Leadership, clinician managers and a thing called “hybridity”

Abstract

The paper is the first to examine the concept of hybridity in the context of clinician leadership. Many approaches to leadership in healthcare fail to address the complexity of leadership within the ranks of clinician managers and thus are unable to deal adequately with the role of leadership in healthcare reform and change.

The reforming appeal of distributed leadership

“…In this instance, committed practitioners assumed responsibility for implementing important changes, covering the decisions associated with this informally and collectively as they balanced the demands on their time and expertise. The more recent research in this review demonstrates that this pattern (Cleary et al, 2011;Fulop, 2012;Haycock-Stuart and Kean, 2013;Chreim et al, 2013;Byres, 2015).…”

“…The empirical evidence detects a mixture of tendencies, with top-down and local leadership combined in various ways rather than conforming unambiguously to a single model or movement. Some commentators, notably Fulop (2012), present this in a positive light, as a corrective to polarised thinking. They see complementary elements compensating for weaknesses in each and offering compromises that may have more relevance for leadership development than prioritizing one approach over the other.…”

“…Some senior nurses (Viitala, 2014) and doctors (Currie and Locket, 2011;Fulop, 2012) offered similar arguments for combining concentrated and distributed leadership, often acknowledging that their views were at odds with the prescriptive literature. Nurses in formal leadership roles were more likely to stress the importance of enabling, guiding and supporting front-line responsibilities.…”

Managing Change, or Changing Managers? The role of middle managers in UK public service reform

“…Clinical areas of operation are now headed by clinical practitioners, who are also the unit general manager with administrative-operational and strategic responsibilities. Reflecting on this professional form of managerialism, Fulop (2012) suggests:…”

“…In addition to such 'institutional work', there are institutional and isomorphic pressures at the sector or population level of organizations, which restrain organizational adaptation and reinforce persistent bureaucratic organizational forms (DiMaggio and Powell 1983;Hannan and Freeman 1989). Professional bureaucracies, such as health care organizations, have complex multiple hierarchies -including medical, nursing and administrative-operational chains -which lead to divisional structures and 'hybrid' forms of managerial work (Fulop 2012). Middle managers in these contexts may have previous professional practitioner experience or may be performing a hybrid practitioner-manager role.…”