John Hoffmire: We share something in common, you and I. We both wrote doctoral dissertations on topics we feel passionate about and then centered our careers around that topic and passion. For you, the focus has been medical leadership development in a low- and middle-income country, i.e. India. I’d love to know how your interest in medicine, hospital administration and medical leadership began first come about?
Dr Kamal Gulati: Absolutely. My interest in hospital administration with special focus on medical leadership began during my early days at the All India Institute of Medical Sciences (AIIMS) in New Delhi, often referred to as the Harvard of India. While working there, I couldn’t help but notice a curious pattern: many doctors were performing management duties. These were renowned skilled clinicians and surgeons who were dedicating a significant amount of their time to administrative works instead of patient care. Given our huge patient load and the long wait times for consultations and surgeries, this struck me as a significant inefficiency. I kept wondering why doctors, who are trained in medicine, were taking on these management roles. It seemed like an under-use of their specialized clinical skills. This question nagged at me for years and eventually became the foundation of my doctoral research.
While I worked on my PhD research, I studied how physicians’ engagement has long been regarded as a critical component for effective performance in healthcare organizations, yet that engagement and leadership is too often found lacking throughout India’s medical care system. I wanted to understand why doctors take on leadership in hospitals and how competent they feel while performing these management functions. This exploration has been incredibly fulfilling and eye-opening. Through my research, first from India, I have shown that while doctors often step into leadership roles out of necessity or a sense of duty, many feel they lack the formal training needed for effective management of healthcare in the public as well as private sector. This can impact their efficiency and the overall functioning of the hospital. My work aims to bridge this medical leadership competency gap, advocating for leadership training for doctors right from the undergraduate level to enhance their leadership capabilities for improved patient care outcomes.
Then shortly after I graduated, I was awarded an International Fellowship at the Institute of Advanced Study, at the Warwick Business School in England, to learn about strategic healthcare management with a special focus on medical leadership. I came to understand, while the majority of hospital CEOs in India are physicians, the opposite is the case in the UK, and in both countries doctors who have MBA degrees are rare. Since then, my research has been focused on bridging the gap between ‘medicine and management’ and how this partnership can enhance the quality, efficiency, and patient-centeredness of healthcare services.
I believe that by aligning the expertise of healthcare practitioners with the priorities of management at hospitals, we can pave the way for a more effective and sustainable healthcare system in India. Interestingly, this point has also been acknowledged by the Indian policy makers and the National Health Policy of India, ‘…recognizes that human resource management is critical to health system strengthening and healthcare delivery …. (and) recommends development of leadership skills, strengthening human resource governance in the public health system.’ Hence, the policy provides a national mandate to direct efforts toward leadership capacity building in India’s resource-constrained healthcare system.
John: So, I understand the importance of aligning the skills of healthcare practitioners and the priorities of hospital management both in India and in the UK. But will you please tell me about some of the complexities that develop as this happens?
Kamal: My understanding of the complexities expanded during my fellowship at Warwick University. Both in the UK and India it is widely felt that there isn’t enough medical leadership development and support provided. The COVID-19 pandemic in particular put a spotlight on the need for well-supported leaders in healthcare. During COVID many doctors stepped up into formal or informal leadership positions during the pandemic, but stepped down again afterwards due to being stressed, overworked, and to help reduce waiting lists. I also surmised that there is also a low proportion of women in medical leadership roles in both countries, further highlighting a need for more training and support to achieve better gender equality.
As you know, I had the incredible opportunity to be selected for the prestigious Chevening CRISP fellowship at the University of Oxford. This fellowship was a true game changer for me. During my tenure at Oxford, I collaborated with Prof. Julie Davies from the UCL Global Business School for Health. Together, we developed a research project titled ‘Enabling Medical Leadership in India and England: A Comparative Study’ (EMLIE). The EMLIE project was designed to delve into the barriers and enablers for physicians aspiring to leadership roles. We aimed to understand what supports and hinders their journey towards leadership. A significant aspect of our research was profiling a subset of women healthcare physicians and medical leaders. We examined their lived experiences of leadership development within the healthcare systems of both India and England. This comparative approach provided rich insights into the different contexts and challenges faced by medical leaders in these countries. Taking this work forward at the ground level, I bid for the Chevening CAPF bid in 2023 and won the award. This Chevening funding provided me with much required support to conduct two in-person workshops for healthcare professionals in India – one in All India Institute of Medical Sciences, Jammu and another at the Postgraduate Institute of Medical Education and Research, Chandigarh. These workshops were well-attended by more than 100 doctors (mostly women), who found it very beneficial.
John: Briefly, because I know you have published several articles on this topic, can you tell me more about the key findings of your research so far?
Kamal: We found that in India, mostly male doctors are in hospital leadership positions such as Director, CEO, or Medical Superintendent, but often without having any formal leadership or management training beforehand. Generally, seniority or rotation is a major criterion to acquire such senior leadership roles. In the UK, there is an NHS graduate management trainee scheme, which is for non-medics to become managers. Neither system is optimal. We also found that in both countries there is, in fact, a lack of women in medical leadership positions. In India, only about 18% of top leaders in healthcare are women. There are also huge statistical anomalies in some specialties too. For example, less than 1% of spine surgeons in India are women, and in the UK, less than a quarter of trainees in orthopedics are women.
Another key finding of our research was that both structural and cultural factors play crucial roles in shaping medical leadership. In India, the hierarchical nature of the healthcare system can be a barrier, while in England, the challenge often lies in balancing clinical duties with leadership responsibilities. For women, additional barriers such as gender biases and work-life balance issues were prominent in both contexts. Our research highlighted the need for tailored leadership development programs that address these unique challenges and promote a more inclusive leadership landscape in healthcare. In addition, we are advocating for: better gender equality reporting; women-only leadership development programs; mentoring; and flexible working. Of these, family-friendly policies are especially key to improving gender parity and more diverse medical leadership in both countries. I am also pleased to mention that my work on gender equality in medicine was recognized by Erasmus MC in the Netherlands, and I was awarded the prestigious Gender in Research Fellowship in 2023. This recognition further validated my efforts and provided additional momentum to continue advocating for gender equality in healthcare leadership in the non-western contexts such as India.
John: I was so grateful that you took the time and joined me for the “Women in STEM and Entrepreneurship: Creating Leaders” event organized by the British High Commission Chevening Office in Kochi, Karala this past January. What was that experience like for you?
Kamal: It was such a privilege to share my professional journey with students and women entrepreneurs from leading technical universities at the Integrated Startup Complex (ISC) in Kochi. In my session we delved into the opportunities for young women within the healthcare sector, emphasizing the crucial role of information, technology and communication. It was a great way to share insights and pave the way for the next generation of leaders in STEM, healthcare, and entrepreneurship. The forum provided an excellent platform for me to share findings from my second Chevening research project titled “Advancing the Entrepreneurship Ecosystem of India: A Qualitative Study with Chevening Fellows”. This research offered valuable insights into entrepreneurship ecosystem in India. The findings revealed what entrepreneurship means to established entrepreneurs, their motivations for embarking on the entrepreneurial journey, the skills required for success, the challenges they face, and their strategies for sustainability. Notably, these aspects are often different from the expectations and beliefs of aspiring entrepreneurs. The recommendations from this study can play a key role in strengthening the Indian entrepreneurial ecosystem, potentially improving the current low startup success rate.
Needless to say, it was also a delight to get the chance to connect with fellow Chevening alumni and leadership and learn about their incredible achievements and contributions, as well as to strengthen that network of connections, both professionally and personally.
John: The Kochi reunion and project was a highlight for me as well. I love seeing my former students. This, by the way, reminds me of when you and I first met, you were a fellow of the Chevening Research, Science, and Innovation Leadership Programme of University of Oxford, 2022. Looking back now a few years, can you tell me what impact that programme and your time in Oxford has had on you?
Kamal: Reflecting on my time in Oxford and the impact of the Chevening CRISP fellowship, I can say it was transformative both professionally and personally. The fellowship provided me with a global perspective on healthcare leadership, exposing me to innovative practices and diverse healthcare systems. Collaborating with esteemed faculty of Oxford, UCL, The Newcastle University, University of Aberdeen and other international experts expanded my understanding and network, which has been invaluable.
Professionally, the fellowship enriched my research skills and provided the foundation for the EMLIE project, which has garnered significant attention and opened doors for further studies and collaborations. On a personal level, the experience at Oxford instilled in me a greater confidence and a sense of purpose. It reinforced the importance of pursuing interdisciplinary approaches to solve complex problems in healthcare and beyond. Overall, the fellowship was a pivotal moment in my career, shaping my approach to leadership and my commitment to driving positive change in the healthcare sector in India. Needless to say, it also gave me some very good friends with whom I regularly interact, and most importantly, mentors like you and Richard.
John: One of the many things I love about working with the CRISP Fellows is that I get to see first-hand the good they are doing in their various fields to make this world a better place. That is especially true in working to improve healthcare. In that work, you are literally trying to save lives and improve the quality and outcome of the health care people receive. And you are working for greater gender inclusion and equity. I greatly admire your work and the outstanding person you are. It’s an honor and privilege to know you and to follow the work you are doing.
Kamal: Thank you, John. As I’ve said before, a truly excellent mentor is difficult to find and impossible to forget and you are such a mentor. Your guiding hand on my shoulder will always be with me! Thank you for being such a great teacher, friend, and mentor to me.
Dr. Kamal Gulati is a Senior Scientist at All India Institute of Medical Sciences (AIIMS), New Delhi, and an Honorary Lecturer at UCL Global Business School for Health, London. He is also a recipient of the Chevening Research, Science, and Innovation Leadership Fellowship of University of Oxford, International Fellowship of the Institute of Advanced Studies of Warwick University, and Gender in Research Fellowship of Erasmus MC, The Netherlands.
John Hoffmire is a Research Associate at the Oxford Centre for Mutual and Co-owned Business
