Theory to Practice

The benefits of managerial training for doctors

By acquiring managerial competencies, these ‘hybrid professionals’ are more engaged in decision-making processes, to the benefit of the entire organization

The context

Hybrid professionals in healthcare combine clinical practice with organizing resources for the department they head: this describes the work of doctors tasked with managerial responsibilities. A prime example is clinic directors who work for public health authorities. Their ability to play a dual role that is both clinical and managerial is essential to enable other professionals to do their best work.

 

An effective link between hybrid professionals and top management can simplify the process of establishing good practices, which in turn contributes to improving the performance of the organization as a whole. But attempts to align professional goals with managerial goals often come up against cultural barriers. A clinical approach traditionally centers on the doctor-patient relationship, and decision-making responsibilities are delegated to individual physicians. The managerial approach, instead, calls for coordination that traditionally follows hierarchical lines of authority. For these reasons, in professional organizations decision-making processes are often upside down with respect to what we find in traditional organizations (which is why we talk about an “inverted power structure”).

 

To help make doctor-managers more effective in their roles, public health authorities promote specially-designed training programs. In Italy’s NHS, for example, heads of department in complex organizations are required to participate in a managementtraining course in order to serve in managerial roles. These programs generally aim to develop skills relating to leadership, human resources management and performance management.

 

Promoting these dedicated training programs represents a major investment for public health authorities, so it makes sense to verify the actual return on this investment. But rarely has the scientific community or medical practitioners ever tried to answer the question, “Does it pay back?”

 

The research

Studying the effectiveness of training is not an easy task. Very often the validity of courses and programs is evaluated simply with surveys given right after the program is finished, asking whether or not the participants are satisfied (so-called smile-sheet surveys). What’s more, given that the possible benefits for participants may emerge over time, it’s complicated to differentiate between the impact of the training itself and other possible factors that intervene in the interim in working lives of the training program participants.

In an attempt to overcome these limitations, we conducted a study* investigating the participation of Italian doctors in managerial training programs promoted by their respective Regional Healthcare Systems (RHSs). Specifically, we analyzed the data from an extensive survey on organizational climate administered to the medical personnel of 69 public healthcare authorities in five different RHSs. Our study focused on the responses provided by over 3,000 doctors who serve in managerial roles.

Our analysis centered on the extent to which managerial training is effective in getting medical professionals more engaged in decisions made by top management. The literature offers overwhelming evidence that the participation of medical personnel in decision-making processes can engender wide-ranging benefits, both in terms of better service quality as well as lower costs. The hypothesis of our study is that training can escalate the involvement of doctors in an indirect way, incrementing their knowledge as well as their competencies (i.e. the ability to put their knowledge into practice). This relates specifically to measuring performance. Performance systems in knowledge-intensive organizations serve as ‘translators’ of different languages (typically professional language and managerial language). In other words, numbers allow different members of the organization to converge on the facts, overcoming the physiological barriers, both cultural and professional.

With the Italian doctors in our sample, we compared data on two groups: the first was made up of participants in a management training course for clinic directors, and the second consisted of professionals who had not participated in a training course. Then we analyzed the following: knowledge of the organization’s annual goals; the doctors’ use of data, as well as planning, programming and control systems in managing their organizational unit; the level of involvement by top management in decisions relating to the doctors’ organizational units. What emerged from our study is that managerial training for doctors has a concrete impact on their ability to participate in decision-making processes. In this sense, playing essential roles are both the acquisition of managerial knowledge and the effective application of competencies relative to performance measurement. It is no coincidence this last factor emerges as being most relevant in the regions where the managerial training program for doctors focuses extensively on healthcare system performance indicators at a national and regional level.

Conclusions and implications

The medical profession at a managerial level is naturally hybrid in nature. Beyond the clinical aspect, the role of professional physicians who are responsible for coordinating their departments entails a managerial dimension, which can be best performed by personnel who have adequate training. By participating in dedicated training programs, doctors acquire the knowledge and competencies that foster more effective interaction with top management and greater engagement in decision-making processes.

 

Learning the language, the practices and the codes of management allows doctors to overcome possible resistance of various professional and regulatory groups; they are also able to redefine their role, beyond the strictly clinical-professional dimension. By the same token, by contributing ideas and experience that come directly from out-patient facilities and hospital wards, top management can get a clearer perspective on possible best practices to implement to pursue the best possible value for patients and long-term economic sustainability at the same time.

 

There is no doubt that managerial training for doctors has a positive impact on their role within the organization. What we still need to understand is what the most effective training methods are and what specific types of competences are needed. This in addition to the environmental conditions that can help (or hinder) the effective transformation of knowledge into good practices. We also have yet to understand what the indirect impact of managerial training is on the overall performance of public healthcare authorities.



*This study was conducted within the framework of the project, “Performance Evaluation Framework for Healthcare Systems” in the Laboratory for Management and Healthcare of the Sant’Anna School of Advanced Studies in Pisa.

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