In conversation with Professor Amanda Goodall

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Hello. I’m Domhnall MacAuley and welcome to this BMJ Leader conversation. Amanda has the most remarkable title – Professor of Leadership. Tell me a little about this title and about your career so far.

AG: Well, I joined academia relatively late after a career working with leaders in universities. And that led to asking the question- should university leaders be experts in the core business, should they be scholars, top scholars, or should they essentially be managers. I’ve been doing research in this field for nearly 20 years now and I’ve replicated it in many, indeed, in almost all spheres and in all types of roles, including healthcare. 

How did I get involved in  BMJ Leader and what took me to creating a master’s degree for doctors, exclusively for doctors, in leadership management? That all came out of research I did focused around hospitals: Looking at the best hospitals in the world, are they more likely to be led by doctors or by managers? And I found that doctors led the most outstanding hospital systems in the world, particularly in the United States. That’s is where I started and that research has continued to build.

DMacA: Having studied the top academics, the Vice Chancellors or Presidents of universities, what are the characteristics that make a good head of a university?

AG: After completing my undergraduate degree quite late, I then worked Anthony Giddens, an outstanding sociologist who led London School of Economics where I did my undergraduate degree. I worked very closely with him as a kind of apparatchik, special assistant, that kind of thing, when he was Head of LSC. Then I went to Chicago, came back, and worked with another University Head at Warwick in a similar role and I noticed that their behaviour was very different. That’s what led to the hypothesis that – maybe it’s because Anthony was very good at research, and still focused on research, that his strategy for the LSC was very focused around research. Based on that hypothesis, I asked the question to university leaders, Deans of Business Schools, and then beyond. I went from sport, such as basketball and Formula One racing, and then to all kinds of businesses and professions. And, yes, I’m really convinced that it doesn’t matter whether you’re a doctor an engineer, whatever profession you work in, you need to have an understanding of the core business of the organization.  And, in healthcare, I think that doctors and other clinicians have that understanding in a way that general managers just cannot.

DMacA: Lets explore this in a little more depth because this is one of the controversies in healthcare management- should it be doctors or should it be career managers? Please share  some of your insight into who make the best leaders in healthcare.

AG: The important thing is to come from the core business. If you’re a lawyer, for example, and we know that one of the top London law firms tried to bring in a general manager because the lawyers just wanted to focus on their law and weren’t interested in going into leadership or management. It was disastrous and that person left pretty soon afterwards. And, if you look at organizational structures: If you look inside Deloitte, McKinsey, KPMG, any of these massive consulting firms, and healthcare  organisations use Deloittes and other  consultancy firms a lot, you will find that only the people who started in them as very young employees go on to be the top executives in those firms. If we look at the most successful organizations in the world, and that’s where we should start, you will find that on the whole they have been led by experts in that core business. 

If we turn to medicine now, and we think about the best organizations in healthcare, there are two American organizations that top the rankings year in year out and they are the Cleveland Clinic and the Mayo Clinic. They were started by doctors and they have only ever been led by physicians. They’ve never been led by general managers. If you look, consistently every year, the top medical organizations in America are much more likely to be led by doctors than general managers. So why might this be? Well, a very simple argument is that doctors and other clinicians, but doctors in particular because they have such a long training, have many years of having ‘ the patient comes first’ instilled into their psyche. Always, Patient First, Patient First, and I think that has a influence on their focus with always thinking of the patient first. 

If you think about the UK, we have, I don’t know the percentage is now, between five and seven percent, maybe even fewer CEOs in hospitals who are doctors. If you look at Germany, if you look at France, if you look at Italy, the numbers are much higher, up in 60% or more and these systems are much more efficient than the NHS. I don’t think anyone would argue that they’re not.  If we look at the comparatives, the NHS has been run down in numbers of clinicians, in money, and all sorts of things but, I still think a massive problem with the NHS is that clinicians are not up there, and particularly doctors, are not in sufficient leadership positions.

DMacA: Many doctors will agree with you wholeheartedly. But I would be the first to suggest that perhaps clinicians, while they might be very good at the clinical work, may need to learn other aspects of the leadership. What are the other skills they need to learn, and how?

AG: Think about any leader. Think about a lawyer who has become a leader, think about an engineer who has to become a leader, think about companies like Mercedes-Benz. The person who turned Mercedes-Benz around recently had a PhD in engineering. Think about Formula One racing. The management teams are those who formerly drove as those who raced racing cars make the best formula one principals. These are very talented people. Doctors are very clever people, they can learn this stuff. It’s much easier to train a doctor or another clinician in leadership and management skills than it is to train a manager to be a highly skilled doctor. So, the idea that a doctor can’t understand how to run an organization… I mean the Cleveland Clinic, Mayo Clinic, are billion-dollar organizations and they’re only ever led by doctors. But, yes, we need to train doctors, absolutely. 

A number of years ago, in 2015, I started the process of creating a master’s degree at Bayes Business School which is now in its sixth or seventh year and it is exclusively around training doctors in leadership and management. That’s exactly what we do and it’s been amazing. Many of those doctors rise in terms of the seniority and, for those who have been on the course, that promotion happens very quickly. Not only that but, because it’s an apprenticeship program, we interview with the doctor’s line managers and so we know how they’re progressing. In other words, it’s not just that they fill out a form to say they like the course, we can see and follow their career progression, and we see them going into leadership management positions. Nurses have been doing leadership and management courses for over 30 years. Doctors have been excluded and I don’t think that that’s right.

DMacA: You’re a tremendous advocate for the clinician leader. Paint us a picture of what you think the clinician leader should look like.

A fundamental point is that we don’t want a lacklustre doctor, or a bad engineer, or a poor lawyer to say- ‘ actually I’m not very good at this I think I’ll go into management. That happens quite a lot in different sectors. It has certainly happened in academia and we don’t want that. In other words, we need really good doctors, and really good professionals, to go into leadership and management because they inspire, motivate, and mentor those who are coming up after them. That’s very important. 

On the leadership and management course that we do for doctors, the first exercise we do is to hold up a mirror to them. The very first module, which is an academic module is, what some people might call ‘soft skills’ but, as they find out very quickly, soft skills are the hardest ones. They have to think about their behaviour and that’s because we believe that, while you might be a brilliant doctor or a brilliant engineer, if you’re a narcissist,  if you’ve poor behavioural skills, if you’re not self-aware, you’re not going to make a good leader. We start immediately with these, holding up a mirror, and we do various training around negotiation, around self-reflection, etc. We also give them professional coaches for two years.  The first module is very psychological. They do action learning, all this kind of stuff, and that’s really important. 

We want people that are able to reflect, to be able to control their behaviour and related factors, so there are definitely generic skills that doctors, just like anyone else, need to demonstrate. There may be slight differences between different professions but, essentially, we don’t want narcissists. 

That’s two components- they need to be good at their profession, not just average or not good and, they need to demonstrate that they have mature emotional skills, emotional intelligence. Beyond that, obviously, they have to retrain in things like health analytics, and we train them in strategy.

It makes a big difference to organizations if they’re led by core business experts. They can see the big picture much more clearly, and can strategize much more clearly. They know what’s coming up professionally. Strategy is obviously very important. Making sure you’re in touch. Some people say “we need outsiders because insiders are too narrowly focused”. Well, was Steve Jobs was narrowly focused? I don’t think so. He was narrowly focused when he came back into Apple. A former Coca-Cola marketing executive was running Apple and had produced many products. Jobs came back in, cut them all went down to four products, and just kept renewing them, and updating them, and that’s basically how it is today. I think that core business experts are naturally better at strategy but they still need to be trained in strategy and, of course, business and management. They need to know about different areas, and how to delegate to people who understand better, whose core business is in HR or finance or whatever, but they don’t need necessarily to be running it themselves. 

I have great faith in doctors particularly but other clinicians as well, that they are able to learn all those things.  That’s what I’ve seen on our course. It’s been amazing actually.

DMacA: You have a book coming out. Tell me a little bit about your book.

AG: I have a book coming out which covers all of my research in one place.  This is a general business book, it’s not an academic book. And, the reason I think it’s relevant to this conversation is that a lot of the evidence that I look at is based around health care, not just hospitals but healthcare in general. It’s coming out in June and it’s called ‘Credible, the power of expert leaders. I think it should be a very accessible book. I hope it’ll be a very accessible book.

DMacA: Amanda that’s been absolutely fascinating, and inspiring. Thank you very much, it’s been wonderful talking to you.

 

Contributors

Photo of Amanda Goodall

Professor Amanda Goodall

Amanda Goodall is a Professor in Leadership at Bayes Business School (formerly Cass).  Her ‘expert leadership’ research looks at the relationship between leadership, management, and organizational performance. She is the founder of the ‘Executive Masters in Medical Leadership’ run at Bayes and designed for doctors. Amanda publishes in academic journals and practitioner publications and is often featured in the media.  She has a general business book on her work coming out in June, “Credible – the power of expert leaders”. Her research is available at www.amandagoodall.com

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

Professor Domhnall MacAuley

Domhnall MacAuley currently serves on the International Editorial Board for BMJ Leader.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

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