Structure of Clinical Management in NHS

23 12 2008

The military is the basis of some of our concepts of leadership. The British Army currently has the following structure.

A Corps

  • two or more Divisions
  • commanded by a Lieutenant-General.

A Division

  • two or three Brigades
  • commanded by a Major-General.

A Brigade

  • three Battalions
  • commanded by a Brigadier.

A Battalion

  • around 700 soldiers
  • made up of five companies
  • commanded by a Lieutenant Colonel


A Battlegroup.

  • mixed formation of armour, infantry, artillery, engineers and support units
  • formed around Armoured Regiment or Infantry Battalion
  • 600 and 700 soldiers
  • under the command of a Lieutenant Colonel.

A Company

  • about 100 soldiers
  • in three platoons
  • commanded by a Major.

A Platoon

  • about 30 soldiers
  • commanded by a Second Lieutenant or Lieutenant.

A Sectionarmy-march1

  • about 8 to 10 soldiers
  • commanded by a Corporal.

Think about a conflict that this Army might be involved in. The overall goal will be well defined, tasks and responsibilities are clear. There are likely to be many good leaders whose efforts may not recognised by any except those closest to that action and the ultimate outcome of the conflict may not reflect the leadership skills of those lower down the structure. What is paramount however is the acknowledged and understood practice of followership.

Now, I’m not suggesting that it should be the same, but can anyone explain the concepts of the structure, aim, chain of command and function of clinical management in the NHS?

Follow my leader?

29 11 2008

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.

follow-my-leader_cropUnfortunately, 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.

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