We need to get serious about management

Kathy Redmond

Clinicians are being increasingly called on to assume hospital management roles. This Editorial looks at an initiative designed to address this need and asks whether professional societies need to introduce management skills into their CME programmes.

Management practices within hospitals play an important role in determining the quality of care. A strong relationship has been shown between hospital-specific management practices and patient outcomes (e.g. mortality) as well as financial efficiency. Yet management practices are known to vary widely both between and within countries, and much more effort needs to be made to improve poorly performing hospitals.

A number of factors are thought to be associated with better management. There is a particularly strong relationship between better management scores and clinically qualified managers, and high-performing hospitals tend to give their managers higher levels of autonomy. Competition has been shown to improve management standards, and private hospitals tend to perform better than public hospitals. These findings have important implications for cancer policy and for how clinicians are trained.

Given the positive relationship between high-performing hospitals and the number of managers with clinical degrees, it appears to make sense to give clinicians management responsibilities. However, few oncologists have formal management skills training and many feel ill-equipped to take on this role. In the current healthcare environment, clinicians are being increasingly called upon to take on management responsibilities including managing people and budgets.

Managing an oncology unit in a complex, resource-constrained and rapidly changing environment is not easy at the best of times, but it is even more challenging if the leader lacks sufficient management and leadership skills. Many clinicians are understandably reluctant to take on this role. This means that decisions that can have a profound impact on the quality of cancer care are often made by managers who lack insight into clinical realities and patient needs.

In the cancer world we focus so much on helping clinicians develop their knowledge and skills in disease management that we seem to overlook the need to train these clinicians to be good managers. Post-graduate training programmes need to address this deficit as a matter of urgency. Professional societies can also help by incorporating management skills training into different CME activities. The renowned Milan-based business school, SDA Bocconi School of Management, is taking a lead by offering a training programme for oncology leaders. The POLE programme, which Bocconi is running in partnership with Novartis Oncology and with endorsement from the European School of Oncology, aims to help oncologists become more effective managers (see www.eso.net).

Clearly, much more is required to achieve a high-performing cancer service, but it would be good to start with the basics and make sure that the people who lead the service know what they are talking about.

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