The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems - Mahatma Ghandi
If you join the group of public sector psychologists practicing clinically in public health settings, there is a curious thing you will notice on your first day, or earlier at your job interview – namely, you are likely to be hired and operationally ‘line managed’ day-to-day by someone who is not a psychologist.
You will usually have an additional ‘professional’ director, senior or leader who is a psychologist; however, this professional leader may be relatively remote from decisions about how you spend your day, team treatment models in place, and your access to practice resources and training.
Colloquially, this is referred to as a ‘Matrix’ model of employment, as the individual psychologist is fully embedded in an autonomous, larger system such as a team, unit or ward – and the non-psychology manager of that system manages the psychologist and other health professionals.
The majority of psychologists working in public sector health contexts in Queensland, work within a Matrix model – only 0-15% (depending on locale) work outside of the Matrix model for a psychologist manager.
What the research tells us
One large survey of Chief Psychologists in mental health facilities found a majority believed that instead of the established de-centralised (Matrix) management, psychologists should have centralised psychology management and budget control. In this survey, they identified a number of factors ‘inhibiting’ the psychology profession’s progress. These included powerful medical model environments, insufficient budgets and staffing, a general lack of understanding of how psychology can assist, and inadequate authority for psychologists in the workplace. If elements of these findings sound local or contemporary, they should not. These findings are from the USA 40 years ago (Wildman & Wildman, 1974).
Other more recent Canadian and USA studies highlight the risk of psychology interests being overlooked in this context, and emphasise a need for adequate operational representation in the workplace (Owens et al., 2013; Rozensky et al., 2014).
Where to from here
For psychologists in public health then, it seems the Matrix dilemma is certainly nothing new, and it generates similar concerns about autonomy and identity outside of Australia. As it seems to displease us professionally, how does the Matrix persist as a dominant and international model? And what can we do about it?
There are multiple external contributing factors reflecting organisational inefficiencies, dispersed locations, and the ‘status quo’ to name a few. Equally, some factors may be internal to the profession. For example, very few psychologists start their training even imagining that they might lead or manage clinical teams – and our initial psychology training is necessarily focussed largely on obtaining clinical competencies (Thorn et al., 2015).
Could affordable access to psychology management training – including reflective understanding of our interpersonal ‘fit’ and abilities as leaders, successful management of teams, marketing of psychology services, strategic health care leadership and financial management – encourage more psychologists to take a leap into clinical leadership domains (e.g. Thorn et al., 2015)?
This seems feasible, but based on the workforce percentages mentioned earlier, career progression outside of the Matrix is markedly limited by a lack of psychology specific leadership roles – so just where could we expect to leap to?
Seizing the opportunity
As much as it clearly seems crucial to maintain and strengthen autonomous Psychology departments and teams, if we are chronically trapped inside the Matrix, we could try again, now, to ‘own it’ and lead from within it.
Psychologists have attempted this in the past, but the timing now is ideal, because there are mounting external pressures – on the Matrix hierarchy and process itself – to change.
Pressures include heightened interest from the public and governments, ‘competition’ from NGOs, and new funding for non-traditional models such as NDIS and GP chronic disease treatment. There is therefore renewed demand on Matrix teams to question their models of care, demonstrate evidence linked and evaluated treatment and outcomes, and to generate clinical research. Here psychology is clearly equipped to excel and create crucial clinical leadership niches, and in turn attract independent funding (e.g. Larkin, 2014).
Due to workload, it has historically been difficult for psychologists to quarantine non-patient time, but digital advances now facilitate great economies of scale. Psychologists in like teams anywhere can network digitally to generate reviews, research and treatment innovation – a virtual psychology department to share and expand resources that promote psychology led models of care.
Leadership of, or within1 contemporary teams (e.g. Karol, 2014) can, and already is, showcasing an increasing proportion of talented psychology leaders.
Signature skills we possess, such as exceptionally well developed clinical research, communication and clinical evidence appraisal and application skills (e.g., Larkin, 2014), could make us highly effective, visible and influential players in the new Matrix of modern and rapidly evolving public health care demands.
The author can be contacted at [email protected]
- High value intervention programs, staff training, program evaluation etc.