Leadership vs Management

Going from Good to Great in Musculoskeletal Care

Photo by Pablo Varela on Unsplash

In our field of musculoskeletal care, maximizing organizational success requires a nuanced understanding of both leadership and management. Though often used interchangeably, these terms represent distinct concepts, each vital for achieving excellence in healthcare delivery.

And what I find is that most organizations lack one of the two (or both). And it isn’t always apparent or self-evident how this impacts the company, but suffice to say, a lot of internal friction, financial difficulties, and poor clinical results could be avoided if companies in our space operated with both effective leaders AND reliable managers. 

The confusion between leadership and management is common but its significance goes beyond just organizational hierarchy. Many equate "leaders" with top-level executives and "managers" with mid-level supervisors, but this view is misleading and oversimplified. Leadership and management are not hierarchical but complementary roles necessary at all levels of a healthcare organization.

Understanding Leadership and Management

Leadership in MSK is about making a significant positive impact by uniting clinicians and supporting staff around a common goal: improving patient function, mobility, and quality of life. It involves envisioning the future, identifying opportunities, and becoming an agent of change. It’s not about being a charismatic person (or “rizz” as the kids say these days); it's about specific behaviors that inspire, mobilize, and bring others in touch with their own resources. Leadership can be found at all levels of the organization, although it is most pressing at the level of senior management. 

Management, on the other hand, involves the systematic processes essential for day-to-day operations in a musculoskeletal care setting. This includes scheduling and staffing, budgeting, quality assurance, and marketing. Effective management ensures that the clinic consistently produces quality and accessible services within budget.

Effective management maintains stability and efficiency so that every patient’s treatment plan is executed flawlessly and the organization runs smoothly. This is a challenging but crucial task distinct from the visionary and change-oriented nature of leadership.

Balancing Leadership and Management

In musculoskeletal care, the roles of leadership and management must be balanced to ensure both stability and innovation. Managers focus on short-term goals, such as ensuring the clinic meets its productivity targets and maintains high standards of care. Leaders, however, look at long-term visions, such as integrating new rehabilitation technologies, incorporating innovative payment models, or expanding services to address emerging patient needs and open new revenue streams.

Leadership Styles and Situational Adaptation

Leadership in musculoskeletal care must be adaptable, employing different styles to suit varying situations. Daniel Goleman, and other geniuses in this space, often employ frameworks of leadership styles that offer valuable insights here:

• Coercive or Authoritative style: Useful in urgent situations or when dealing with new employees who need clear guidance on the clinic’s protocols and patient care standards 

• Participative or Democratic style: Effective with experienced physical therapists, orthopedic surgeons and other staff, in order to involve them in the decision-making process, foster ownership and initiative, and build buy-in through collaboration and consensus. For example, when making changes to documentation systems or developing new rehabilitation programs, gathering input from seasoned staff members ensures the program is comprehensive and operationally feasible. 

• Pace-setting or Delegative: Appropriate for highly competent and motivated employees in situations where senior staff members are involved, and have autonomy to lead certain initiatives. This can be highly effective, for example, when allowing a senior physical therapist or clinic director to oversee the onboarding, training, and mentoring of a new staff member. 

Often, a combination of styles is necessary. For example, you might initially use an authoritative approach to establish a new policy, then switch to a democratic style to gather team input to operationalize that policy into clear clinical guidelines, and finally, you delegate specific tasks to competent staff members in order to implement change.

Leadership Through Disruption

Disruption, whether from technological advancements, regulatory changes, internal crises, or global events like the COVID-19 pandemic, demands a special kind of leadership because during these black swan events, leadership which embraces change can transform potential setbacks into advancements and opportunities. For instance, the pandemic accelerated the adoption of telehealth in musculoskeletal care, allowing for remote consultations and therapy sessions, which have become integral to many practices (in fact, for some organizations, it represents the entire value proposition).

Many clinics may pass up on this opportunity, deeming it operationally unfeasible. While others give a half-hearted attempt, essentially implementing their standard clinical approach overlying a digital platform. But those who do this most effectively will modify their entire treatment approach and protocols, recognizing both the inherent drawbacks and advantages of an online video-based medium, and thus re-structuring clinical assessments of strength and range of motion, for example, and subsequent matched exercise interventions in such a way so as not to denigrate the validity and reliability of these assessments when switching to a digital medium.

The last thing we want to do as a medical profession with this new opportunity in telehealth is to turn the therapy session into a glorified online personal training/exercise session. And those leaders that truly excel will not only find a way to incorporate telehealth effectively, but also create a synergy with in-person visits, thereby creating a situation where the patient has the flexibility to do some sessions at home and some sessions in the clinic, whilst simultaneously opening up new revenue streams in the form of remote therapeutic monitoring and other innovative programs.

Leaders in our field must leverage the Overton window to explore new strategic options and implement innovative practices that were previously not considered. For example, integrating AI-driven patient intake and diagnostics (such as THERAPHA) to enhance patient assessment, streamline documentation, and support clinical decision-making. Securing these small wins over time is important to build momentum towards more extensive change. 

The Key is Visionary Leadership & Organized Management

In musculoskeletal care, the synergy between strong leadership with effective management is crucial for transforming from a good practice into a great one. Understanding and balancing these roles, adapting leadership styles to fit different situations, and navigating through disruption with innovative strategies, musculoskeletal care organizations can achieve and sustain excellence. The balance here will ensure that we not only maintain high standards of patient care, but that we push the boundaries of what is possible and continue to improve our care delivery models over time.