Tuesday, 5 April 2011

Forging new relationships in a messed up world

On Friday, I attended a conference organised by a group of this year’s Darzi Fellows in Clinical Leadership at the Kings Fund; one of the themes of the day was to encourage collaborative working between doctors and managers, and the target audience for this message was a small group of junior doctors, and importantly, an enthusiastic and talented group of graduate management trainees.

There was a strong buzz throughout the day, and workshop groups in the afternoon had some honest and interactive discussions about what unites managers and doctors, and what divides them. I guess the key thing for many people that afternoon, was a clear crystallisation of the idea that there are many more things that unite doctors and managers than divide them, and that at the heart of this, there is a genuine ambition by many people, wherever they work, to provide good patient care. The message from the managers was loud and clear - you do not have to directly deliver patient care for this to be your driving force, and doctors do not have a monopoly on caring.

This experience was overwhelmingly positive, but the day also invited some honest reflection: we can all tell horror stories of the way people have treated us at work, but there was something deeply insidious about the kinds of stories that managers were telling about the way consultants had treated them in the past. It’s not that they were rude (although they clearly were). It’s more that encased in the narrative was the sense that doctors were not just acting out of a sense of professional frustration or indignation, but rather, they were motivated by the sense that, beyond their clinical expertise, the day to day issues with delivering a decent health service were someone else’s problem.

Now these are my words, and this is my interpretation of what managers said on Friday tagged on to my experience of the type of interactions that I have seen pass on countless occasions between consultants and managers.

So the optimism needs to be tempered. And it was tempered even further following a chat with a particularly grounded friend of mine who is a talented orthopaedic surgeon.Her particular gift is her ability to make other people eat their bullshit for breakfast. As I was recounting my experiences of the conference on Friday, she ‘real world-ed me’ and reminded me of how far relationships between managers and clinical staff in some places have broken down, and backed up this sentiment with example after example. While she demonstrated a clear bias, in that in each case the managers were at ‘fault’, her point was well made: the relationship between managers and doctors in many places is poisoned and poisonous, and finding one’s way back from this is going to be difficult in many cases and impossible in others.

But who said it was going to be easy? While it is usually useful to have a well timed reality check, Friday’s conference good precisely because it illustrated a way through this mess. There is no likelihood of all managers and doctors liking each other and wanting to work together, but there is the possibility that some managers and some doctors want to do it, and this was demonstrated on Friday. The slow, steady march to a better healthcare system can begin with connections being forged between managers and doctors who are interested in collaborative working. This won’t be everyone, and there may well be very few to begin with. But once these alliances start to yield results, and once the language of collaboration, rather than confrontation starts to be heard more in hospital corridors, it is possible that some cultural shifts may begin to emerge.

One of the points that I know resonated with a number of people on Friday was when Bruce Keogh remarked that he had only ever achieved success when he was supported by an able manager. He used the term ‘fighting pairs’ and this seemed to strike a chord with many people in the room.

The message they went away with is that they don’t have to change everyone, they just have to connect with someone. If we each find one person from ‘the other side’ in the hospital we work with to connect with, then who knows how much could change.

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