When you think of a manager, what image springs to mind? For me, earlier in my career, I may have pictured Montgomery Burns, the quintessential evil capitalist manager of Springfield Power Plant in ‘The Simpsons”, or David Brent , the hilariously incompetent regional manager of Wernham Hogg, in “The Office”.. Perhaps our opinions are influenced by the media, where greedy ‘fat-cat’ NHS managers are often criticized and scapegoated for NHS failings. Could these negative stereotypes be divisive, alienating clinical and managerial components of the NHS team? And could poor relationships between doctors and managers be counterproductive in the effective running of the NHS?
Until recently, I had very little contact with any NHS managers, and thought that they cared more about money, bureaucracy and politics than patients. This opinion was only informed by what I had heard from other doctors, the media, and the frustrating dealings I’d had with medical staffing departments at numerous inefficient hospital inductions. One memorable interaction resulted in doctors losing our only meeting/seminar/break room, as a result of a top-down decision by a ‘faceless’ manager, grand rounds were re-located to a soft play area where latecomers had to sit on an animal beanbag, or even worse the floor. I have also lived through challenging change in the NHS, driven by political agenda and largely facilitated by managers. I perceived a gradual erosion of doctor’s professional autonomy, with us coming under growing scrutiny through revalidation, targets and inspections, implemented mainly by non-clinical figures who seemed to me to have little insight into the realities of ‘front line’ work.
So when an opportunity arose in my latest training post to meet and work with a manager on an NHS Change Day project at Birmingham Children’s Hospital, I was both curious and keen to discover what managers were really like and share my opinions and insight into patient care. Meeting with Lydia Salice and her colleagues, completely turned my view of managers on its head. I had no idea that managers could be so enthusiastic about their jobs, compassionate about patients, keen to improve the NHS and such a pleasure to work with. I certainly did not think that managers wanted to engage with doctors, let alone work in a team with them out of choice!
From this new relationship network grew our project, Paired Learning, a successful scheme that links junior doctors and managers together in dialogue and shadowing, with the aim of breaking down barriers, challenging stereotypes and driving improvements in clinical leadership. This innovative scheme, inspired by an idea of Paediatrician Dr Bob Klaber, provides hands-on management and leadership training, and allows participants to create a non-hierarchical professional network and to influence change at work and in the wider NHS.
From undertaking Paired Learning, I have learned that managers can have plenty in common with frontline staff, sharing enthusiasm and values and putting patients at the centre of their work. Non-clinical leaders and managers play an absolutely vital part in the smooth running of the NHS, and work tirelessly in a complex, difficult and often thankless task; coordinating patient care, balancing budgets and facilitating the work of frontline staff. I have also discovered that it is critical that clinicians are engaged in NHS management processes, to represent and act as a voice for our colleagues and patients in crucial decisions about our services.
I have witnessed how good inter-professional relationships and cohesive informal networks between clinical and non-clinical colleagues can improve patient outcomes, staff experience and help implement innovative and effective change. Conversely, lack of understanding of each other’s backgrounds, training, job roles and values of each group can contribute to relationship breakdown and poor team performance. This is one reason why we would like to share our experiences and promote Paired Learning across the NHS. You don’t even need a formal scheme- just find a willing manager and meet for a coffee! Maybe you would like to consider trying Paired Learning as your action for NHS Change Day 2015?
Dr Nicki Kelly, Specialty Registrar in Paediatric Intensive Care Medicine, Birmingham Children’s Hospital
How to get involved in Paired Learning: