The NHS has sometimes been accused of operating a macho management culture. Is performance-driven, target-obsessed government policy to blame, or do leaders just lack people management skills, asks Blair McPherson

Does the NHS climate breed the wrong kind of management behaviour, allowing arrogance, secrecy and bullying to flourish? Or are such claims made by people who are unused to being held accountable and who find it uncomfortable to have their performance compared and failures highlighted?

In my view, the problem is not a performance management culture but the poor quality of management.

Born to lead?

We still seem to think managers are born rather than developed. People are promoted to management posts because of their professional skills. We do not routinely expect managers to have a management qualification except for the most senior posts and even then MBAs are used as a selection criterion rather than evidence of management competence. In my experience, MBAs are good at helping managers develop their strategic thinking but do not focus on people management skills.

A person's first management post is the hardest. It is not usually managing the budget that causes problems but managing the staff: confronting people about their time-keeping, attendance, inappropriate summer clothing, reluctance to attend training courses, cynicism towards any new initiative, antagonism towards certain colleagues, inappropriate 'jokes', insensitive comments, underlying sexist, racist or homophobic attitudes.

Effective managers are explicit in their expectations, challenge poor practice, get people to do what needs to be done and show no favourites. Managers with good people skills recognise there is a difference between being friendly and being friends with the staff you manage.

Leading culture

If all staff feel valued and respected, if they feel they are treated fairly, then the organisation they work for is unlikely to be characterised by bullying, harassment and discrimination. This requires managers to become more sensitive to peoples' needs and to improve their leadership skills by gaining insight into how their behaviour affects the people they manage.

In my own organisation, we have chosen to develop managers' people skills through executive coaching tailored to their needs. The aim was to provide the top 30 managers in the directorate with the chance to get detailed feedback on their performance so they could gain insights into the impact of their behaviour and receive guidance or coaching to improve their performance. The feedback was provided by management consultants who observed the manager in a range of settings and activities over two working days.

After each observation session, one-to-one feedback was provided. The information from these sessions was supplemented by 360-degree feedback questionnaires completed by the person's manager, colleagues and staff.

For most senior managers, this type of direct feedback was not something they had experienced since they first started out in their professional career. Despite some initial anxieties, the evaluation showed that people found the experience positive and helpful. This approach is now being extended to all managers.