Medical Leaders and Management

Abstract

Health care organizations, like all organizations, are established by owners (be they public or private) to achieve a purpose, in this case treating patients. The owners typically appoint a governing board with the responsibility of achieving the purpose within a mandate they are given. The Board appoints senior management, sets the strategy and monitors performance. Thus the hierarchical management structure and management roles are established.

Managers’ work involves managing information, people and tasks. Theories of the role of managers and the functions of leadership intersect in particular in the area of managing people. While theories of management and leadership abound there is little reliable evidence to relate these to managerial or organizational performance. Health care organizations differ from many other organizations in that autonomous professionals, in particular the medical staff, control the core work processes. This breakdown in the traditional hierarchical structure is, arguably, at the root of many of the challenges in managing them. This has implications for the design of the role and the development of competencies of clinical managers, who are expected to control this professional autonomy on behalf of the organization by being both credible and competent as managers and as clinicians. It also influences the design of mechanisms for coordinating the work of the many health professionals involved in treating patients with the need for a contingent approach to collaboration and an emphasis on enhancing programming coordinating mechanisms in parallel with feedback. Influencing and developing clinical management involves planned change strategies. A number of frameworks for managing and sustaining change are provided.