Physician Leadership in the Arab World … a Call for Action !

The Covid-19 pandemic has reminded us how complex healthcare has become worldwide. The challenges of balancing high-quality healthcare against, ever-increasing, costs and of harmonizing technological advancements (such as artificial intelligence) with humanity has placed increasing demands on clinicians and hospitals alike. The most successful health systems in the world have strong physician leadership cultures. Since physicians are unique “domain-experts” of healthcare (first contact for most with the health system, long-term caregivers, trusted sources of information and fiduciaries for patients) they can have a disproportionate impact on the health system compared to other healthcare stakeholders. 

Physicians can enhance organizational performance for many reasons: they create a more productive environment for fellow clinicians, they enjoy peer-to-peer credibility, they naturally champion a patient-focused strategy and are willing to support clinical innovation more readily. When physicians are properly trained, in leadership competencies and technical skills, they can outperform their non-physician, management and administration, colleagues both clinically and financially. In a 2016 US News and World Report, large hospital systems led by physicians received higher USNWR Quality Ratings and Bed Usage Rates than did hospitals led by nonphysicians, with no differences in financial performance. Their analysis showed that it is the proportion of managers with a clinical degree that had the largest positive effect.

Internationally, a recent systematic review of leadership and management competencies for hospital management included five hospitals in Asia (Iran, China, Thailand, Indonesia and Vietnam), two hospitals in each of (USA, Australia, South Africa) and one hospital in Finland. The study identified six healthcare management competencies essential for success: Evidence (informed decision-making), Resource management (operations, administration), Knowledge of healthcare environment and the organization, Communications (interpersonal, communication qualities and relationship management), Leadership (leading people and organization), and Change Management (enabling and managing change). While healthcare system Evidence and Knowledge are intuitive to physician leaders, Resource management, Communications, Leadership and Change Management require further training and expertise. At the core of all these deficits is the lack of physician training in emotional intelligence and teamwork. Situational awareness and control is a challenge for most physicians who are used to working alone. Physician clinical training has focused more on the “heroic lone healer” and built individual competence at the expense of collective competence and teamwork dynamics.  

Interestingly, physician leadership culture has been less successful in the Arab World. In the Middle East, a review of the “Ranking Web of World Hospitals” by Cybermetrics Lab in 2017 was conducted and a total of 283 Arab hospitals were ranked. Among the top 50 hospitals, 54% of the CEOs were physicians, whereas the remaining were nonphysician managers. Among the bottom 50 hospitals, 74% of the CEOs were physicians, whereas 26% of the CEOs were nonphysicians. Physician leadership was significantly associated with lower hospital ranking (bottom 50 hospitals) in the Arab World (P = 0.0031). The findings suggest an under-development of formally trained physician leadership culture in Arab hospitals. A survey of Arab physicians identified some of the barriers to them participating in health care system design and change. The barriers were both physician-based and system-based. Physician-based barriers mostly relate to Arab physicians not having enough time (or compensation) to spend on leadership issues and most physicians felt they did not have adequate training in the “hard” and “soft” skills and competencies of leadership. Also, some physicians involved in leadership were not viewed highly from some of their peers and physician leadership positions were looked at as a senior or phasing-out type of passive commitment (and not seen as an active role in healthcare delivery). On the system-side, political obstruction from traditional, non-physician, health system leaders had led to an increasingly complex system with multiple layers of administration leading Arab physicians to believe their voice was lost. 

With proper training and an organized strategy, Arab physician leaders will meet the challenges necessary for positive transformation of Arab healthcare systems to maximize healthcare value: raising quality and reducing costs. Formal training in leadership competencies and technical skills (through programs offered in-house by their hospital organizations or by professional societies) will enhance Arab physician leaders’ abilities to navigate through the complex administrative structures in place. Physician contracts should protect, if not compensate, time for physicians to play active roles in administrative leadership positions. Ideally, proper physician leadership mentorship programs will be formalized and valued from both frontline physicians and non-physician administrators. Arab physician leadership will have its own unique character yet share some common fundamental principles with the rest of the world. 

References

Chedrawy. Well-led teams. The big payoff. Physician Leadership Journal. Nov/Dec 2020.  https://www.physicianleaders.org/news/5-questions-with-edgar-chedrawy-md-msc-mha-frcsc-facs-cpe

Fares et al. Physician leadership and hospital ranking: Expanding the role of neurosurgeons. Surg Neurol Int 2018;9:199 http://surgicalneurologyint.com/Physician-leadership-and-hospital-ranking:-Expanding-the-role-of-neurosurgeons/

Kakemam et al. Leadership and Management Competencies for Hospital Managers: A Systematic Review and Best-Fit Framework Synthesis. Journal of Healthcare Leadership 2020:12 59–68

Stoller et al. Why the best hospitals are managed by doctors. HBR. Dec 27, 2016

Tasi et al. Does physician leadership affect hospital quality, operational efficiency, and financial performance?  Health Care Management Review: 7/9 2019 – Volume 44 – Issue 3 – p 256-262.

About the Author

Edgar Chedrawy is Head of the Division of Cardiac Surgery at the Nova Scotia Health Authority and an Associate Professor of Surgery and Health Administration at Dalhousie University in Halifax, Canada. Chedrawy is a Fellow of the Royal College of Surgeons of Canada (2003) and a Fellow of the American College of Surgeons (2008). Chedrawy’s clinical career has focused on minimally invasive cardiothoracic surgery and cardiac surgery for advanced heart failure. Chedrawy’s research has focused on healthcare team design and dynamics, collaborative care and innovations in healthcare services delivery. Administratively, he has served in leadership roles for Quality and Patient Safety, physician practice management and strategic planning for surgical programs. Dr. Chedrawy currently functions as a Cohort Leader for Certified Physician Executive (CPE) Certification by the American Association for Physician Leadership (AAPL). Chedrawy became a Fellow of AAPL in 2021 and serves as an educational consultant for hospital leaders with a focus on physician and executive coaching and development leading to improved physician-hospital alignment and transformation.

Chedrawy can be reached at: edgar@chedrawymd.com

Edgar G. Chedrawy MD MSc FRCS(C) FACS MHA CPE FAAPL | LinkedIn