Leaders and managers of health systems?

How do clinicians construct their identities as leaders and managers?

Leader or Manager

Leaders provide the strategic vision and direction for health care organisations and prioritise and allocate the necessary resources. Clinician managers articulate this vision to clinical teams and ensure that these teams have the staff, medications and the other operational requirements to deliver high quality care.

Clinicians as leaders

Clinicians enter their profession and develop their professional identities once they start working in their chosen fields of medicine, nursing, pharmacy or allied health. It is important to understand how clinicians prepare themselves for leadership roles and the skills needed?

We should acknowledge, that management and leadership requires different skills to that of the practicing clinician. Clinicians usually work as part of a team of health professionals to promote healthy lives, prevent ill-health and to treat and cure diseases.

Healthcare leadership has been described by the King’s Fund, an independent body that conducts research into health and health systems, as ensuring the ‘direction, alignment and commitment within teams and organisations’. In a comprehensive review of leadership development in health care, the Fund determined that a number of competencies are important for leaders. These are:

• Technical competence – knowledge about the strategic direction of the organisation, how it is structured, the processes as well as an understanding of health care services, treatments and technologies.
• Conceptual skills – knowing the complex internal and external environments of health organisations. These skills are necessary to analyse, plan and make key decisions needed for healthcare organisations to function.
• Interpersonal skills are important to understand the needs of health workers. Being aware of the reactions of others is essential as well as monitoring the effects of one’s own behaviours and the impact upon others.(West et al.,2015).

What is the role for clinicians as leaders and managers in the health system?

Clinicians who find themselves in the role of manager must be able to direct teams, manage and understand budgets and ensure that care is delivered safely and to a high quality. Clinician leaders will provide direction and a clear vision and focus in the clinical area where they work. Many nurses will move from clinical to management positions and they manage aged care facilities, patient flow processes, clinical wards and operating theatres. Other clinicians also lead and manage teams, large medical and allied health workforces, health care organisations, and drive the policy and strategic direction of health care systems.

Clinicians who lead, manage and build teams need an understanding of human resource management functions, such as recruitment, talent management and how to build effective cultures. Clinician managers will also be focussed on the sustainability of the workforce, retention of workers, ensuring that the right skills are in the right place at the right time. This will require that clinicians have the ability to participate in health workforce planning and management.

Hybrid managers

The delivery of healthcare services is complex and relies on many components working together. Clinicians, as they gain experience may also lead and manage health care organisations and teams. Such roles are referred to as hybrid managers.

We will have a detailed look at the hybrid manager in the next step.

Your task

Do you know of anyone who is a clinical leader? What do you think is the most important quality of a clinical leader?

References

Clay-Williams R, Ludlow K, Testa L, et al.(2017). Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors? BMJ Open: https://bmjopen.bmj.com/content/7/9/e014474.long)

Kippist, L., Fitzgerald, A. (2009). Organisational professional conflict and hybrid clinician managers: The effects of dual roles in Australian health care organisations. Rerieved from: https://doi.org/10.1108/14777260911001653), Journal of Health Organization and Management, 23(6) 6, pp.642-655

Nzing, J., McGivern, G., English, M.(2018). Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens. Retrieved from: https://doi.org/10.1093/heapol/czx167), Health Policy and Planning, 33(2), ii27–ii34

Sarto et al. (2016). Clinical leadership and hospital performance: assessing the evidence base. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896259/pdf/12913_2016_Article_1395.pdf), BMC Health Services Research, 16(2), 169

West, M., Armit, K., Loewenthal, L., Eckert, R., West, T. and Lee, A. (2015). Leadership and Leadership Development in Healthcare: The Evidence Base. London, Faculty of Medical Leadership and Management.

WHO (2010). Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. Retrieved from: http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf](http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf