Hybrid Clinician-Managers: Exploration of opportunities and challenges in a hospital setting.

Background: Effective leadership and management are required for quality health services in low- and middle-income countries (LMICs). As in higher income countries (HICs), clinicians in LMICs often transition from a purely clinical to a hybrid role with managerial responsibilities, without management training. These clinicians with dual responsibilities are referred to as hybrid managers (HMs). This study explored opportunities and challenges experienced by HMs in a tertiary academic hospital in South Africa. Methods: A qualitative study was conducted using purposive sampling. In-depth interviews were conducted with 12 clinicians who were in a managerial role for over 12 months with no formal management training. Results: Hybrid managers experienced minimal support when first stepping into the job and articulated the large administrative burden. In an academic hospital, there is the double burden of bureaucracy from the hospital and the university, with the expectation to conduct research, teaching and training. However, direct patient interactions and clinical service also brought opportunities. This included knowledge of the business needs from a clinician's perspective, as well as meaning-making, de-stressing and job satisfaction. Conclusion: Hybrid managers in this LMIC setting share challenges experienced by HMs in HICs with respect to identity, competing work priorities and the complexity of research and teaching responsibilities. Contribution: Hybrid managers in tertiary hospitals require support with adequate orientation towards the administrative processes, budgeting, human resources management and workflows in the hospital and university. Mentorship is key, as is training towards a mind shift change for HMs to truly embrace the role.