From Management to Leadership in the Health Care System
Fuad Basis MDa
Department of Emergency Medicine, Rambam Medical Center, Haifa, ISRAEL
Abstract Public hospitals are not-for-profit organizations. The directors of the different departments are considered to be the "Midro" rank. In the health care system, as in most organizations, this sector is crucial to proper functioning. Department heads, on one hand are expected to excel as medical professionals so that they can add to the prestige of the whole organization, while on the other hand they are expected to know how to manage and lead people toward achievements, within the organizations structure. The professional demands on physicians often impart some ways of functioning or thinking that do not necessarily suit effective managerial style. Most of the hospitals in Israel emphasize professional prestige in selecting managers, without objectively evaluating their fitness for the job. Little is written about this subject in the health system. This article will discuss this subject from an "organizational consultant" and physician point of view, considering what is written in the literature in general about managers as leaders.
MeSH Words: Management, Health Care Team, System, Leadership
Introduction According to the "Three M" model, each organization contains three functional levels: the Micro level, i.e. the workers; the Macro level, i.e. the administration; and the Midro level, i.e. the managers of the different departments in the organization (the directors of the different departments of the hospital in our case) . What are the health system needs from those managers? What happens when there are incompatible or even conflicting needs? What are the priorities of the organization in such cases?
Public hospitals are typically not-for-profit organizations. Since the main goal of the hospital is to give good and professional healthcare, they expect managers of the different departments to be professional, specialists in their field, have the ability to teach young physicians, to be appropriately qualified to have a national or international reputation. At the same time, hospitals expect every manager to have the ability to manage teamwork with harmony, to promote and develop human resources toward professional achievements, and to give good service to their patients, within the system's financial and functional limits. Hence, we are talking about two demands that do not
Israeli Journal of Emergency Medicine – Vol. 6, No. 3 Sept. 2006 - 76 כתב העת הישראלי לרפואה דחופה
From Management to Leadership
necessarily go together in the same physician, and sometimes even conflict. Jim Collins, in his book "Good to Great"  says that in order to survive, every organization must strengthen its specialty and advantage over its competitors. This can explain to us why managers of hospitals develop their "special" departments at the expense of the "standard" ones. Usually in, such cases, the managers of these departments are physicians with national or international prominence and prestige. It is said: "The history of the world is a collection of the history of great individuals." This pattern of thinking coalesces with the fact that most of the departments are built, as Collins wrote, around a "genius" with many assistants who gives that department his reputation, instead of a "leader" surrounded by many "stars," where the sum of them together as a team, is greater than the sum of them as individuals. Most, if not all of us, are familiar with professional demands from the manager of a medical department. But what are the demands of the system from those managers as managers/leaders, in addition to their roles as physicians? Each organization seeks in its managers "the ability to mange or lead." Several questions are to be asked here: 1) How many of those managers have the native talent to mange/lead a team towards a...