Dissertation: The ‘Clinician-Manager’ Paradox

Tittle: The ‘Clinician-Manager’ Paradox Role of professional management in AIIMS, PGIMER & six-AIIMS project under PMSSY

Preface
The running of a hospital requires two types of management. The ‘Clinical management’ or ‘Patient management’; that deals with the care of individual patients and ‘Health management’; that deals with provision of health care facilities and handling of human, financial, infrastructural, information & communication resources. Traditionally the matrons have assisted the doctors in running the clinical and the health management in the hospitals. (Davies and Harrison, 2003; Degeling et al., 2003) However lately, specialised managers are being appointed to undertake the task of health management or the doctors have the responsibility to act like professional managers. (Hoggett, 1996; Flynn, 1992) The doctors do not want to be involved in management, on a perception that it conflicts with professional duties and adds unnecessary work. (Atun, 2003) Nevertheless, managerial input is required for efficient resource management and effective service delivery. The clinician concern about patient outcome and the managerial concern about management of patient experience within finite resources, cause different perceptions on management in a hospital. (Edwards et al, 2003) This creates a dichotomy, resulting in a ‘Clinician-Manager Paradox,’ in which the two roles are placed in continually opposing professional perspectives. (Goodwin, 1996)

This discordant behaviour is explored in the dissertation, through the management theories, and in different medical practices around the world, to find the cause and the effect of the acrimonious relationship. The academic analysis subsequently focuses on ‘Clinician-Manager paradox’ in two of India’s largest tertiary medical care Institutes AIIMS, New Delhi and PGIMER, Chandigarh. A team of doctors and bureaucrats, headed by a Director, runs the Institutes. The Government through Ministry of Health supervises them. (AIIMS, 1956; PGI, 1967) The prime focus of managers and bureaucrats is to administer these Institutes managerially and financially. The clinicians in the Institute are focused on patient care, research and medical excellence. The two often run at cross-purposes in trying to balance between resource availability, deliverance of patient care and achievement of research excellence.

Harmeet had worked in PGIMER Chandigarh from 2002 to 2006 as the Chief financial officer and his background as a medical professional and as a bureaucrat allowed exposure to both sides of the story. The sojourn at University of Birmingham has now afforded an opportunity to explore this area of management formally, in great depth with his mentor and guide A. N. Rubienska. ‘Annie’ has years of experience of working in several countries in the fields of management, social marketing and leadership. The dissertation explores the issue from an insider personal standpoint and from an outsider academic viewpoint. The draft ideas, which emerged, have been discussed with the clinicians and managers, the actual players in this drama. The purpose is three-fold. Firstly, to analyse the existing discourses and to suggest ways in which the managers and clinicians can work together, in AIIMS and PGIMER. Secondly, to provide a fresh perspective on adoption of an appropriate management models for the forthcoming six-AIIMS like Institutes under PMSSY. Thirdly, it aims to augment the teaching curriculum of the upcoming hospital managers (MHA Students) in these institutes by sensitizing them to the paradox.

Complete Dissertation:
The ‘Clinician-Manager’ Paradox