Fewer hospital dramas?

Many NHS doctors are adding MBA to the letters after their names in a bid to run hospitals more efficiently and create a more unified workforce. Helen Jones reports

NHS managers and medical staff often have an "us and them" mentality according to David O'Regan, a cardiac surgeon. The two don't feel intertwined and there is very little cross-functional thinking,"he says. But O'Regan is trying to break down barriers between the two by taking an executive MBA at Leeds University Business School.

NHS managers and medical staff often have an "us and them" mentality according to David O'Regan, a cardiac surgeon. The two don't feel intertwined and there is very little cross-functional thinking,"he says. But O'Regan is trying to break down barriers between the two by taking an executive MBA at Leeds University Business School.

"It's one of the best things I've ever done," he says. "It has been a fantastic opportunity to step out and look at the organisation and it's been most enlightening."

O'Regan is one of a growing number of doctors taking an MBA course to help them work more effectively and to understand how big organisations like hospitals can be run more efficiently.

Dr Timur Kouliev, an American who has worked in hospitals in Canada, Japan, Russia and the UK, is studying for an MBA at Tanaka Business School at Imperial College. "I'm doing an MBA because I plan to practice in the US where physicians are often taken advantage of because they know little about business processes," he says. "They don't know about managing a hospital as a business. I need to know how to manage the supply chain, how to work with a large number of people and know where money is coming from and how to maximise it to give patients the best possible care."

According to Professor Jenny Simpson, chief executive of the British Association of Medical Managers, which offers information and support for doctors in managerial roles, it is definitely a trend for doctors to get some management training like an MBA. "The role of any senior doctor has a management component but most have very little formal training," he says. "It's very difficult to care for patients without management and leadership skills to make the system work as a whole."

Most doctors studying for an MBA opt for a part-time course so they can begin putting their new management skills to immediate use. Dr Kouliev is something of an exception as he is taking a full-time MBA. "I chose Tanaka at Imperial because I wanted to do a one-year course.," he says. "You can't do that in the US and American business schools are very US-centric so you don't get the bigger world picture. As a physician you simply can't be away from clinical practice for too long."

Dr Lorna Okalebo, who trained in Nairobi and at Harvard before joining the NHS six years ago, recognised the need for a management qualification when she became a registrar in a general practice in north Oxfordshire. "Previously I had a purely clinical role, which was fairly predictable," she explains. "Suddenly I was faced with new challenges such as setting up innovative services from scratch, for example an obesity clinic. While I had been acutely aware of the emotional, social and financial needs of patients, and how these affect their health, to set up an effective service required a different set of skills."

Dr Okalebo took an executive MBA at Oxford University's Said Business School to develop her strategic decision-making skills. "I need to think about resources, budgets, staffing, funding, and the strategic direction of the practice," she says. "To fulfil this demanding role I need to have a clear understanding of the current health priorities, the management of a patient safety culture, clinical effectiveness, as well as auditing in primary and community care."

The most useful part of her MBA course has been the case studies of real businesses that have managed to improve their performances, says Dr Okalebo. "The turnaround of Lufthansa from near bankruptcy and Archie Norman's role in creating a strategic vision for ASDA were particularly illuminating," she says. "Norman's philosophy was that one of the key attributes of successful managers is communication and being able to 'walk the talk' and lead by example. For clinical leadership to have a real impact on the overall future strategic direction for the NHS, they have to engage more with NHS managers, patients and other stakeholders, listen more and be in touch with front-line workers."

In her experience the MBA provides the right business knowledge to enable her to fulfil her role in delivering a seamless health service and improve standards.

While Dr Okalebo chose to do an MBA to further her career in medicine, a few doctors use it as a way of switching careers. "There are some doctors that are looking for a way of doing something else," says Professor Jenny Simpson. "After I got my MBA I was offered management consultancy jobs in the UK and the US - I could have earned so much more, but I am still a doctor."

Dr Kouliev plans to remain working as a doctor too. In the long run she plans to establish her own chain of clinics in China but needs business expertise, she says.

One of the biggest issues facing doctors after completing an MBA is that they can become quite disillusioned, according to Professor Simpson. They can see how the system should be managed and they get frustrated that it isn't.

Fortunately, this is not the case for O'Regan who says that he has had fantastic support from colleagues, the nursing staff and the chief executive. "I'm very positive about the whole experience," he says. "I'm not going to give up being a cardiac surgeon."

But there is a place for hybrid managers with clinical expertise who can work to improve the system for patients, he believes. " I'd like to keep my feet on the ground and get a real sense of what's happening on the shop floor and then translate that into a business strategy."