managing doctors: doctors managing - professor huw davies

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#ntsummit Managing doctors: doctors managing Professor Huw Davies, Professor of Health Policy and Management, University of St Andrews @univofstandrews

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#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.