Why healthcare systems need medical managersBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7095.1636 (Published 07 June 1997) Cite this as: BMJ 1997;314:1636
Doctor managers have distinct advantages
Healthcare systems need the best management. This can happen only if doctors become more involved in management and increase their management skills. Experience in many health systems has shown that doctor managers have distinct advantages over their non-medical counterparts, including greater credibility, a deeper knowledge of how health care works, and a less trammelled ability to speak out. But these advantages will count for little unless doctors who become managers are well trained and work to develop the intellectual base of medical management. Various initiatives are under way to develop medical managers, including the relaunch in February 1998 by the BMJ Publishing Group of the journal Clinician in Management.
Doctor managers put patient care and clinical outcome ahead of the financial imperative, and this ultimately is the only way to develop the business of healthcare systems–looking after patients. Businesses prosper not because they try to make profits but because they do something important well. The British healthcare system, the NHS, like many systems has two lines of management. One is a bureaucracy characterised by a hierarchical, top down management inescapably bound up with politics. Alongside this system sit the professionals, often working in teams with members whose status is essentially equal. This coexistence inevitably generates tension between the professionals, who organise through peer review, and managers, whose survival is dependent on achieving targets set from above.
Clinicians who are well trained in management have a unique power base. They have an intimate knowledge of how the service works, and their views are thus often accepted more readily than those of non-clinicians. Furthermore, medical managers have a clinical career to develop or return to. They can thus afford to adopt high risk strategies with far greater comfort than their non-clinical colleagues. And they can speak out. Consider the trust that faces a health authority making irrational decisions. A medical director can argue against it and is likely to be believed. It is much harder for chief executives to make similar statements, not least because their average length of time in post is currently running at two years and eight months. No matter how much a chief executive's values may coincide with that of the clinicians, he or she is vulnerable if there is direct conflict between what is right for patient care and what is demanded from above.
Senior strategic roles in management now attract the brightest and best doctors, and this must be encouraged if doctor managers are going to make real improvements in healthcare systems. Management should no longer be seen as an eccentric hobby for the bored or inept doctor. All clinicians must know something about management, even if it is to be able followers rather than leaders. Doctors have a duty not only to play their part in management but also to ensure they have the knowledge and skill to do it well. There is an art and a science to the management of services–making them work, developing contingency systems, motivating, managing colleagues' performance, and understanding service operations. It is time for doctors who have taken a lead in management to share their knowledge and enthusiasm with the medical profession as a whole. The next generation of doctors must not only be able clinicians but must also know how to run an effective clinical service, from understanding the budget to improving clinical outcomes.
The maturity of medical management is signalled by the increasing contribution of medical managers to major national committees; the emerging interest from the royal colleges; the development of the Scottish Intercollegiate Initiative in Medical Management; the growth in the British Association of Medical Managers (BAMM), which now has 800 members; and the appearance of the new journal. Clinician in Management was originally BAMM's in house publication, but it will now become a quarterly peer reviewed journal with an international circulation. It will publish research, air controversial issues, share good practice, and examine every aspect of healthcare delivery and the role of professionals. One way in which doctors can contribute to management is to bring their research based scientific tradition to the discipline This will be one of the aims of Clinician in Management.
Jenny Simpson is editor of Clinician in Management: see advertisement in this issue (except compact edition).