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BMC Health Services Research
Published in: BMC Health Services Research 2/2016

Open Access 01-05-2016 | Debate

Medical doctors in healthcare leadership: theoretical and practical challenges

Authors: Jean-Louis Denis, Nicolette van Gestel

Published in: BMC Health Services Research | Special Issue 2/2016

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Abstract

Background

While healthcare systems vary in their structure and available resources, it is widely recognized that medical doctors play a key role in their adaptation and performance. In this article, we examine recent government and organizational policies in two different health systems that aim to develop clinical leadership among the medical profession. Clinical leadership refers to the engagement and guiding role of physicians in health system improvement. Three dimensions are defined to conduct our analysis of engaging medical doctors in healthcare leadership: the position and status of medical doctors within the system; the broader institutional context of governmental and organizational policies to engage medical doctors in clinical leadership roles; and the main factors that may facilitate or limit achievements.

Methods

Our aim in this study is exploratory. We selected two contrasting cases according to their level of institutional pluralism: one national health insurance system, Canada, and one etatist social insurance system, the Netherlands. We documented the institutional dynamics of medical doctors’ engagement and leadership through secondary sources, such as government websites, key policy reports, and scholarly literature on health policies in both countries.

Results

Initiatives across Canadian provinces signal that the medical profession and governments search for alternatives to involve doctors in health system improvement beyond the limitations imposed by their fundamental social contract and formal labour relations. These initiatives suggest an emerging trend toward more joint collaboration between governments and medical associations. In the Dutch system, organizational and legal attempts for integration over the past decades do not yet fit well with the ideas and interests of medical doctors. The engagement of medical doctors requires additional initiatives that are closer to their professional values and interests and that depart from an overly focus on top down performance indicators and competition.

Conclusions

Different institutional contexts have different policy experiences regarding the engagement and leadership of medical doctors but seem to face similar policy challenges. Achieving alignment between soft (trust, collaboration) and hard (financial incentives) levers may require facilitative conditions at the level of the health system, like clarity and stability of broad policy orientations and openness to local experimentation.
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Metadata
Title
Medical doctors in healthcare leadership: theoretical and practical challenges
Authors
Jean-Louis Denis
Nicolette van Gestel
Publication date
01-05-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue Special Issue 2/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1392-8

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