The nature of the medical practice has rapidly changed in the last two decades but the preparation of the next generation of leaders for the health professions has not kept pace.
Historically, doctors assumed leadership roles mainly as a result of their clinical content expertise or research pre-eminence. Furthermore, medical professional organizations had a dominant influence over the conduct of healthcare and generally gated access to medical information for the public in the pre-internet era.
Now, the context has changed. Knowledge in biomedicine continues to rapidly expand and is widely available to society at large. Patients are cared for by teams of health professionals in which the doctor is just one member.
The technologic basis of medical care is accelerating and healthcare organizations are increasingly complex and often large, integrated and decentralized in structure. Management and fiscal decision making is often distant from the clinical coal-face. In addition, the professional values, work-interest, and aspirations of young doctors are changing and contrast with those of the older generation.
The sorts of dynamic and nimble leadership required for modern healthcare systems are not provided from historically entrenched professional bureaucracies which are characterized by diffusion of power, individual autonomy and rigidity. Traditional top-down command and control structures are no longer appropriate. A new style of medical leadership is needed to steward delivery of high quality care to society.
Leadership in healthcare today requires not only an understanding of complexity but also the skills to lead through that complexity. Successful management of the day-to-day or week-to-week operations alone will not suffice. Organizations that attract and retain leaders with those needed skills will flourish and create sustainability. In the 1970’s, Arie de Geus of the Royal Dutch Shell planning group defined some of the key elements that predict sustainability within organizations. These include:
- Sensitivity to the environmental context – constant vigilance for environmental shifts within and beyond the core business;
- Cohesion and identity for the people within the organization – the creation of living working communities;
- Tolerance and decentralization – allowing individual creativity to prosper and devolving decisions to many within the organization, and;
- Fiscal conservatism.
There are five essential qualities or abilities for new medical leaders who will create sustainable healthcare organizations with the characteristics referred to be de Geus. Leaders in a new paradigm must:
- Champion the identity of their organization’s identity – defining what the organization stands for, what it values and how those values are delivered to society;
- Create linkages for the organization – nurturing interdependencies between parts of an organization and establishing linkages between different organizations;
- Interpret the complexity in which their organization operates – discerning the environmental shifts, making sense of them and explaining how the organization needs to respond;
- Understand resource management – ensuring an appropriate balance between short and long term investments;
- Modeling ethical behavior – setting the standards of integrity and transparency and personally putting them into practice.
Developing the new leaders of medicine with these attributes requires that:
- Current leaders embrace new approaches to wider and deeper engagement within organizations;
- Young doctors and health professionals with potential for leadership are identified early, have concrete development plans and are given opportunities to lead and learn on the job;
- Preparation of future leaders move away from training them for management to educating them for leadership;
- Mentorship programs are provided at all levels of the organization.
Based upon a longer article published in MJA 2004; 181:652 – 654