Getting along: Managers and doctors connect through paired learning

On my first day on the NHS management training scheme, someone joked that the biggest challenge in our jobs would be difficult consultants who believe that all managers care about is money.

‘We can no longer afford to have two tribes, because two tribes bring half the benefit to patients’

This division has a long, well documented history, but the way the hospital is run has such an impact on patient care that we all need to be involved and work together to make things better for patients.

As British Medical Association council chair Mark Porter reminds us: “We can no longer afford to have two tribes, because two tribes bring half the benefit to patients.”

• Clinicians and doctors must end their standoff
• Seeing eye to eye: managers and clinicians can work together

Entrenched stereotypes

At Birmingham Children’s Hospital we were lucky to have NHS organisational development expert Michael West speak at our staff engagement week last year about team working.

His research shows that where teams work well together, patient experience is better and communication is improved, which in turn leads to greater innovation.

Doctors in training don’t have regular opportunities to meet managers, and therefore some of these stereotypes about managers can become entrenched by the time a doctor reaches consultant level.

The latest King’s Fund report on medical engagement describes how valuable it is for clinicians – along with non-clinical colleagues – to focus on the culture of an organisation.

They describe it as “a journey, not an event” and at our hospital we firmly believe this journey should start early and be from board to ward.

‘The medical engagement journey should start early and be from board to ward’

I learned of the concept of “paired learning” from Imperial College Hospital in London which had successfully brought together doctors in training and managers earlier on, to get to know each other and work together.

I jumped at the chance to try something like this at our hospital, and despite a little resistance from both sides, our paired learning programme got underway. We now have 30 doctor-manager pairs are now on board.

The positives of paired learning

One of the most important things about paired learning is challenging some of the perceived differences in values - with doctors focused on patients and managers on money - when in reality we all share the same values and have one shared goal: to provide excellent care and a great patient and family experience.

This can really only be overcome through mutual trust and appreciation, and paired learning enables doctors and managers to share their challenges, highlights and frustrations and gain an insight into each other’s values and reasons for choosing to work in the jobs we do.

‘An important part of team working is identifying who is in the team’

Our chief executive Sarah-Jane Marsh is very visible in the hospital and makes an effort to spend time with all staff groups in the organisation.

Paired learning extends to all levels of the organisation, helping staff to recognise that our technical and clinical competencies are just one aspect of our development and reflect on the type of leader that we would like to be.

Professor West’s research shows an important part of team working is identifying who is in the team - echoed at our first workshop by some of our doctors who told us that they weren’t motivated to engage with emails from managers who they had never met.

Emails can seem really impersonal and aren’t a good way to show that we all share the same values.

Making the personal connection

As an organisation, we have strong values but this needs to be shown by a personal connection.

Paired learning has been one way to make more connections in the hospital between managers and doctors in training.

‘We may be on different planets but we’re in the same universe orbiting around the same goal’

Our pairs have built up relationships - appreciating each other’s contribution to the organisation and the values that drive us - and they are therefore much more enthusiastic about working together to make improvements for our children and young people.

Through this - for example, shadowing in the paediatric intensive care unit has helped one manager articulate more strongly the need for a new long term ventilation unit - we have changed the way doctors in training are represented in hospital meetings, and some of our doctors in training will now be pursuing a career in medical leadership.

So, are doctors from Venus and managers from Mars?

The first cohort of paired learning has learnt that we do have different roles in the hospital, so although we may be on different planets, we are in the same universe, orbiting around the same goal to make things better for patients.

Lydia Salice is service manager of the paired learning programme at Birmingham Children’s Hospital