DEVELOPING MEDICAL DIRECTORS

IN CLINICAL DIRECTORATES

 

by

 

LIK MUI

April, 1997

 

 

ABSTRACT

 

A Medical Director (MD) is one of 5 Executive Directors on the board of an NHS trust — i.e. a self regulating hospital or community care unit.  The MD role was created by statue in 1989 at the beginning of the internal market reform in the UK. This role epitomises the British government’s effort to involve clinicians in the management of the health service in the sense that those in the MD posts are not only doctor-managers, they are senior executives at the trust boards.  Due to the recent nature of MDs in the NHS, relatively little research has so far been conducted regarding this role.  Most doctors do not have much, if any, training in management when they assume the MD posts.  How should a doctor prepare and develop himself or herself for this Executive Director position?  The attempt to answer this question forms the body of this thesis.  Since most of the trusts studied in this research operate in clinical management structures which are variants of the increasingly popular clinical directorate model (Disken, et al., 1990), findings in this thesis are most relevant for this type of trusts.

 

In order to satisfactorily answer the question posed above, the current state of the MD role has to be clarified first.  This effort forms the first part of this thesis.  After careful considerations of the concept of role and of the analysis of findings about MDs, a typology is proposed to characterise the current state of the MD role.  This thesis argues that this typology clarifies the MD role by making explicit the competing forces crafting the role in different circumstances, thus also addressing the weaknesses in current characterisations of this role.  Based on the understanding of the MD role, development issues associated with the role are considered.  In contrast to the often ad-hoc observations in the existing literature about MDs, this thesis attempts to systematically identify MD development needs based on a carefully designed analytical framework.  Both development needs for the MD post and for those who become MDs are considered.  Recommendations are made to address these development needs.  In studying the MDs, theoretical implications are also drawn for the conceptualisation of role.