Area of work:

A keystone of health care policy for some years now has been the encouragement of greater engagement of clinicians – especially doctors – in managerial roles. Poor relations between managers and clinicians was flagged up in the Francis Report as contributing to the failures in care at Mid Staffordshire NHS Trust. Many of the other issues raised in the Francis Report about openness, candour and focusing on compassionate care relate to governance, and the relationship between doctors and managers is at the heart of this.

Understanding the difficult relations at the heart of the NHS

This project, led by Professor Huw Davies and Dr Alison Powell of the University of St Andrews, aims to explore the perceptions that doctors and managers have of each other and their roles, using a national survey. Traditionally doctors have enjoyed considerable independence and autonomy, but the last twenty years have seen the growth of a different model of governance, which emphasises comparative data over personal clinical experience and brings clinical activities into the scope of formal governance and managerial relationships.
Their earlier work, published in 2003, found tensions and suspicions between doctors and managers alongside other areas of agreement about these new ways of working.
Since that survey was conducted, much has changed in the NHS, including a renewed focus on the importance of clinical engagement and the role of leadership (clinical and non-clinical) in shaping the culture of NHS organisations, in the wake of both Francis Reports and other government initiatives to drive up the quality of care in hospitals. The NHS is also experiencing a period of financial pressure unprecedented in its history, which has increased the challenges for those leading organisations to balance cost, quality and access.
This project, which runs until the end of 2015, will include:
  • a rapid review of the recent research on doctor manager relations
  • a web based survey, including chief executives, medical directors, clinical directors and other managers across the UK
  • focus groups to explore emerging findings
  • a final reporting seminar to disseminate the findings     
If you are interested in contributing in any way to this research, please contact Ruth Thorlby.

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