01.10.15
Tensions between managers and clinicians
Source: NHE Sep/Oct 15
Finding ways to improve the relationship between managers and clinicians has never been more important, says Shirley Cramer, CEO of the Institute of Healthcare Management (IHM).
The evenings are drawing in and there is a chill in the air. Winter is approaching, heralding more problems for the NHS. There are the already well-known and loudly broadcast difficulties: increasing financial deficits, extended waiting times and the changing and growing demands on the health system from its political masters. Given the ongoing pressures on capacity, the unknown – think new pathogens and outbreaks of infectious diseases – do not bear thinking about.
But increased demand on services in the cold months ahead is a certainty. The need for everyone working in the NHS to work together, in an atmosphere of trust, towards their common goal of improving patient experience of healthcare services and achieving better outcomes, has rarely been so urgent.
Most organisations tussle with turf issues and internal politics and the NHS is no exception. As elsewhere in the western world, across the UK the tensions and suspicions that exist between managers and clinicians, in particular, have been long acknowledged by both professions, with the need to improve the situation addressed in numerous studies over recent decades.
A small survey (just over 200 managers) carried out by the IHM recently confirms that the issue is far from resolved. Nearly three-quarters of managers (73%) said they thought the relationship between the two groups of professionals could be defined as “a partnership with areas of tension” or “a relationship of tolerance with frequent tensions”. A similar percentage (73%) thought the relationship would stay the same or get worse over the next five years, while 14% described it as having “persistent and unresolved tensions”.
Encouraging an open and honest discourse between clinicians and managers must now transcend perceived current or past tensions and barriers between the two professions. Only by working closely together can the strong relationships, which will lead to an NHS that’s open to innovation, be fostered and thrive.
Facilitating better relations
Clinicians and managers have both highlighted a number of facilitators to fostering a positive relationship. They include: trust, mutual respect, support, accessibility, visibility, good communication, close proximity, mutual interdependence and friendship. Identifying and listing positive facilitators is easy; however, successfully implementing them in a working environment is clearly more difficult.
The IHM would like to see the introduction of more paired learning initiatives, such as those piloted at Imperial College Healthcare NHS Trust during 2010-11, which invited both clinicians and managers to spend time learning about each other’s roles and responsibilities. Learning together, forging a common language and gaining a greater understanding of each other’s viewpoint can only be beneficial when it comes to making important decisions that may ultimately affect patient care.
Joint management training programmes and events should support these initiatives. Clinicians, like managers, need development and support and may benefit from training in areas such as managing staff and budgets, business planning and organisational change.
Clinical leadership is a significant theme of the modern health system, as well as managers going “back to the floor” to experience the front line, and IHM would also like to see more clinicians encouraged to take up management roles. Suspicion of managers and their motives has led many clinicians to avoid taking these on and to shy away from getting involved in service development.
Environmental factors
Creating working environments that encourage informal interactions between clinicians and managers would help build trust and interdependence, not least because close-proximity to one another can lead to relaxed, spontaneous contacts outside of the formal working setting.
However, while the environment in which clinicians and managers work can play a part in bringing about change, individual clinicians and managers also bear some responsibility for deciding on the changes they can make to improve their relationships with one another. Over 40% of respondents to the IHM survey thought that this was where the main responsibility lay.
The time to move on is long overdue. It may well be true that differences in culture have contributed to the cool relations between managers and clinicians but those differences should not be detrimental to a common cause. Understanding them and building on similarities is important.
The relationship between managers and clinicians has been highlighted as a critical determinant of the success of healthcare organisation (see, for example, the article ‘Manager-physician relationships: an organizational theory perspective’ by Dr Amer A Kaissi).
Collaboration, or the ‘partnership working’, ‘joint working’ and ‘joined-up thinking’ we have heard so much about for so long, is not always easy. Nevertheless, it is vital if better problem solving, increased productivity and the most effective use of existing resources have a hope of becoming reality.
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