Clinician leadership: insecurity, amateurism and innovation
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2011)

Despite general acceptance of the doctor–manager divide, doctors do become managers and some even reach the alien perch of chief executive of an NHS organization. Presumably some managers become doctors but we tend not to hear much about their journey. Lord Darzi's NHS review for the previous government argued the case for change based on commitment from frontline staff. The current government has followed his direction albeit with a shocking acceleration. Talk, incessantly, is of clinician leadership but tinged with scepticism about our ability to implement it – and perhaps confusion as to what it means?

We know that traditional medical training is an inadequate preparation for management responsibilities. More recent initiatives, like associations for medical managers and postgraduate qualifications in clinician leadership, struggle to replicate the challenges experienced by leaders of organizations. There is a good reason why many top business people have succeed without an MBA, why admission tutors will advise prospective candidates to take the chance of senior management experience instead of enrolling for an MBA: there is no substitute for how much you learn in a spell as a chief executive or a managing director.

Typically, that experience is usually unavailable to doctors before they acquire a top management post. Even so, the small number of doctors who do become chief executives must offer valuable lessons for their colleagues with similar aspirations, as well as for an NHS chanting the mantra of clinician leadership? Chris Ham and colleagues set out to explore this issue against the background of advanced plans to create a faculty of medical leadership and management (JRSM 2011;104:113–19).

The researchers discovered that doctors often hold only one chief executive post in their career. The training they receive is variable. While they welcome the opportunity to effect organizational and service improvement, doctors emphasize the insecurities associated with being a chief executive. In essence, they are ‘keen amateurs’ who experience a change in their identity, occupying a hybrid position, and they would benefit from structured support.

Where this takes us is unclear? While the authors argue that the study supports their plans for a medical leadership faculty, they should be judged on their achievements rather than their intentions. Would a new faculty akin to a royal medical college really revolutionize clinician leadership? Presumably the authors have something more radical in mind? The new faculty's defunct predecessor, the British Association of Medical Managers, was distracted by an aspiration for acquiring collegiate status.

Perhaps we need true innovation? Stephen Smith, a gynaecologist and chief executive of Imperial College Healthcare NHS Trust, argued at a recent Royal Society of Medicine lecture that the UK's weakness in taking the innovatory step is threatening its future as a leader in research and development, and healthcare more broadly. For our failings in innovation read our failings in preparing clinician leaders. True innovation might not mean a new faculty for clinician leaders. It could mean an NHS Staff College as previously proposed in this journal (JRSM 2010;103:387–91). It might take both initiatives for us to succeed or a third, even more radical, option that is yet to emerge?

But we do know for sure that whatever we have been doing for many decades to prepare clinician leaders hasn't been working. There is no point in continuing to fiddle around the margins. For clinician leadership to be effective we need radical, innovatory solutions – and we need them now.