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