Partha Kar

Measuring the competence of NHS managers

I had a thought the other day while having a discussion with some trainees.

We were going through the e-portfolio, which is a chore.

There are numerous seniors out there secretly grateful they didn’t have to do anything as onerous as this. There’s no denying it represents rigorous testing of a junior doctor’s competence.

Have you done enough procedures? Have you got proof of that? How do you assess yourself as regards competence in that procedure? What does your supervisor think about your competence in that area? It’s endless…

Performance management is a buzzword which has stuck in the NHS and prompts different reactions. Have you started your clinics on time? Have you finished your theatre list too early? What’s your LOS?

Recently a manager asked me what time I started and finished clinic. He opined it was less than the 4 hours of a PA. I pointed out that I also had 20 ad hoc slots through the week- which equated to not just an hour but more than that.

They were put in place to help adolescent patients who couldn’t attend at times of my choosing but at their choosing. Patient choice anyone?

He understood but felt it would be easier for him to collect his data if I didn’t do these ad hocs. A polite smile and a firm ‘no’ is what he got.

I did try to point out that my abilities as a doctor are also measured by what patients thought about me (both on paper and online, which is available to view); what my colleagues thought about me (360 appraisal available); what my outcome measures are, such as admission to hospital for the adolescent patients (publicly available).

So, back to my initial thought – how do you measure the competence of an NHS manager?

I put the question out there on Twitter: lots of ethereal answers, lots of intuitive thoughts. The end product – very little.

Why is that? Is it blasphemy to suggest that managers, who often see themselves as the guardians of tax payers’ money in the face of consultant profligacy, should face some sort of scrutiny themselves?

Is there a robust system out there which I am not aware of?

I have seen plenty of managers in my time as a clinical manager – some good, some awful. How could I differentiate them? One characteristic stood out…listening. The good ones listen with one thing in mind – how to improve patient care.

For some it’s all about meeting a target, a number. If that’s what they are judged on, then I understand the reasons why. When your job is on the line, ‘patient care’ evangelism will drop down the agenda. But it suggests that the markers on which we judge managers, either formally or informally, are wrong.

So, I would like all NHS leaders to come up with something which could be useful. Something which ties in with what the clinicians are trying to do – and makes us all sing from the same hymn sheet.

Something radical perhaps like measuring team performance, including the managers, on patient outcomes, feedback etc.

Until that day, it doesn’t matter how many courses you run on teamwork or how many group hugs you engineer, the NHS will always be divided into ‘them’ and ‘us’.

If the drivers for different members of the same team are different, then there is no chance of those teams pulling in the same direction.

So, who wants to work on that with some clinicians? I am game. Any managers interested?

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One Response to “Measuring the competence of NHS managers”

  1. Joe says:

    To say no change is not an option’, and then argue that the only alternative to no change’ are these reforms, is very dishonest. This might not be full privatisation or a US style health insurance system’ yet, but they are great strides towards that goal and that is clearly the direction the government is going in.
    There are also no clear plans for accountability in the proposed system, and there is no evidence that it will cost less than the current system. And the mantra that competition improves performance / quality’ is just a myth – there is no evidence that this is the case, and in fact the evidence from previous privatisation of public services shows the opposite, ie that quality is severely reduced (e.g. social services, trains) and the cost to the taxpayer is greatly increased (utilities, water, trains).
    Nobody denies there is a need for reform, but market reform and creeping privatisation is not the answer. Nobody wants these reforms, and nobody voted for them, so they need to be ripped up completely and replaced with clear evolutionary change that is built on greater co-operation NOT more competition.

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