'Most doctors would struggle to conceive of a hospital in anything other than descriptive terms'
Last month's surprisingly absorbing three-part BBC series on management at Rotherham foundation trust revealed a lot about what is right and wrong in the NHS.
Everyone was trying to do the right thing - the NHS ethos is still working its magic - yet was stymied by small obstacles in a depressing environment of 'no can do', in which staff felt like 'cogs in a blancmange', as one of my medical friends puts it.
In Can Gerry Robinson Fix the NHS?, staff implied that a key problem is that hospitals are run by two interdependent yet isolated groups - the consultants and the chief executive.
Doctors and managers clearly needed one another to make things happen, yet neither knew how to talk to each another, much less tell each other what to do. Where authority was unclear, committees - the algal bloom of bureaucracy - thrived.
The scenes reminded me of incidents in my early medical career, to which my absurd confidence and lack of managerial training contributed. One was arriving at my first house job at Glasgow Royal Infirmary to find that there was no desk for doctors to write notes on.
Junior doctors were practised in the art of creating towers of medical records and writing notes on the uppermost record. But every day the towers collapsed, causing records and test results to spill across the polished floor. I remember crawling under patient trolleys to retrieve a particularly critical x-ray.
In a fit of frustration and naivety, I telephoned a supply unit to ask for a desk. (I didn't know that managers existed. We knew nothing of them from medical school.) When the man asked for my authority to buy the desk, I said I was a doctor. He promptly sent a new desk wrapped in bubble wrap. The look on the ward sister's face remains in my memory. I have no idea who got the invoice. This didn't matter to me, since I didn't know what an invoice was.
This experience illustrates part of the problem. Doctors are not stupid people. Their preferences, decisions and non-decisions profoundly affect many things for which chief executives are responsible: waiting times, equipment, cost of procedures, number of ancillary staff, admissions policies and length of stay, to name a few.
Yet, with few exceptions, doctors have no training in management, finance, conflict resolution, price negotiation, working with trade unions, organisational analysis, employment, administrative or EU law, or any other skill sets you need to get things to happen in large organisations.
To learn these things, you virtually have to quit medicine. There is no training stream or specialty that leads you from medical school to chief executive.
And hospitals do not work like single-partner practices. Just as medical treatments now require specialised skills and co-ordinated teamwork, management isn't like it used to be, when matron and doctor could apparently run the Brompton, or the Crimea for that matter.
What fixes are there? If only it were as simple as in Bob the Builder. No doubt Sir Gerry is right to suggest that the chief executive should get out and talk to the clinical teams, of which he appeared terrified but admirably determined to do. And it did seem to make a difference. But, as Brian James has himself suggested on www.hsj.co.uk, it will take more than 'walking the floor' to transform the two cultures and turn the blancmange into a well-oiled machine.
Having trained as a doctor then run a company for seven years, I believe that one major obstacle is the profoundly different way in which doctors and managers are trained to view the places in which they work.
Chief executives have years of training and experience in thinking about hospitals in terms of organisational systems. For doctors, William Osler, the 19th century physician who virtually prohibited thinking beyond the patient in bed, remains our patron saint.
Most doctors would struggle to conceive of a hospital in anything other than descriptive terms, rather than analysing it as an organisation. Non-medical chief executives would have the same problem with diseases.
In short, neither party really knows what the other worries about, yet both wield a lot of authority that profoundly affects the other.
I am not trying to argue that consultants should become chief executives or vice versa, but that a real understanding of what the other does might improve communication and, ultimately, leadership. It is bad enough having two head chefs in the kitchen, let alone two chefs who view it in completely different ways.
There are several tools for sharing, enlarging and transforming ways of seeing. One is McKinsey's 7S framework. 7S describes the factors that leaders need to consider for organisational coherence. It can reveal differences in how groups see their roles and others' in organisations.
It would be interesting to see what Sir Gerry might make of the ways in which managers and doctors would understand the elements of 7S: structure (how people are co-ordinated, including reporting lines and accountabilities, task division and integration); systems (procedures that govern activity); strategy (the goals and actions they believe will lead to success); style (leadership approach and cultural style); staff (in terms of organisational groupings); shared values (principles upon which a hospital is built and things that influence people to work towards common aims); and skills (distinctive capabilities and competencies).
Transforming divergent 'ways of seeing' is a big task but perhaps not insurmountable, given how much NHS professionals want to make things work. Maybe we need Bob the Builder, to rally things along: Can we fix it? Yes we can.
Dr Anna Donald is chief executive of healthcare information provider Bazian and a new regular columnist forHSJ .