Over the last few years I have been involved in a number of different projects that focus broadly on the engagement of doctors in health organisations. There are many reasons why doctors play an important role in health organisations. They are a major professional grouping and are responsible for a large portion of all the care that we receive through the health system. Doctors are also often advertently or inadvertently responsible for many resource allocation decisions in the health systems. As highly trained and specialist professionals the same sorts of power and command structures don’t always work for these individuals. The same sorts of hierarchies that might work for other professional groups don’t always work as well with physicians. Often collegial influences will have greater influence than traditional modes of power. This means that credibility is incredibly important and sometimes more so than formal positions of power. Leaders of health care organisations therefore have to negotiate, rather than impose, new policies and practices, working in a way that is sensitive to the culture of these organisations.
Whilst working in the UK I was involved in a number of projects that investigated the issue of how to engage doctors in the management and leadership of health organisations. Chris Ham and I undertook a review of the literature and one of the international evidence a few years back. The evidence base has developed on since this time, but one interesting observation is that we haven’t yet managed to become clearer about what we mean by medical engagement, how we can measure it or what we hope that it might achieve.
Dickinson, H. & Ham, C. (2008) Engaging doctors in leadership: review of the literature. NHS Institute for Innovation and Improvement / Health Services Management Centre, Coventry.
Ham, C. & Dickinson, H. (2008) Engaging doctors in leadership: what can we learn from international experience and research evidence? NHS Institute for Innovation and Improvement / Health Services Management Centre, Coventry.
Chris and I were also involved with other colleagues in a study of doctors who had gone on to be chief executives in the NHS and what their career trajectory looked like. If you read the report below you see that all of these individuals had a very different story and the only thing common across these narratives is people telling them that a doctor going into leadership roles is a bad idea!
Ham, C., Clark, J., Spurgeon, P., Dickinson, H., Armit, K. (2010) Medical Chief Executives in the NHS: facilitators and barriers to their career progress. Coventry: Institute for Innovation and Improvement and the Academy of Medical Royal Colleges.
Following on from these reviews, our team were involved in some empirical data collection to examine the structures, processes and outcomes and medical engagement in a number of English trusts. The results of this appear in the report outlined below. Overall we found that England has moved quite some way on the topic of medical engagement since the last systematic research was conducted. However, we argue that there is still some way left to go and some important issues and tensions that need resolving if the aspirations of the English Department of Health are to be realised.
Dickinson, H., Ham, C., Snelling, I. & Spurgeon, P (2013) Are we there yet? Models of medical leadership and their effectiveness: an exploratory study. Final Report. Southampton: NIHR Services Delivery and Organisation Programme.
Recently I have finished a process of data collection with doctors in leadership roles in Australia. We are just in the process of writing up these findings and will hopefully be able to report these soon. We have found much that is similar to the UK experience but also a lot that is different. If you are interested in issues of medical engagement and want to talk about this further I’d love to hear from you.