Doctors as hospital CEOs An extreme sport worth investing in

In my career, I have spent 10 years as an NHS hospital chief executive. I have worked to turn around some very challenged organisations, and worked as a system leader. I am also a doctor. When I talk to my medical school friends they think I am crazy, especially people I haven’t met for a while who raise their eyebrows, thinking ‘rather you than me’.  For my part, being a hospital CEO is one of the best jobs in the world. It is, however, something of an extreme sport. In addition, while you might think that being both doctor and CEO brings membership of both ‘tribes,’ the risk is that you are regarded as neither fish nor fowl!

So where are we when it comes to doctors taking on CEO roles of hospitals and, indeed, care systems in the NHS? And do we want to encourage more doctors into these roles?

The literature both in the UK and US points to a value of the ‘physician’ CEO in driving up quality and outcomes. With the increasing focus on quality, systems, pathway redesign and population health, the benefits of the doctor’s approach to decision making – seeing things through the clinical lens – and maximising peer-to-peer trust, enhancing credibility, seem to be strong drivers.

If you look around the NHS there is more than a scattering of hospital and mental health CEOs who are doctors. The creation of CCGs has created a step change for GP leaders across the country. However have we really made progress over the last decades? How much does the NHS really value these individuals? And what effort, if any, is being made to further encourage the medical CEO?  

My experience as a hospital CEO tells me that there can be little doubt of the progress made in having doctors leading services. The management model where doctors lead services, as part of a divisional or directorate structure, is well embedded within the NHS. Much progress has been made in identifying those with the right skills and succession planning – a move away from the past where senior doctors reluctantly took on these roles on rotation. And I can vouch for the feeling of excitement as you gain increasing confidence in your clinical directors as they rise to the challenges, take responsibility and drive improvements, many of which are instinctive.

The last decades have seen some inspiring and innovative leadership programmes for doctors. These include NHS London’s ‘Prepare to Lead’ (which supported talented doctors nearing the end of their training to take on leadership roles) and the Darzi fellowship scheme (a year-long programme supporting clinicians at the start of their leadership journey). It’s thanks to programmes like these that a cadre of young doctors with leadership skills and ambition is emerging.

Based on those that I mentor, the next generation of consultants and GPs is impressive in their understanding of the importance of leadership, the wider system and clinical processes, and their ability to think as teams. This bodes well for the future.

However doctors who take on leadership roles at service or divisional level still seem reluctant to make the step up to chief executive. Indeed, despite a lot of talk the number of doctors at the helm in hospitals and mental health trusts remains limited. Those doctors leading Sustainability and Transformation Plans are almost exclusively from a general practice background and still look to be the exception rather than the rule. None of the emerging hospital chains is led by a doctor.

So despite some promising signs, the NHS doesn’t appear to have fully embraced seriously the doctor as CEO. In times of extreme austerity – when the NHS will be even more dependent on transforming clinical processes across organisations and systems – it would be remiss not to capture the unique contribution that doctors can make in this role. This will only happen if the NHS commits explicitly to supporting medical CEOs, distinguishing clearly between these and other leadership roles and supporting individuals in the ups and downs of this extreme sport.

Lucy Moore (@LucyMooreNHS) currently works as a coach and strategy consultant