Dr D J Brown, a clinical fellow in emergency medicine, offers tips on how to be a better health service manager

So there you are: dealing with patients and families, trying to plug staff shortages, coping with equipment breakdowns, reversing administrative snafus and battling useless computer systems and, lest we forget, you may spare an occasional moment for some clinical work. You are, in short, doing your day job. Then suddenly the door opens. Oh, good lord. It's "senior management".

They swan in with some VIPs. They smile like royalty, nod with concern at a couple of insignificant problems, point out the new machine (that doesn't work), shake hands with a couple of people who don't work here and then swan out again. "Carry on regardless" they say.

It just makes you mad, no? It makes you want to throttle them - or at least to undermine the overpaid idiots. (It's OK. We have all thought such things at one time or another).

But there is a bigger problem. Those "senior managers" you occasionally despise… unfortunately, they're YOU. Now before you object, think of this: wherever you are in the leadership hierarchy, you are still higher up than someone - and to them, you are senior management.

Dream scenario

Imagine instead a visit from your ideal senior manager. What would happen in this ideal world? Well, first of all, they would be alone and not distracted. Then they would say: "Your colleague Jo tells me you and your team did a fantastic job helping them with their staffing issues. Thank you so much for helping out. Without people like you we couldn't run this place."

After that they would say: "Last week you said you needed four more widgets. I've found two you can borrow. I've ordered some new ones through my emergency budget."

Then they would ask: "Is there anything else you need from me in the way of equipment or resources? And tell me: what's working well around here and who, in particular, is doing a really good job? Who's been a real help to you?"

They would make notes of your discussion and, at the end, they would say: "Thank you for all your hard work. See you same time next week, ok? Unless you call me in the meantime, of course." Then they would go off and thank the person you just mentioned for helping you. That would be good, huh?


Well, it's not difficult. The process is called "doing your rounds". It is the same process clinicians use when checking the progress of patients.

Doing your rounds as a leader improves patient outcomes as well as staff satisfaction. It also makes your life easier.

Our view is clear: if you want to succeed as a leader, do your rounds. If you want to succeed as an organisation, make sure all your leaders do it all the time.

Here is how we explain it to our clients:

  • be personal: make enough time to talk to every one of your staff individually. This is neither a group nor a public activity;

  • listen: really address your staff's problems and help to solve them. You'll develop stronger relationships with them as a result;

  • be positive: ask questions about what is working, seek out and acknowledge the relationships and events that support the organisation and make people feel good about coming to work;

  • compliment people: say thank you and well done (apparently it's free). You'll make people feel good about their work;

  • be specific: use people's names and real examples. Avoid generalities, gossip and stories. Don't take sides.

But perhaps most importantly, you should make these rounds into an effective management system in two ways:

  • do it regularly and frequently: if something goes wrong, it gets picked up early. If staff know you will be back, they are less likely to bother you in the interim;

  • write it down! you won't forget what has been said and what has been requested. You should also insist that your leaders do the same.

Such systemisation of rounds has long been recognised as imperative in medicine. It is important in leadership too.

Do your rounds systematically and I guarantee you will be a better leader.

HCV is holding a senior leadership seminar at the Royal Society of Medicine on 9 February called "Don't Carry On Regardless".