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Rapid Responses: Rapid Responses published:
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MANAGERS OR PATIENT CARERS
- ROBERT MANSEL (22 March 2003)
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High quality information for managers: National electronic Library for Health Management
- Lynette A Cawthra (1 April 2003)
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WHAT DOCTORS CAN LEARN FROM MANAGERS
- David E Allen (23 February 2004)
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Re: WHAT DOCTORS CAN LEARN FROM MANAGERS
- Michael L Cox (3 March 2004)
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Re: Re: WHAT DOCTORS CAN LEARN FROM MANAGERS
- David E Allen (10 March 2004)
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ROBERT MANSEL, PROFESSOR OF SURGERY UWCM CARDIFF
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IT WAS INTERESTING TO SEE THE 2 LEADING ARTICLES IN THE BMJ ON THIS TOPIC, SINCE IT WAS HARD TO IDENTIFY ANY PRACTISING DOCTORS AMONG THE WRITERS (APART FROM ONE). HOW CAN SMITH PONTIFICATE ABOUT THE MOTIVES OF CURRENTLY PRACTISING CLINICIANS IN THE MODERN NHS WHEN HE FAILS TO MENTION THE GROSS UNDERFUNDING, LACK OF BEDS ,CANCELLED SESSIONS ,ARTIFICIAL TARGETS ETC AS THOUGH THESE ARE ACCIDENTAL RATHER THAN GOVERNMENT POLICY FAITHFULLY IMPLEMENTED BY MANAGERS. ALSO WHERE IS HIS EVIDENCE IN PARA 2 THAT MANAGERS WORK EXTREMELY HARD- WHERE DOES ONE FIND A MANAGER IN A HOSPITAL AT 8PM ON A FRIDAY NIGHT?. I HAVE NEVER SEEN ONE IN 32 YEARS IN THE NHS. IF SMITH IS SO PERCEPTIVE HOW DID HE FAIL TO PREDICT THE COMPLETE LACK OF ACCEPTABILITY OF THE (MANAGEMENT LED) CONSULTANT CONTRACT IN THE NHS. THIS SURELY IS A BETTER MEASURE OF THE CURRENT MANAGER/DOCTOR DIVIDE. I ALSO NOTE HIS ARROGANCE IN REFERENCING HIMSELF OR HIS PUBLICATION EXCLUSIVELY. Competing interests: PATIENT CARE AS FIRST PRIORITY |
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Lynette A Cawthra, Information & Library Service Manager King's Fund, 11-13 Cavendish Square, London W1G 0AN
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Richard Smith mentions that NHS managers often lack access to high quality information. The National electronic Library for Health (NeLH) is doing something about this: it has set up a specialist library for health management which aims to provide timely and efficient access to high quality information resources for health managers, clinical managers and leaders and those involved in commissioning health services. It is freely available to all at www.nelh.nhs.uk/management . This project has been running as a pilot and has as of today (1.4.03) been given 3-year funding by the NHS Information Authority; we very much welcome feedback as we look to develop our site. Quality criteria for assessing Web resources, produced by OMNI/BIOME [www.biome.ac.uk], have been used as a quality threshold for resources included in our database of appraised resources. In addition the team has piloted quality criteria for use specifically with management resources (loosely based on the DISCERN appraisal tool for consumer information [www.discern.org.uk]) which continue to be evaluated for usefulness within the project. Competing interests: Project Manager, National electronic Library for Health Management |
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David E Allen, MPHe Management Course Development Specialist 1. Evidence for Population Health Unit, Medical School, Oxford Road,Manchester, M19 9PT
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It may be a bad time to suggest that doctors can learn from managers (1). “There has been a breakdown in the relationship between doctors and managers” (2) and doctors’ morale has been sapped “by excessive, intrusive audit and the imposition of Department of Health diktats”. (3) As even the House of Common’s committee (4) found some of these targets to be counterproductive, it is not surprising if many doctors feel unhappy about their loss of clinical autonomy and power and that their distrust of managers has increased. The jobs doctors now have may not be what many had or expected, but it is no good dreaming of a past. (5) The NHS costs too much, it has to be managed. (6) If we disagree with Government policy we either have to try to change the Government or find ways to cope. If trust between doctors and managers is to be improved we must be aware of the differences between the two groups. Just as many managers have no first hand experience of the complexity of clinical practice, so many doctors often do not understand about managing complex organisations. However, medicine is not a factory and doctors rightly get offended if medicine is treated as a “production line” (3). When there are medical problems on the ward, it is the clinician who is the prime target of complaints; patients know they see clinicians and not managers, but when performance targets are not met, it is managers who must answer. Medicine is not always a matter of life or death, but it is usually a serious matter, especially to patients. Management, although it can be, is rarely a matter of life or death. Managers can be sacked if they do not meet a target, but if they make a management mistake, exceptionally they might be sacked, but generally they try to correct it, hopefully learn from it and carry on, while a bad decision may finish a doctor’s career. The differences between medicine and management will inevitably produces different pressures and actions. Just as managers need to learn more about doctors’ pressures and priorities, so doctors need to learn more about managers’ problems and methods Managers can learn from clinicians, be more aware of their needs and regularly spending time on the wards and in the theatre is formative. “There needs to be considerable subtlety in the relationship between doctors and managers”, (2) imposed changes in management requirements without involvement saps morale, which can be demotivating and managers need to be sensitive to this. Managers have to “show true leadership” and “set a path for service delivery which everybody buys into” (2) and work with doctors to develop a common approach to meet targets and improve quality of care. It requires goodwill and skill, but discussion and partnership is the key to improving morale and the Service. Doctors need to contribute to this process as active partners. “With the right kind of communication, you would get agreement (on targets) from many doctors….Doctors are often very creative people and if their creativity is unlocked they will find solutions “ (2) The NHS needs that involvement and creativity. Many doctors are too preoccupied with clinical practice to have time for reflection on wider issues, but their training and experience enables doctors to make a unique contribution to the management of the Service. It is surely a professional responsibility of doctors to be involved in how the system delivers care to their patients. Medicine must become more than delivering care to patients it has to provide services to the population. Doctors and managers do share some things in common. Both groups serve patients and recognize that the guiding principle for actions should be what is in the best interests of patients. Of course, although there is agreement on ends it is how to find agreement on means, which is the problem. There are at least three ways doctors can try to improve agreement on means. 1/ Doctors can engage in the debate about Health Service policy and organisational structure. However, Government policy is difficult to influence. The policy development process is complex and unpredictable. 2/ At a more immediate level, doctors can seek to improve relations between themselves and managers. Why are managers bad? How can doctors help? Or could it be that doctors do not always understand what managers are trying to do or understand their methods? 3/ Doctors can become involved in management. Doctors already practice management. Doctors face many of the same problems as managers. Doctors deal with the personal managerial problems, also the general managerial roles of leadership, developing their team, management of change to improve their service, budgeting, quality management, etc. Understanding managers’ methods could help doctors. Much of management “theory” may be little more than common sense, but it is "systemised common sense" and I would be surprised if, after studying management most doctors do not change their practice. When the Americans landed on the Moon, the New York Times published an editorial saying, the point of going to the Moon was not to discover what the Earth and Moon have in common, but to see their differences, so we could better understand the Earth. That is why doctors need to learn from managers: to be better doctors. 1. Smith, R. What doctors and managers can learn from each other. http://bmj.com/cgi/content/full/326/7390/610 2. McLellan, A. “Rock and Role; the hsj interview with Sir Liam Donaldson”, HSJ, 27/03/03 3. Beecham L. BMA Chairman criticises erosion of clinical autonomy. http://bmj.com/cgi/content/full/327/7405/8-a 4. NHS target obsession “cost patients their sight". The Times Online. 22/07/03 5. Fiddian-Green.R.G. Red tape: a double-edged sword. http://bmj.com/cgi/eletters/325/7376/S191a 6. McGucken, B. Doctors and Managers. The other end of the telescope. http://bmj.com/cgi/eletters/326/7390/652/a#30870 Competing interests: I organise management courses for doctors |
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Michael L Cox, Dental Surgeon Oldham Tameside and Glossop PCT
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Sir, - I read with great interest the article by Allen entitled ‘What doctors can learn from Managers’ 23 February 2004. I am employed as a dentist in a PCT and although I have no direct experience of the relationship between managers and doctors, I feel that the same principle described can be applied to dentistry. I am amazed that management is not taught in dental or medical training, particularly in dentistry. Around 80% of graduates will work in the General Dental Services, which will lead ultimately to buying and running a practice. The remaining graduates will work within the N.H.S. in hospital services where an insight into management is essential. I can’t speak for medical staff, but postgraduate fellowship exams in dentistry have a module in law, ethics and legislation that affect dentistry but management is not included. As well as the three suggestions that you mentioned in the article perhaps a theme of management should be introduced in undergraduate teaching and expanded in fellowship/ post graduate training? M. Cox
Competing interests: None declared |
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David E Allen, MPHe Management Course Development Specialist Evidence for Population Health Unit, Medical School, Oxford Road,Manchester, M19 9PT
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I agree with Cox, that all doctors and dentists would benefit from management training, particularly general practitioners and dentists working in practices who are really running a business. Even, or possibly especially, dentists and doctors working in PCTs need management training. Some medical schools (Manchester included) have management as an option in the undergraduate curriculum, but it is very difficult to get management into the undergraduate curriculum, there are so many demands on the students’ time. Also studying management is a bit like reading a travel guide, it is not until you get there that you really start to appreciate what it is all about. But I think all Undergraduates could benefit from some training in personal management skills, like Time management and team development, which would actually help them during their studies. Other management skills, such as leadership and management of change, become more relevant when they start working in the NHS, then management is all around. Some fellowship exams do have a least a token management component, but I agree with Cox all (especially Dentistry) should have some component of Management. Competing interests: I teach a management course in a medical school |
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