ABSTRACT
Introduction This chapter is intended to offer medical practitioners a very practical insight into the demands of senior healthcare management roles, including that of chief executive. It should also assist a doctor in understanding the work of management colleagues. Chief executive jobs differ between larger and smaller organizations, and in the public, commercial and charitable sectors, but there is a core commonality. The underlying assumption in this chapter is that readers have a good knowledge of certain clinical services, but that their career so far has not equipped them fully for senior management. This is a challenge that doctors have faced for many years, including those who take on administrative roles in hospitals and health boards, and those who become directors of clinics or physician executives in the varied healthcare cultures in, for example, Europe and America. The lack of a career path for doctors to become chief executives, in terms of learning and development, as well as pay and progression, remains very apparent in the UK National Health Service (NHS),1 and doctors aspiring to such roles need to some extent to be self-taught, learning on the job. With the lack of a set career path, they must have the spontaneous drive and ambition to seek opportunities to gain experience, and to take on management and leadership responsibility. Many readers will have attended courses and conferences, and read assorted papers on leadership, management, governance and similar themes, often specific to areas of healthcare.2 Some of this content is also now appearing in medical training curricula in the UK, which is promising for the future. I attempt here not to summarize this knowledge base, nor to explicitly pursue a competency-based approach or other accepted framework of reference, nor even to list the available literature. Rather I suggest that personal accounts of leadership roles are particularly useful to certain audiences including doctors,3 and therefore offer a brief personal account in straightforward language, which describes the challenges as frankly and as simply as possible. To some extent this sets the tone for how doctors should themselves approach a chief executive role, and is informed by what I have understood from a variety of mentors, peers and colleagues over the years, and by what I have observed and learnt first-hand. I particularly focus on people issues which I see as fundamental, before covering other key areas, including personal and career aspects.
