American healthcare is in the midst of cataclysmic change. During the last 3 decades, the development of integrated healthcare systems, the rise of highly metrics-driven approaches to management, the increase in evidence-based medicine approaches, and, more recently, the creation of accountable care organizations (ACOs) have driven an increased degree of cooperation among physicians, nurses, and the healthcare organizations. One of the most significant transitions has been the development of physician and nurse leaders, whose roles within the healthcare system include ensuring that the changes needed to serve the patient and those who serve the patient can be accomplished in as smooth and efficient a manner as possible. Is the management training of physicians and nurses different and if so, why? An increasingly large body of literature indicates that there are significant differences in the management and leadership of highly trained medical professionals compared to other healthcare administrators. Not the least among these differences is the fact that while physicians and nurses have received substantial clinical education and skills training, they have in most cases have had little in the way of formal leadership and management training.1
Most current physician and nurse leaders rose to management positions because they were so good at their craft that someone said to them, “You are really good at what you do, why don't you become the director of the department?” Physicians and nurses have been educated to care for and heal patients, but few have been educated to manage or lead the process by which that care is delivered. Thus, these leaders often find themselves ill-prepared for the challenges in creating the vision and building an engaged team to deliver coordinated care.
The advent of chief medical officer (CMO) and chief nursing officer (CNO) positions in the vast majority of hospitals has given rise to not only a clear understanding of the importance of clinical leadership in the senior administrative ranks, but also the advent of combined MD/MBA, RN/MBA, and executive MBA and/or MHA programs. Despite the recognition of this need, there is still a relative dearth of formal leadership and management training in most medical and nursing schools.
Nonetheless, there is still a rich heritage of excellence in leadership and management in medicine and nursing, largely, but not exclusively, at academic medical centers such as Duke University Medical Center, Mayo Clinic, Cleveland Clinic, and Kaiser Permanente. The best of these programs have always had a close, collaborative, and collegial partnership between their physician and nurse leadership. However, the pace of change and the push for integration in healthcare has accelerated radically and will likely continue to do so, which will continue to drive the need for the presence of excellent physician and nursing leaders in all organizations.
Successful healthcare organizations have certain common characteristics, perhaps the most important of which is the capacity for nursing, physician, and administrative leaders to work cooperatively in devising strategies, systems, processes, ...