Do doctors make bad managers?
In recent times there appears to be a growing school of thought that our public health facilities are ailing mainly due to poor managerial hands. In particular, doctors, who invariably are the institutional heads, have come under attack for poor management and leadership skills.
In defence of the recent removal of the medical director of the Ridge hospital, the minister of health, Kwaku Agyemang Manu alluded to his belief that “the doctors are collapsing our hospitals” in an interview on an Accra-based radio station.
In deed, many watchers of the health sector believe that this perception accounts for the exclusion of doctors from the president’s three-man ministerial team for the health ministry, much against global trend where the health ministry tends to be headed by a medical doctor.
Is this perception backed by evidence? Would our health facilities fare better if they were headed by non-medics? Are there any particular benefits in our tradition of maintaining doctors as heads of public health institutions? These among others are the questions this piece seeks to discuss relying on available evidence as well as the writer's experience in the arena of healthcare management.
Those who believe doctors are poor managers often point to reported incidents in individual health facilities as examples to buttress their point. The poverty of that kind of argument is evident in the fact that so many other doctors have distinguished themselves and continue to do so in public sector management and leadership. In the private sector, many doctors have built international standard hospitals right here in Ghana from scratch.
The current practice in these parts of the world where doctors serve as heads of healthcare institutions has been proven to be a sound one and in line with modern management science taught and practice.
The “theory of expert leadership” espoused by contemporary management scientists is one new concept that favours this kind of arrangement. In her book ‘Socrates in the boardroom’ published in 2009, Amanda Goodall PhD clearly demonstrates that knowledge-based institutions perform better when managed by experts in that area.
She argues, for instance, that a research institution is better off with a consummate researcher at the helm rather than a career administrator. Similarly, a university lecturer is best suited to be the head of that institution than a management expert.
In a more recent study, Amanda Goodall established an association between doctors’ leadership and the performance of the top hospitals in the United States of America. In other words, a hospital is likely to perform better when it is headed by a doctor than when it is not!
This work was published in a number of scientific journals and also in the July 10, 2011, issue of the renowned Forbes Magazine. It also formed the basis for an article in the New York Times on the 7th of July 2011 titled “should hospitals be run by doctors?”
Similar findings have been made locally. In April 2014 Dr Jehu-Appiah and her team published in an online magazine their findings when they compared the technical efficiencies of the various categories of health facilities in Ghana. What stood out in this survey was that quasi-governmental hospitals (all headed by doctors) and public hospitals (all headed by doctors) performed considerably better than mission hospitals (mostly headed by non doctors).
It is evident from the above discussion that doctors do not make worse managers as compared to other professional groupings and that the converse may actually true. But are there particular advantages derived by our fledgeling healthcare system by this arrangement where doctors are the heads? My answer is yes. Consider the following points:
1. Most doctors in the peripheries work around the clock and usually request no compensation for the extra hours beyond the 40 hour week. The reason mostly is that the younger doctor sees his/her senior (who usually is head of the hospital) working round the clock for free and often feels bound to follow suit. This altruistic posture is likely to change when the head is a regular non-clinician manager a situation that could adversely affect the cost and quality of healthcare services.
2. There are many health facilities in deprived and rural communities that have highly qualified medics at post solely because the doctor there relishes the opportunity given him/her to lead. Such communities would lose these valuable skilled hands if the arrangement was different.
3. The main reason why doctors’ strikes in this country have tended not to be as effective as they should be is the fact that the medical directors/superintendents are bound to stay on as heads of facilities even during industrial disputes. This is necessary for the current volatile health labour market!
So there you have it. Doctors are not necessarily worse managers than any other persons. If anything at all, the healthcare system is better because they are at the helm of affairs! I have not argued that doctors’ management styles and outcomes have been beyond reproach at all times.
Like in all aspects of human endeavour medics in management require the institutional arrangements, resources and orientation to succeed. These, in my view, are the ingredients lacking in our health institutions and not just who the head is.