Medical doctors in healthcare leadership: theoretical and practical challenges

Abstract

BackgroundWhile healthcare systems vary in their structure and available resources, it is widely recognized that medical doctors play a key role in their adaptation and performance. In this article, we examine recent government and organizational policies in two different health systems that aim to develop clinical leadership among the medical profession. Clinical leadership refers to the engagement and guiding role of physicians in health system improvement. Three dimensions are defined to conduct our analysis of engaging medical doctors in healthcare leadership: the position and status of medical doctors within the system; the broader institutional context of governmental and organizational policies to engage medical doctors in clinical leadership roles; and the main factors that may facilitate or limit achievements.MethodsOur aim in this study is exploratory. We selected two contrasting cases according to their level of institutional pluralism: one national health insurance system, Canada, and one etatist social insurance system, the Netherlands. We documented the institutional dynamics of medical doctors’ engagement and leadership through secondary sources, such as government websites, key policy reports, and scholarly literature on health policies in both countries.ResultsInitiatives across Canadian provinces signal that the medical profession and governments search for alternatives to involve doctors in health system improvement beyond the limitations imposed by their fundamental social contract and formal labour relations. These initiatives suggest an emerging trend toward more joint collaboration between governments and medical associations. In the Dutch system, organizational and legal attempts for integration over the past decades do not yet fit well with the ideas and interests of medical doctors. The engagement of medical doctors requires additional initiatives that are closer to their professional values and interests and that depart from an overly focus on top down performance indicators and competition.ConclusionsDifferent institutional contexts have different policy experiences regarding the engagement and leadership of medical doctors but seem to face similar policy challenges. Achieving alignment between soft (trust, collaboration) and hard (financial incentives) levers may require facilitative conditions at the level of the health system, like clarity and stability of broad policy orientations and openness to local experimentation.

New public management, physicians and populism: Turkey's experience with health reforms

“…New modes of governing focused on physicians not only as objects but also as actors directly involved in governance (Kuhlmann et al 2013, McDonald et al 2008, Vicarelli and Pavolini 2017. As a result, boundaries between professionalism and managerialism and between professions and organisations are 'blurring' and new forms of more hybrid, integrated or transformative professionalism are emerging (Denis and van Gestel 2016, Kuhlmann and Burau 2015, Martin et al 2017, Noordegraaf 2015, Waring and Currie 2009). The various forms of integration of managerial and professional governance tools may create new and hitherto unknown alliances between NPM and other political agendas like populism.…”

“…, Vicarelli and Pavolini ). As a result, boundaries between professionalism and managerialism and between professions and organisations are ‘blurring’ and new forms of more hybrid, integrated or transformative professionalism are emerging (Denis and van Gestel , Kuhlmann and Burau , Martin et al . , Noordegraaf , Waring and Currie ).…”

Enablers and barriers to clinical leadership in the labour ward of district hospitals in KwaZulu-Natal, South Africa

“…In a health system that is still maturing, 1 2 policies aimed specifically at clinical leadership would provide a broad context and strategy to ensure that frameworks and guidelines exist to guide the roles and responsibilities of clinical leadership, and the training and development required to ensure effective clinical leadership. [39][40][41] Having policies on clinical leadership might help to address the enablers and hindrances identified at each of the levels.…”

Evaluation of the Roles of Physicians and the Functionality of the Healthcare System in Nigeria

“…Additionally, our survey reported that physicians believe that problem identification, leadership, healthcare delivery, policy recommendation and research should be the main roles of physicians in the healthcare system of Nigeria. These are some of the documented roles of physicians in healthcare system around the world [11,12]. Except healthcare delivery, the engagement of the Nigerian doctor in other identified roles is debatable and were specified has been grossly suboptimal.…”