Friday, August 28, 2009

On Optimal Expertise for Leadership in Biomedicine

There has recently been debate on these pages regarding optimal expertise for biomedical leadership, precipitated by Roy Poses' posts "Health Care Leaders: Don't Know Much About Health Care" and "NY Times Proclaims Anyone Can Run a Health Care Organization with a Little Studying Up".

I am resurfacing a post I wrote in Jan. 2009 entitled "Pfizer/Wyeth Merger And Sacrificing The Future: Laying Off Scientific Staff All Over The Place" that I believe succinctly states the problems with 'management by amateur.'

Read the entire post, but here are the highlights:

... Those in charge [and who lack domain credentials -ed.] cannot see that which the domain specialist sees.

They cannot see because they lack the training, experience, and what is described as 'meta-competence' (in this brilliant article on competence [the Dunning-Kruger effect - ed.]) essential to seeing that which is obvious. Obvious, that is, to those who do not lack these characteristics. In addition, I've also observed that some lack the fundamental analytical abilities essential to understanding and managing the complexities of biomedical R&D.

Why those without domain expertise are in charge of organizations whose long term viability depends entirely on the most advanced and creative pursuit of biomedical 'miracles' is another matter. I won't address this here, other than saying it reflects the adverse consequences of a bias that has evolved in management "science."

That bias is the belief that all the world consists of faceless labor resources performing easily definable processes upon interchangeable widgets, and that management can therefore be done by generic managers, exclusively. Some of the world is like that [i.e., fast food chains - ed.], but some isn't, such as biomedical R&D. [And clinical medicine as well - ed.]

Management in the absence of domain expertise in this industry is, in fact, mismanagement.

There is nothing here to spin, there is nothing to debate. There is nothing to discuss. This is a first principle.

Failure to accept this reality results in corporate failure.

Those who believe otherwise are engaging in magical thinking.

Further, those without biomedical domain knowledge who disagree should be prepared to discuss how their lack of domain knowledge might affect their insights and opinions on such complex matters, compared to those with both domain knowledge and leadership experience. A question is this: based on the same Western traditions of inquiry and critical thinking that led to modern biomedical science and its accomplishments, whose opinion is likely to be more valid?

-- SS

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