Healthcare has placed ever-increasing demands on clinicians due to the complexity of balancing modern technology against human needs and quality against cost. These challenges require excellent leadership and doctors were once viewed as "heroic lone healers" and ill-prepared for leadership roles, but this has recently changed.

A study that examined CEOs in the top-100 best hospitals in the US was published in 2011. It found that hospital quality scores were approximately 25% higher in physician-run hospitals compared to manager-run hospitals. Of course, a single study cannot prove that doctors make better leaders, despite how the results were consistent with the claim.

But other studies also find this correlation. A recent UK-US collaborated study showed how good management practices are vital to hospital performance and how the proportion of managers who possess a clinical degree, had the largest positive effect. It also meant the separation of clinical and managerial knowledge inside hospitals were associated with worse management.

So what makes physician-leaders different from managerial-leaders?

Physician-leaders have "walked the walk"

Physicians create a more sympathetic and productive work environment for other clinicians as they are "one of them". They also share an understanding about the motivations and incentives of other clinicians. Dr. Toby Cosgrove, CEO of Cleveland Clinic also said that "credibility... peer-to-peer credibility" is one of the factors.

In other words, when a physician leads a major hospital, it meant that they have "walked the walk," and have earned credibility and insights into the needs of their physicians. Therefore they know how to raise the job satisfaction of other clinicians, contributing to enhanced organisational performance.

A research by Cass Business School, UK, also suggests that if a manager understands, through their own experience, they may create the right work environment, set appropriate goals and accurately evaluate others' contributions. Therefore, having an outstanding physician leader sends a signal to external stakeholders, pharmaceutical industry, donors or patients about organisational priorities.

Cosgrove also suggests that physician-leaders are also more likely to "tolerate crazy ideas" – often, more innovative ideas - and believes that, that in turn provides safe space for fellow physicians to grow. They are also able to tolerate appropriate failure, which is a natural part of scientific endeavour and progress.

Can it be improved?

Great leadership takes great social skills. The lack of teamwork between physicians can also cost lives, but physicians are not trained to be team players. They have been traditionally been trained in "command and control" environments as "heroic lone healers" who are collaboratively challenged.

Paradoxically, medical training is against great leadership, making successful physician leaders "accidental leaders" according to Dr. Victor Dzau, President of the National Academy of Medicine.

There is a clear need to train physicians more systematically such as a two-tier approach pioneered by Paul Taheri, CEO of Yale Medicine that has proven itself useful. The first tier introduces physicians to the fundamental principles of business in the delivery of healthcare, and personal leadership development, routinely in a day a month for a whole year. An MBA is then encouraged for those physicians who stand out as clear leaders.

Many world renowned hospitals have been training physicians to lead for many years, through in-house programs or collaborations with business schools. In Singapore, healthcare organisations such as Raffles Medical Group have emphasised on the growth and development of physicians into leaders. Likewise in Malaysia, there is a rise in institutions offering courses related to hospital administrations.

There is a popular consensus that physicians should be trained to lead and such training will lead to the enhancement of the pipeline of physician-leaders so that it can be realised that there are benefits of physician leadership. MIMS

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The art of empathy to become a better healthcare professional
Private and public hospitals in Singapore: Doctors working together for better healthcare services