Doctors in management: three doctors' experiences.
Authors: R Hardwick, J De Bene, A Bussey
Journal: BMJ (1987)

Towards the end of my clinical career I have suddenly found myself the part time unit general manager of a unit responsible for acute services and services for the elderly and physically handi? capped. How did it happen? I have always had an interest in hospital management; I was a member of the local hospital management committee and after the 1974 reorganisation found myself the consultant representative on the district management team for the next four years. In 1982, with the formation of the district health authority, I became the consultant member on the authority. When the Griffiths structure was being talked about I thought it essential that the medical profession should participate and started to persuade my colleagues to apply for the unit general management posts. It was with genuine surprise that I found myself being persuaded to apply for the job. I have been in post for almost 18 months and am beginning to see how it is possible to be a part time clinician (five sessions a week) and a part time manager (five sessions a week), managing a ?17 million budget and with responsibility for the district general hospital, an ear, nose, and throat and eye hospital, some continuing care beds for the elderly, and the associated community services. From the outset I realised that it would be essential to have a good deputy and to divide the unit into definite and identifiable sections, each with its own manager. In this way I could be shielded from the hour to hour, day to day problems and be left with time for the major issues. I also realised that a large amount of time would be taken up with the inevitable meetings necessary to liaise with the rest of the units, the district general manager, and the district health authority. Here I met the first problem. While everyone agreed on the necessity of a strong deputy it seemed that it was not possible to get a grading for this post that would suit the calibre of person required. In the end the right person was appointed, but this is an area that needs to be kept under review so that a person of sufficient calibre to support a medical unit manager may be attracted to this post when the existing incumbent moves on. For many years the unit has functioned on four separate sites, with obvious revenue consequences. So a plan to reduce to three sites immediately, to two within four to five years, and to one within the decade was worked out. After some discussion this was agreed with the clinicians, but agreement could not be reached with the community health council (CHC), which opposed parts of the plan. The negotiations and the procedures that had to be followed to try to get this deal through were a fascinating example of the way that the National Health Service works. As a result of CHC opposition these potential economies have been delayed and the necessary additional consultant appointments on which the money would have been spent have had to be postponed. There is a continuing problem of finance and financial control. The unit seems to be overspending. I have had the greatest difficulty in getting sufficiently accurate figures fast enough to achieve tight financial control. If sensible and sensitive financial control is to be achieved I am convinced that each unit must have its own management accountant responsible to the unit and not just to the finance department. This has now been agreed and the post has recently been filled. In discussion with my clinical colleagues it is obvious that they appreciate that funds are limited and that money spent on one thing cannot later be spent on another. Accurate, simply laid out financial information would win their cooperation. Apart from this I have not run into any major hazards, and after almost 18 months the unit is beginning to weld into a team and the great majority of the year's objectives have been achieved. My background as a consultant physician has been helpful. It has meant that I have been able to discuss matters easily and informally with all my consultant colleagues and several issues have been solved which, without this informal approach, could have worsened. It has also meant that when I have had to say no it has been appreciated that the clinical consequences have been understood as well as the management ones; this has helped my clinical colleagues to accept the decision. The fact that I have worked in the district for more than 25 years has also helped as I have known and been able to talk to many of the staff as a clinician with management interests. Doctors must be prepared to take up their share of management responsibilities if the best and smoothest running health service is to be developed. I am concerned that my colleagues do not appreciate this and that in the future there may not be a sufficiently powerful medical input into management. On the whole I enjoy my job. I think that I have been able to simplify the chain of command and to give people definite areas of responsibility within which they are the boss. This not only gives the managers job satisfaction but is also satisfying to those managed as they see a person who is in charge and who has the power and ability to deal with their day today problems. I am also concerned in the further development of the district general hospital?another major building phase is planned over the next five years?and am able to initiate plans for building links between the hospital and a teaching hospital which will include medical students to consultants. It is all very exciting.? Robert Hardwick.