"Best to quit while someone still misses you"
Interview with the Páll Matthíasson
Interview with the Páll Matthíasson, CEO of Landspítali National University Hospital. Translated from Icelandic by Ellen Ingvadóttir (Court Interpreter and Authorized Translator, EU-ACI).
Why did you become a manager?
Actually, this was a coincidence. I have always wanted to be near the patient and to solve his problems in many ways. Most physicians practice micro-medicine, sitting by the patient alone, talking to one at a time and trying to make him change his life. Those who do not find this to be sufficient move over to meso-medicine in order to reach a larger group of patients that way. Then there is the macro approach, where the physician assumes control of a hospital or of a whole healthcare system, and thus tries to improve the life of the patients through the auspices of the institution. I wanted to have a greater impact than I could through seeing individual patients, which is why I initially applied for management positions within healthcare.
Have you always been a determined person?
Yes, and I wanted to realize my opinions. This means leaving the bench in the staff canteen. Just moping about in the canteen, complaining and criticizing without a will to get involved, is not my thing. As it happens, the canteen naggers are totally useless. They have nothing to contribute and are not members of the team. One must be prepared and ready to roll up ones sleeves and thus make a difference.
How did running the psychiatric wards go?
I managed to achieve various things. The principal issue is serving the patients. My professional background is psychiatric intensive care, forensic psychiatry but on the other hand also community psychiatry. I established a PICU, transformed forensic psychiatry and also started a few community psychiatry teams, including assertive community treatment (ACT) teams, an early onset team and rehabilitation support. Through these service improvements we succeeded in reducing the number of inpatients. Psychiatric wards of university hospitals should not tend to all patients; instead only those needing specialized services, at the same time building bridges into the community.
Are you innovative?
I have always been attracted by new things and have certainly not feared trying something new. During my studies in the UK I was always prepared to participate in new teams or some other experimental activity.
Should physicians be managers?
Yes, the physician possesses an overview and knowledge that serves him well in administration. Nevertheless, he must conduct himself in the best manner for serving the interests of the patients, and must also have a strategy to offer.
What symbolizes a good manager?
I like the theories of Patrick Lencioni. He talks about three principal factors a good manager must possess, i.e. hunger, humility and being smart. He needs to be hungry, i.e. he must want to do good and perform well and skillfully. He needs to be smart, namely possess knowledge and understand well the relevant activities. Having a manager who is constantly hesitant is very uncomfortable. Last but not least a good manager needs to be humble and able to work with others.
Yes. Arrogance is a characteristic that badly suits managers. Management is teamwork, involving the know-how of several people working together. People must be able to conduct themselves as equals within such a system. A hospital is indeed a complex system and one must be prepared to make and admitting mistakes. The manager must look ahead in his complex activities, generally on grounds of limited information. This was indeed very apparent during the Covid epidemic where people stumbled about in darkness and frequently had to make fateful decisions very promptly. Humility is a necessity in such circumstances, one must admit how one does not know everything yet at the same time having to make decisions on grounds of incomplete information. Then there are circumstances where a backwards step must be taken. The manager cannot allow himself to be obsessed by the need to be perfect, as this makes him hesitant in an unclear and constantly changing environment.
What characterizes a bad leader?
Decision fear and fear of taking a stand. A leader who is not prepared to enter into decisions and take measures is equally as bad as the physician who is not prepared to diagnose and launch treatment of his patient.
To what extent has your expertise in psychiatry helped you as CEO?
Having this background has served me well, in fact I am of the opinion that the hospital CEO should have a health education background. The operation of a hospital is highly complex and various matters materialize where expertise is necessary in matters of disagreement, and also the leader must lead and to do that you need a well grounded vision. The psychiatrist is trained in difficult dialogues and knows how to treat people respectfully. The psychiatrist generally knows the dynamics of group therapy which in turn is helpful at meetings. Having a working knowledge of transference and countertransference is good for understanding the interaction between the staff. Everyone has a role one should be able to define. Withdrawing from the position I held has come easy to me. Conflicts have not affected me much, as I do not define attacks against me personally; instead it is against the office I hold. Every psychiatrist is experienced in separating himself from his professional work.
What about general judgment of character?
Have you had management training?
Yes, however, I find the education and experience in psychiatry to be more significant. Management theory is not a very complex field and although more than one hundred thousand management books have been written, the most practical theories are easy to understand -yet hard to implement.
You are retiring from the directorship. How does this feel?
I proudly look back. This is a workplace of 6000 people and assessing the results is difficult, but nevertheless, I feel as having achieved much.
Do you feel unfairly criticized?
Not me, however, the hospital has been very unfairly criticized as people do not take into account the complex overall picture running a hospital represents; instead people tend to focus on a small part of the activities and then pass judgment on such grounds.
Best to quit while someone still misses you! □