Doctors and leadership of healthcare organizations.

C facing healthcare organization in the twenty-first century are unprecedented: rising customers’ expectations, financial crisis, high cost care, new sets of diseases, crisis of equity, accessibility, and leadership of healthcare systems.1 Management of healthcare needs to respond efficiently and effectively to these challenges in order to meet the expectations, and survive current turmoil. It has been recognized that “commonality and interaction between medicine and management dictates more involvement of doctors in management, and scientific evidence supports the need for more involvement of doctors in managing healthcare systems.”2 In fact, doctors “ought to be playing a central role in making the changes in the health care system that will allow the system to offer better outcomes, greater ease of use, lower cost, and more social justice in health status.”3 For doctors to respond well to the above challenges they have to be leaders.2-4 This paper addresses leadership in health care systems: meanings, types, and how to be a leader. The aim is to share and initiate scientific debate on the subject with interested parties particularly doctors in healthcare management. In addition to being care providers, doctors occupy many senior management positions in healthcare organizations. Some administrators may argue that doctors must be reserved for care provision only, and leave management to administrators. This argument does not take into consideration the ground reality, and the fact that “ in the context of clinical practice, management forms part of the basic structure of the medical consultation, and doctors in management role will ensure that patients care is provided and supervised by staff with appropriate skills.”2 The existing trend of appointing doctors to senior positions in many healthcare organizations, both in developed and developing countries has to be welcomed. But, also it has to be acknowledged that most of doctors in these senior positions exhibit management style more than leadership style. This explains, at least partly, why most health care organizations stuck in day-to-day business, and fail to survey the horizon for opportunities, and anticipation of change. Looking into the dynamic of existing health care systems, one would say with confidence that healthcare organizations are over managed, and under led. Doctors particularly those occupying senior positions in their organizations need to be leaders rather than managers. Leaders innovate, while managers administer; leaders do the right things, while managers do things right; leaders’ eyes is on the horizon, while managers’ eyes is on the bottom line; and leaders challenge the status quo, while managers accept the status quo.5-7 Managers concentrate on daily businesses, subjects, and materials, while leaders concentrate on developing people and creating change.5-7 Change is perhaps the keyword of the twenty-first century, for example, USA President-elect Barrack Obama emphasized the need for change in his campaign. Globalization and world financial crisis called for change at all levels of management, and for all type of organizations. Healthcare organizations in its existing way of management are costly and ineffective. This has to change into a more cost-effective healthcare organizations that addresses the expectations of both customers and governments. This is a difficult task without doctors playing leadership role in introducing and managing change. Leadership is the cure for the degenerative arthritis that affects healthcare organizations at an early age, and makes them stiff and inflexible to change. So what is leadership? Many definitions are found in literature, but the definition of Northouse6 seems more relevant to our purpose: leadership is “a process whereby an individual