Clinicians are from Venus, Managers are from Mars

discuss.

What is responsibility in management without power to effect change?

Talking to a colleague I have grave concerns about undertaking a role of middle management within the NHS.

Marnoch described the position as “at worst, medical directors and clinical directors will be used as go-betweens in a familiar book-balancing exercise that involves closing wards periodically, not filling vacancies and cancelling operations. At best they are the basis for a new strategically led style of corporate management in the NHS .”(Marnoch, 1996: 61)

The disappointment frequently expressed is that there are great ideas, innovative developments and progressive strategies very few of which can be moved forward because there simply is no power to effect change. Now every good management student knows that ideas, innovations and strategies work best when willingly adopted by supportive colleagues.

In medicine there are different rules of engagement.

Rather than develop these ideas, innovations and strategies medical managers essentially have only responsibility to deliver on targets and edicts delivered from on high with few opportunities, finance or support for innovation and ultimately their ability to effect change in the professional bureaucracy is hampered by their lack of power.

So the basis for this “new strategically led style of corporate management” is hamstrung from the outset. It doesn’t have to be this way but what is responsibility in management without power to effect change?

Marnoch, G., McKee, L. and Dinnie, N. (2000) Between Organisations and Institutions. Legitimacy and Medical Managers. Public Administration, vol.78, pp.967-87

Follow my leader?

The blog Inside Work asks some searching questions of leaders.

• What may I expect from you?
• Can I achieve my own goals by following you?
• Will I reach my potential by working with you?
• Can I entrust my future to you?
• Have you bothered to prepare yourself for leadership?
• Are you ready to be ruthlessly honest?
• Do you have the self-confidence and trust to let me do my job?
• What do you believe?

One of the challenges of Leadership is followership and it seems clear to me that to be a good leader I must consider how I act not only as a leader but also how I act as a follower. Then those who work with me will learn from my example of followership how they might also follow me.

Unfortunately, the opportunities to mis-lead are therefore plenty. I suspect this is the case for many across the NHS as Consultants struggle with their “followership” of the management in Medicine. Unwittingly, complaints and railing against “managment” will work their way into the consciousness of junior staff destined themselves to become leaders.

It must however also play a considerable part in the interface between physicians and management that Consultants find themselves unable to have confidence in leaders who are unable or unclear in their responses to the questions posed above. Without that confidence there will not be followership and thus however good, innovative or worthwhile the management advances are the chances of success are extremely limited.

Dear Santa,

Yesterday I was involved in a fairly high level planning meeting to rationalise and develop the trauma service provision for a region. There were many important and knowledgeable people who planned and discussed and theorised and developed what could be an exceptionally good service. Then someone asked the key question, “Will the Primary Care Trust support this?” There was a sad shaking of heads. And then I realised this was probably going to be happening all over the world for the next month.

Every year at this time children excitedly “write” their lists to Santa. The whole intricacy of what goes on is hugely complex with parents listening for ideas and themes but also bringing  a gentle sense of realism so that come the fantastic day they can meet some of the little darling’s expectations but also within their own financial limitations.

The sadness is that is exactly how we see medical management often works; the clinicians actually often come up with really impressive ideas about developing a service local or even nationally but the financial limitations of NHS prevent this coming to fruition. Even worse the inability to plan long term brings frequently brings about short term solutions that neither meet the demand nor save money in the long term. In short rather than getting what we would like to provide for the health of the nation on Christmas Day the package under the tree only holds disappointment. The contrast between this and the American Hospital buying a da Vinci robot to essentially keep up with the Dr Joneses is stark.

And yet again we have a problem of clinicians and management of the health service where the aspirations simply cannot be met. Whilst clearly there needs to be some reigning in of unreasonable demands at this time of year there is a huge difference between shopping at Poundstretcher and slightly more upmarket boutiques.

The heartbraking part of it is that trauma is the leading cause of death in children and young people and there is clear evidence that improvements in trauma care delivery bring about improvements in survival.

Do you think Santa has anything in his sack this year for trauma provision?