<<If managers bought in from the Services, the Civil Service, Production
or distribution, banking or wherever are better in some instances than
some managers grown in the NHS, then does this not point to specific
areas where we should learn something from those other areas -
selection, training, or indeed when to push out somebody who is better
suited to fulfill their potential _somewhere else_>>
There are two problems in this specific area----one is understanding what
the NHS is about and in particular what motivates the people who have
chosen (and of course what are their reasons?) to work in the NHS; the
other is training to a high level of competence in PEOPLE MANAGEMENT.
Anecdote time----I know an occupational psychologist, sound man, down to
earth. Into a big multi-nat on a contract to assess managers; found six
out of ten he interviewed did not like people. Therefore found it very
hard to manage people. So why were they promoted? Because someone up top
reckoned they deserved promotion. Company clearly failing in its duty to
manage. I don't know how much of this went in his report. Anecdote mode
off.
<< I think the medical profession is insufficiently forthright
in contributing to the apraisal of NHS managerial and support staff.>>
I don't agree. Have you tried it recently? And been listened to?
<<>as Mintzberg et al?
Sorry, who and what was he?>>
Big man on organisation theory; guy who wrote the obituary for the
collective delusion in big business which is called "strategic planning."
Strategy is what happens. Or what happened last year. Not what is going
to happen. Sorry, I thought you would have known him because I remember you
mentioning Belbin some time back---Belbin would be less well known.
<<> I recall trying to get one or two awful
>nurses promoted to desk jobs simply so they could do less harm than on
>the
>wards.
Sorry, but I regard that as a (very common) dereliction of duty.
If no good then retrain or fire.>>
But when there seems to be no alternative and when the desk jobs are
sinecures anyway and when the desk jobs don't really have any power and
when the nursing hierarchy simply refuses to listen to what virtually
everyone in the ward is saying. I recall one ward which was one of the
best I ever worked in. New sister came in, nice but ineffectual and
within two years every experienced nurse on the ward left because they
could not work with her.
<<BUt these are people who draw general principles (many of which appear
not to be in use in the NHS) from many organisations and areas of
enterprise.
To suggest that bringing them in and listening to what they say would
be useful is to suggest that there are other areas from which the NHS
could draw useful comparisons.>>
Firstly, Drucker in particular defines the function of management very
clearly indeed. Looking an NHS managers around me I note that very few of
them seem to have a clear idea of their role.
Secondly, these guys are geniuses at observing, thinking, reporting and
recommending. Peters in particular will (or his researchers will) hunt out
numerous examples of people and companies doing absolutely superb service
jobs. He refers to some work on patient-centred care which is especially
thought-provoking (details available if you want) but really my point is
that we don't need more third rate management consultants coming in and
writing down what we tell them---we need good ideas and critical analysis
of how we do things. I don't think this is the same at all as hiring all
NHS managers exclusively from M&S or whatever.
Incidentally I hope to bring Peters here for a public seminar (in Belfast)
next year----THIS IS NOT AN AD!!!!!----and if you or anyone else cna raise
the money/sponsors he probably would find it a fascinating challenge to do
a seminar on NHS management. That's if the idea of socialised medicine
doesn't stick in his craw---I think he's a Republican.
On watching the workers---<<The answer of course has been given, and it is
no, yes it does
demotivate.>> But why oh why do we let it go on? I got heartily sick of
sticking up for the attached staff when the deskbound came down on top of
them. Partly I got sick of it because of the sick deskbound minds I was
fighting and partly because the attached staff could perhaps have fought a
little themselve. But this is, I feel, one of the most serious problems in
the NHS today. Most NHS staff are exceptionally motivated and dedicated to
the ideal of service---they have to be or they would work somewhere
else-----and yet it seems to be a given with most managers I meet (in the
NHS) that the workers need watching. I could tho I shouldn't give you the
example of two GPs in a partnership; one treated his staff as much as
possible as equals while the other had attitudes best described as
pre-Victorian. If you can guess which GP inspired the staff most, which
one they felt happiest working with and which one they gave 110% routinely
then you win the prize. And I have seen hospital managers who made that
particular pre-Victorian GP look like a pussycat.
There IS a new paradigm in medical care and it goes beyond just management.
Management is in some respects trying to cope with a clumsy overgrown
system which no longer does what it should and effectively prevents any
substantial change. Bureaucracy has insinuated itself into the cracks so
well that the whole lot may well tumble down without the bureaucracy. So
let it tumble and build new and better ways of providing patient-centred
care. Is patient care influenced for the better or for the worse by the
Red Book, by form-filling, by annual reports which are never read? Of
course not but these things are part of the current paradigm and the
changes we have seen so far such as fundholding and those to come such as
PCGs are also part of the current paradigm. PCGs will be
bureaucracy-ridden, incredibly constrained in their function and in many
eyes simply taking the flak for rationing off the government. I can
develop this MUCH further if anyone is interested but for now, the accounts
call.
BCNU
Declan
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