A theory of expert leadership (TEL) in psychiatry.

Abstract

Leaders' technical competence - 'expert knowledge' - has been shown in many settings to be associated with better organizational performance. In universities, for example, there is longitudinal evidence that research-focused scholars make the best leaders; results from a hospital study show that doctors instead of professional managers are most closely associated with the best performing institutions. To explain these patterns, and raise hypotheses, a theory of expert leadership (TEL) has been developed that might explain these patterns. In this paper the framework for expert leadership is applied to psychiatry. The TEL proposes that psychiatric leaders, as opposed to non-expert managers, improve organizational performance through several channels. First, experts' knowledge influences organizational strategy. Second, having been 'one of them', a psychiatrist understands how to create the optimal work environment for psychiatric teams, through appropriate goal-setting, evaluation and support. These factors are positively associated with workers' wellbeing and performance. Third, exceptional psychiatrist-leaders are likely to set high standards for hiring. Fourth, leaders' credibility extends their influence among core workers, and also signals organizational priorities to stakeholders. Finally, a necessary prerequisite of TEL is that expert leaders have direct executive power inclusive of budgetary and strategic oversight.