The NHS is facing up to some uncomfortable truths. Several recent reports have identified a bullying management culture and a lack of compassion. Could it be that clinicians do not make very good managers?

‘Being a very able professional does not equip you to be a competent manager’

The medical model of management is based on the idea that, as your boss, “I am more experienced, more qualified and more learned than you. Since I have done your job I know how to do it better than you, so you follow my instructions because I know best.”

Some refer to this as the “command and control” model: I tell you what to do and you do it. But that has military conations and this autocratic style is more to do with the idea that: “I am in charge because of my professional expertise.”

Being a very able professional does not equip you to be a competent manager. In fact the more senior you become as a manager, the less relevant your professional background. Managers need to be able to manage budgets, buildings and equipment, information and people. Senior managers need to be strategic; to see the bigger picture.

Background and skills

They need to be able to foster partnerships, they need to be able to inspire staff and in the public sector they need to be politically sensitive. But, most of all, a senior manager in the new NHS needs to be able to manage across disciplines, departments and specialisms.

Their professional background is less relevant than their management skills. These skills will enable them to effectively manage services they have no professional background in but only if they adopt a different management style: “I haven’t done your job, I don’t know how to do it and I have neither the time nor the inclination to do your job for you. I will delegate, I will discuss, I will explain and I will lead. I will front up the unpopular decisions and I will listen to staff, patients and relatives. I will negotiate with other organisations and seek to influence policy makers and those who allocate our budget and I will rely on the skill and commitment of my team.”

Clinician can make excellent chief executive officerss provided they acquire the necessary management skills and conversely CEOs can come from any professional background provided they have the management skills.