Imran Didir, Rog Karen, Gallichio John, Alston Laura
Colac Area Health, Colac Victoria, Australia.
Western Health, Melbourne, Victoria, Australia.
BMC Health Serv Res. 2021 Apr 15;21(1):351. doi: 10.1186/s12913-021-06356-w.
In Australia, activity-based funding models have emphasized the need for hospitals to be accountable for their clinical performance. Clinician managers, with medical backgrounds are essential to ensuring high quality clinical performance and operational management of hospital services. The purpose of this study is to 1. Identify factors influencing doctors to become clinician managers in the Australian healthcare setting. 2. Understand the pathways and challenges faced by doctors in becoming clinician managers.
We undertook a qualitative study with semi-structured interviews of 18 clinician managers (who have medical practitioner backgrounds) with formal leadership administrative roles. Interview transcripts were analysed with systematic text condensation.
All eligible participants approached in this context, agreed to participate and over 80% of the participants were male. We identified five themes: 'Motivations for leadership', 'Pathways to managerial role', 'Challenges faced in management roles', 'Credibility through clinical practice' and 'Management skill cultivation and support'. Clinician managers progressed from being doctors to leadership roles through being encouraged to take on roles, while others felt pressure to take on leadership roles even if this was not a personal goal. Clinician managers described challenges such as feeling under-prepared, maintaining respect form colleagues through still participating in a clinical load, along with juggling priorities such as administrative tasks, managing budgets and performance managing other doctors.
There needs to be an intentional and more structured approach to training and supporting clinician managers that considers the complex challenges faced by individuals (especially women) as they progress into these roles in the Australian tertiary health services context. There is a need to consider ways of supporting clinician managers to focus on management skills, effective mentorship and address perceptions around losing respect from colleagues if clinician managers cease their clinical loads. Further research is needed among the female medical workforce, along with research to understand if maintaining clinical loads when undertaking a clinical management role in fact leads to better effectiveness in contributing to better patient safety and quality outcomes. Such evidence may assist in addressing these social pressures among clinician managers, and contribute to addressing gender inequality among the clinical management workforce.
在澳大利亚，基于活动的资金模式强调医院应对其临床绩效负责。具有医学背景的临床管理者对于确保医院服务的高质量临床绩效和运营管理至关重要。本研究的目的是：1. 确定在澳大利亚医疗环境中影响医生成为临床管理者的因素。2. 了解医生成为临床管理者所面临的途径和挑战。
我们进行了一项定性研究，对18名担任正式领导行政职务的临床管理者（具有医生背景）进行了半结构化访谈。访谈记录采用系统文本浓缩法进行分析。
在此背景下接触的所有符合条件的参与者均同意参与，超过80%的参与者为男性。我们确定了五个主题：“领导动机”、“管理角色的途径”、“管理角色中面临的挑战”、“通过临床实践获得的可信度”以及“管理技能培养与支持”。临床管理者通过受到鼓励承担角色从医生晋升到领导岗位，而其他人即使这不是个人目标也感到有压力承担领导角色。临床管理者描述了一些挑战，如感觉准备不足、通过仍承担临床工作量来维持同事的尊重，以及兼顾行政任务、管理预算和管理其他医生等优先事项。
需要有一种更具针对性和结构化的方法来培训和支持临床管理者，考虑到个人（尤其是女性）在澳大利亚三级医疗服务环境中担任这些角色时面临的复杂挑战。有必要考虑支持临床管理者专注于管理技能、有效指导的方法，并解决如果临床管理者停止临床工作量会失去同事尊重这种观念。需要在女性医疗工作者中进行进一步研究，同时进行研究以了解在担任临床管理角色时维持临床工作量是否实际上能更有效地促进更好的患者安全和质量结果。这些证据可能有助于应对临床管理者中的这些社会压力，并有助于解决临床管理劳动力中的性别不平等问题。
