Making the transition from NHS clinician to manager 

Guest blog

As a divisional medical director in an NHS hospital I have made the step from full-time clinician to clinical manager, albeit with a foot in each camp. This was never going to be easy for me, given my allegiance to clinical work and the negativity attached to NHS management.

Direct contact with patients was always at the heart of my decision to pursue a career in clinical medicine, and is the source of much job satisfaction. The transition to clinical management has involved coming to terms with the move away from direct patient care towards more strategic work which will impact patients on a much greater scale.

Attitudes towards NHS managers are now changing, although there are still some who refer to the ‘dark side’ and seem to relish any opportunity to cause division – no coincidence that it’s usually those same individuals who complain management processes are forced upon them. But with the introduction of NHS management into medical school curricula and service innovation programmes for junior doctors, more clinicians are now realising that doctors are in a strong position to effect real change in the NHS.

Undertaking the Top manager programme at The King’s Fund helped me to make that transition to management, learning much about myself during the process. Three aspects that stood out to me were:

1. The discipline of being present in the ‘here and now’

Too often we are ineffective at work as our minds are one step ahead, fretting about the next meeting, the next clinic or the next on-call. Meetings used to stir up feelings of resentment in me for taking up valuable clinical time, and my aim would be to get through the agenda as quickly as possible – and then feel justified in my assumption that the meeting was pointless! But after the programme I now approach (most of) my numerous meetings with the expectation of learning something, or adding value by bringing my clinical knowledge and experience to the table. Thinking ahead will always have its place, but managing my anxiety sufficiently to stay present in the here and now leads to greater effectiveness, productivity and satisfaction.

2. Reconnecting with core values

People who work in health care are often admired for their desire to help others, but when the constant sacrifice is never enough it’s not surprising that our compassion is often eroded. On the programme, listening to the life experiences of guest speakers, visiting various community systems and even hearing from fellow course delegates of devastating encounters in the NHS allowed me to realise and get back in touch with my core values. One guest speaker who suffered mental health and addiction problems told of their harrowing journey through the system, and the lack of compassion they encountered was stark. Similarly, accounts of prejudice in the public sector against disadvantaged individuals from ethnic minority backgrounds hit home hard. I emerged on the other side feeling more certain of my principles and even more determined to embed them into my leadership style.

3. Noticing unconscious behaviour

Noticing how different people and different circumstances make us feel and – in some instances – recognising the possible origins of those feelings, gives us a better understanding of others’ behaviour. It also makes us more aware of the impact of our own behaviour, which is important in leadership and relationships in general. The programme helped me to notice. Now in my interactions at work I’m aware of people’s body language and the words they choose to express themselves. I am confident in my own intuition and, instead of making snap judgements, try to be inquisitive about the reasons for certain behaviour and what makes up the person beyond the exterior. The programme also gave me confidence to harness useful elements of my personality and behaviour, and put into perspective my less developed attributes – particularly during times of high stress.

The Top manager programme is a unique course – in its length, structure and depth of exploration. Initially the time commitment required sounded as attractive as being bleeped at 4am after having only three hours’ sleep over a 72-hour on-call weekend – only to be told by the instigator that they were just checking your pager works! Feelings of anxiety, frustration and even anger were common amongst attendees on the programme as we contemplated the hundreds of emails clogging up our inboxes. But on reflection I will always appreciate the time, space and carefully chosen surroundings that gave me permission to engage and learn away from the pressure-cooker environment of the NHS – which continues to overheat whether I am there or not.

Ultimately the programme has helped me in the challenge of becoming a senior manager within the NHS by enabling me to understand myself – and in doing so has clarified my core values and fortified my decision making. It has helped me to understand others more and realise that relationships lie at the centre of my work. By focusing more on the here and now, I am more effective and productive and feel that I am actually making a difference. All these aspects combined have made me a much more resilient leader.

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#545970 Phil Strong
Managing director / product designer
Ergo - Ike

Unfortunately i am far from convinced that anything is changing in Health and Social Care management thinking from what you have described in your post! I am afraid the "here and now" mentality lacks any proactive thinking as a way forward and is one of the major reasons we have the mess we are in now! The present management training and thinking you are describing is not going to be sufficient or desirable for the needed change in Health and Social Care. By simply being trained and educated by the same people and thinking that have created the mess we are in will not be suffice! NHS Management training needs a radical shake up with an awful large amount of managing out and a large amount of managing in!

#545971 George Coxon

I made this very transition in the 90s (mental health clinician - CMHT team leader to primary care mental health advisor at Avon Health Authority). My path then headed off into the wild and wonderful world of commissioning - from health inequalities to acute & specialist commissioning to cardiac care, cancer and end of life care and many more areas too. I am these days a portfolio career type of chap working across H&SC with a commitment to versatile cross connecting enthusiasm with some hard wired views on how important clinical transitions to manager roles are. I do however say. If you no longer do the thing you are leading or advising about your credibility gradually becomes less & less. Talk the Talk must be accompanied by Walking the Walk too!!!

#545983 elizabeth Angier
Portfolio Gp

This is an interesting blog Dilys.
I would also be interested to hear about the difficulties faced by those clinicians who would like to do a portfolio of both clinical and management work.It sometimes seems as though it has to be one role manager or clinician . I think it would be good to see how the environment could be changed to support both with an emphasis on leadership and service improvement across the system.I'd also like to see a generalists view of the top manager course and how it adapts to the community setting and whole system approach.

#545985 Kevin McKenna

Phil, what you say sounds seductively credible. Without clear evidence however, that it is exactly the same people who are teaching the same old patterns, with no learning from their mistakes, your argument seems to hang in thin air.
When you lead on to say this though, without any further detail or context:
"large amount of managing out and a large amount of managing in"
I'm left bewilderered and worry that the new thinking you speak of may be just as bad as the old.

#545986 Rachel Matthews
Programme Lead For Patient and Public Involvement
NIHR Collaboration for Leadership and Applied Health Research and Care Northwest London

A thoughtful reflection on the fundamental desire to care for others and what that means to do so in different roles and at different levels. I'm struck by the human element of this description. Structural and organisational changes may be necessary in the NHS but the humanity in the work is undervalued. The skills and behaviours acquired on this programme probably serve to bring some hope and compassion into daily interactions which may be in short supply - I know patients, carers and co-workers place high value on these skills and attributes.

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