Education And Debate

Management for Doctors: Analysing your organisation and environment and setting its strategy

BMJ 1995; 310 doi: (Published 25 February 1995) Cite this as: BMJ 1995;310:514
  1. John S M Zorab, medical directora,
  2. Ann Lloyd, chief executivea
  1. a Frenchay Healthcare NHS Trust, Frenchay Hospital, Bristol BS16 1LE

    Frenchay Healthcare Trust was a second wave trust and came into being on 1 April 1992. It has an annual budget of pounds sterling89m and employs 4000 staff. The organisational structure, comprising seven clinical directorates and four executive directorates, was introduced the previous summer.

    The underlying philosophy of the organisational structure is that the delivery of the clinical service is the responsibility of those consultants who have been appointed as clinical directors. The clinical directors are central to the management process and are directly accountable to the chief executive. This places the clinical directors firmly within a general management context without any intervening tiers filtering the communication and accountability between them and the chief executive.

    This, combined with the responsibility that goes with budgetary control and the management of staff and contracts, has enabled the relevant consultants and managers to work as unitary teams. Responsibility for setting the direction for each directorate within the whole organisation truly rests with the clinical director—together with the management and coordination of directorate activities.

    An essential component of this system is that each clinical director is supported by a high quality general manager (grade SMP 13-15) together with, in some instances, a specialist grade senior clinical nurse. Nevertheless, both the general manager and the senior nurse are responsible to the clinical director for the work of the directorate. Thus the clinical director is not a medical manager but a director supported by a professional manager and a professional nurse.

    All clinical directors sit on the management team, which advises the chief executive on all strategic, policy, and major operational issues. Clinical directors therefore influence decisions affecting the whole trust within which they must manage their directorates.

    It is our firm belief that consultants do not need to learn to be professional managers. They do, …

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