The troubled relationships between powerful doctors and managers date back to the creation of the NHS – but now a think tank claims to have developed a solution.
The Centre for Innovation in Health Management (CIHM) at Leeds University Business School has produced a toolkit designed to encourage more productive interactions between doctors and managers in NHS trusts.
It follows a national inquiry into medicine and management conducted by the CIHM which investigated the ingredients of success in trusts where conflicts had been eased or resolved.
“Broadly, we found that the first step in developing productive relationships is for the two sides to be willing to work together. Both have very strong power bases within their organisations and in many cases doctors and managers choose to fight each other.
“But there is an alternative – to take a genuine interest in the business you are running together, and pool your strengths,” the inquiry concluded.
Each side needs to gain a perspective of the other side’s problems, recommends the CIHM. “This means learning what it is like to be a manager if you are a doctor, and what it is like to be a doctor if you are manager.
“Our research showed it was down to doctors and managers to create the conditions for productive relations themselves,” says the report.
In one case study, managers and medical directors were threatening SHOs over waiting times in A&E going over target. When clinicians and managers sat down together to find a way of resolving the problem a new model was introduced of putting consultants the front line treating patients rather than seeing them on a consultancy basis. The trust is now one of the top ten trusts in the country for their A&E score.
The toolkit offers a way of improving productive working between doctors and managers in a series of steps that encourage conversations between all parties and identifies any development required.
“Where doctors are engaged in management, quality improves for patients. Moreover, it is the partnership between doctors and managers that makes the difference – where they have a productive working relationship,” say the authors.
The CIHM’s inquiry into management and medicine found that doctors and managers work best together when the following conditions exist:
– a clear focus on the clinical business
– space is created for local innovation by managing upwards
– decisions are devolved to the right level
– there is continuity over time
– complacency is avoided by seeking internal and external challenge
– interests are aligned through rewards, information, and performance management.
– doctors and managers make sense of the external environment together
– there is frequent dialogue to build a shared purpose
– differences are seen as an asset – conflict is used positively
– managers and doctors understand each other
– there is investment in organisational change, doctors and managers learn together, and locally relevant performance management systems are developed.