Management is a dirty word for clinicians.

Doctors, nurses and allied health professionals rightly want to dedicate 100% of their time and effort to the prevention, diagnosis or treatment of patients. They make adequate time for the clinical management of their patients whether it be audit, risk management, clinical governance, research, continuous professional development or training. They may also spend time commissioning clinical systems in support of these requirements.

However this same group resents total system change, especially where it is imposed by the Department of Health, for what is perceived to be political reasons. In reality change should properly come from the hospital’s own strategy and continuous improvement programmes, supported by the clinicians. Part of this non engagement is tribal. We see increasingly management structures grouped by clinical specialties around delivery of care (eg emergency, elective, chronic disease, etc), but with the separate tri-partite arrangements of doctor, nurse and management remaining in each group. Each has a different agenda: doctors are interested in the “higher orders” of care – diagnosis, treatment, research and patient ownership/confidentiality; nurses are concerned with ward management, patient care, infection control , clinical governance and risk avoidance; managers with government targets (waiting lists), payment (commissioning), budgets, new investment (capital and revenue budget) and efficiency.

Doctors should want to spend more time on management.

It is very rare to see these tri-partite arrangements working in unison. For example, if all doctors could dedicate a small proportion of their time to total system change and administration beyond their own speciality, instead of expecting that it should be automatically undertaken on their behalf, they may actually see that the perceived time wasted translates into improved overall outcomes. At medical school there is very little time dedicated to management science, even the principles of which would provide a sound foundation for future management cooperation and the take up of senior administrative positions by doctors.

Nurses should concentrate on what works well for patients.

Similarly if nurses were able to spend less time completing paperwork that is designed to avoid risk (seeing care to be done), but rather spend more time providing care in a pre-emptive sense, patient satisfaction would rise and infection rates would fall. At the basic level this is about nurses adopting patient care practices around what works, rather than trying to remedy what doesn’t. Appreciative Inquiry for example is a qualitative approach to organisational development that aims to build good practice around these concepts.

Managers should learn to think outside the box.

Around one third of all hospital managers were once nurses. Nurse training is very much focused on being able to react to developing situations, and delivering care plans, however they are taught little of management skills such as forecasting, planning, investment analysis, business improvement and strategy; in other words how to manage the future. Another cohort of management comes from the commissioning sectors of the NHS. Although well versed in payments and data quality, these skills lie around securing payments from within the system. This group has less experience on winning new income streams or genuine profit and loss management capability. If management could be made less parochial, by encouraging outside talent, bringing in medical talent, and fostering internal talent, genuine new solutions at the level of hospitals and local communities could make a genuine difference to health.

All staff should embrace appraisal and talent management.

Bringing about cultural change in the NHS could be helped considerably if modern appraisal practices were embraced. These would need to applied at the level of individual, the team and the wider clinical system (ie including all stakeholders in the community) to underpin the changes in attitude we seek to achieve. Hospitals should seek to become employers of choice through genuine staff involvement, personal development and talent management. This will attract and retain the best staff, reduce staff turnover costs, and surely foster the innovation required in the sector.