Intended for healthcare professionals

Rapid response to:

Editorials Christmas 2012: Editorial

When managers rule

BMJ 2012; 345 doi: (Published 19 December 2012) Cite this as: BMJ 2012;345:e8239

Rapid Response:

Re: When managers rule

Jarman in his editorial ‘when managers rule’(1) eloquently highlighted the need to refocus on the quality of patient care and the importance of clinicians’ leading in the NHS. Darzi, in his review (2), defined quality as ‘clinically effective, personal and safe’ and reintroduced the concept of ‘clinical leadership’ as crucial to this vision. He envisaged ‘a lot of clinicians will now be responsible and will have tremendous powers within the system’ (3), thereby associating a clinically driven NHS with improved quality of patient care and safety. Kaiser Permanente achieved efficiency, improved quality of patient care and outcomes through making clinical leadership central to their reform agenda (4). However, at the most crucial of times, clinical leadership in the NHS is patchy at best, misinterpreted and unsatisfactory.

Clinical leadership has been described as ‘leadership needed to transform the performance of the health systems that must come principally from doctors and other clinicians – whether or not they play formal management roles’(5) thereby distinguishing it from clinical management. If quality is truly desired it is crucial that clinical leaders steer away from herd like thinking or safe opinion at face value and actually lead the way in strategy, policy development and implementation based on information and evidence. It is time to advance on achieving the ultimate goal of patients and clinicians at the center of decision making or the vision of quality and clinical leadership will remain ‘the emperor’s new clothes’.

(1) Jarman, B. When managers rule- Patients may suffer, and they’re the ones who matter. BMJ 2012;345.
(2) High Quality Care For All – NHS Next Stage Review Final Report, Lord Darzi, Department of Health, 2008.
(3)Gainsbury, S. Darzi turns up the heat on clinical leadership. Health services journal, 2008.
(4) Light, D., Dixon, M. Making the NHS more like Kaiser Permanente; BMJ, 2004: 328(7442): 763–765.
(5) Mountford, J., Webb, C. Clinical leadership-unlocking the performance in healthcare. Health International; 2008.

Competing interests: No competing interests

31 December 2012
Shanaya Rathod
Consultant Psychiatrist
Southern Health NHS Foundation Trust
Tatchbury Mount, Calmore