Karen Caines says her successor as IHSM director should be someone who 'doesn't mind being slagged off '. But what measures should be used to assess their performance if membership and money are ruled out? Mark Crail reports

People do not exactly clamour to be director of the Institute of Health Serv ices Management.

Two months after the job was last advertised as vacant, its then president Brian Aird admitted that there had been fewer than 10 applicants.

But if things looked bad in 1996, with the IHSM's financial calamities still only a wild rumour, how encouraging will they appear three years on to Karen Caines' potential successors as they decide whether to apply?

Ms Caines, who leaves on 9 April to complete a PhD and work part-time as a consultant with the Institute for Health Sector Development, is adamant the IHSM's record is not one of failure.

She points to the large number of seminars and forums which do not show up in the accounts, to the professional development the IHSM offers members and to the alliances constructed with other NHS bodies as examples of success.

In particular, she says, merger with the Association of Managers in General Practice to create a new Institute of Healthcare Management means the organisation is ideally placed to cope in the new world of primary care groups.

Arguing that the IHSM's record of deficits over the past decade is not a good performance measure, she says:

'It is not a business, it is a professional institute, and if it was making huge profits I would be just as concerned.'

Nor is it possible to judge on the number of members - the IHSM has just over 8,000. Ms Caines says it would not be 'realistic' for the IHSM to set out to recruit the 3,000 executive directors who serve on NHS boards.

Of the five types of executive director, she says, chief executives are 'our territory', but finance, medical and nursing directors are not.

'It makes no sense for the IHSM to try to pinch members from the Healthcare Financial Management Association.' She adds: 'That leaves one other space to fill: if they are a director of operations they ought to be ours; a human resources director might want to join us or some other body.'

Ms Caines argues: 'In my time here, the IHSM has never claimed that we were seeking to get into membership all those different tribes. I think that's not realistic and I don't think it is helpful.

'What I do think we need to do and we have been doing is to share views about what is going on with the other bodies and to build really strong alliances with them.'

Suggesting that the IHSM should be the voice of all those in NHS management, she says, is 'trying to assess the institute against things it has never pretended to be about and against things which it should not be about'.

'In the time I have been involved, the IHSM has never been trying to get huge numbers of members. You cannot assess the performance of the institute against membership numbers.'

But if the IHSM intends to be one voice among many in the NHS management world, this may come as news to some of its more prominent members.

Former president Ken Jarrold says:

'Strictly speaking, Karen's analysis of the board members is correct. But while they may have natural homes elsewhere there are a very large number of health service managers who do not.

'If the institute is going to survive it does need to broaden its membership base. Her response is factually correct, but it doesn't address the challenge.'

Speaking at last year's annual general meeting, another former president, Roger Stokoe, said: 'The vision in the early 1990s was 30,000 members.

If we are going to have a real impact on the policy agenda we need to expand membership considerably.'

David Knowles, his successor, concedes: 'There is nothing more ex than an ex-president. Nine times out of 10 I would expect to support any decision the council makes, out of loyalty and respect for their right to do things their way.'

But he adds: 'Obviously the vision I had and members of my generation had was that we expected the institute to represent all groups of managers.'

Long-serving former council member Howard Lyons, who describes Ms Caines as 'an excellent director who has turned round the institute', believes her successor will have to 'market the IHSM much more aggressively to new members'. Competitors such as the First Division Association are able to 'meet the needs of chief executives by focusing on them in a way the IHSM cannot' because the institute is serving a wider constituency, he says.

The 'Little IHSMer' view might also surprise the Karen Caines of April 1996, who told HSJ she wanted to entice doctors and technicians through the institute's doors. 'I think it would be very sad if every particular group set up its own 'professionals in management' body, ' she said then.

However the IHSM develops now, though, its new director - or IHM chief executive, as they will become - needs to be tough. Former directors, past presidents and other management leaders agree it is a difficult job.

'It needs someone who can deal with you lot, ' says Ms Caines, meaning journalists in general and HSJ in particular. 'Someone who is resilient and does not mind being slagged off. It is a high profile post. You need someone who understands health issues and can speak authoritatively. But you also need somebody who is willing to get their hands dirty - there are very few people at the head office, and you have to be able to turn your hand to all sorts of things.'

No one person can do all of it, she says. They must do what they can, and surround themselves with others who can fill in the gaps.

With three years to go to its centenary, the IHSM once again faces questions about its future.

At last year's AGM, Mr Jarrold called for a 'fundamental review of what the institute is for', to be conducted by younger members rather than ex-presidents. He stands by that proposal, and adds: 'I was very disappointed that following my suggestion there was absolutely no indication that Karen was responding.'

He says: 'We have to be sure that the younger generation of managers coming through really believe that they want to keep this thing going.'