The most uncomfortable job in the managerial hierarchy has to be the middle manager: dumped on by top managers and beset with seemingly impossible objectives on the one hand, and reviled as mere clipboard carriers by those they supervise on the other. An impossible job, and yet no organisation can do without them. We should understand their role better and make it more rewarding.

Middle managers' function

Wouldn't life be simpler if we could do without the middle manager and cope with only two levels of management, the doers and the thinkers? Such a view is utopian and unrealistic in today's complex organisations. Most organisations can be classified into four or five levels.

The Brunel Institute of Organisation and Social Studies spent several years analysing how work is organised in the health service and came up with five levels (see box, page 24).

1There is a need for doers, supervisors of doers, coordinators of doers and thinkers about what should be done. Different skills and attributes are required at each level, although it is a mistake to think that thinkers never have to do anything: top managers can and should answer their own phones some of the time.

Middle managers are typically the co-ordinators. They take messages from senior and top managers and convert them into operational work, making sure that the various components fit with each other. Their span of control is over a group, and effectiveness relies on how far these groups can be made to work smoothly.

This requires middle managers to understand the nature of operational work, and as most of them have come up through the ranks this should not be too difficult. But occasionally it can lead to conservatism, what Charles Handy has called cultural rigidity.

2Middle managers are very useful to top managers when they are able to bring a degree of reality into discussions of what will work and what will not. But if top managers don't listen, they can scarcely be surprised if things go wrong.

Another important role is to maintain standards. The bottom management levels may be tempted over the years to take short cuts or to pervert the way the organisation runs. Middle managers have a role in redefining standards and scheduling their application through the day-to-day supervisors and chargehands. Basically, they act as the mortar which keeps the organisational edifice intact.

So why is it that whenever downsizing comes back onto the agenda, top management looks to middle management as the best place to reduce staff numbers?

Partly, it is an innate prejudice that middle managers are people who haven't quite made the grade, so they are expendable. And, partly, it is a mistaken idea that we do not after all need the bureaucracies which we ourselves have created. Both ways of thinking are dangerously crude.

No large organisation can be expected to work effectively if groups of workers are left to their own devices - however much they might initially fancy the idea. In fact, they quickly become disenchanted with the resulting chaos as no one knows what anyone else is doing. My favourite example is the idea that the patient's day on the ward would be improved if they had breakfast at a reasonable time, say 8.30am. But just think of the consequences for the rest of the day's work - the toileting, the bathing, the treatments both on the ward and in other departments, and the ward rounds. You quickly realise that even a halfhour shift in the routine could disrupt the whole hospital.

And if, despite this, you decide to do it, you won't find the ward sister or her staff have the time to effect the changes - only a middle manager could do that.

Who are the middle managers?

Broadly speaking, middle managers are of two types:

those on the way through and those who have got as far as they are going.

The first group will be young and relatively inexperienced, and they may see this part of their career as a necessary evil to be got through as quickly as possible.

Those they work with will often have the same view and will, therefore, not be committed to them on the grounds that they won't be around for long. This leads to problems because in effect, the middle manager is ignored as far as possible and the individual fails to learn much, which will make them less effective as they ascend the managerial hierarchy.

The middle management job is essential for the highflying manager in that it gives them their first experience of turning policy into action, of uniting the top and bottom of the organisation.

Failure to do this means that what managers at the top decide is never effectively implemented as the shop floor subverts the organisation for their own ends. This process has sometimes been described as the difference between the formal and the informal organisation. However sociologically interesting the phenomenon might be, it cannot be tolerated if the organisation is to be effective.

The attributes of an effective passing-through middle manager are a mixture of tact and drive. Tactfulness acknowledges that the people you are working with know a great deal more about the business than you do, but drive is required to arrest the tendency to carry on doing things in the same old way. Indeed, a good passing through middle manager can revitalise staff who may be becoming a bit jaded in jobs they have held for a long time.

The other broad type of middle manager is the person who has got as far as they are going. They are both the backbone of the organisation and also, at times, its most vulnerable vertebrae. They have a great deal of knowledge and will often be able to remind more senior levels of management of the organisational history. This is necessary if top managers are to make appropriate judgements about what is possible and what is not. These middle managers give context to those deliberations.

Their potential weakness is that they may have been over-promoted out of day-to-day operational management, where they were showing signs of incompetence, to the next level where that incompetence is even more marked - the infamous 'Peter principle'. I remember one hospital I worked at where this process was all too apparent. 'She was no good on the wards, so she landed up in matron's office, ' was everybody's understanding. This was, admittedly, a long time ago, but the same process is sometimes discernible today when a ward nurse takes on an administrative role in a clinical directorate or is shunted into what too often becomes the quality management siding.

The failure is not so much of the individual concerned, but of the organisation for not helping them to overcome their difficulties. Although, ultimately, it can be a problem for both parties. Just what options are available to people who are bored and tired, and how can the organisation help them?

First, it is useful to help the manager redefine their role.

Over the years they may have allowed themselves to think that, despite their efforts, no one actually cares about what they do and they then become demoralised. Showing them that without them the organisation cannot be effective will help.

Second, continuing education is essential. The chance to reflect on the nature of your job from time to time brings back meaning and relevance to your work.

How many times have I seen tired and bored staff start a management course and seen the same people leave revitalised, full of ideas. We ignore continuing education at our peril.

Job rotation is another perfectly good solution as it is all too easy to become institutionalised. Such a change can be made within the existing organisation and, indeed, will often be particularly useful in helping everyone to be more tolerant of each other's difficulties.

Effective middle managers

Good middle managers make all the difference. They keep top managers in touch with reality and they support those actually doing the day-to-day work, especially when its gets onerous. Using their own experience, they are able to reinterpret policy and strategy so that operational staff understand it and see the point. They could be said to be managing meaning.

Today's key middle managers are those running clinical directorates in trusts, those heading specialist departments and also those third-in-line people in health authorities who do most of the negotiation of service agreements.

There is one snag: if they become really good they either move upwards or they commandeer work which is more appropriately done at a higher level. The degree of freedom which they should have is difficult to judge. Just how far should a HA service agreement manager go when negotiating with GPs or with the primary care groups of the future? They will certainly have built up a relationship based on detailed knowledge of those GP practices, but the service agreements still have to be within the health improvement programmes agreed by the HA itself. There will always be a time when a boundary has to be drawn.

If the middle manager goes too far they will betray the trust which is vital to their reputation - trust which their own boss has in them and trust from their client organisations that they are people with integrity. Getting it right is certainly not easy. Back in the hospital or in the district, finding this balance between flexibility and adherence to agreed frameworks is similarly tricky.

The first step to success is for top managers to give back middle managers their self-esteem by acknowledging that the organisation cannot work without them.

REFERENCES

1 Jaques E. Health Services: their nature and organisation . London: Heinemann, 1978.

2 Handy C. Understanding Organisations. London: Penguin, 1976.

Brunel's work strata in today's terms

1. Working to prescribed duties - little initiative required, eg domestics.

2. Using initiative to respond to established situations, eg staff nurse.

3. Providing consistent services within known resources, eg departmental head.

4. Providing comprehensive services with some discretion on resources, eg clinical director.

5. Devising policy on services and resources, eg board director.

Key points

Middle managers are essential to organisations but are often unsupported by those above them and reviled by those they supervise.

Effective middle managers keep top managers in touch with reality and reinterpret policy and strategy so operational staff understand the point.

Organisations should reassure middle managers about the validity of their work and provide continuing education.