A critical distinction was drawn many years ago between task and relationship (Blake and Mouton, 1985; Hershey and Blanchard, 1977). A similar distinction is drawn between transactional (task) leadership and transformational (relationship) leadership—though “transformation” is a term that is loaded with much more than just a focus on relationships. The task/relationship distinction continues to be important, though, as in the case of Spalina’s list, effective leadership often requires a balancing and even blending of tasks and relationships (Forsyth, 2019). The second sector in the leadership/management models offered by Blake and Mouton, as well as by Hershey and Blanchard, incorporates an orientation to both task and relationships.
McKenna and Pugno (2006, p. 87) turn to yet another physician leader, Richard Birrer, MD, MPH, MMM, CPE, to identify the competencies that all those who effectively lead a health care system should have acquired:
- management of medical staff relations (including conflict resolution, the issuing of credentials and privileges, network management, and recruitment and retention)
- efficiency practices (including those involved in informatics, staff performance and compensation, and managed care/insurance)
- quality management (including quality assurance, clinical benchmarking, outcomes and disease management, resource utilization, risk management)
- legal and regulatory issues
- liaison functions (including mergers/affiliations and operations)
- cost management (including finances, cost accounting, cost containment, profit/loss statements)
- technology assessment
- decision making in uncertain situations
- clinical medicine
- organizational issues (including sales/marketing analysis, negotiation of contracts, strategic planning, governance).
I introduce this list because it might more accurately reflect how “real” physician leaders think about what they need to know in a challenging mid-21st Century healthcare environment (Fish and Bergquist, 2022, Fish and Bergquist, 2023a; Fish and Bergquist, 2023b). I would also note that Birrer was more task-oriented than Spalina in identifying the competencies needed by “physician executives” (another term often used by those in the Managerial culture). While management of medical staff relations certainly requires a blending of task and relationship-based competencies, the remaining items on the list are primarily task-oriented. “Executive action” often points the way to a focus on “getting the job done” without major concern for the input of all relevant parties.
