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01.12.16

Nuffield Trust: Financial pressures undermining doctor-manager relations

Hospital managers and senior doctors are working together better than before but tensions have raised due to financial pressures, a new survey has revealed.

A report by the Nuffield Trust, ‘Managing doctors, doctors managing’, which polled 472 leaders and clinicians in management roles, found that 60% now believe that local doctor-manager relationships are positive, up from 47% in 2002. However, 37% now believe that relations are likely to deteriorate over the coming year. 

Risk factors for this included new financial pressures and regulatory drives as well as the 2012 Health and Social Care Act. The report concluded that a lack of relief from reorganisation is risking senior relationships when co-ordinated change is essential.

One of the authors, Huw Davies, said the NHS faces a complicated challenge in delivering high-quality care under rapidly changing demands.

“Good working relationships between managers and doctors mean that their complementary knowledge, skills and experience can be harnessed to address these challenges. But a key finding from our study was that successive and often conflicting government policies have undermined the stability of these relationships,” Davies explained.

“NHS managers – both medical and non-medical – need to be valued by government, given enough resources, and provided with a stable context in order for them and the hospitals they manage to flourish.”

Nearly 90% of respondents agreed that the management and regulatory system for hospitals was poorly co-ordinated and punitive, while 87% sensed rising tension between financial prudence and improving care standards.

The survey also revealed a divide in world view between doctors and management with CEOs having the most positive view and clinical directors the least positive.  Four-fifths of CEOs believed that relations would improve in the next year, but only 35% of clinical directors agreed.

Two-thirds of respondents believed that managers pressured doctors to discharge patients early, but most chief executives disagreed. Managers’ decision-making processes were seen as unfair by half of respondents across all roles.

The study also examined initiatives to improve the working relationship between doctors and management. While collaboration on individual efforts was found to be widespread, training and opportunities for the groups to meet informally was less consistent. CEOs were again more optimistic about these initiatives existing than medical leaders on the frontline were, showing a potential disconnect between the two organisational levels.

While the survey was sent to 3,467 NHS CEOs, medical directors, clinical directors and directorate managers between May and October 2015, only 472 (13.6%) of those asked responded, comprising 59 CEOs, 131 medical directors, 132 directorate managers and 150 clinical directors.

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