management education

In recent years there have been various attempts to stimulate some joint activities with middle level managers and specialist registrars.

1This suggests that joint early training may generate clearer appreciation of respective roles and values.

Some contend that doctors' management skills should not be developed in isolation from other types of managers.

2But it is difficult for doctors to develop management skills during their training years, when the overriding concern is for clinical skill development. The challenge for doctors and managers is to develop a model of competency that reflects the complexity of clinical management priorities.

3Both pre-registration house officers and trainees on the NHS management training scheme are required to demonstrate competence in a variety of standards as part of their training.

Both groups have to demonstrate communication skills, team working and time management.

The trend to competency-based approaches to training of both groups provides opportunities to develop joint programmes at all levels of the doctor and manager hierarchies.

A pilot 24-hour residential workshop for nine trainees from the 1999 intake of the NHS management training scheme alongside nine preregistration house officers from the West Midlands region was developed by the MTS national education centre (Universities of Birmingham and DeMontfort), the Postgraduate Medical Deanery at the University of Birmingham and the West Midlands MTS regional steering group.

The aim was to:

Appreciate the factors that might influence managers and doctors to have differing perspectives;

Gain a shared understanding of developments in training and education for doctors and in the organisation and delivery of healthcare;

Experience working together on the development of common competencies.

The pre-registration house officers were selected from a variety of hospitals across the West Midlands. All were in their first job. The management trainees were from the 1999 intake and were still undertaking their orientation or 'cook's tour' of the NHS before starting a junior management role.

The key factor was identifying cohorts of similar age at the start of their careers.

The workshop was designed to develop greater understanding of :

Communication skills;

Stress and time management;

Team dynamics and roles;

Leadership styles.

Participants were asked to fill in a short questionnaire before and after the workshop seeking their perceptions of each other's roles, attitudes and values.

Nine questions out of the 24 revealed differences in opinion before the workshop. Managers were more strongly of the view than doctors that regular meetings should take place between the two groups for the benefit of patients, and that doctors should focus on medical issues rather than taking a more broad holistic approach.

Managers were also more strongly of the view than doctors that they were essential for running a hospital and that they were generally undervalued by other health professionals.

Doctors were more likely to agree than managers that more doctors were needed in hospitals, that managers earn more than they are worth, and that managers were 'in the pockets of politicians'. Doctors also more strongly considered that junior doctors worked longer hours than managers and that managers have less stress than junior doctors.

For the majority of questions, the differences in views were less marked after the workshop. But views became more polarised on questions relating to managers being in the pockets of politicians, managers being essential for the running of a hospital, and managers being undervalued by other health professionals.

The management trainees did change their views. They became less convinced that doctors and managers needed regular meetings and they became convinced that managers were more committed to the NHS than doctors were.

Communication Both groups recognised that better understanding of respective roles could be achieved by improved communication. All agreed that communication had to be for a purpose and were sceptical about forcing relationships. Simple steps could include shadowing, greater visibility of managers at induction programmes and attendance at departmental meetings.

Stress management Participants were given a questionnaire following a talk on stress management.

Each question considered a source of pressure in the work situation.

From 30 questions there were six which were scored significantly higher by managers than doctors.In contrast there were no factors that were scored higher by doctors than managers.The different responses are detailed in Table 1.

Questions were grouped together into three broad stress areas 'my job', 'my relationships' and 'my situation'. For 'my job', the managers were significantly more stressed than junior doctors. For the other two factors there was no difference between the two groups.

Team dynamics and roles Doctors and managers easily identified characteristics of effective team working, both groups emphasising the importance of good communications, having common and clear goals, an ability to listen, and good relationships. Doctors also stressed the need for teamwork to allow basic physiological needs to be fulfilled, such as allowing rest periods.

Managers more strongly emphasised mutual respect as being important in effective teamwork.

When the doctors and managers worked together on a creative, time-pressured task, it was interesting to note the almost immediate shedding of role stereotypes. An outsider would have seen a group of intelligent, highly motivated and enthusiastic young people working together towards the successful completion of a task.

Leadership styles As both doctors and managers undertake leadership roles, it was considered relevant to explore personal styles of leadership, to identify similarities or differences which may be associated with the different groups.

Participants completed an inventory designed to identify their preferred approaches to handling different situations requiring leadership. This was based on a situational model of leadership.

4This identifies four styles of leadership; directing, coaching, supporting and delegating and suggests that, while leaders will need to be able to utilise all of these, depending on the situation, individuals may have a preference for certain styles. It was interesting to note that both doctors and managers indicated a preference for a coaching style which combined a high degree of directing with a high degree of supportiveness.

The delegating style was the least favoured by both, possibly owing to the perception that leaders must be seen to be leading. Doctors seemed somewhat less reluctant to adopt a directing style.

The similarities between these profiles outweigh the differences, again suggesting similar learning and development needs in respect to leadership.

All doctors have to deal with management issues at some time, whether they aspire to become a clinical or medical director or chief executive, or simply want to get on with colleagues.

1This now also applies to general practitioners as greater managerial demands are placed upon them within primary care groups and trusts.

Similarly junior managers quickly realise that if change is to be effected within a health organisation, they need to develop an understanding of clinicians' needs, demands and attitudes.

When should doctors be taught management? Many believe it should be when they are medical school undergraduates. Others feel the curriculum is already overcrowded and that management issues are best given a first airing at registrar, or even consultant level.

This pilot project suggests that, given the similarity of some core competencies, joint training should take place early in the careers of clinicians and managers.