Doctors v managers : A relationship that needs rescuing

A questionnaire landed on my desk about the relationship between doctors and managers. As someone who has been a doctor for over 20 years and a clinical manager for 15 years, I am definitely in a position to comment, but to tell the truth, I was initially quite bemused this is still a question…

At first glance it seemed blindingly obvious to me; the NHS could never flourish if the relationship isn’t fantastic. Could it? However I as I ploughed further through my answers, the rather less shiny reality sunk in. I found myself admitting that actually the relationship between doctors and ‘managers’ is not all that great.

The historical reasons for this are well rehearsed so I won’t list them out. A far more interesting question for me is how do we make this relationship better? As I mused on this, the idea that popped into my mind was task-interdependence. The real reason why people do and don’t get along is a fascinating topic. The findings are rather surprising; it has much more to with the factor in the environment we share than differences between individual people. So one powerful way to make sense of relationships in groups is task-interdependence.

The basic line of argument is this: groups form to achieve something – a goal. Relationships in groups are strongest when achieving the collective goals and this means different members have to work in a way where they are dependent on each other for success.

When we look at the relationship between doctors and managers through this lens it is revealing. What is the group goal? How dependent are each group on one another for success? Of course, both sides would chorus the goal is ‘great patient care’. And I believe both sides really do share this goal. On paper.

However, when you look closely at how dependent each side feels, especially as finances are squeezed, there is big gap and I fear it is widening.  Typically, both blame the other for the respective difficulty achieving the goal. This was most vividly illustrated in the Mid-Staffs scandal. The managers goal was to achieve management targets whilst the clinicians saw this as incompatible with their goal – good patient care. The divide led to the patients suffering terrible care. In my view finding ways to help both sides see how the in fact they are dependent other contribution will be  he most powerful solution to this issue.  My suggestion is simple: train both groups in process science … and apply this to their joint challenge.

Dr Steve Allder is a consultant neurologist at Plymouth Hospitals NHS Trust