Developing medical leadership in India: A mission impossible?

Abstract

PurposeGlobally, there have been calls to enhance medical leadership in healthcare, although we know little about how this objective has been pursued in low-income middle-income contexts such as India. This paper highlights the opportunities to strengthen leadership in this context, while also considering the obstacles to this change and how they might be overcome.MethodsThe paper draws on a review of available secondary sources including published journal articles in the academic and grey literature, reports published by the Indian government and transnational organisations. The search focused specifically on medical leadership, clinical leadership, management and governance in the Indian healthcare system.FindingsIndia is currently in the throes of the world’s biggest experiment in universal healthcare popularly known as ‘Modicare’. However, these reforms have been criticised with regard to the lack of solid healthcare management framework in the country. The current National Health Policy highlights the need for specialised ‘public health management cadre, human resource governance and leadership development’. Nevertheless, the available research highlights a gap in the research on this topic, specifically about the development of medical leadership competencies. Our findings highlight not only the opportunities to develop medical leadership but also the obstacles to this process. Inadequate training and education, spiralling workloads, low salaries in the public sector and a growing culture of kickbacks have all stifled attempts to engage more doctors in leadership roles.ConclusionsWhile the Indian government is now focusing more on the need to strengthen medical leadership, there are significant barriers to change. In future, building leadership capabilities will require deeper reforms in training, regulation and remuneration of doctors to generate sufficient incentives especially in the public sector.

Striving for equity: exploring gender-inclusive medical leadership in India

“…However, in the World Economic Forum's Global Gender Pay Gap Report 2023,[38] India was ranked 127 out of 146 countries world-wide. Further, significant medical leadership competency gaps [19] exist in Indian health sector, which can be addressed through leadership development programmes [20]. India's 2017 national health policy [39] recognises this need for leadership and states that "human resource management is critical to health system strengthening and healthcare delivery ... [and it] recommends development of leadership skills …in [the] public health system."…”

“…To maintain research rigor and mitigate potential bias, the coding process was documented. The research findings were disseminated through workshops and blogs [24] and through checking [25] within the medical community.…”

“…While research within Indian healthcare has informed substantial medical leadership competency gaps in both public and private sector hospitals, [19][20] we know little about the perspectives of Indian physicians, particularly women and their leadership development needs following the COVID-19 pandemic. In this paper, we investigate how physicians' experiences and perceptions of leadership impact the dynamics of professional behaviour change within the medical field.…”

Vaccinating a billion people against COVID-19: India’s quest for systems leadership in exceptional times

“…This failure to public health reform has made India’s battle against COVID-19 even more difficult. We have earlier informed the presence of significant medical leadership competency gaps among doctors in India, which resulted in the under-performance of India’s major national health reforms (Gulati and Kirkpatrick, 2020). Further, to address the COVID-19 pandemic effectively, we demonstrated that leadership should be distributed across political, scientific and frontline clinical domains, with synergistic, rather than fragmented, momentum (Currie et al , 2021).…”