Is it time for clinicians in management?

In the last decade or so the role of senior clinicians has been gradually expanded to include management and clinical leadership. This has been actively promoted in the UK especially in relation to the overall operation of the NHS. Traditionally, the overall management of medical institutions and health system is left to managers with no clinical experience while clinicians focus on patient care. It has been realised that somehow when this traditional approach is adopted, the point of emphasis is shifted more toward economics than patient care. It is envisaged that bringing clinicians on board will somewhat correct this anomaly. According to some of the proponents of this concept,” the Clinicians in Management initiative is about giving health professionals a greater say in the planning and management of health services.” It is an effort to improve the standard of management with the primary purpose of providing better quality patient care. The initiative aims to involve doctors, nurses and allied health professionals with managers in decision making and to devolve responsibility for resources down to local level. It must be realised that clinicians have always been involved in management – they have the responsibility for the quality of care of their patients and managing their own department and staff.

The importance of management skills to Clinicians arises from both their role as leaders and also their relationships with other Health Service decision makers. Consideration need to be given to how this relates to us in the Caribbean region. Is it applicable in our setting? Have we been doing this all along without realising it? If we haven’t, should we consider doing it at all? A lot of issues should be taken on board before adopting a concept that may sound nice in theory but likely take away from the clinical effectiveness of the clinician. The role has to be clearly defined as to whether it is ‘consultative’ or ‘executive’. For a senior clinician taking on an executive role may create tension since clinicians see power in terms of patient and specialty which is personal rather than managerial leadership power which is positional. Given the choice, most clinicians are likely to stick with what they know how to do best – patient care. There is however a genuine reason to consider the involvement of clinicians in management for they are the ones who have the true knowledge of what their patients need.

There is an aggressive move pushing for this concept to be adopted more or less internationally and it is time for us to open up a debate on this issue in order to determine what works in our region. Whether it is done now or later, it will have to come to the table someday and must be decided whether it is just an illusion or indeed a reality.


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