Doctors and managers

Editor—Doctors and managers obviously need to work together. To have two powerful groups not working together is likely to frustrate the efforts of both and to damage the service offered to patients. Why then is the relationship between doctors and managers often strained and currently perceived to be at a low ebb? Why is it that two groups, both protesting a desire to put patients at the centre of decision making, often find it difficult to find common ground? Although doctors and managers apparently agree about the objectives of the NHS, the reality is that the views of the medical profession about its purpose are different from those of managers. This is not surprising given the different backgrounds of doctors and managers. Doctors are trained in medicine; they tend to be numerate and are trained in the scientific method. They are socialised into a professional model that values both individual and professional autonomy. Many value medicine more highly than they do the NHS. Some perceive themselves as advocates for their patients in the face of governmental and managerial intervention. Contrast this with managers, who are essentially selected for various characteristics, including good communication skills, ability to create change, and assertiveness, as well as a knowledge and experience of how the NHS functions. Managers have a clear sense of hierarchy and are less concerned with personal or professional autonomy. They recognise lines of accountability and accept that these extend outside their organisation, ultimately to the secretary of state and to government. How can these two groups be successfully brought together? To assume that doctors and managers agree about objectives when they meet may be wrong. In practical terms, therefore, it is often worthwhile making certain that objectives are shared before debating the process. If agreement cannot be reached then there is little point in debating process—the debate needs to be more fundamental. But if agreement can be reached about the objective then the collective creativity of doctors and managers working together can be exciting, worthwhile, and rewarding.