Mark Newbold

A challenge from the management corridor

I’ve been agonising over what to write for my first blog here on Hospital Dr. Nobody knows me yet and I feel I should introduce myself, say where I have come from, and why am I here?

And why am I here? As a manager (there, I’ve said it) I have a feeling it’s my role to stir up the readership, to epitomise the ‘problem’ that doctors face daily, and to stimulate discussion on all that is wrong with the way we run our health service.

Which is fine, except that I am almost certainly as frustrated by ‘management’ as you are! This is because like you, I spend my days trying to provide good quality healthcare to those who need it most. And like you, I think I could provide this care so much better if it weren’t for the interference of ‘those who do not understand’.

I could use my 500 words to try and justify why management is important, and why doctors just need to understand us better and change the way they work a little bit. But actually, it is for me and my ilk to work out how to run the system without consistently frustrating, demoralising, and even alienating the docs who the patients come to see in the first place.

Maybe I’m not the manager blogger that is wanted here? I don’t want to stir up, or justify, I just want to encourage a dialogue between colleagues. A dialogue about how we, jointly address the really significant challenges we face.

And here’s the thing. These challenges are not created by managers, or by the politicians, bless them. They are not created by anyone – they have arisen through societal changes, or medical advances, or the need to manage chronic conditions instead of curing acute ones, or a downturn in our national wealth.

I have talked about what keeps me awake here (with safety topping the list). I’d be interested in your thoughts on these, because people were surprised. I’m surprised too – why would a hospital CEO want to provide anything other than safe and caring services with good clinical outcomes? Beats me.

So my rallying call to doctors is this. We must move from a model of care that treats acute illness, to one that actively aims to keep people well, especially people with chronic illness and frailty. We must also get much better at understanding how effective doctors are, by measuring and publishing outcomes – so it isn’t only people ‘in the know’ who can access our best colleagues. And we must make the best use possible of an increasingly constrained budget, to get from it the very best health benefit we can.

It is our duty to do these things – your duty as doctors as well as mine as a CEO. And we can do this much better by helping each other.

Does this make sense? Do let me know and we can start a debate that will hopefully be interesting and informative to all parties.

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9 Responses to “A challenge from the management corridor”

  1. Bob Bury says:

    Oh God, just what we need – a sensible manager. Mark, you have to realise that bloggers like me rely on stereotypes to generate their regular output of bile and sarcasm – we can’t have you bucking the trend like this.

    Still, you’re a doc as well (and from a ‘service’ specialty like me) so you can’t be all bad……or good.

    We’ll soon knock you into shape.

  2. Flip flop says:

    I do like a manager who’ll enter the lion’s den! Your list of priorities is interesting … but is caring really above efficiency for most senior managers in the NHS? I agree it’s not a managerial conspiracy, and pressures are being placed on the system, but there’s good current evidence, i.e. Mid Staffs for one, that ticking all the high profile, politically-driven boxes has been a higher priority for many trusts than making sure they are really, really safe and really, really care. Though I guess when the Inquiry comes in maybe that will change …

  3. Tom Goodfellow says:

    No Bob, it is much worse than that!

    Not only is Mark a “sensible” manager, he is also (sharp intake of breath) a genuinely nice guy!

    How on earth can we portray him as the lickspittle running dog mouthpiece of management under such circumstance.

    Mark and I are old colleagues and buddies (Hi Mark) – that is until he turned to the Dark Side. Now he is going to turn up in our inbox on a regular basis in a sort of “Luke I am your father” type of way.

    It is unsettling! Verbal light sabres at the ready I say.

  4. Mark Newbold says:

    Thanks all for commenting!

    Bob, I understand, so long as it’s okay for me to use stereotypes too – of consultants!

    Flip Flop I think you are right in some circumstances, sadly. Efficiency is crucial, but it is an enabler rather than a primary purpose. If we lose sight of this we start to make bad decisions. Trusts that are struggling tend to focus on the short term only, with predictable results. I will comment a bit on Mid Staffs in my next post.

    Tom, Hi good to hear from you I hope you are well! A vigorous debate will be great, my verbal light sabre is charged and ready! You will not find me apologising for, or defending, bad management though – it gets all of us a bad name as you know!

  5. TreeShaker says:

    Do I detect a hidden assumption there that quality (effectiveness) and delivery (efficiency) are mutually exclusive? A belief that we cannot have higher quality and lower cost at the same time? This “see-saw” hypothesis does not stand up to even a simple thought experiment when we consider the financial cost of avoidable errors. So if quality can go down and cost go up at the same time then the converse must be true too – by removing the causes of errors. That would sound to me like worthwhile work that doctors and managers could do together. Our patients would benefit and so would we – that’s three winners at the same time! Win-win-win. Now where have I heard that before?

  6. Mark Newbold says:

    TreeShaker, no not at all in fact quite the opposite as you say. We waste an inordinate amount of resource correcting for things we get wrong the first time, so the two go together I’m sure. In fact the way we manage people with chronic disease is a prime example of this – because we do not provide timely proactive support, they all too frequently fall ill and require (expensive) admission to hospital and subsequent rehabilitation.

    Sorry if I wasn’t clear!

  7. MDRXCW says:

    Nice to hear a management viewpoint but regrettably the comment”…These challenges are not created by managers, or by the politicians, bless them. They are not created by anyone…..” just shows what a gulf there is. Take ED 4 hour waits – these are clearly political targets. Managers strive enthusiastically, even rabidly, to meet them, Monitor get involved when not attained. Cue blame spreading – typically along the lines of clinicians ‘keeping people in hospital too long’. As for the viewpoint that we can convert substantial amounts of emergency admissions into better proactive care in the community, this is from a different planet/reality.

  8. Umesh Prabhu says:

    Dear Mark,

    I am not a CEO and have no intention of becoming one. Managing doctors is a challenge but I relish it but managing nurses, porters and others is not my cup of tea and managing politicians and others, is beyond me. So decided to stay as the Medical Director.

    The real challenge is true medical leadership at every level of our NHS. If we as doctors show the leadership which our patients deserve, NHS needs and our profession expects then we can sort out the NHS. When I say we, I mean both primary and secondary care medical leaders and also each and every consultant and GP.

    Of course, we got to completely modernise our NHS and make sure that GPs and consultants work much more closely, in the community to manage chronic diseases much better, reduce admissions, reduce length of stay, consultant delivered service at least from 8 am to 11 PM and 7 days service, not simply in the hospital but also primary care, social care and so on. This is the only way NHS will survive.

    We should also have a debate about dignified death. It looks as if we all have forgotten that there is something like dignified death rather than keeping our elderly patients with multiple co-morbidities with or without dementia alive at any cost with ventilators, tube coming out of every opening and drugs which make them so disabled, just because family wants us to do everything for their loved ones.

    NHS can only become a very strong organisation when all doctors show true leadership which our patients deserve and the NHS desperately needs.

  9. Mark Newbold says:

    MDRXCW – the point I was making is that the ‘real’ challenges we face, in my opinion, are not ones created by managers or politicians. Targets were brought in by politicians, of course, although I believe the 4hr target has broad medical support nowadays. Can’t defend poor implementation though. Re better care of folk with long term conditions – there is evidence from the US (Kaiser, Veterans Association) that active support and care keeps people well and reduces the number of acute exacerbations and hospital admissions? We should strive to make this ‘our reality’?

    Umesh – absolutely agree about medical leadership. It is not people like me who are needed, but doctors who still practice and lead in their own area. I am sure you are right that this is the route to a better run NHS

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