Intended for healthcare professionals

Careers

How does leadership differ from management in medicine?

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i631 (Published 03 February 2016) Cite this as: BMJ 2016;352:i631
  1. Matthew Limb, freelance journalist
  1. 1BMJ Careers
  1. Limb{at}btinternet.com

Abstract

Matthew Limb looks at what leadership and management mean for doctors and whether the two concepts can be considered separately from one another

“Leadership” and “management” are so often used interchangeably in discussions about the health service that any distinction between the two roles is often lost.

Michael West, head of thought leadership at the health think tank the King’s Fund, believes that management is about “supporting, resourcing, and facilitating day to day work,” whereas leadership “creates direction, alignment, and commitment.” He says, “The two are interlinked, and it is slightly artificial and misleading to separate them out and treat them as distinct. Leaders must manage to be effective, and management very much involves leadership.”

Lisi Gordon, a research fellow at Dundee University’s Centre for Medical Education, says, “Management is absolutely about process: the day to day to running of known processes. Leadership is more about change: it’s more about continuously reviewing and exploring possibilities for improvement and change.”

Jonathan Fielden, medical director at University College Hospital, London, agrees. “Leaders without management skills rarely become good leaders, and managers without the ability to lead people rarely can achieve what they need to,” he says. In practice, most senior roles demand management and leadership qualities, whether these are informal roles or formal roles such as medical director, chief executive, consultant, clinical leader.

He adds, “It’s really important, particularly for doctors, that they understand that they have both leadership and managerial responsibilities whatever their roles are. Individuals do tend to move more towards one than the other, but you need both skill sets.”

Creative thinking about roles

Doctors who want to be leaders can sometimes feel that they are being sucked into the business of just managing because of political, budgetary, and other pressures. Gordon says, “I can understand how there may be a feeling that people get bogged down with the day to day management, the processes.” But she believes that people need to step back and think more creatively about their roles and regard the wider service they provide.

Peter Wilson, a fellow of the Health Foundation’s Generation Q leadership development programme, says, “I don’t believe that in a good organisation management and leadership are separate.” As clinical director at Southampton Children’s Hospital, he says that he is managerially held accountable for targets and performance but also leads a “change agenda.”

Doctors may tend to see themselves “as leaders but not managers,” but that thought process has to change, Wilson says. “Actually, everybody is a leader and a manager simultaneously, because they are managing situations and leading situations. I think it’s a cop-out to pretend we’re not. It’s a way of dodging the bullets as it were. Leadership has to be about how you look at situations, utilise the data that you’ve got . . . and challenge where it needs to be challenged.”

Stephen Gillam, a GP and lecturer at Cambridge University’s Institute of Public Health, admits that he has “never got too hung up about the demarcation” between leadership and management.

But he believes that the current desire to aim for “distributed leadership,” which he interprets as “telling doctors you’re all leaders now,” risks underplaying or “sanitising” a salient characteristic of leadership. “Proper leadership requires sticking your head up above the parapet in a rather more prominent way and is more than just doing the things we all do like leading teams,” he says.

Detachment and toughness

One of the difficulties for clinical leaders is that they may often have to “be awkward” and challenge their colleagues to bring about changes, he believes. “You have to be a certain sort of individual to take that on,” he says. “You have to have a detachment and toughness very often to be an effective leader.”

Simon Bird, who leads on UK healthcare practice at the consultancy firm Hay Group, says that the term “clinical leader” has itself become “unhelpful” for doctors wishing to develop their careers. He believes that it has been “overused” by employing organisations, which often fail to define it or spell out accountabilities, leaving doctors without the support or resources to perform effectively. “At worse, doctors can then feel hoodwinked or caught out for being asked to do an impossible job,” he says.

Bird, a former NHS manager who works with NHS organisations on leadership and organisational development, says that trusts should be more “thoughtful and serious” about what they mean by clinical leader roles.

He also suggests that senior doctors in leadership roles who seem reluctant to accept management type duties are almost behaving like teenagers. “It’s almost naive to expect to be able to have the benefits of a leadership role without having to take on some of the other stuff that might be less attractive that comes your way with it,” he says. “I think it’s now impossible to separate the two.”