The new breed of clinical managers need the right support if they are not to feel alienated and reluctant in their role, write Alex Till and Gerry McGivern

Clinical leadership and management is increasingly seen as an answer to problems facing healthcare systems around the world. The demand, evidence, and political will for clinicians to move into these roles is growing.

While clinicians moving into management may be good for healthcare services, it comes with both opportunities and risks for clinicians themselves, who can be viewed by some clinical colleagues as moving over to the ‘dark side’, ‘selling out’ or no longer being part of the clinical team.

Alex till

Alex till

This tribal approach can be challenging, particularly when called on to question outdated professional practices and initiate transformational change which, at times, might compete with traditional ideas about being a clinician by prioritising population health needs over that of individual patients.

‘Incidental hybrids’ feel obliged to ‘do their time’ and see their managerial responsibilities as incidental to their professional, personal and social identities

Reconciling this paradoxical relationship challenges traditional ideas about being a clinician and can leave new ‘hybrid’ clinical managers questioning who they are, if they feel comfortable with that, and struggling to reconcile their new professional identity within their new ‘hybrid’ role.

Doing their time

Yet, if clinicians are to run the NHS, they need to fully embrace managerial roles.

Recent research (McGivern et al, 2015), on which this article is based, suggests that clinicians assume one of two identities in clinical management, ‘incidental’ and ‘willing’ hybrids:

‘Incidental hybrids’ feel obliged to ‘do their time’ and see their managerial responsibilities as incidental to their professional, personal and social identities. They hold fast to a clinical professional identity, maintain traditional professional norms and ‘influence’ colleagues to do the same.

Gerry mcgivern

Gerry mcgivern

Incidental hybrids enact their managerial roles temporarily and from a clinical perspective, taking their clinical judgement and experience into the role. They represent and protect clinical colleagues from what they see as the potentially damaging effects of management, so that clinical colleagues can ‘get on and do their thing’. Incidental hybrids tend to keep things as they are, and are less likely to change how health services are run.

‘Willing hybrids’, however, proactively claim hybrid roles and legitimise the permanent integration of leadership and management into their core professional identity.

This often results from positive experiences of clinical leadership and management earlier in their careers, including being involved in improving health services and having inspiring clinical-manager role models and mentors.

‘Selling out’

Accordingly, through ‘identity reconciliation work’, willing hybrids reframe clinical practice and clinical management as complementary to construct rewarding, interesting and useful hybrid careers.

Accusations from colleagues of ‘selling out’ simply prompt critical reflection on the difficult realities of delivering contemporary healthcare and the outdated nature of traditional professional norms to further revalidate the importance of their role and their hybrid identities.

We must do more to develop and nurture ‘willing hybrids’ from the start of their careers within a culture that accepts diversity and encourages rather than inhibits leaders to step forward

Traditionally, hybrid clinical managers have learned their roles on the job: there are no formal career paths and there is little training or support. Combined with the stigma hybrid clinical-managers face, and the fear they experience over losing their professional identity and credibility when assuming advancing hybrid roles, we have seen a reluctance from clinicians to step into, and fully embrace, these roles.

If clinical leadership and management is to address the pressures we face within the health service, and we are to maintain and improve the quality of care we provide, we must do more to develop and nurture ‘willing hybrids’ from the start of their careers within a culture that accepts diversity and encourages rather than inhibits leaders to step forward.

Legitimate, valued and respected

We must work with the national organisations, such as the Faculty of Medical Leadership and Management and the NHS Leadership Academy, to help support every clinician to become a better leader and manager; develop dedicated career pathways to accelerate the ascent of clinicians into leadership and managerial roles; and accept responsibility locally for developing opportunities within the clinical environment, at both an undergraduate and postgraduate level, for experiential learning, mentoring and role modelling between established and aspiring clinical-managers.

Clinical leadership and management is becoming a legitimate, valuable and respected profession within healthcare. However, as the research illustrates, for these professionals to make sense of and legitimise who they are individually and collectively, we must remember that learning to be a hybrid is more important and challenging than learning to do management.

Dr Alex Till is national medical director’s clinical fellow and executive MBA student, and Professor Gerry McGivern is professor of organisational analysis, both at Warwick Business School