Just how big IS the elephant in the room?

3 08 2009

My previous post prompted a commenter of some pedigree Ben, to suggest it may be worthwhile trying to measure exactly how big the gap is between clinicians and management. Interestingly there is not that much in the literature of either medicine or management attempting to quantify this situation. After some searching however I unearthed this little nugget: “Views of doctors and managers on the doctor-manager relationship in the NHS” Davies et al BMJ 2003;326:626-628

The study was a postal questionnaire carried out in 2002 of Chief Executives, Medical Directors and a stratified sample of Clinical Directors randomly selected from 75 Trusts. Responses were received from 103 Chief Executives, 168 Medical Directors and 445 Clinical Directors. It is pertinent to explain that Chief Executives are purely from a management origin and Clinical Directors are Consultants heading up a clinical grouping known as a Clinical Directorate. Importantly, the latter group are clinicians, undertaking a management role in addition to their clinical role. These doctors will share most closely the opinion of the majority of clinicians although it should be noted that their role identifies them as having a bent towards management that other clinicians may not share. So they will have a more positive view of management generally than the majority.

A series of questions were posed and the answers assessed to see how much (or little) the respondents agreed with the question. The results of the study are clear and are summarised by the the authors,

” Clinical directors were easily the most disaffected, with many holding negative opinions about managers’ capabilities, the respective balance of power and influence between managers and clinicians, and the prospects for improved relations.”


I have uploaded a spreadsheet of the results here with the questions and the responses from the two groups discussed. I’ve also done a little additional work of my own calculating the distance between the answers of managers and clinicians. Allowing a 5% error each way (ie >10% difference is significant) it is intriguing to see that of  the 26 questions in only 4 was there any similarity of opinion.

So, how big is the elephant in the room? I think we need to address a few other issues now apart from its size…

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5 responses

3 08 2009
Steph

I slept with an elephant once, covered tusk to toe in armour (the elephant) and looming impressively over our little group of huddled sleeping bags in Leeds Armoury museum.

To ride one, is at the same time terrifying and irenic, a dissonance not entirely without it’s own peculiar harmony, but to ride ‘the elephant in the room’?

The didactic v experiential nature of the pathways towards medicine and management are intrinsic to the resultant approaches of both disciplines.

Where management education may take the path of bounded reality medicine uses “the distillation of… years of experience and knowledge of others to the point at which there are a finite ways of deciding”

This railroad track of disciplined thinking in medicine appears sure and steady, but once aboard there is little scope for detour. After all why change what appears to work so well? And constant reiteration (some would say tautology) affirms.
Years down a track of proven decision making can breed a difficulty of perspective/perception for an idea that there may be an equally valid route to station ‘delivery of health care’.

Management on the other hand whilst infinitely adaptable to the vagaries of hostile through (sic) friendly terrain on foot may envy the direct surety of the railroad. Without it’s intrinsic discipline of direction and route their path is as you have previously discussed ‘often significantly affected by external factors, some of which may be unknown even to the practitioner’.

Both routes have their efficiencies and place but finding a train that is happy on the road… is this your elephant?

4 08 2009
Graeme

I read the same article a little while ago. I guess the questions coming out of this are why (beyond the obvious what you see depends on where you stand explanation) clinician directors were most sceptical and questioning of the management roles and power in the NHS, and is it possible/ desirable to engineer a consensus? Are they predisposed by training/ values etc or is it experience of working with managers, etc. This may give some clues as to how to bring about a meeting of minds – if its desirable.

10 08 2009
inseiffolliet

heavens Steph, that is some complex stuff you’ve written there. i will try to unpack it in a later post

10 08 2009
inseiffolliet

aha. have just written some 9000 words on that topic…

6 02 2011
Zener Diode

:”- that seems to be a great topic, i really love it ‘.`

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