Are We There Yet? Models of Medical Leadership and their effectiveness: An Exploratory Study

Abstract

Aims The main aims of the study are to provide an up to date picture of the nature and range of medical leadership structures in NHS trusts in England; to analyse how different structures operate in practice and the processes at work within these structures, for example between doctors, nurses and managers; and to relate evidence on structures and processes to available data on organisational performance. Methods The study uses a mixed method approach involving a questionnaire survey of NHS trusts in England; case studies of nine NHS trusts that responded to the survey; and the use of the Medical Engagement Scale in these case studies to establish the extent to which doctors feel engaged in the work of their organisations. The results of the Medical Engagement Scale are related to available data on organisational performance. Results A wide variety of structures are identified including divisions, directorates and service line approaches, sometimes in combination. Most of the case study sites report themselves to be medically or clinically led with doctors holding leadership roles at three or four levels. Triumvirates exist on paper in most sites but in reality the duality of medical leader and general manager is perceived to be more important. An engagement gap between medical leaders and their colleagues is commonly reported, though this is seen to be part of the journey trusts are on. There are variations both between and within trusts in the extent to which doctors feel engaged in the work of their organisations. Trusts with high levels of engagement perform better on available measures of organisational performance than trusts with low levels of engagement.