I have known her for a few years now and she rarely ceases to amaze me. Practically indefatigable, always with a smile, always optimistic...even in the most dark days when someone has lost their cool, she has been pretty rock solid. Works far harder than what she is paid for, balances her personal life, little baby at home...pretty close to Wonder Woman in my book. The world wouldn't know her- as she isn't on twitter, isn't on Facebook, rarely spends time preaching about what "needs to be done" or winning awards...just gets on with the job. What do you reckon- describing a Consultant? A super Nurse? Nope, she's a manager- and a bloody super one at that. I have sat down over a coffee many a time and always, without fail, what has come out has been the deep seated desire to improve patient care. Her name? Maria Purse. She works in Queen Alexandra Hospital- and in my 5 years as a clinical manager, have always had time for her- based on one thing- the ingrained desire which shines through of keeping patients at the centre of any plan.
Do you know why I mention her? Because I have stumbled upon so many examples in my travels where clinicians are getting jammed or tired of plans getting put on the back burner to improve patient care. Somehow for some, management is about keeping the numbers right, its the fear of being "performance managed" on targets which admittedly clinicians are not subject to. Let's be honest- if a 4 hour target fails, the Consultants still get their salary- yes, reputation wise it may hurt but its not linked to salary (just to clarify- neither should it be) but for the poor manager caught in between, their job rides on it.
When you have one party desperate to get to a target or improve one, come hell or high water- on which ones job depends and then that conflicts with someone for whom patient care is paramount- two things happen. In the main, the clinician gets tired after some point, shrugs his shoulder and walks away...clinical engagement becomes a sound byte. The NHS is jammed to the edges, to squeeze anything extra, you have only one currency left..goodwill. Lose that and those targets sink further. Result? The truculent manager loses his/her job, moves on..the clinician stays..after all...this is healthcare..patients come to see clinicians- the manager is the character actor in the show. Don't forget that for a clinician, it makes for an easier and simpler life if you put your head down, do your job..and pick up your payslip at the end of the month. And to be honest, the payslip ain't too bad...so why bother? Sometimes, flashpoints erupt...and it boils down to what extreme you are willing to go to improve care...go the whole hog and be called a whistle-blower as in the case of Raj Mattu et al..or play a singular tightrope with the system.
And to be honest? It's disappointing especially after I meet Liz Saunders, Pollyana Jones, Fiona Rodden and others who talk a different language, meet folks from NHS graduate scheme who burst with enthusiasm to stand next to a clinician and help. Hopefully with time the mentality will either change or the old dinosaurs who stand in the way of clinical care will make way for the new generation.
To anyone involved in management, here's my gauntlet put down...be a Maria Purse, see how targets can be achieved by keeping patients at the centre- learn and sense how it can be done. Otherwise, although harsh, the reality is that in all likelihood, the clinician will still be there long after you have gone- picking up the pieces of a system wrecked by the obstinancy of chasing targets to protect one's own job. The dust hasn't yet setlled on the Francis report; a report which caused angst to so many hard working souls...lets not aim to create another such one.Remember the name- Maria Purse. She is trying darned hard to ensure we don't have another one.
As a clinician, I promise you I am. Are you?