Editor's choice

Urgently needed: leadership and mutual respect

Improvement within the NHSor any health servicewill have to be delivered by the staff. No amount of rhetoric, clever policies, threats, or even extra resources will improve a service if the staff are demotivated. Three editorials in this week's BMJ look at the importance of staff and how they behave.

BMJ readers (most of them doctors) know that many doctors are fed up, but they may be more surprised by an editorial on the despair of health service managers (p 1262). These managers are used to being unloved by the public and doctors, but they now feel that they have neither the trust nor the respect of politicians. They are seen by almost everybody as part of the problem rather than part of the solutionwhich is clearly wrong. The managers do not disagree with what the government wants to do, but they don't like the methods. The government's words may be empowerment, devolution, and support but its actions are increased control, instructions, unprecedented micromanagement, unrealistic targets, and blame. Traditionally the government could rely on the loyalty of managersbut perhaps no longer.

Managers also sometimes find themselves in conflict with senior doctors, and Tom Treasure, a professor of cardiothoracic surgery, takes up this theme in an editorial on leadership and doctors (p 1263). Leadership has been seen by some doctors as making "a bloody nuisance of yourself until you get what you want," but browbeating managers is not leadership. (Nor is leadership "being hostile, critical, and discouraging," as a junior doctor describes in a personal view on being bullied when a surgical trainee (p 1314)). Rather leadership is working with others, helping create a path forward, and then motivating and supporting others to follow the path. Health services where politicians, doctors, and managers do not respect and trust each other will find it impossible to make the substantial improvement that all services need.

And there are tough problems ahead. Trevor Pickersgill describes how from 1 August 2004 junior doctors in Europe will not be able to work for more than 58 hours a weekand "work" means time spent in the workplace, even if resting or asleep (p 1266). This will mean in the UK a reduction of 19% from the current 72 hours a week. Already many acute hospitals are struggling to provide an adequate service while complying with current rules on junior doctors' hours, and the 2004 change in the law will hasten the drastic organisational changes that are needed. The debate on acute services is heating up (p 1305), and there is no doubt that leadership will be needed from doctors and managers to build a sustainable and better service.

Footnotes

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