Management for Doctors
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The seven principles are:
selflessness
integrity
objectivity
accountability
openness
honesty
leadership.
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All practising doctors use resources and play a role in setting priorities,
developing policies and making other management decisions. All doctors
have an obligation therefore to work with both medical and non-medical
managers in a productive way for the benefit of patients and the public.
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This b ooklet is concerned with principles of good practice and is not
intended as a general management handbook, although we intend
to publish more detailed guidance to sup plement these principles.
The principles and ethical standards set by the British Association of
Medical Managers, the Institute of Healthcare Management and the
Department of Health’s Code of Conduct for NHS Managers are consistent
with those described in this guidance.
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Management for Doctors
Good Management Practice
Providing a good standard of management practice
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It is not possible to set out all the roles doctors take on as managers. If your
role involves responsibilities covered in this booklet, you should do your best
to make sure that:
systems are in place to enable high quality medical services to be provided
care is provided and supervised only by staff who have the appropriate skills
(including communication skills), experience, training and qualifications
significant risks to patients, staff and the health of the wider community
are identified, assessed and addressed to minimise risk, and that they are
reported in line with local and national procedures
the people you manage (both doctors and other professionals) are aware
of and follow the guidance issued by relevant professional and regulatory
bodies, and that they are able to fulfil their professional duties so that
standards of practice and care are maintained and improved
systems are in place to identify the educational and training needs of
students and staff, including locums, so that the best use is made of the
time and resources available for keeping knowledge and skills up to date
all decisions, working practices and the working environment are lawful,
with particular regard to the law on employment, equal opportunities
and health and safety
information and policies on clinical effectiveness and clinical
governance
are publicised and implemented effectively.
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Management for Doctors
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It is crucial that clinical performance is managed at the local level. This is an
essential feature of a GMC-approved working environment. You must make
sure that effective systems are in place to give early warning of any failure,
or potential failure, in clinical performance, and that such failures are
addressed quickly and effectively.
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You should make sure that the p eople you manage have appropriate
supervision, whether through close personal supervision (for junior doctors,
for example) or through a managed system with clear reporting structures.
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You should make sure that adequate systems are in place for investigating
complaints promptly, fairly and thoroughly and that all staff, regardless of
grade or seniority, are aware of reporting and complaints procedures and
can seek advice, report an incident or make a complaint when necessary.
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You should make sure that appraisals are completed fully and on time for
the staff you manage. You should enable your staff to complete activities
identified by appraisal.
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Management for Doctors
Competencies and standards that define a good manager
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As an effective manager, you should be able to:
lead a team effectively
identify and set objectives
communicate clearly
manage resources and plan work to achieve maximum benefits,
both day to day and in the longer term
make sound decisions in difficult situations
know when to seek help and do so when appropriate
offer help to those you manage, when they need it
demonstrate leadership qualities through your own example
manage projects
manage change
delegate appropriately - to empower others, to improve services and to
develop the skills of the people you manage - without giving up your
own responsibilities
consider and act upon constructive feedback from colleagues.
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Management for Doctors
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As an effective manager, you need a sound working knowledge of the:
main clinical and other issues relevant to those you manage
key skills and contributions of other health professionals
roles and policies of local agencies involved in healthcare
needs of patients, carers
and colleagues
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use and application of information and information technology
nature of clinical and other risks
limits of what is affordable and achievable
principles of change management
culture of the organisations in which you work
structure and lines of accountability in the organisation in which you work
principles of good employment practice and effective people management.
Responsibilities, conflict and accountability
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You should establish clearly with your employer the scope of your role and
the responsibilities it involves. You should raise any issues of ambiguity or
uncertainty about responsibilities in multi-disciplinary teams in order to clarify:
lines of accountability for the care provided to individual patients
who should take on leadership roles or line management responsibilities
where responsibility lies for the quality and standard of care provided
by the team.
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Whether you have a management role or not, your primary duty is to your
patients. Their care and safety must be your first concern. You also have
a d uty to the health of the wider community, your profession, your
colleagues, and the organisation in which you work.
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Management involves making judgements about competing demands on
available resources. If managerial concerns conflict with your primary duty
to the extent that you are concerned for the safety or well-being of your
patients, you should declare the conflict, seek colleagues’ advice, and raise
your concerns formally with senior management and external professional
bodies as appropriate.
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At times you may not have the resources to provide the best treatment
or care that all your patients need. At such times your decisions should be
based on sound research information on efficiency and efficacy, and in line
with your duties to protect life and health, to respect patients’ autonomy
and to treat justly.
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You should take into account the priorities set by government and the NHS
or your employing or funding body. You should discuss the issues within the
healthcare team, with senior management and, when appropriate, with patients.
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You are accountable to the GMC for your own conduct and for any medical
ad vice you give, including while you serve on a hospital board or other
corporate body. If you are concerned that a board decision would put
patients or the health of the wider community at risk of serious harm,
you must ask for your ob jections to be formally recorded and you should
consider taking further action.
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If you have good grounds to believe that patients or the health of the wider
community might be at risk of serious harm, and you have done all you can
to resolve the problem by raising your concerns within the organisation in
which you work, you may consider making them public,
provided that
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patient confidentiality is not breached. You should consult a defence body
or professional association before taking a decision of this kind.