Educating clinician leaders: can the NHS benefit from the US MD/MBA experience?
The correlation between strong clinical leadership and improvement across various healthcare measures – patient experience, outcomes, organisational performance, staff engagement and overall care quality – has generated considerable interest.1 By contrast, effective healthcare management remains under-celebrated, despite evidence suggesting that management responsibility is widely distributed in the NHS, with most clinicians receiving minimal management training.2 As the UK's healthcare architecture assimilates increasing complexity, there is a growing implication that clinicians should formally acquire capability in subjects traditionally considered non-clinical, including financial and operational management, human resources and service transformation, to better understand healthcare as both system and industry, and best navigate, lead and improve services for patients.
Opportunities for UK medical students to build fundamental skills in these areas are limited. Efforts to introduce general leadership themes into core curricula have achieved mixed reception,3 and little robust evidence indicates that existing approaches have improved leadership development.1 A restricted number of medical schools offer intercalated bachelor degrees in management principles, conferring comparable competency to undergraduate science. Students demonstrating early potential as clinician researchers, however, can further undertake integrated MB/PhD degrees at a selection of institutions, while ongoing clinical and management preparation remains separate. UK medical schools are yet to embrace the best regarded management qualification, the MBA, as a joint degree programme.
The MD/MBA pathway is well established in the US. Medical students join traditional MBA cohorts, representing diverse employment backgrounds, to graduate with a broadened appreciation of healthcare amid other sectors. The majority appear to pursue clinical training, later assuming leadership and executive positions.4 In healthcare, the ability to communicate with clinical and non-clinical colleagues in their respective languages, while determining strategic, operational and financial objectives according to patient priorities, informed by clinical experience, seems particularly valued.
Of challenges raised by the MD/MBA, tuition costs rank foremost; top US two-year MBA programmes charged approximately $115,000 (£78,800) on average in 2014/15. Averages in Europe were approximately $77,800 (£53,300). In context, the Personal Social Services Research Unit estimated in its 2014 publication, Unit costs of health and social care, that the total investment required to train a UK medical graduate was £236,129. Though policies vary, US institutions often reduce costs by integrating the six years required to attain MD and MBA degrees in series into a five-year joint programme, with many providing financial assistance during the year in which students are enrolled as MBA candidates.
Another concern is the potential for deskilling, if early MBA exposure is not reinforced by sustained management responsibilities throughout clinical training. Innovative US residency programmes, combining continuing education, clinical and management rotations, relevant project work and focused mentorship, offer guidance here.5 Similarly, UK postgraduate management training could borrow from the Walport Academic Clinical Pathway,6 releasing trainees from service to pursue appropriate activities and concurrently delivering benefit to the wider system.
The NHS requires clinician leaders who are equipped to lead. Competitive selection of MB/MBA students, alongside ongoing postgraduate leadership and management opportunities, could produce a calibre of healthcare executive not seen before in the UK (see Box 1 for recommendations to improve medical education, training and practice).
Box 1. Formally equipping clinicians to lead: ten recommendations to improve medical education, training and practice.
Acknowledgements
We are grateful to the Rouse Ball Research Fund (Trinity College, Cambridge) and Gates Cambridge Trust for supporting the presentation of this work at the 13th Annual International Conference on Health Economics, Management and Policy, hosted by the Athens Institute for Education and Research, Greece, in June 2014.
- © Royal College of Physicians 2015. All rights reserved.
References
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- West M
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- Buchanan DA
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- Walport M.
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