I had been a partner for 10 years and had been on a secondment as Vice-Chair of a PCG, which had come to an end. I could have gone back to full time practice but that seemed a static move rather than developing the breadth of my experience, so I elected for one of those, then relatively rare and rarefied, Masters in Business Administration.
Obviously, this was a long time ago and MBAs have changed, but so have medical degrees. It has been a constant refrain over the years that “management” can be considered a bit of a dirty word in medicine. I was reassured by one colleague who, when referring to the support that we had given their practice, said “when I first heard you talking about this Richard, I thought it was management bull, but it really works.”
As a full time frontline GP I was very aware that many of the frustrations my patients experienced were arising long before arriving in the consulting room and could not be relieved by me increasing the depth of my technical knowledge. Knowing what to do, the skills that had got me through many—but not all—medical exams was not enough. General practitioner partners had to be able to deliver healthcare outcomes at high volume and high pressure.
Going back to university was a culture shock. MBA courses are different from medical courses, and they are different from each other. I chose a course predominantly by a practical fact that I could mix my attendance with my clinical duties. It was good fortune that the course offered suited my learning needs. The study of Business Administration is the study of groups of humans within an organisation, i.e social anthropology. This is a social science rather than natural science and as someone coming to this with good hard scientific A-levels I had to work through how to gain from both approaches rather than get stuck in an either/or. There were some vigorous debates about what actually constituted “research proof”.
I did deliberately though choose a non-medical MBA because I wanted the different approach and I met some really smart, really interesting, really different people to learn from. Some of whom I am still in touch with.
What you learn on an MBA depends not only on the course but also your own learning needs and learning gaps. One of my medical school contemporaries did the same degree course a couple of years further on but her experience is that of a medical director with a large teaching hospital. I suspect the parts that she felt particularly rewarding were different from those that I did.
The key courses I found, and still find, useful were;
Operations Management. As the Quality and Outcome Framework became more and more incorporated into general practice it became clearer that proactive “population-based” healthcare is different from the reactive “family doctor” healthcare for which I had aspired, trained and enjoyed. This then leads to the emphasis swaying not so much towards doing the right thing but avoiding doing the wrong thing. There are trends and much research that understands how companies (organisations), such as Toyota, are delivering better and better—i.e. with ever decreasing errors. Some of their techniques can be mapped across to healthcare in standardised situations (which in my role at Xytal we have done). When I am talking about management in healthcare, many doctors often say to me, “where is the evidence”?
The issue here is that this evidence is taught in the business schools and not the medical schools, yet it is the outputs of the medical schools - us doctors - who are desperate to avoid errors.
Leading and Managing change. It is logically obvious that better healthcare requires innovation and doing things differently, otherwise we would still be worrying about “mal air” and bleeding our patients. There is an enormous body of literature observing what techniques work well and what techniques work less well. Again, this is taught in the business schools not the medical schools, but you could consider it mission-critical knowledge for those clinicians who are passionate about actually delivering new and better care for their patients. All healthcare is delivered by people, so surely knowledge around the sciences of how people can perform at their best is beyond important.
Finance. This was enabler knowledge for me in that, like many independent contractor GPs of my age, we view certain aspects of NHS bureaucracy is the problem rather than the solution. We were pleased and proud to be independents. Being taught clearly and precisely the core concepts of finance have enabled me to keep on track the independent business that has meant that we could deliver the support to the clinicians that we do, utilising the best parts of NHS organisations and independent organisations. Having said that I am recurrently worried when I come across practices whose owners are (a) dependent on the profits from the practice and (b) totally unaware on a day-to-day basis on how and how much profits are being (or not being) generated.
My journey is my journey, and I would not dream of suggesting that this path is for everyone. I have found the practice of medicine imperfect and as General Practice changed from “family doctoring” to predominantly long-term condition management I have found that the opportunities generated by my business school skills to be rewarding. In addition, it has been helpful in my role as a managing partner in practice, and furthermore in my role as CEO of Xytal. It has given me, at this stage in my career, the chance to be more wise and less busy.
Dr Richard More,