Attempts to improve leadership in medicine are gathering pace in the UK and elsewhere. Doctors, academics, and healthcare leaders around the world are pondering key questions including the type of management skills doctors need, when they should start management training, and how to ensure they can put learning into practice.

The enhancing engagement in clinical leadership project—a joint initiative between the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges—is leading the way in the UK but has taken inspiration from abroad.

“In other countries you find a pattern very similar to our own.” says Chris Ham, professor of health policy and management at the University of Birmingham, who researched international approaches to management for the project. The numbers of doctors in chief executive or leadership roles are not much higher than in the NHS and their training programmes are usually voluntary.

But there are some exemplars. One is Kaiser Permanente, an integrated healthcare provider in the United States that has a high proportion of doctors in leadership roles. This is partly because of the organisation’s structure. Regional Permanente Medical Groups are entirely governed by doctors, and there is an expectation doctors will take on extra responsibility and management roles as their careers progress.

“But they don’t just expect people to take on those roles without giving them training and support,” says Professor Ham.

Medical groups offer clear career structures, which allow doctors to undertake clinical and leadership responsibilities in different combinations, supported by a comprehensive programme of skills development and leadership training. Doctors on the first rung of the ladder can access training on finance and decision making. As they move up they …