Published: 28/02/2002, Volume II2, No. 5794 Page 29
The press loves the idea of failing doctors - the juicy detail and moralising is good for umpteen column inches, readers' letters and much debate. Strange, then, that the failure of managers only makes the headlines when they are paid off or suspected of a financial scoop. And yet managers fail more frequently, and the implications can be far more catastrophic.
I have been in the NHS for nearly 19 years, and not only have I seen it all - I think I know what makes it happen. There is a pattern to failure within the NHS, but most people move on before they - or others - can appreciate it. Governments like nothing less than learning from the mistakes committed under the auspices of their predecessors and ignore the signals that could save them grief.
Picture the scenario. A trust is failing: big debts, poor patient care, public confidence at zero. It calls for a major overhaul, and this is achieved by getting rid of senior managers; one or two perhaps, or most of them, depending on the depth of the local mire and proximity of an election. In comes the new manager, often with an excellent track record in several other trusts. They are 'sold' to the staff, the press and the watchdog. They listen for a few weeks to the old guard, decide that communication is the thing and set about improving matters. Great so far.
But after a few months of 18-hour days and discussion with everyone from the hospital cat to the most senior medic, it becomes obvious that our manager is wearing him or herself out.
The next step is a retrograde one. Go back to dear old St Elsewhere's and tap up a few old mates; you can convince your new employer that a shuffle of jobs is essential and you can find someone good at finance, planning, or what you will. Some may have moved on from St Elsewhere's at about the time you did, but they will respond to the call.
It is a small step to prime them, interview and set up your new team. It sounds wonderful - for a while. Any doubters are accused of being dodos; those with local knowledge who agree with you get a small role in the future - milk their ideas and use them as your own is the usual technique. For a while, things can only get better.
But there has been no real change in the situation that caused the problems and you have put in a layer of your cronies whose prime aim is to keep their job. So you are kept in the dark over problems.
You will not realise this, as good news continues to appear on your desk. Agency theory, you may remember from management courses, tells us that anyone employed to further your interests within a growing organisation will first fulfil their own aims.
On the day the local paper breaks the embarrassing story leaked by the junior nurse, frustrated porter or young medic, you will have barely an inkling of the problem because your cronies have been busy keeping things from you. So who do you trust? The answer is 'nobody' and you have seen the cycle through as your predecessor did.
If the answer for you is to quit, then the whole edifice will collapse - hurting those you brought in just as surely as it hurts those who stayed from the previous regime.This is the domino effect.
And yet it could have been avoided. Engraved over the desk of every senior manager should be the words 'Only me' in answer to the question, 'Who is in charge here?'Yes, it is lonely there and yes, it requires a great deal of commitment and confidence, but it is the only way to retain control.This does not stop you having deputies, but the moral is to cast your net wider rather than lumber yourself with those who need to keep you sweet.
If you only want to hear the good news, then get out of the NHS. If you seriously believe that bringing your own team with you is the answer to taking on a problem job, then think again.
The cycle takes about five years.Ask anyone who has survived in the NHS for 10 years or more and they will recall instances of 'new manager failure'.
The writing is on the wall and it says 'cronyism destroys'. But cronyism is only a symptom; the disease is the organisation of the NHS and other government bodies which require top managers to keep the lid on all problems and toe the party line in order to keep their jobs.Change is needed. If you trust someone to perform, if you pay them well to take all the flak, you must ensure that they do not feel constrained from speaking out.
The purpose and the mission statement of our most senior managers should not be 'Keep them sweet at the Department of Health' but 'Tell it like it is'.Not as comfortable, perhaps, but more rewarding for managers and patients.
Sue Hood is associate manager, clinical audit, Mid-Essex Hospital Services trust.
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