The role of consultants in hospital management.

Abstract

The Maltese public health care system is currently undergoing radical reform. These reforms are intended to tackle the organisation, management and financial aspects of the health system. A key area of change is that relating to hospital management and the involvement of consultants as a way of improving accessibility, quality of care and cost-containment. The purpose of this study was to explore the role of clinicians in management from the perspective of hospitals consultants and to elucidate those factors that influence these perceptions. An exploratory descriptive research design was used to determine consultants' attitudes towards taking up managerial roles, to explore their level of preparedness and commitment to adopting such roles and to identify the skills and resources consultants consider necessary to participate in management. The managerial activities currently performed by consultants at different public hospitals were examined, together with future challenges and implications upon management philosophy and structure if the consultants' role were to be extended. All hospital consultants were invited to participate with a response rate of 71 %. A self-administered questionnaire formulated by the researcher was used to collect the data after testing the tool for validity and reliability. Quantitative data was analysed using statistical tests whilst the qualitative data was analysed through content analysis. Findings from this research reveal that at present consultants do not have a homogenous role. There are differences between consultants working at various hospitals as well as differences in the degree of involvement between consultants working in the same hospital. Consultants at Hospital C were more involved in management, likely reflecting a different culture of management practised at this hospital since its inception. The data indicate that there are two categories of consultants, with a subset of more involved consultants encouraged to assume albeit limited managerial responsibilities. Most consultants (55%) did not consider their working relationship with managers as effective. One can conclude that there exist different levels of the organisation which are not synchronised with each other. Consultants strongly agreed that the adoption of management roles would benefit the whole organisation, and would help to shift the decision-making process to the functional units - decentralisation. Leadership development is high on the consultants' agenda while the financial aspects of management are not given priority. A major concern of consultants relates to the commitment of time for management rather than clinical responsibilities, as well as a lack of appropriate resources, including clinical and management support staff, meaningful management information and adequate reward systems. The results of this study may be utilised to propose several recommendations. Prior to the introduction of new roles, a policy framework should be developed to provide clarity about authority, responsibility and accountability arrangements at all levels within hospitals. A more participative management style through decentralisation is recommended. A radical large-scale organisational change, requiring strong leadership at all levels of the organisation, is needed to achieve such an ambitious agenda; a suitable model may be the McKinsey 7S approach which takes into account the complex interdependence of the various aspects of an organisation. The lack of financial, human and other resources should be addressed through a careful cost-benefit analysis which gives a realistic view of the costs and consequences of the alternatives being considered. An evolutionary change to influence consultants' cultural and cognitive factors may be promoted through a structured mechanism of management development programs tailored for the specific needs of consultants. The development of a cadre of consultants adopting managerial roles is a long term task which requires substantial individual and orga!1isational development work.