The development of medical-manager roles in European hospital systems: a framework for comparison

Abstract

A central motif of health reforms around the world has been the drive to persuade doctors and other clinical professionals to become more actively engaged in the management of services. Examples include moves to extend the commissioning role of primary care doctors (such as general practitioners in the UK) and the introduction of ‘clinical directorates’ in secondary care. This strategy has been seen as a means of controlling professionals, turning ‘poachers into game keepers’, especially with regard to resource allocation. However, there is also a mounting body of evidence pointing to how clinical leadership may play a role in stimulating quality improvement and new innovations inservice design, with positive consequences for patient safety and satisfaction (1). Focusing on the top 100 hospitals in the US Goodall (2) finds a strong positive association between the ranked quality of hospitals and whether the chief executive officer was a clinician. A survey of 1200 hospitals across seven countries (UK, US, Germany, France, Italy,Canada and Sweden) conducted by McKinsey and LSE also finds that clinically qualified managers improve both the effectiveness of management decisions and clinical performance of hospitals overall (3).

Polish and UK doctors’ engagement with hospital management

“…In the UK, a unit level role has existed (Llewellyn, 2001), in being part-time and straddling both the clinical work and managerial worlds. There tends to be a 'troika' type arrangement at this level, similar to that seen at hospital level in Denmark (Kirkpatrick et al, 2009;Dent et al, 2012) with the Clinical Director operating alongside a business and staff manager, sometimes a nurse (Ferlie et al, 1996;Dopson, 2009 In contrast, doctors in Poland have reportedly "tended to be attracted to the chief of ward role because of the influence that it gives them" (Polish Hospital Manager), in the way some physician-executives have in the US (Hoff, 1998;Montgomery, 2001). This may be because they have enjoyed a broad range of autonomy, appointed for six years and often holding the role for longer (Sagan et al, 2011).…”

Exploring professionals' motivation to lead: a cross-level study in the healthcare sector

“…Although investigated in many industries, MTL has received little attention in the healthcare sector (Kirkpatrick, Bullinger, Dent, & Lega, 2012). Because of the high power, status and autonomy of physicians, as well as recent reforms that have introduced new managerial positions in this field, the healthcare sector represents an ideal setting for examining this topic.…”

“…Professionals are characterized by specific features, such as high status, power dominance and autonomy (Allen & Katz, 1985;Freidson, 1983Freidson, , 1984. With the 'managerialization' of organizations, professional workers are increasingly being placed in managerial roles (Freidson, 2001) and experiencing dramatic changes in their working conditions (Fitzgerald, 1994;Hunter, 1996;Kirkpatrick, Bullinger, Dent, & Lega, 2012;Lega, 2008;Lega & De Pietro, 2005;Lega, Prenestini, & Spurgeon, 2013). Empirical evidence suggests that the effectiveness of such changes strongly depends on the ability to place the right professionals into managerial positions (Braithwaite & Westbrook, 2004;Fitzgerald & Ferlie, 2000;Fulop, 2012;Ham, Clark, Spurgeon, Dickinson, & Armit, 2011;McNulty & Ferlie, 2004).…”

The missing link: toward an assessment of innovation capacity in health care organizations

“…Provan and Kenis [34] refer to the "struggle for legitimacy among participants in different internal networks" leading to tensions and instability in the organization. Kirkpatrick et al [35] argue that calling medical professionals to management roles and thereby "turning poachers into gamekeepers" have had a positive effect on "quality improvement and innovation design with positive consequences for patient safety and satisfaction". Degeling et al [36] plead for a strengthening of clinical governance by combining the interests of "both clinical practice and organizational structure", thereby "integrating financial control, service performance and clinical quality".…”