managing doctors: doctors managing - professor huw davies

Download Managing doctors: doctors managing - Professor Huw Davies

Post on 24-Jan-2017

730 views

Category:

Healthcare

3 download

Embed Size (px)

TRANSCRIPT

  • #ntsummit

    Managing doctors: doctors managing

    Professor Huw Davies, Professor of Health Policy and Management, University of St Andrews @univofstandrews

  • Professor Huw Davies

    Dr Alison Powell

    School of Management University of St Andrews

    Supported by:

    MANAGING DOCTORS, DOCTORS MANAGING

  • THE DOCTOR-MANAGER RELATIONSHIP

    - AT THE HEART OF THE NHS -

    Perennial part of the political and public discourse ------------>

    Prominent in policy reviews (Darzi, Dalton etc.)

    Indicted in failure inquiries (Kennedy, Francis etc.)

  • from Administration to Management

    Slow diminution of doctor dominance and autonomy?

    Counter-balancing growth of managerial influence?

    Managing Doctors, and

    Doctors Managing

  • Some NHS work over a decade ago (in NHS Acute Hospital Trusts)

    BMJ 2003; 326:626-8

    Doctors and managers in the NHS are often dissatisfied with doctor-manager

    relationships but differ in their views depending on their role in the organisation.

    In general, senior managers were more positive than staff at directorate level, and

    lay managers were more positive than medical managers.

    Clinical directors (or those in equivalent roles) were easily the most disaffected

    with many holding negative opinions about managers capabilities, the respective

    balance of power and influence between managers and clinicians, and the

    prospects for improved relations.

  • But what of doctor-manager relations in a

    post-Francis world and an austerity NHS?

    New national survey in UK acute hospitals

    Total of 472 respondents (88% in England) Chief Executives (n=59)

    Medical Directors (n=131)

    Directorate Managers (132)

    Clinical Directors (150)

    Additional depth interviews, plus focus group (n=22)

    Supported by:

  • Are relationships between doctors and

    managers improving or getting worse?

    Narrative of continuing challenge

    Lack of regard/respect/trust

    Defensive and oppositional behaviours

    Widespread view that clinical power retained

    Some pockets of effective working

    Local,

    Local,

    Local

  • Chief

    Executives (n=59)

    Medical Directors

    (n=131)

    Middle managers (n=132)

    Clinical Directors (n=150)

    Positive ratings

    72% 62% 64% 50%

    Negative ratings

    10% 9% 6% 19%

    Relations likely to improve

    80%

    66%

    67%

    35%

    - Around a quarter or more of each group dissatisfied with

    resources and effort devoted to nurturing local relationships

    Strained Doctor-Manager Relationships - national UK survey NHS Acute Trusts, 2015

    Relations likely to

    deteriorate

    18%

    27%

    29%

    51%

  • Power tensions between Doctors & Managers

    Statement:

    Trust Chief Exec

    (n=59)

    Medical Directors

    (n=131)

    Middle managers (n=132)

    Clinical Directors (n=150)

    The relative power and influence between management and medical staff is about right

    70%

    68%

    55%

    44%

    Percent agreeing with statement:

    Doctors have sufficient influence on hospital management

    81%

    62%

    81%

    46%

    Doctors have confidence in management leadership

    79%

    56%

    59%

    34%

  • Resource tensions between Doctors & Managers

    Statement:

    Trust Chief Exec

    (n=59)

    Medical Directors

    (n=131)

    Middle managers (n=132)

    Clinical Directors (n=150)

    Management do not exert pressure to discharge or transfer patients early

    53%

    33%

    34%

    22%

    Percent agreeing with statement:

    Management do not exert pressure to reduce use of tests or services

    78%

    79%

    68%

    61%

    Management is driven more by clinical rather than financial priorities

    96%

    70%

    71%

    43%

  • (How) does the policy context shape

    relations between doctors and managers?

    Funding constraints, moving targets, regulatory and media pressures and frequent redisorganisation

    Managerial capacity: loss and churn;

    Managers seen as the agents of government

  • Conclusions

    Relatively little change since 2002 is this good or bad?! Clinical directors a concern

    Positive views and optimism holding up; but hardening of pessimism looking forwards;

    Whatever the national picture, local relations matter more

    The broader policy context shapes interactions

    An area warranting investment??

  • Investing in the

    Doctor-Manager

    relationship

    Understanding the

    dynamics and

    impacts;

    Seeking greater

    functionality.