Leadership and Management for Doctors in Training

A Practical Guide

Stephen Gillam

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9780429533327
• Edition: 1
• Topic: Business
• Subtopic: Leadership
• Index: Business

This guide helps undergraduate medics and junior doctors, as well as experienced doctors taking on new managerial responsibilities, to become effective leaders and managers by introducing both management and clinical leadership theory and practice, and the challenges facing medical managers in today's NHS. Despite growing recognition of the importance of leadership and management to doctors in meeting their clinical responsibilities, training in medical schools and foundation years remains patchy.

APPENDIX 1

Theories of management

For over a century, people have been studying managers at work in an effort to distil the principles that underlie good management. From such studies have emerged several different schools of thought with different approaches to management. There is no need for you to have a detailed knowledge of each, but being familiar with these alternative approaches can provide you with a variety of perspectives on your work. They can also yield a better understanding of your job and thereby lead to more effective performance. Here, eight approaches to management are reviewed in roughly the same order as that in which they emerged on the management scene.

THE SCIENTIFIC APPROACH

Around the turn of the twentieth century, Frederick Taylor and others began trying to apply scientific methods to management rather than the rule-of-thumb approaches then current. In other words, they brought the skills of observation, quantification, analysis, experimentation and evaluation to management in place of the more traditional precedent, intuition, personal opinion and guesswork. Their work gave rise to an approach known as ‘scientific management’.

Taylor advocated five basic principles for his approach:

1. Give responsibility of organisational work to managers.
2. Use scientific methods to assess the most efficient ways of doing work (by studying tasks and specifying in detail how work should be undertaken).
3. Select training of workers scientifically.
4. Monitor work performance by relating detailed job specifications to particular outcomes.
5. Undertake ‘management by exception’, where routine decision-making is handled at a lower level and exceptional cases are handled higher up the organisation.¹

Taylor’s concern was to improve efficiency. His quest was to find the fundamental principles of efficiency, and underlying his search was the belief that there was ‘one best way’ of doing any job. He insisted that it was management’s task, using careful experimentation and observation, to identify the one best method and to develop standardised tools (even down to the shovels) for implementing it. Then they should select their workforce very carefully, choosing only first-class people, and train them to use only the best methods. In this way, production could be improved and costs reduced. Workers would share in the resulting benefits by being rewarded for a ‘fair day’s work’, their assigned goals being carefully determined by stopwatch studies. Taylor acknowledged that this could lead to higher wage costs, but he argued that management should be concerned less with labour costs than with overall costs per unit, and that his methods would lead, through increased output, to a reduction in unit costs. To achieve increased output per worker, he called on management to improve working conditions and reduce physical effort and fatigue.

THE PROCESS APPROACH

The process approach to management owes much to Henri Fayol’s thinking at the beginning of the twentieth century. Fayol focused attention on the things that a manager does, and wrote that to manage is ‘to forecast and plan, to organise, to command, to coordinate and to control’² A hundred years later, his analysis still forms the basis of one of the most frequently adopted views of management, so much so that it is often called the ‘classical view’.

There have been numerous attempts to improve on what Fayol wrote. For example, the idea of a manager ‘commanding’ now has a strangely old-fashioned ring to it. It has often been replaced by words such as ‘directing’ or leading’, although these, too, can sound dated in the modern world, with its concern for ideas of participative management and democracy. As a consequence the word ‘motivating’ is often preferred because it sounds less loaded.

Into this category fall numerous theories of strategic management. ‘Management by objectives’ (MBO) was first popularised by the economist Peter Drucker. He suggested that the objectives for an organisation should be defined for each insectionidual working there, both managerial and other staff. These objectives should be the basis for assessing performance thereby aligning goals throughout the organisation. It can certainly be argued that an obvious weakness of the National Health Service (NHS) is that the disparate, often conflicting objectives of different staff working within it. Clear and shared statements of purpose provide the basis of the organisational mission statements that Drucker also championed. Associated with this approach is the acronym SMART, suggesting that objectives should be specific, measurable, achievable, realistic and time-bound.

Strategic management theories have given rise to numerous formulations commonly employed within health and social services. These include the SWOT analysis (of strengths, weaknesses, opportunities and threats).

Mintzberg identified three types of strategies: ‘intended strategy’, as conceived by senior managers; ‘realised strategy’, which is that actually undertaken; and ‘emergent strategy’, which is the pattern of actions that emerge as managers respond to changing external conditions.³ Realised strategies may follow from intended or emergent ones. The main message is that strategy development is not the neat and rational approach that some managers like to imagine. Cultural, political and other non-rational factors shape strategies and their implementation.

THE HUMAN RELATIONS APPROACH

Although its origins can be traced back to the nineteenth century, the human relations approach developed strongly during the 1940s and thereafter, partly as a reaction against the seemingly impersonal features of the scientific approach, but mainly because research studies during the previous two decades had demonstrated the importance of good human relations and the influence of social factors on workers’ motivation. These so-called Hawthorne studies are regarded as a milestone in the evolution of management ideas. An important observation made in these studies was that output and morale went up every time management varied its working conditions, regardless of whether the change was for better or worse. The inference drawn from this was that workers respond positively whenever management appears to be concerned with their working conditions. This important finding is now commonly referred to as the ‘Hawthorne effect’.

Elton Mayo, who was associated with the Hawthorne studies, concluded that:

• ➤ people are basically motivated by social needs
• ➤ they satisfy their needs through social relationships at work, rather than through the work itself, which often holds little satisfaction
• ➤ the work-group exerts more influence on a worker than do the incentives and controls used by management
• ➤ supervisors are effective only to the extent that they can satisfy their subordinates’ social needs.⁴

In the years following the Second World War, men like Rensis Likert and Douglas McGregor conducted further research into group behaviour and management styles.

Likert’s studies seemed to show that departments with low efficiency tended to be managed by people who were job-centred - in other words, by managers and supervisors who regarded their main function as being to get the job done - and who viewed people as being just another resource provided for this purpose. Such managers tended to adopt the attitudes that stem naturally from Taylor’s scientific management: ‘keeping their subordinates busily engaged on prescribed work, done in a prescribed way, at a prescribed pace, determined by time standards!¹ Such methods, it was noted, could achieve high productivity, but they tended to create very unfavourable attitudes towards the work and the management, often resulting in strikes and stoppages, as well as high wastage rates.

Likert’s studies also seemed to show that, in contrast, work groups with the best performance were often managed by people with genuine concern for their subordinates’ well-being.⁵ Such employee-centred managers and supervisors appeared to regard people as people, not as just another resource. In addition, they were perceived as exercising a much looser form of control, but they compensated by setting very high performance targets and by motivating people to meet them.

THE QUANTITATIVE APPROACH

As the name implies, the quantitative approach lays prime emphasis on the use of quantitative techniques. This approach can be traced back to Taylor’s scientific management. However, a more recent antecedent is to be found in operations research.

The quantitative approach has gained impetus both from the availability of computers capable of storing the data in management information systems and from the ability of such computers to manipulate the complex mathematical models that are used to stimulate business activities. Computers allow us to collect a great deal of information about an organisation’s day-to-day activities. Sophisticated software programs allow such information to be pulled together, ‘smoothed’ to remove aberrations and displayed in boardrooms in readily assimilable formats such as pie charts and diagrams. Such programs assist short-term forecasting and thus allow optimum use of resources to be planned.

THE SYSTEMS APPROACH

Systems thinking developed concurrently with the quantitative approach, and emerged strongly during the 1960s and 1970s. It is an approach that emphasises the interrelatedness and interdependence of the parts and the way in which this contributes to the functioning of the whole. It is not unique to management thinking, having been applied to problems in many scientific fields, but it provides a helpful way of looking at many management problems, particularly those concerned with organisations.

When the systems approach is applied to organisations, it highlights the obvious point that if any part of a system is altered it is likely to have repercussions for the system as a whole - the magnitude of the repercussions depending on the nature of the change and the system affected. It follows that managers need to understand the way in which their own units or sections relate to other parts of the organisation and to the functioning of the organisation as a whole.

Every system and subsystem (unit or section) has a boundary that separates it from all the others. A closed system is one that functions entirely within its own boundary, and is unaffected by anything outside itself. Most systems, however, are open and are interrelated to others. The concept of boundaries is important to managers, for it is there that problems all too easily arise.

For a system to function effectively, resources such as materials, money, human resources and information must flow freely through the system. The flow may be affected by a variety of factors, which may be human as well as technical, and both are important subsystems that need to be given careful consideration.

THE ORGANISATIONAL BEHAVIOUR APPROACH

This developed from the human relations approach, and builds on the belief that in order to put strategies into action people must be encouraged to act in a way that produces the desired results. In line with the human relations approach, the organisational behaviour (OB) approach is concerned with people as insectioniduals, their behaviour in groups, their insectionidual motivations, their development within the organisation and their receptivity to new ideas and change.

However, in addition, the OB approach takes into account the organisational structures within which people work. Do the structures allow people to come together in the right groupings to perform a task or to make a decision, or do the barriers of sectionision or department, or the hierarchical structure, or the complexity of the decision-making structures get in the way?

OB approaches remain pervasively influential. They seek to match an insectionidual’s aspirations as closely as possible with those of the organisation, so that what is good for the organisation is good for the insectionidual. Managers cognisant of OB theories try to create an environment in which learning and personal development take place, and typically encourage staff training and coaching. This benefits insectioniduals in terms of career development and the organisation in terms of the quality of workforce.

THE CONTINGENCY APPROACH

In essence, this approach takes the view that it all depends on circumstances’. Circumstances, as we well know, can be totally different from one situation to another, and the situational approach recognises that it is impossible to prescribe any single solution that will be best in all circumstances and situations. In contrast with Taylor, it claims there is no ‘one best way’.

‘Contingency theory’ argues that the structure required is contingent on the circumstances. In other words, structures must be adapted to the circumstances. The theory suggests that an organisation will be more successful if it consciously adapts its structures and its administrative arrangements to the tasks that need to be done, the technology that is used, the expectations and needs of the people performing the tasks, the scale of the total operation, and the complexity and change it has to deal with in its environment. In some versions of this approach there is a flavour of natural selection, which suggests that those who do not adapt do not survive.

Large and complex organisations end up with different designs for different parts of themselves, because the circumstances differ in different parts of the organisation and call for different answers. Very much reflecting the views of the OB approach, contingency theory suggests that people with different needs and motivations need different forms of management structure if they are to function well. Thus, people with a high need for security, a low tolerance of ambiguity and a dislike of risk and chance tend to wor...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• About the author
• Dedication
• Introduction
• Section I: Management and leadership in theory
• Section II: Management and leadership in practice
• Section III: Being a leader and manager
• Appendix 1: Theories of management
• Appendix 2: Management competencies
• Index