Continuity and tension in the definition, perception and enactment of the first-line management role in healthcare
Friday 22 February 2013
A study that examined first-line management in health care organisations has found that effective first-line management in the NHS requires more coherent, focused and credible roles.
The study, led by academics at the University of Surrey and funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme, focused on two distinct first-line manager roles in two acute care trusts: general service manager – a position with ad hoc responsibility for assisting with planning, monitoring and measuring operational performance against targets and budgets; and ward sister or charge nurse – a position that combines both clinical and managerial responsibilities.
The methodology included researcher interviews with first-line managers and other employees, work shadowing first-line managers and attending ward sister ‘study days’.
The study found that the service manager role is not an explicit, well-defined first-line management role. Staff make themselves useful by providing information and owning the problems of other members of staff.
Ward sisters, who have always had a leadership role at ward level, have acquired additional formal managerial responsibilities. As a ‘practitioner-manager’ – they must meet the conflicting demands of hands-on nursing, professional ward leadership and, increasingly, organisational management.
If, by prioritising clinical work, ward sisters relegate management control to formal compliance and ‘box-ticking’, they may be failing to bring sought-for management disciplines to nursing activity on the ward.
Professor Colin Hales, the lead researcher, comments: “Ward sisters should either be left to get on with patient care or receive training and development which cultivates the skills required to finesse the competing demands and priorities they face.”
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