Working in management

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7137.1091 (Published 04 April 1998) Cite this as: BMJ 1998;316:1091

NHS managers have fundamental duty to put patients first

  1. Dianne M Jeffrey, Chairman
  1. Community Health Care Service North Derbyshire NHS Trust, Chesterfield S41 7PL
  2. Gwent Community NHS Trust, Cwmbran, Gwent NP44 8YN
  3. East Sussex, Brighton and Hove Health Authority, Lewes, East Sussex BN7 2PB

    EDITOR—Many doctors find that solving management problems appeals to their creative talents. Some have found the experience so rewarding that they wish to continue. For others it is an emotionally draining, and at times nerve wracking, experience. This, it seems, is what Ayres has found, for he has emerged with a truly fanciful notion of the role of the manager.1

    The quality of the product of health care is determined by the expert skills and knowledge of the front line workers—the clinicians—who, by every decision they make, commit whatever resources are available. The non-clinical managers cannot directly control their activity. Yet they are in place to take responsibility not only for effective use of resources but also for implementing all other aspects of government health policy. This demands a skilled, sensitive management team, drawing on the skills and leadership qualities of the medical and nursing staff and pulling the decentralised clinical teams together to form an effective, corporate whole.

    Ayres concedes that operational management staff will always be needed in the NHS. Healthcare provision, however, demands an extremely high calibre of leadership, in addition to “operational management.” It is difficult, but …

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