The Real Inspector Hound.

4 07 2009

A long, long time ago, just after 7.30pm on a Thursday we “did” a play at school called, “The Real Inspector Hound,” by Tom Stoppard. It was quite an undertaking for many reasons not the least that it was the first acting I had ever really done, it involved actual kissing on stage (I was 15 at the time!) AND me getting hit by an occupied, speeding wheelchair every night for four nights. Fiona Lindsay went on to great things after our on stage kiss, (“Don’t say anything for a moment; just hold me” gets me every time) and I was left with more than just significant bruises; but I blame Jonathon Smith who was piloting the wheelchair.

The play is actually a lot of fun and revolves, quite literally, around a murder mystery plot, the actors, Inspector Hound who is investigating the murder and the critics who are viewing the play. I won’t spoil the ending for you but you have to pay attention. The strangest part of this essentially strange little play is that for the whole of the first act there is a dead body lying right in the middle of the stage. The whole cast are completely oblivious to this and carry on with a cocktail party and bizarre game of cards right up to the point at which Inspector Hound, who has been sent to investigate the murder finds himself stood on top of the body.

the real inspector houndMy journey into Clinical Leadership continues and I can share with you now that it hasn’t been straightforward. Master Po of course would have explained this to me more prosaically suffice to say I am encountering various challenges that I am sure will make me wiser in the end. My enduring question has been regarding the nature of the interaction between clinicans and management. Various comments and colleagues have suggested that I have approached this problem from a negative and unnecessarily personal perspective and that the reality is far less disparate than I would portray.

As I prepare for an assignment for the course I have discovered an article that at last begins to mirror and more eloquently describe some of my poorly expressed thoughts on the matter; “Clinical Leadership: the elephant in the room” John Edmonstone.

I hope to discuss the whole paper in much more detail in later posts but in summary it describes the author’s contention that the concept of clinical leadership although frequently discussed and even formally studied (sic) it is not actually well defined. This is partly due to the divergent views of what clinical leadership represents: an essential and intrinsic part of clinical practice or a block to innovation and change. Edmonstone further contends, and here I would full support him, that this dissonance is principally due to diametrically opposite views on the nature of the organisation which then extends into totally contrasted views on the nature and delivery of health care.

Interestingly, in the play the exact identity of the body causes significant confusion and actually turns out not to be who we all believe it to would be. This adds to the overall farce as it is in fact two people and their roles are central to the play itself.  The point I am struggling towards here is that the body laid in the centre of the room and almost totally ignored by the cast on stage represents clinical leadership in the discussion around medical management.

Edmonstone suggests, “Clinical Leadership is large and significant- an obviously important entity that is often ignored or goes unaddressed for the convenience of other interested parties; principally general managers and politicians of all persuasions who (consciously or unconsciously) operate to a command and control model of leadership”

I believe the role of clinical leaders needs thorough investigation,  that their position and influence within the management of the NHS has to be re- addressed and embraced rather than simply ignored as “the elephant in the room” because what they bring to the discussion is not simply negativity and a block to innovation but an intrinsically different and important view on the value, purpose and practice of the organisation. The failure to even acknowledge the body is a principal cause of the disconnected hierarchy that now exists and the serious disquiet between clinicians and management.




3 responses

5 07 2009
Claire Hayward

I have read many of your posts with great interest. I wholly agree that there is a dirth of options for discussion and support for clinicians even considering management positions. I think many health care staff go through similar quandaries of being unhappy with those “on high” and wanting to get involved at a management level to try and bring a clinical perspective to the men in suits (sorry will try and be more balanced!). But this is countered by an unwillingness to leave or minimse clinical input, and uncertainty about having the skills for the job – having obviously focused in direct patient care for a considerable time. In my own trust there are a few bolt on courses for clinicians moving into management but these always seen to be low priority and frankly a bit of an after thought. I turned down a mangement post for my current clinical position, and I’m fortunate to have a senior banding with no real management responsibilities (shhh!). That said I want to get my fox of feeling I am making a difference in ways other than clinical stuff. For now that need is met through involvement with my national (and international) professional body, teaching under and post grads and leading a grant funded project to address a service issue which I am proud to have taken from concern to action. Anyway bit of waffle but the gist is: I agree, and keep posting!

25 07 2009
Ben Wilberforce

Welcome back
Have read your last posting ….after a long break.Like some of the others I found it of interest but also frustrating.You ,and your other correspondents, have over the past few months very intellectually and eruditely commented on something that none has adequately defined.It is a bit like two folks in a darkened room trying to desribe an elephant,or the debate that took place many years ago concerning the possibilty that there was another planet similar to earth on the other side of the sun moving at exactly the same pace in the same orbit. Some proof is needed.The clinician/management gap( if one exists)needs to be quantified.

As a non medical observer I feel that the points you raise require both clarification and quantification.If not by you and your colleagues perhaps by a social science researcher(You may question the description) thus giving a simplistic data base from which to analyse and comment.As nothing of this ilk has appeared so far perhaps now is the time to experiment and any useable data that arises could lead to could be developed more detailed and sophiticated studies, The preparion of a short well conceived and well presented questionnare could help you identify your own position and be useful in conducting structured interviews or a small mail survey

At present the elephant in everyones’ room lacks identifiable bones. Until folks can see what is being debated they cannot really communicate satisfactorily.Bear in mind that the word communicate has as its source the Latin “communis” ie in “common” .

2 08 2009

Thanks Ben, clearly a commenter of some pedigree. I think your point is well made and I shall address that in a future post. It will be interesting to see if there is a true measure of the problem and clearly, if not, measure it myself.

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