The relationship between managers and doctors is pivotal to the effective delivery of healthcare services. Healthcare organisations can succeed or fail as a consequence of the nature of this relationship. Edwards et al. (2003) comment on the risks of not allowing medicine and management to come together in the organisational setting. They illustrate that there is a 'mounting body of evidence that badly managed organisations fail patients, frustrate staff, deliver poor quality care, and cannot adapt to the rapidly changing environment in which they operate and go on to suggest that 'poor management practice is at least as lethal as poor clinical practice.
This chapter seeks to explore the nature of this relationship between managers and doctors, both from an interpersonal perspective and an organisational perspective as illustrated in Figure 15.1. Although the discussion will focus primarily on the manager—doctor relationship, it is clear that many of the themes and frameworks can be extrapolated and transferred to other relationships between managers and the wider clinician community in healthcare organisations. This chapter particularly explores the changing nature of the relationship between doctors and managers over the last 30 years within the context of National Health Service changes and reforms in the United Kingdom, but it is fair to say that the issues faced by managers and doctors in the UK are found in many other countries globally, particularly in the United States and Europe.
It is critical for managers to understand the impact of professional and organisational cultures on the relationship they have with doctors, particularly in terms of behaviours displayed at an organisational level. The design and implementation of specific types of organisational structures will also affect behaviours within the relationship. This chapter illustrates how the organisational forms prevalent in healthcare have a significant impact on how doctors and managers work together. The overarching aim of the chapter is to provide both managers and doctors with the