Giving NHS managers a boost

A big dose of management and leadership development to recognised national standards could be just the right medicine the NHS needs at this critical time to improve under-par performance. Report by Erika Lucas

Managers in the NHS have taken a real bashing of late. Crises in health trusts like Mid-Staffordshire and Birmingham have hit the headlines and the blame has been laid firmly at the top leadership’s door.

It’s easy for those outside the sector to point the finger and talk of bungling and bureaucracy – and there’s no doubt that there have been some serious failings. But the NHS is a hugely complex environment where managers have to meet challenging targets, deal with conflicting demands and answer to a diverse range of stakeholders.

The issue that perhaps needs to be raised is whether managers are actually being given the support and development they need to operate successfully in this difficult environment.

The NHS National Leadership Council – set up 18 months ago by the previous government – is working to try and improve leadership and management standards across the NHS.
But there is still no requirement for managers operating in the healthcare system to be accredited and no nationally agreed standard for them to be operating within.

This has led to a situation where there are pockets of excellent practice in management development across the sector – and other areas where efforts are disjointed, divorced from organisational needs and only available to the chosen few.

CMI director of business solutions Tricia Williamson CMgr FCMI believes the need to tackle this issue has become even more pressing, following recent government announcements about changes and plans to cut as many as nine thousand managers out of the NHS in the immediate future.
“It’s a case of do we put managers under even more pressure or do we develop them and give them confidence to deal with critical issues, implement change and to do it well?” she says.  “In a system like the NHS, in order to achieve one target you are often doing something which has a knock-on effect on another target.  Do you hit your finance targets or do you keep the A&E department open because people are turning up at the front door?

“So it’s about how do we make sure managers are equipped to challenge appropriately, prioritise and achieve efficiencies and ultimately keep patient care at the heart of it all.”

Professional qualifications

CMI has been lobbying government and senior health service officials about the need for a more coherent approach and the importance of enabling NHS managers to become professionally qualified.
The organisation has developed a health sector specific management programme that unlike generic management programmes concentrates on two key health sector issues: managing resources and managing performance. The CMI Health Sector Programme is for managers at all stages of their careers in the health sector. Candidates on the programme may elect to undertake further assessment to achieve a nationally recognised Level 5 Management & Leadership Award or Certificate qualification.

CMI works with a number of hospital trusts, ambulance services and primary care trusts around the country and would like to see more healthcare organisations following the lead of these forward-thinking bodies.

Investing in skills

Jean Hartley, professor of organisational analysis at the Institute of Governance and Public Management at Warwick Business School, and co-author of the recently published Leadership for Healthcare, says: “There will be difficult decisions to be taken within hospitals, for example, about how money should be spent - and clinical and general managers are likely to be coming at the issue from completely different standpoints.  “Clinicians are likely to want more money spent on medical equipment or on more clinical staff.  The manager, on the other hand, will have to think about rents, financial servicing of debt and a whole range of different staff.”

Research by CMI suggests that in addition to the need to develop this ‘big picture’ thinking, there are several other quite specific areas where managers need more support to develop their skills.  Performance management, resource management and delegation all came high on the list.

“Our sense is that skill levels in these areas can be quite low, and when they come together what you see is a failure of decision making to be pushed down into the organisation,” says Williamson.  “So you find nursing directors and clinical directors are taking all the decisions – and a lot of the decisions are not that big – and because it’s not delegated into their teams it slows down the decision making process, makes it inefficient and makes that person’s life a misery because they are so overloaded.”

Political awareness

Hartley believes NHS managers also need help to develop their political awareness (with a small ‘p’) of what’s going on both in and outside their immediate environment.  “Healthcare managers need the ability to work with a diverse range of stakeholders because most health leadership isn’t just about leading a team.  If you are at senior level, it’s about having to try and shape and influence partnerships and people over whom you have no direct authority, only influence, so political awareness is pretty important too,” she says.

Williamson says: “There are a lot of very busy managers in the NHS. It’s not that they are sitting about not doing anything, but it seems like there are a lot of pinch points where people feel like they haven’t got the time to do what they should be doing – but if they were more skilled and were managing their teams better, the whole system would work more efficiently,”  she says.

Extract from article featured in the September issue of Professional Manager

Further information
NHS National Leadership Council – www.nhsleadership.org.uk
CMI Health Sector Programme – call 01536 207404 or e-mail employer.engagement@managers.org.uk. For general information about CMI qualifications visit www.managers.org.uk/qualifications
Warwick Business School – www.wbs.ac.uk
Leadership for Healthcare by Jean Hartley and John Benington, published by The Policy Press, rrp £19.99, ISBN 9781847424860

CMI and Warwick Business School have developed a unique Political Awareness skills 360-Degree Tool, focusing on the behaviours and skills involved in demonstrating political awareness in leading others. For further information call 01536 207404 or e-mail employer.engagement@managers.org.uk. The research is based on a 2007 report published by CMI and Warwick Business School. A free executive summary of the report is available at www.managers.org.uk/researchreports

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