Making doctors manage… but how? Recent developments in the Italian NHS

Abstract

BackgroundInvolving doctors in management has been intended as one of the strategies to spread organizational principles in healthcare settings. However, professionals often resist taking on relevant managerial responsibility, and the question concerning by which means to engage doctors in management in a manner that best fit the challenges encountered by different health systems remains open to debate.MethodsThis paper analyzes the different forms of medical management experienced over time in the Italian NHS, a relevant “lab” to study the evolution of the involvement of doctors in management, and provides a framework for disentangling different dimensions of medical management.ResultsWe show how new means to engage frontline professionals in management spread, without deliberate planning, as a consequence of the innovations in service provision that are introduced to respond to the changes in the healthcare sector.ConclusionsThis trend is promising because such means of performing medical management appear to be more easily compatible with professional logics; therefore, this could facilitate the engagement of a large proportion of professionals rather than the currently limited number of doctors who are “forced” or willing to take formal management roles.

Operating Room Management after 2008 Economic Crisis in Italy: A Literary Review

“…The projects were supported by collaboration between surgeons, anesthetists, medical and general direction doctors and nurses. In fact in Italy, in addiction to clinical and management engineers who are obviously expert about ORM, the number of the doctors involved in the management is growing [28]. This aspect certainly facilitates the application of these models in the clinical environment and confirms the interest for the topic not only by the managers but also by the physicians.…”

Physicians in the management and leadership of health care: A systematic review of the conditions conducive to organizational performance

“…[40,51,62] To avoid "incidental" medical leaders, recruitment should be formalized, identification of leadership potential should start at an early stage by engaging in conversations with front-line physicians, and these future physician leaders should be supported and molded through op- overall lack of support, and challenges tied to the timing, location, and process of managerial meetings. [17,20,23,28,[31][32][33]44] This can be done by setting clear expectations [44], introducing collective leadership [19] or through hybrid organizations. [68] The latter resonates well with the idea of professional bureaucracies where staff has greater influence on decision making than people in formal positions of authority.…”

“…and clinical logics are challenging for physicians to reconcile. [15][16][17][18] Medical leaders are perceived to occupy a no-mans-land,[19] often not meeting the expectations and authority vested in them [20]. Many are concerned with losing their credibility among their peers and becoming outsiders,[21] with management referred to as the "dark side".…”

“…Current undergraduate medical education programs provide only limited opportunities for professional development and neglect strengthening the ethos and professionalism that would make physicians better fit for the purpose of their work [21]. During their clinical careers, they are not sufficiently exposed to professionals who are able to develop their managerial mindset [20]. Management skills are perceived to be in conflict with a medical caseorientation and interventionist professional action [29].…”

“…CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. strategic hospital-wide perspective [20]. Even if physicians enter management, they see this merely as an intermediate role.…”