Strategies for transitioning from clinician to manager: a qualitative interview study of clinician-managers in South Africa

Introduction Clinicians transitioning into clinician-manager roles have reported feeling unprepared. We studied this in South Africa, where certain healthcare managerial roles are reserved for clinicians. Methods This is a qualitative study based on 33 in-depth interviews with clinician-managers as well as other key informants, complemented by document reviews and field notes. Transcripts were analysed thematically and theorised by comparing functional (surface level) and critical (focused on understanding power) analyses of the data. Results We identified three strategies clinicians reported during this transition. First, they applied clinical problem-solving skills. This was sometimes, but not always successful. Second, some clinician-managers sought out formal training opportunities in management. Participants valued such training, but many commented on the gap between classroom-based learning and application in practice. Third, we found examples of informal, on-the-job learning including learning by doing and shadowing, supplemented by peer-support networks and with mentors. On-the-job learning was popular and often perceived as effective; however, we identified examples of clinician-managers who struggled during their transition and of participants who were excluded from key learning opportunities. Each strategy can be viewed functionally, as an adaptive response by individuals or groups to the challenges of a new role. They can also be viewed more critically in terms of how power is secured and how individuals can be excluded from opportunities. Conclusion Understanding the strategies used by clinicians to adjust to a managerial role will help inform more evidence-based ways of supporting this important transition.