Advertisement

Medical Leaders and Management

  • Johannes Stoelwinder
Chapter

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.

Keywords

Health care organizations Organizational theory Transformation system Leaders Managers Clinical managers Professional control Management and leadership development Coordination Collaboration Change management 

References

  1. 1.
  2. 2.
    The Kings Fund. The future of leadership and management in the NHS no more heroes. In: Report from the kings fund commission on leadership and management in the NHS, 2011. London: The Kings Fund; 2011.Google Scholar
  3. 3.
    Dinh JE, et al. Leadership theory and research in the new millennium: current theoretical trends and changing perspectives. Leadersh Q. 2014;25:36–62.CrossRefGoogle Scholar
  4. 4.
    Mintzberg H. Managing. San Francisco: Berrett-Koehler Publishers; 2009.Google Scholar
  5. 5.
    Rundall TG, Davies HTO, Hodges C-L. Doctor-manager relationships in the United States and the United Kingdom. J Healthc Manag. 2004;49(4):251–68.CrossRefGoogle Scholar
  6. 6.
    Hood C. A public management for all seasons? Public Adm. 1991;69(1):3–19.CrossRefGoogle Scholar
  7. 7.
    Ham C, et al. Doctors who become chief executives in the NHS: from keen amateurs to skilled professionals. J R Soc Med. 2011;104:113–9.CrossRefGoogle Scholar
  8. 8.
    Dickinson H, et al. Are we there yet? Models of medical leadership and their effectiveness: An exploratory study. Final report. NIHR Service Delivery and Organisation programme. 2013. https://www.nwpgmd.nhs.uk/sites/default/files/Dickinson%20et%20al%202013%20are%20we%20there%20yet.pdf. Accessed 16 Apr 2015.
  9. 9.
    Vinot D. Transforming hospital management a la francaise: the new role of clinical managers in French public hospitals. Int J Publ Sect Manage. 2014;27(5):406–16.CrossRefGoogle Scholar
  10. 10.
    Stoelwinder JU, Charns MP. A task field model of organizational analysis and design. Hum Relat. 1981;34(9):743–62.CrossRefGoogle Scholar
  11. 11.
    Francke AL, Smet MC, de Veer AJE, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008;8:38.CrossRefGoogle Scholar
  12. 12.
    Retchin SM. A conceptual framework for interprofessional and co-managed care. Acad Med. 2008;83(10):929–33.CrossRefGoogle Scholar
  13. 13.
    Van de Ven AH, Sun K. Breakdowns in implementing models of organization change. Acad Manag Perspect. 2011;25(3):58–74.Google Scholar
  14. 14.
    Lewin K. Frontiers in group dynamics: concept, method and reality in social science; social equilibria and social change. Hum Relat. 1947;1:5–41.CrossRefGoogle Scholar
  15. 15.
    Kotter JP. Leading change. Boston: Harvard Business Review Press; 2012.Google Scholar
  16. 16.
    Beckhard R, Harris RT. Organizational transitions: managing complex change. 2nd ed. Reading, MA: Addison-Wesley Publishing; 1987.Google Scholar
  17. 17.
    Institute for Healthcare Improvement. How to improve. http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/. Accessed 16 Apr 2015.
  18. 18.
    Buchanan D, Fitzgerald L, Ketley D, et al. No going back: a review of the literature on sustaining organizational change. Int J Manag Rev. 2005;7(3):189–205.CrossRefGoogle Scholar

Further Reading

  1. Beech N, Macintosh R. Managing change: enquiry and action. Cambridge: Cambridge University Press; 2012. A how-to of organizational changeCrossRefGoogle Scholar
  2. Bohmer RMJ. Designing care: aligning the nature and management of health care. Boston: Harvard Business Press; 2009. A novel re-think of the management and design of the patient care processGoogle Scholar
  3. Day DV. Leadership development: a review in context. Leadersh Q. 2001;11(4):581–613.CrossRefGoogle Scholar
  4. Ely K, et al. Evaluating leadership coaching: a review and integrated framework. Leadersh Q. 2010;21(4):585–99.CrossRefGoogle Scholar
  5. Greenhalgh T, Robert G, Bate P, et al. Diffusion of innovations in health service organisations: a systematic literature review. Malden, MA: Blackwell Publishing Ltd.; 2005. An extensive review of change initiatives in health careCrossRefGoogle Scholar
  6. Hannum KM, Craig SB. Introduction to special issue on leadership development evaluation. Leadersh Q. 2010;21(4):581–2.CrossRefGoogle Scholar
  7. Langabeer JR, DelliFraine JL, Heineke J, Abbas I. Implementation of Lean and Six Sigma quality initiatives in hospitals: a goal theoretic perspective. Oper Manage Res. 2009;2:13–27.CrossRefGoogle Scholar
  8. Micklethwait J, Wooldridge A. The company: A short history of a revolutionary idea. New York: The Modern Library; 2005. A useful background to the establishment of organizations, their roles and purposeGoogle Scholar
  9. Orvis KA, Ratwani KL. Leaders self-development: contemporary context for leaders development evaluation. Leadersh Q. 2010;21(4):657–74.CrossRefGoogle Scholar
  10. Solansky ST. The evaluation of two key leadership development program components: leadership skills assessment and leadership mentoring. Leadersh Q. 2010;21(4):675–81.CrossRefGoogle Scholar
  11. Starr P. The social transformation of American medicine. New York: Basic Books; 1982. Describes the evolution of the authority of the medical professionGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Johannes Stoelwinder
    • 1
  1. 1.School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia

Personalised recommendations