Simon Bird on whether clinicians are always the best leaders

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It seems rather counter-cultural right now to question the drive for clinicians to take up leadership positions. However, the assumptions behind the drive, while compelling and applicable to some, should not be extrapolated across whole professions.

Putting greater emphasis and focus on clinical leadership intuitively seems to be the right thing to do. Lord Darzi's High Quality Care for All rightly points out that quality improvement strategies are more likely to succeed where they are led by clinicians.

There is evidence of this stretching back to the 1990s when total quality management was being implemented, not to mention the array of quality improvement programmes that have followed.

We also know that it is clinicians who are best placed to inform the commissioning process through their insights into clinical pathways and the ways services actually work and integrate - or not - with each other.

So the answer seems clear - let's put clinicians in all the available leadership roles, in these areas at least.

There is a counter-view to this assertion. Some years ago, it was widely believed that the NHS needed to recruit its chief executives from the rank and file of finance directors. Some excellent appointments were no doubt made. There were probably also some appointments that were not quite as excellent. It was also thought that human resources directors could never become chief executives.

These views have since been countered. However, I used to hear them espoused by very influential and senior people in the health system, and I was often struck by the finality and mechanistic nature of the debate. There seemed to be a search for a simple solution - and it was based on assumptions that certain professional experiences would automatically make someone a good chief executive.

It is a relief that we have moved on somewhat from that position, and the focus on clinical leadership in recent years is extremely welcome.

There are some impressive examples of doctors taking chief executive jobs in NHS organisations. I personally know some doctors I find inspirational in the way they manage themselves, their staff and their services.

But let's not assume in an Orwellian way that 'managers are good, clinicians better', or even more extreme, 'clinicians are good, but doctors better'.

The inconvenient truth is that a person's professional background and experience will tell you little about their potential to succeed in the health service's top jobs. It will give you some information about their skills and areas of expertise, but will not tell you about their motivation, passion, resilience and drive - all of which good chief executives have in abundance. The reality is that finding people for the most challenging jobs is messy, resource intensive and not completely scientific.

Above all, we should not lose sight of the person behind their professional background.


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