The Need for Expert Leadership in Medical Services

A row has broken out in Australia over who is best equipped to manage specialist medical services. A team of psychiatrists claim that managers with no medical background do not necessarily have patient care as their primary focus. They argue that as they themselves have medical training and bear ultimate responsibility for clinical decisions, they should also have the final authority for such decision making. They have made their complaint official.

Research conducted by Amanda Goodall, senior lecturer in Management at Cass Business School, supports their view. Amanda has proposed a Theory of Expert Leadership (TEL), based on her finding that, "Successful leaders are those who have a deep understanding of the core business of their organisation. Being a capable general manager alone is not sufficient. " Amanda studied Formula One racing teams, research universities, hospitals in the USA, and professional basketball (NBA) teams. She found that in each case, the best performers were led by people who were very successful and had many years of experience in their field.

Based on these findings, it is reasonable to propose that psychiatrists, preferably experienced ones, lead psychiatric services. Managers have a place in organising the operational side of these units, in support of the clinicians, and in proper consultation with them regarding these matters. The core business of health services however is patient care, and this is not what managers are trained to do.

A paper by A/Prof. Neville Hicks,Department of Community Medicine, University of Adelaide, entitled Economism, Managerialism and Health Care, points out that the practice of managing health care as an economic commodity, ruled by market forces, is based on false premises.

He also makes the point that managerialism in health services has not achieved the desired market outcomes. Despite the obsession with KPIs, quality assurance, 'best practice' and meeting budgets, these health service reforms have not reined in costs, have not improved efficiency, and have not increased accountability.

Amanda Goodall recognises some potential problems in the TEL model however. She acknowledges that experts may be too self-focused, lacking in empathy, and overly confident in their abilities. Good leaders, she argues, are those who "show humility (a capability to listen to others) instead of hubris (expressed as over-confidence)." Integrity and empathy are other qualities cited as important for good leadership. An extended version of this article was originally featured in medicSA.