Home The Quarterly 2013 Leadership in Practice: Case Studies


Leadership in Practice: Career Case Studies Print E-mail
The Quarterly 2013

This article was written by Dr Susan Keam, derived from material presented by Dr Brett Gardiner and Rear Admiral Robyn Walker AM on the 1st of August 2012 for the RACMA Interact Webinar series. A recording of the webinar can be found on the RACMA website here.

Dr Brett Gardiner

Dr Brett Gardiner graduated in 1983, then became a Rehabilitation Medicine Specialist in 1988. In 1990, with minimal management experience, appointed Managing Director/Clinical Director privatised public health entity in Tasmania (clinician manager). Achieved FRACMA in 1996. From 2000, worked in a range of locum clinician manager roles in major metropolitan hospitals, e.g. Director Rehabilitation & Aged Care Services. Appointed Director Medical Services in a major metropolitan hospital in 2001, and stopped clinical practice, but worked as expert witness head injury assessments. During this appointment, was acting general manager of the hospital for approximately 1 year. In 2006 appointed to a role as Area Director Medical Administration with responsibility for approximately 2500 doctors. From 2010, has worked as Director Clinical Governance & Chief Medical Officer (Tertiary Hospital) St Vincent’s & Mater Health. Maintained part-time clinical work for two tears until 2011, which helped in keeping current in rehabilitation medicine and in understanding how the hospital and community sectors work. This background has helped in understanding what medical management is, the importance of good leadership, and identifying the differences between clinician manager and medical administrator roles.

The Clinician Manager

The clinician manager role is an exceptionally difficult role to perform effectively, as it requires a careful balancing of time devoted to clinical responsibilities and that required by management accountabilities. In this role the clinician manager needs to be able to balance the issues characteristic of the clinician role (e.g. individual patient advocacy, individual autonomy, and flexible hours and high remuneration) with those associated with the senior leader/manager role (taking a system view, group teamwork, and lower remuneration, with standard, generic employment contracts). A clinician has expertise in the clinical domain without needing expertise in management skills, whereas a medical manager must demonstrate an understanding of and expertise across a number of management domains, including planning, operations, finance, information technology & human resources skills. Because of the disparity between the skill sets required of clinicians and managers, there are often difficulties in holding concurrent clinical and management roles.

Being a Medical Administrator

To successfully lead in medical management, the eight RACMA role competencies (Medical Leader; Medical Expert; Communicator; Advocate; Scholar; Professional; Collaborator; Manager) need to be developed to the highest level. Competency as a medical expert is very important to distinguish from Medical Administrators from senior, nonmedical managers in the healthcare system. There is a perception among clinicians that "if you are not working in clinical medicine, you don’t know what is going on". While this is not true, it is an attitude that healthcare has to work with, and this is where Medical Administrators can add value.

What Makes a Good Leader?

Most effective leaders have high levels of emotional intelligence at work. The five major components of emotional intelligence are self-awareness, self-regulation, motivation, empathy and social skill, and high levels of these components result in a high level of self-understanding, self-awareness, and understanding and awareness of others). Good leaders are capable of taking on different roles during change, ranging from that of sponsor (let it happen; having the power to sanction change and create the new environment) to those of change agent (help it happen; facilitate and manage needs of stakeholders), advocate (support it to happen; want to achieve change but lack power to sanction), implementer (make it happen), and mentor (guide implementers). While a leader can’t take on all these roles simultaneously, they can involve others in the roles they as leaders cannot fill, so that the change will be embraced. Leaders can take on different roles during the change process as a learning opportunity, but also need to understand expectations and the support available.

Rear Admiral Robyn Walker

Rear Admiral Robyn Walker spent nine years working in the Australian public health system, then joined the Navy because of opportunities to practice diving and submarine medicine. Has spent 20 years in the Navy in various roles, including 10 years in diving and submarine medicine , followed by operational health planning in Fleet, Joint Defence Services operational health planning (including for Iraq/ Solomon Islands/East Timor and the Banda Aceh tsunami response), before becoming the Director General of the Navy Health Service, then Director General Health Capability /Garrison Health/Strategic Health Policy and most recently (December 2011) Commander Joint Health/SGADF. In this role, is responsible for developing policy for providing health care for the Australian Defence Force on a national level and, in conjunction with Australia’s allies, on an international level. These changing roles within the Navy required moving from being a clinician to those of clinician manager, then health planner, medical manager and policy developer. Gained FRACMA in 2010 through the accelerated pathway. While there are many differences between medical leadership in the military and civilian environments, there are a number of challenges that are common to both.

Day to day challenges for leadership

In order to effectively administer resources, leaders need to understand the system they are working in. The day-to-day challenges facing leaders are numerous and diverse. Human resources management takes up the most time, because a key leadership task is to create an environment in which people from diverse backgrounds and experiences, with varied wants and needs, can work together as a team. This requires balancing individual agendas and priorities to achieve the overall goal.

Stove piping of communication (i.e. not all information is passed on), and a belief that information is power needs to be overcome by increasing communication flow across areas and sharing knowledge. In an age of emails and electronic communication, it is difficult to maintain corporate knowledge about decision-making; this can be overcome by creating repositories to keep track of how decisions were made.

Other challenges include achieving finance and efficiency dividends in the face of reduced budgets (e.g. providing high quality healthcare in an environment of increasing demand and cost), overcoming a "failure to solve, failure to ask" way of thinking, lack of decision making (it’s better to make a decision, even if it is wrong, than make no decision at all, which paralyses an organisation). Staff roles need to be clearly defined and communicated. Priorities need to be set, clearly articulated, and then reset if priorities change. If priorities change on a day-to-day basis, staff don’t know how to work effectively.

Medical Leadership in Defence

Medical Leaders in defence need to understand the concept of war, and the challenges of clinical governance in a deployed environment. Issues unique to medical leadership in a combat environment include the ethics of health support to combatants, detainees, local populations and managing ethics and torture. They also need to work out how they can comply with government intent, or how to influence the government so that the best outcome is achieved. They are frequently managing people from a wide range of different cultures, and they must provide the best possible service, while keeping expenditure within budget. There may be difficulties on assuming a leadership role, especially when moving from a junior to a more senior management role, as some of those being managed don’t always accept that the promotion has occurred. Honest performance appraisals, especially where poor performance is highlighted, is important in Defence, because managers need to document issues and show how they have managed poor performance in a crisis.

Health is not the primary organisational role of the military - health are advisors and not decision makers. They are not just the patient advocate, but must consider whether patients are fit or not fit for the job, keeping in mind that the military pay for and provide healthcare. A further dimension complicating the role of medical leadership in Defence is that their patients are also their colleagues, and when on operations, they need to provide them with best possible healthcare even in emotionally difficult times.

Leaders in Defence, including those managing health, need to work at being a tough times or crisis leader. It must be an inherent consistent style, which is not switched on and off, and requires strong initial credibility with those we are trying to lead. An individual's leadership style needs to be honed and developed in easy times so that it becomes automatic for the tough times.

Anyone who aspires to become an effective leader needs to: 
  • develop a realistic and achievable vision. They need to do their homework, understand other points of view and be positive.
  • demonstrate their values. They should set the standard for others, and do and say things because they are the right things to do.
  • welcome new ideas, but remember that even old ideas can come of age.

The Royal Australasian College of Medical Administrators
Dr Brett Gardiner and RAdm Robyn Walker, , p650
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