Executive Leader/Managerial Culture
In recent years, physicians have often played this key executive leadership role. They perform this administrative role not in a clinical setting but instead in the administrative offices of their healthcare system. As in the case of physician leaders who identify as experts, the physician leader who serves as executive is operating within the confines of a specific healthcare system. The key focus of those serving in this executive role is the achievement of organizational excellence. However, as McKinna and Pugno (2006, p. 65) have observed, the focus of many physician leaders is on “career survival.”
Furthermore, there is often an untested belief that the skills that make the physician a successful clinician are also those that will make them a successful administrator. However, McKinna and Pugno (2006, p. 66) offer a cautionary note in this regard: “some traits associated with clinical excellence can be applicable to the work of leadership. [However] there are many differences between the work of clinicians and the work of administrators.” Those physicians who serve in the executive role typically manage staff and resources in their organization. They bring important knowledge regarding clinical needs to this role; however, they must also be knowledgeable about system-based perspectives and practices. Furthermore, these executive leaders must possess functional skills in such managerial areas as supervision, delegation, and motivation.
An important perspective is introduced regarding the interplay between executive leadership and the Managerial Culture. It is important to note that physician leaders are often drawn to the role of executive because the administrative services and the attendant Managerial Culture bring much value to the healthcare community. Some physicians have chosen to move from the clinical to the administrative setting because of the challenging world in which healthcare now operates in most societies. Specifically, the Managerial Culture builds on the dichotomy between control and chaos. Members of this culture (including physician leaders) fear their loss of organizational control. They are anxious about organizational chaos—a threat particularly apparent in our mid-21st Century world of volatility, uncertainty, complexity, ambiguity, turbulence, and contradiction (VUCA-Plus) (Bergquist, 2020; Fish and Bergquist, 2023b).
Those aligned with the Managerial Culture resolutely hold theories about organizing for maximum effectiveness. These theories concern the achievement of predictability regarding the outcomes of any change effort. Managers look for organizational strategies that will reduce their anxiety regarding organizational chaos and VUCA-Plus conditions. Over the years, healthcare managers have primarily focused on the provision of resources for amelioration rather than prevention of illness and injury. These managers have traditionally believed that they could reduce both their own anxiety and the anxiety of their customers (patients) by demonstrating that they could provide healing services at reasonable costs to their customers.
