Published: 01/12/2005 Volume 115 No. 5984 Page 25

Recently, I was asked to lead a workshop on a professional development course for a group of medics on the cusp of becoming consultants. To prepare, they spent a week with two of the country's sharpest health service management educators - and an afternoon with me.

My task was to provide information to help them work the system more effectively as senior clinicians, and get them thinking about how collaboration with managers might be beneficial.

The premise was simple: if you got to know managers, and understood the pressures they were under, you would be in a strong position to secure local influence.

How difficult could it be?

They were smart and eager. I began by asking them about current policy and what they thought about the future in light of payment by results, practice-based commissioning and the imminent reorganisation. Few had heard about them; fewer knew the detail. When I outlined what was likely to happen, they were startled.

I then asked what they thought united and separated clinicians and managers. Their responses were, in the main, as I had expected. We had the same employers, worked in the same buildings and ate in the same canteens.

The differences they identified were fascinating. They were professionals (managers were not).

They had a particular training, which engendered different values (they couldn't articulate what they were). They viewed patients holistically. Above all, they were driven by a pure desire to improve patient outcomes. I dug deeper.

Managers were not interested in patients, I was told, but solely in maintaining financial balance. And they implemented policies. Badly.

Mustering my best facilitation skills, I strove to receive the information fairly. But my passion got the better of me. I pointed out, perhaps a little too hastily, that improving patient outcomes was the fundamental motivation for me and many of my colleagues.

And I went on. From where I sat, consultants often appeared more interested in their particular clinical specialty than the overall well-being of patients. And if there was no-one to ensure delivery mirrored need, manage the budgets, plan the workforce, do the recruitment, contain expectations and maintain financial accountability, we'd be in a big mess. Oh dear.

I regained my composure and suggested a tea break. Afterwards, we discussed prejudice and its part in blocking progress. We talked about how clinicians and managers saw the world differently, and often found themselves at odds with each other as competing priorities increased. Conversation turned to how clinicians and managers needed to work together. Patients needed them to do so.

It is true; the ongoing resistance from clinicians is frustrating. But medics' poor understanding of what managers do represents a serious communication failure. Managers have a responsibility to transcend the deep cultural differences.

Prejudices at once cause, and somehow legitimise, the turbulence experienced in forging new ways of working. This cannot continue.

We are facing an unparalleled upheaval. To survive, we have to engage clinicians in managing the changes. They have perspectives that we ignore at our peril. Otherwise, we will never achieve our shared goals of improving patient outcomes.

David Woodhead works in the public health team at the Healthcare Commission. He writes in a personal capacity.