Letters

I am responding to the letter from Peter Coles and Neil Goodwin about 'management governance' (17 June). They are right, and the Institute of Health Services Management could be a major player in delivering a solution.

It does seem very difficult, if not impossible, for managers to insist clinicians adopt evidence-based medicine, keep themselves clinically up to date or adopt clinical governance if managers themselves exhibit no similar behaviour.

My thoughts on this are a little incomplete and would be enhanced by the debate Coles and Goodwin ask for, but I have in mind a form of personal accreditation with at least three elements to it:

Acquisition of a baseline set of competencies, skills and knowledge. For most of us, at the moment, this would equate to formal qualification but in the medium term might be replaced by practical work-based competence assessment. The institute could set and accredit this standard.

Agreeing to conform to a set of ethical management behaviours such as those exposed and published by the institute, although these will need enhancing.

A commitment to keep oneself up to date with our management learning; again the institute's continuing professional development springs to mind here, but I suspect many of us pass our exams and cease to learn thereafter.

There could be a fourth element based around demonstrating evidence-based management in practice, but there is a long way to go here.

At the moment, such a three-part code would have to be voluntary, but if we persuade all health employers, including chief executives and senior managers, that adopting the code was worthwhile, it might demonstrate to the wider health community the managerial intent to lead debate, not follow it.

In the longer term it could lead to some sort of 'fitness to practise' certificate with an element of compulsion about it, or would we only see this as something for our clinical colleagues?

I will watch the correspondence columns with interest.

Stuart Marples

Director-designate

IHSM