Selecting Physician Leaders for Clinical Service Lines: Critical Success Factors

Abstract

Institutions should be explicit about the strategic purpose and stage of development of their clinical service lines and be clear about their expectations and requirements in hiring service line leaders.

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

“…[32,42–44] Matrix organizations and distributed leadership are presented as solutions, yet medical leaders still believe that real decision-making power lies outside of care environments, is externalized, and hierarchical. [15,45] Decentralization has been highlighted as a contributor to role ambiguity and overload. [17,46] A lack of support leads physicians to rely on personality, status, and hierarchy, which are insufficient for complex tasks.…”

“…Clinicians on different management levels in hospitals and primary care describe a sense of powerlessness over being held accountable for performance measures and organizational issues with neither the authority, staff, budget, time, nor support to actually implement change or to improve. [15,21,32,45,46,48] The overwhelming number of performance targets and guidelines that are externally imposed conflict with professional values and interests,[26,49] and are so demanding that managers tend to focus on compliance, rather than the proactive development of new solutions, and interest in knowledge creation and innovation diminishes. [16,49] Lack of internal peer support makes medical leaders feel that they are alone with their managerial challenges with limited opportunities to discuss and develop ideas for improvement.…”

“…[40,61] Recruitment of medical leaders most often occurs through informal networks and succeeds through the persuasive ability of the current managers, without explicit selection criteria or expectations related to performance objectives, goals, or measures of success. [23,33,44,45] When formal recruitment procedures are followed, the process still tends to be ad hoc and lessons learned by search committees are neither captured nor shared. The consequence of these coercive or ad hoc approaches that generate “incidental” leaders instead of “willing” leaders can be seen early in leadership development, where the latter are more able to “absorb” or construct managerial expertise.…”

Transplant Organizational Structures: Viewpoints From Established Centers

“…The process of selecting leaders is sometimes faulty. This has been outlined by Epstein and Bard (11), who studied the process of leader selection in service lines. They stated that directives given to service‐line leaders were often misaligned with institutional strategic goals, resulting in the inability to obtain proper resources as well as poor execution.…”

“…Leaders were frequently entrenched in matrix structures that thwarted their ability to secure resources, manage budgets, hire and promote staff and set enforceable quality and productivity expectations. This resulted in a scenario of responsibility without authority, which makes leaders much less effective (11).…”