How do we bring doctors and managers closer together?
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2010)

The Rand Corporation among others has pointed to a widening rift between doctors and managers. How do we bring these protagonists closer together? We need radical thinking and we invited JRSM readers to submit their ideas, the best of which are published here.

Harvey Marcovitch, medical editor, Oxford

The best way to heal a rift between two individuals is for each to put themselves in the place of the other.

The best way to achieve that is with the help of a skilled facilitator.

The best way to learn is from others’ mistakes (as anyone instructed to provide medicolegal reports will tell you).

So, let's run learning sessions at which medical directors and CEOs reveal to sceptical clinicians, stage by stage, a suitably redacted recent cock-up and see how the latter claim they would have responded.

Then tell them why their solutions would not have worked, how much they would have cost and ask how they feel now at being fired.

Hugh C Rayner, consultant nephrologist, Birmingham

Whatever your taste in architecture or your views on alternative medicine, we can all learn from Prince Charles. Now money is tight, he has got into bed with a business partnership which shares his values. Sustainable use of resources, respect for your fellow worker and excellent quality are values that also fit well in the NHS. We too need new business models based on mutual ownership by communities of clinicians and managers who are committed to continuity of care of their local population. ‘NHS Originals’, anyone?

Alastair McLellan, editor, Health Service Journal

Doctors need to develop a thicker skin to work well with managers. Working well with managers means making overt decisions on the rationing or restructuring of care and being held publically accountable for them. Many doctors will do almost anything to avoid being publically associated with unpopular decisions. Not because they disagree with them, but because it might damage their status. This thinness of skin is also apparent following any suggestion that the medical profession might offer poor value for money or deliver outcomes which would be, at the least, questionable in other fields. The medics and the managers should be friends.

Alan Maynard, professor of health economics, York

Each hospital has two firms: the medical demanders pressing for ‘more’ to improve patient care, and the managerial suppliers of resources working within tight budgets, subjected to ‘terror and targets’ from Whitehall village and equally committed to helping patients.

How can the two competing firms compromise efficiently to achieve their joint purpose? In extremis shouting and screaming inevitably occurs but as in many marriages making up involves improved systems of negotiation and appreciation of the needs of both.

I suggest that over Christmas you listen to Rogers and Hammerstein's musical ‘Oklahoma’ and to the tune ‘the farmers and the cowmen should be friends’. When doing this replace these agricultural references with medics and managers! Conflict damages patient care so love thy neighbour as thyself!

Rosemary Stewart, honorary fellow, Green Templeton College, Oxford

A better understanding of each other's role helps to improve relationships. Doctors need to be given some understanding of management. Some consultants have found that taking on a managerial role provides an interesting new challenge.

Give both consultants and managers the opportunity to shadow each other for a day and to be stimulated by a tutor to reflect on what they noticed.

Paul Cooper, retired house governor and general manager, Great Ormond Street Hospitals for Sick Children

A good NHS Leader must see and be seen. He must understand and support the role of everyone within the organization and be perceived as a senior colleague not as a director. He should share the planning and problem-solving role with relevant colleagues, and make, or ensure that, agreed policies and solutions happen. He should promote this team ethos throughout the organization. He should be someone who makes friends and influences people, not least other echelons of the NHS, and he should be perceived outside the organization as a strong and respected diplomat and accountable for the organization as a whole.

Neeraj Bhala, medical researcher, London

To be fair, managers are often trying to make the system better. Perhaps they could sort out the paperwork, reducing the tick-boxing exercises, administrative forms and regulation gone crazy. It would allow clinicians and researchers to go back to what they do best – managing the treatment of patients.

Idris Mohammed, professor of medicine and immunology, Gombe, Nigeria

I don't know about genius as I am not one, but as doctors, perhaps the best means would be to train medical students as managers before awarding them the MB, so that they can manage both patients and the health service. Beware, however. In 1985, Nigeria decided to appoint doctors as chief executives of teaching hospitals – I was one of the ‘Foundation chief medical directors’ – and guess what? The first strikes against the management were by resident doctors, and this has since become a recurring decimal!

Mark Aitken, consultant physician, Colchester

In a group of 10 doctors, there will be 10 leaders. Nine will want to lead their own lives. One may aspire to lead the group. This is the conflict! For the group to become a team they collectively need to embrace team spirit. Goals scored or conceded must be accredited not to the person closest to the ball but to the team's combined efforts. Group fragmentation allows managers to plough their own furrow. When managers have to interact with a team, aspirations, with different origins, become greater than the sum of their parts. Symbiosis is the way forward.

Peter Gooderham, research associate, Manchester

Problems arise from the fact that doctors are bound by professional standards but managers (unless they are healthcare professionals) are not. A ‘GMC’ for managers, with standards and professional discipline, would help to put doctors and managers on an even footing.