Challenges for Physicians in Formal Leadership Roles: Silos in the Mind

Health care systems are among the most complex organisations, facing a wicked intertwining of rapid change in knowledge, cost pressures, increased demand for access, for evidence-based medicine, and for more connection with patients and their families. Within this world, physicians are called to take up formal leadership positions as directors of quality, chief medical officers, section or department chiefs, deans of medical schools, and senior leadership positions in practices, hospitals, and health systems.

Because their training inculcates values of autonomy, learning from experience, and professional distance, physicians see a team (managerial) approach as ‘other’ and distance themselves from those colleagues who take up formal leadership roles.

The consequences are ambivalence and splits, both among leaders and within individuals who accept such leadership roles. A maladaptive strategy is often silos in the mind, in which the different bodies of knowledge (clinical and business) are kept too separate, with the latter denigrated. Yet, many of the current challenges require closer linking of substantive medical knowledge with sophisticated organisational and managerial knowledge to invent and implement new systems.

Working with case material from US Academic Medicine, which socialises the majority of the USA's future generations of physicians, the article will explore the consequences and some of the challenges of linking these bodies of knowledge in the service of meeting the adaptive challenges facing health care.