Mark Newbold

Are doctors from Mars and managers from Venus?

Firstly, thank you for making me feel welcome and responding to my first blog on Hospital Dr!

In my blogs I’d like to unpick the doctor-manager relationship, to better understand why it is frequently a strained one. To start, let’s examine why doctors and managers often seem to have different agendas.

This is a fascinating question. I commented in my last blog that the ‘real’ agenda was not one created by managers or politicians, but one that had arisen through evolution – of the consumer society, of medical advance, of disease patterns, and of the economic climate.

What have been created though are targets. These, and the ‘target culture’, are generally unloved. But are doctors opposed to targets per se? Few feel it is right for people to wait over 4 hrs in ED, or over 18 wks for a hip replacement, or over 2 wks for cancer fears to be checked out? I suspect what doctors oppose is unintelligent target chasing in ways that set aside the interests, rights, and dignity of patients. Box ticked but point missed.

Look at Mid Staffs I hear you say? The issue there was not targets, or the need to balance budgets or achieve FT status – it was that clinical safety and patient dignity were allowed to fall by the wayside in pursuit of these aims. The system never mandated this, but it happened because the trust board felt an imperative to achieve and then allowed themselves to make bad decisions. They failed to recognise what was right, and to keep that as their guiding principle.

Management must manage rigorously, and must be prepared to take difficult decisions, but it must also be strong enough to do what is right. And doing what is right might be, in some circumstances, the hardest thing of all. Especially if you feel culpable for getting into a difficult situation in the first place.

Easy to say? Sure, but management is not easy and neither is leadership, which is called for on such occasions. Boards have a non-executive majority to provide challenge, and they have people senior and strong enough to challenge the wider system if it seems to be requiring the wrong things to be done.

Of course, the aim is to avoid getting into a ‘no win’ situation, by managing effectively and being clear about values, aims, and priorities. If these are the right ones, and they are adhered to consistently, then there will surely be alignment with the medical body? Then, if matters deteriorate, managers and medics will be together, and positioned to address difficulties jointly, in a way that doesn’t compromise those values and priorities.

It’s clear what the NHS is for, so it takes some doing to break the natural alignment of all those working in it, be they doctors, managers, or anybody else! It reflects poorly on management that it happens so frequently.

A final point – we often blame ‘the system’ but the best way to improve it is from the ground up. A consensus amongst doctors and managers would be a powerful way of creating a strong enough movement to do this. We are too passive. We should seize the initiative and shape the system so it always acts in the patient interest, because we know this is right.

Bookmark and Share

4 Responses to “Are doctors from Mars and managers from Venus?”

  1. Mark II says:

    Managers are losing their jobs, and those that remain are having to take on extra responsibilities.

    Consultants are having their reward package cut significantly (pay freeze, no CEAs, more expensive pension) and being expected to do more.

    High performance and joint working requires motivated staff. Blitz spirit will not be enough. Good leadership will only get us so far.

    These challenges are systemic, and create fundamental problems for ‘alignment’ in real terms.

  2. Malcolm Morrison says:

    Doctors and managers DO come at the job with different agendas. The doctor’s primary job is to “treat the patient in front of him/her”; whereas the manger’s job is to “provide a service to the community” – within the resources available.

    One of the problems of modern life is that (for obvious reasons) neither doctors nor managers are prepared to tell the public “You can’t get a quart out of a pint pot”! Politicians limit the ‘resources’ (money and manpower) against an almost insatiable demand – yet they will not address the problem of ‘rationing’ which MUST happen in such circumstances (either as waiting lists and times to be seen, or some treatments not being ‘funded’ by the purchasers)

  3. Mark Newbold says:

    Mark II – yes the economic pressures are creating a difficult time for doctors and managers alike, but surely neither party can expect terms and conditions to be as favourable in such circumstances? And such pressure could just as easily lead to greater unity could it not?

    Malcolm Morrison – you are right about the different focus, but this is possible to reconcile as most doctors are also concerned with the greater good? I understand the point about rationing but I’m very uneasy with it as a solution when we know there is so much to gain in terms of efficiency and productivity within the system.

  4. Jammi Rao says:

    Good point, Mark, about the targets being desirable but the relentless pursuit of the target under a ‘hit it or else’ culture is what can get in the way of managers and doctors working together.

    Most doctors I meet have their solution for what ails the ‘system’ but it needs someone to ensure that one doc’s radical solution does not create a crisis somewhere else in the system. This is where good and intelligent managers could be a godsend, if only they were allowed the time and freedom to manage the system rather than be judged on how well they manage upwards.

Post a Comment

Enter this security code

Submit Comment for Moderation