Medical managers in contemporary healthcare organisations: a consideration of the literature

Abstract

Objectives. To consider the literature supporting the evolution of the roles of a Medical Manager within contemporary healthcare organisations. Design. Consideration of available literature. Results. Limited dedicated literature available. Consideration of available studies and expert opinion reveals benefit of doctors in management positions within healthcare organisations. The roles of Medical Managers arise from: organisational structure-theory of healthcare’s ‘professional bureaucracy’; clinical directorate models; clinical governance, legislative and public health requirements; and the duality of combining medical knowledge with business and healthcare management training. Roles identified are: (1) leadership and management of medical staff including appointments and credentialing, and mentoring of medical staff in Clinical Directorate roles; (2) strategy development including Medical Advisory Role to Executive; (3) clinical governance including quality and risk management and legislative requirements; and (4) operational areas that benefit from clinical and management skills. Discussion. Strengths of this review include considering contexts of Medical Managers in medical and healthcare management literature. Weaknesses include drawing inferences from theory. Future recommendations include formal studies and systematic reviews of available literature of the subject. Conclusions. In light of falling Medical Management trainee numbers, this study highlights the value to the health system of a dwindling Medical Management profession, the urgent need to encourage more medical practitioners into management and for organisations to further embrace Medical Managers in key leadership roles. What is known about the topic? Although there is general acknowledgement about the benefits of medical leaders within health services, the exact nature and evidence for the Medical Manager role in current health services has not been comprehensively explored and articulated. What does this paper add? The aim of this consideration of the literature is to explore the evidence-base supporting the roles for Medical Managers within contemporary healthcare organisations, and articulate the exact nature and scope of the role. A concordance of studies and expert opinion highlights the benefits of Medical Managers within contemporary healthcare organisations, illustrating a theoretical basis for the differing roles. The nature of the roles include: leadership and management of medical staff (from organisational structure theory); leadership of the organisation within the executive team; clinical governance oversight; and operational management of medical areas with a business focus. What are the implications for practitioners? In light of falling Medical Management trainee numbers, this study highlights the value to the health system of a dwindling Medical Management profession, the urgent need to encourage more medical practitioners into management and for organisations to further embrace Medical Managers in key leadership roles.