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Health boss on big salary blamed for knee-jerk reaction


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Thursday, 18 August 2011

Health boss on big salary blamed for knee-jerk reaction

“Health boss on £230k salary takes on new role” declares a headline this week in the East Anglian Daily Times, though it could have been any paper in any other week of the year.

Readers need go no further to know what to think. They are already pre-programmed for ironic contrast – bosses get further bloated pay awards while nurses and other frontline staff are forced to eat their children to survive.

The media know how to push our buttons and we react with gratifying predictability.

The NHS is a priceless national asset. People take to the streets to defend it against pillaging governments or raids by the new Vikings of the US healthcare industry, but are strangely resistant to the idea that NHS managers should be appropriately rewarded.

Doctors earn our undying gratitude – literally. It would be deeply churlish to quibble about what they get paid and we rarely do. 

Compare and contrast the managers of the system in which these acts of clinical heroism are performed. Surgeons save lives. Managers save money. Nurses make people feel better. Managers make them sick. 

It is a curious feature of our culture that we denigrate managers one minute and wonder why nothing works properly the next. We seem incapable of holding onto the thought that bad managers should be sacked without it bolting towards the conclusion that all managers should be sacked.

We’ve all seen the popular dramas in which the brave medicos pit their wits against hospital managers whose sadistic desire to under-resource is only matched by their compulsion to over-manage.

Of course the relationship between managers and clinical professionals is sometimes adversarial. That’s as it should be: it’s the tension between what the NHS would like to do and what it can afford to do.

A less obvious truth, skilfully disguised by casting good-looking, charismatic manager-villains in the medical soaps is that successful management is invisible and fundamentally dull. In the real world, managers are only interesting or newsworthy when they are bad or failing.

Paying six-figure salaries doesn’t automatically mean you get the best people for the job, but not paying them guarantees mediocrity. Ambitious clever people are not only attracted by the cash. They won’t be any less motivated without the prospect of financial reward; they will just be working somewhere else.

Working out how many nurses you would get for one chief executive is good sport but entirely facile. Increasing the numbers of troops on the frontline achieves nothing on its own. See the First World War for details. 

The public can be forgiven for believing the worst. People enjoy horror stories and they enjoy vilifying managers, particularly high-earning ones. Add a twist of incompetence and a pinch of mediocrity and you have the perfect tabloid cocktail.

Some of the same prejudices persist inside the NHS. Of course there are bad managers, but our determination to keep management in its place or run it down compounds the problem.

If you are determined to argue that managers are no good and to prove it by refusing to pay for good ones, you should not be surprised to find that you’re consistently right.


Tahirnaeemkhan says:
Aug 19, 2011 07:01 AM
I fully agree with this post. I believe the root cause of NHS problems is this phenomenon of 'Managerial Aristrocracy'. Over the years I have seen that managerial arm of NHS has expanded tremendously. To keep their post safe they create work for others especially medics and have an irresistible desire to dominate them despite the fact they have no knowledge of 'patient care'. Further whenever they start work they are always looking to create posts to have secretaries and Asst. Managers and then the vicious cycle starts.

NHS is a specialised organization which high expectations which can be effectively run by doctors/nurses only who know and can spot the clinical problems and provide solutions because they are the ones who are intimately associated with the care of their patients.

Another serious set back is that the managerial control of NHS became 'Peripheral' and frontline medical staff was excluded in the process of decision making. Only the Head of Department is summarily informed about the decision which have been taken and are ask to implement them. I believe a 'central' management system should be cultivated where the Managers gets into discussion with all consultants in the department and seek for appropriate directions. They then should work under their guidance to implement.

Another serious flaw I notice is that the managers create a lot of meetings to show that a lot of work is being done which is not only waste of time and resources butthey have little time to attend to the 'Bench - work place'. The remaining staff is left to struggle with the work while the Managers remain in a state of Nirvana in the meetings.
billymckee says:
Aug 19, 2011 08:02 AM
Said manager jokes about his new 3 SHA cluster as having been dubbed "The Middle East". He will need the skills more usually associated with the UN Secretary General to sheppard this lot through the next few years. I wish him luck.
lynne says:
Aug 19, 2011 11:10 AM
William may be right about needing the skills associated with the UN secreatry general however he[the sec. general that is [rightly]] has a very large staff and does nothing alone. The divide between the haves and have little is vast [for proof see recent riots]. With the best will in the world it is hard to belive this person is worth 230K ...because after all he is not the UN Secretary general is he?
rejack says:
Aug 19, 2011 12:25 PM
Tahir i think you need to read the editors blog. Your reply is a stereotypical reaction from someone who clearly does not understand the principles of good management that are in place in many areas of the NHS. Clinical Divisional teams are made up of clinicians and managers who make joint decisions taking all views into account. Most Doctors and Nurses want to treat patients within a well managed framework, they want a say in how things are run but they do not want their time taken up in putting the necessary systems and processes in place.
simon@simondodds.com says:
Aug 20, 2011 01:31 PM
So called "bad managers" are like "bad doctors" - their decisions and actions result in adverse outcomes and the toxic effect spreads through an organsiation like cultural poison. The question I would like to pose is "Is this bad-outcome-generating-behaviour deliberate and therefore malicious?" My experience says "No" - the decisons and actions seem to be well intentioned. So this suggests that the way we are making decisions is flawed - and on investigating this hypothesis I discovered a possible reason. We are have not learned how to make better decisions - we appear to learn our healthcare management skills by osmosis - observing what we see,assuming it is "best practice", and then copying it. So if we are learning this way than what we will learn is how to create and maintain the status quo. In my role as a clinical director I see mostly good management, dedicated hard working managers, and well intentioned decisons and actions. What I do not see much of is outcoime improvement: higher quality AND lower costs. Lessons from outside healthcare prove that this elusive win-win outcome is possible - so I know there is an opportunity to improve both healthcare and healthcare management. I have discovered that there are tried-and-tested techiques and tools that we could learn to use - we were just never taught them at medical school or at management school. They do not feature on the MBA courses either which is a bit worrying. The approach is called "Improvement Science" and it is blend of people-factors and process-factors: heart and mind. The process-factor stuff is the quickest and easiest to learn and apply - and delivers improvements in effectiveness and efficiency almost immediately and at no cost. So, we can side-step the whole debate about good-versus-bad managers and how much-or-not they are paid and instead focus on developing better and better managers. Curious? If so have a look at the Improvement Science forum at www.saasoft.com/blog and draw your own conclusions.