it is vital for physicians moving into leadership roles to understand them and prepare for them.
Two leadership development approaches
The third article — by Sacks and Margolis3 — explores how two American health organizations, buffeted by change internally, each forged a new vision and business model that made them stronger and positioned them to thrive and excel. Top
One organization experienced a void when its primary physician champion and thought leader left in the midst of great change, underscoring the need for ongoing physician leadership development. The departure also initiated a period of discovery on how physician leaders can best communicate with other doctors.
The other organization, through a series of transitions, created a leadership development model that teams physicians and administrative professionals throughout its organizational training and development modules. They work together on creating solutions to existing real-world challenges facing their organization, essentially forming a brain trust that constantly develops fresh ideas while fostering synergies between new leaders. Top
Throughout, this article explores how organizational change fostered cultural changes and how leadership navigated through those shifts. And it presents two different approaches to physician leadership development efforts.
All three articles represent a broad phenomenon that is emerging internationally, as a consequence of ongoing demands for health care reform to address the new and emergent health and wellness needs of developed-country populations. The seas are not calm. Strong physician leadership, based on an understanding of medicine’s contribution to high-quality health care, is necessary. New models of physician involvement are required to engage physicians more in leadership roles. Robust physician leadership development efforts are vital. Both efforts will enhance collaborative leadership, positioning doctors as true partners in health care reform. Top
1.Goodall A, Bastiampillai T, Nance M, Roeger L, Allison S. Expert leadership: doctors versus managers for the executive leadership of Australian mental health. Aust N Z J Psychiatry 2015;49(5):409–11. Available: http://tinyurl.com/zyh4cuh
2.Sanford KD. The five questions of physician leadership. Front Health Serv Manage 2016;32(3):39–45.
3.Sacks L, Margolis R. Physician leadership in organizations undergoing major transformation. Healthcare; in press. Corrected proof available http://tinyurl.com/jtm294e
Graham Dickson, PhD, is senior research advisor to the Canadian Society of Physician Leaders.
Correspondence to: email@example.com
This article has been reviewed by a panel of physician leaders.