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Published: 27/03/2003, Volume II3, No. 5848 Page 14 15

Seventy one per cent of managers believe they have a good relationship with their medical colleagues, according to an HSJ survey. But better understanding of each others' roles is essential - and soon.Paul Stephenson reports

When the new consultant contract was rejected by doctors in England and Wales, one of the main reasons for the 'no' vote was believed to be a suspicion that managers would not treat them fairly if the contract was introduced.

If they had seen the findings of the HSJ survey on the doctormanager relationship, they would learn that managers take a markedly different view of the current state of play. In fact, 71 per cent of respondents believe they have either a good or very good relationship with doctors working in their trust.

Considering that 19 per cent of managers describe their relationship with doctors as 'neutral', that leaves just 10 per cent who say they have a bad relationship. Only 2 per cent say it is very bad.

Of the 126 managers, including medical managers, who replied to the survey, more than half believe that where there are difficulties in working relationships with doctors, targets are a major cause.

And 47 per cent think that requirements from management have forced doctors to distort clinical priorities - either sometimes or frequently.

One medical manager said: 'There is a risk that doctors and consultants will descend into local warfare when the real problem is the unending stream of initiatives, some of which are incompatible with each other.'

But not everyone shared this view, and one GP and primary care trust professional executive committee chair said that coping with constant initiatives could bring doctors and managers together: 'Joint working on new and changed systems leads to mutual respect and understanding.'

Other popular reasons for breakdowns in working relationships were different professional perspectives - listed by 63 per cent of managers - and heavy workload, cited by 60 per cent.

The other major reason that managers gave for poor working relationships was a general lack of understanding - and doctors agreed. Doctors said they could work far better together by understanding one another's jobs and pressures. They listed training, education and communication as keys to ensure clinicians understand what managers do - and why - and vice versa.

As one doctor put it: 'Communication is key. A teambased integrated approach, bringing management closer to the point of delivery of the service, would help with understanding of the issues.You can't hate them if you get to know them.'

Joint training sessions on clinical and management topics were popular suggestions. One medical manager said: 'We do not educate doctors as trainees and students about the need to manage in their future careers, so how do we expect them to do it?'

A nurse manager said: 'I do not remember much on the nursing curriculum about how the NHS works - the structure, accountability and what managers do. I remember thinking that as a nurse I knew the NHS, and the steep learning curve when I moved into management'.

Another nurse manager highlighted the fact that managers and doctors sometimes have different agendas: 'Inevitably, there are occasions when their different perspective affects their relationship. If they really understood why the other holds their particular views, it should be possible for each side to understand the professional stance of the other and, where necessary, reach a mutually acceptable compromise.'

What this would help overcome was illustrated by one manager who had worked in the private sector for 17 years before joining the NHS.He said: 'Clinicians hide behind the excuse that they alone are the professionals, and how dare anybody challenge their expertise?

'It is very difficult for management to argue against that on a clinical level.'

One manager said what was needed was 'to change the management perspective from one of managing doctors to allowing doctors to concentrate on clinical work and working with them'.And an acute trust chief executive said what was needed was 'more collaboration in relation to goal-setting'.

Much of it is perhaps best summed up by one manager, who said things would improve with 'honesty, no bullshit and proper explanation to understand difficult decisions'.