“Top Down” Management – blessing or curse?

The key to quality patient care is ‘doing the right things and doing things right’. Whilst not disparaging the efforts of anyone in the pandemic management cascade, it is clear that the response has been erratic and ill-coordinated. In addition – and of equal or greater concern – has been the overarching micromanagement (and arguably, the mismanagement) of both the treatment and prevention of disease by the Government, PHE and NHSE/I. It has at times appeared reminiscent of the much-maligned WW1 Generals’ strategy – policies, procedures, orders are frequently hurried and contradictory and rushed out with little knowledge of the current status at the front line or the real needs rather than those distantly and sometimes erroneously perceived. The hierarchical, sinuous management system does not allow or encourage provider clinical staff to have an influential voice at strategic or tactical levels; indeed when concerns and suggestions are forthcoming they tend to be dismissed or “patronisingly acknowledged” but ignored. The impression that is given is that those on the front line are unable to see the big picture and are disruptive and unhelpful. As a consequence of all the above, many of those who are best placed to identify and prioritise clinical and managerial problems and formulate solutions are largely disregarded and cowed into silence with a resultant unspoken schism between the upper echelons and the care providers.




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