Clinicians’ experiences of becoming a clinical manager: a qualitative study

Abstract

BackgroundThere has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development.MethodsWe did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation.ResultsWe found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively.ConclusionsPath dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially for early stage clinician managers.

Role-meanings as a critical factor in understanding doctor managers' identity work and different role identities

“…While some advances have been made regarding categorising DMs' stances, the understanding of how different responses develop are at best partial. In particular, these studies have plotted variation in doctors' enthusiasm for entering and working in management and classified them into two types, variously described: that is investors versus reluctants (Forbes at al., 2004); adoption of, or alienation from, management values (Martinussen and Magnussen, 2011); cosmopolitans versus locals (Spehar et al, 2012); organization-compatible versus profession-compatible (Hoff, 1999); incidental hybrids versus willing hybrids (McGivern et al, 2015).…”

“…Hallier and Forbes, 2005;Cascón-Pereira and Hallier, 2012;Lewellyn, 2001;Spehar et al, 2012;McGivern et al, 2015). The research has drawn attention to the individual experiences and antecedents of identification with the managerial role.…”

Selective Consent and Dissent: Professional Response to Reform in the Post-Crisis Greek NHS

“…Medical associations in the UK and the US, for example, have been influential at the macro level; they have legitimacy as 'guardians of public health', control licencing and, therefore, the aggregate supply of professionals and have collective voice in opposing new polices that undermine their power base (though admittedly not always successfully) (Bolton et al, 2011;Harrison and Ahmad, 2000;Kirkpatrick et al, 2009). In the Continental model, despite the growth of professions within the bureaucracies of the welfare state, empirical research shows similar collective mobilisation in response to challenges to the professional base of power (Spehar et al, 2012). At the micro-level, professionals enjoy autonomy in their daily work when there is limited bureaucratic or market interference and they are able to exercise control over the division of labour and resources (Freidson 2001).…”

“…The relationship between professionals and the state, and the impact of the introduction of managerialism into the public sector, has for over a quarter of a century been a feature within the sociology of the professions (Dawson et al, 1995;Spehar et al, 2012;Reed, 1996;Flynn, 1999;Kirkpatrick et al, 2007;Kurunmäki, 2004;Waring and Curie, 2007;Montgomery, 1990;Hoff, 1998;Forbes and Hallier, 2006). A wealth of studies explore the response of professionals to state imposed managerialism and the ramifications for professional power and autonomy.…”

“…A model of professional dominance -state intervention -collective/individual professional response is typically employed to highlight occupational change and the restructuring of service organisations in a variety of national contexts. In particular, medical professionals' response to managerial reforms ranges from dissent, resistance, direct conflict with the state and alienation from managerial ranks (Harrison and Ahmad, 2000;Bolton, 2005;Dawson et al, 1995;Spehar et al, 2012;Reed, 1996;Flynn, 1999), to engagement, assertion of ownership of managerial practices, 'co-optation' and 'hybridisation' of medical with management practices (Kirkpatrick et al, 2007;Kurunmäki, 2004;Waring and Curie, 2007;Montgomery, 1990) and/ or to a pragmatist embracing of managerialism from younger doctors who see a career path in healthcare management leading to re-stratification of the medical profession (Hoff, 1998;Forbes and Hallier, 2006;Dawson et al, 1995;Skountridaki, 2015). To an extent, dissent or consent is a continually unfolding dynamic and complex picture that depends on how doctors perceive the incentives behind and outcomes emanating from changes.…”