Annex A > Chapter 8 - Management and Culture of the UBH and the UBHT > The development of the clinical directorate structure > The relationship between the clinical directors and the general manager - the `managerial bubble'
<< previous | next >>
The relationship between the clinical directors and the general manager - the `managerial bubble'
113 The key managerial relationship in each directorate was that between the general manager and the clinical director. Dr Roylance's concept of how the clinical director and the general manager should work together evolved over time, from the `managerial bubble' to the clinical director being accountable to him, with the general manager supporting the clinical director.
114 Dr Roylance explained further the reasons for this evolution:
`... each partnership of Clinical Director and General Manager ... formed a working relationship which was based upon their individual expertise and abilities, and their willingness to undertake tasks. They developed the role together. Slowly, as I think was predictable, and probably directorate by directorate, they found it easier to converse and to be understood by others if it was absolutely clear that the Clinical Director took final responsibility and the General Manager's responsibility was to make them successful.' [133]
115 Miss Lesley Salmon, Associate General Manager of Cardiac Services 1991-1993 and General Manager, Directorate of Cardiac Services 1993/94, gave her view of lines of responsibility:
`Q. To whom were General Managers accountable?
`A. I think the use of the word "accountable" is interesting. I felt that I was managerially responsible as a General Manager to John Roylance, but I had some accountability to the Clinical Director for the directorate in terms of the way I worked and what I did.
`Q. You use the word "responsible". Can I take you to WIT 0170 0004, Kathy Orchard's statement that we looked at already, briefly, paragraph 9.
`By all means take a moment to read the whole paragraph. The passage I am focusing on is the last sentence. [134]
`Do you agree or disagree with that paragraph?
`A. It is interesting, actually. I did see myself as being directly responsible to John Roylance. Whether I saw the Clinical Director being directly responsible to Dr Roylance, I am not sure.
`Q. Who did you see the Clinical Director as being responsible to?
`A. To some extent, to the Medical Director, but I suppose in the fact that the Clinical Director was to some extent a management position, albeit not a direct line management responsibility, that he did have some responsibility to Dr Roylance as Chief Executive.
`Q. The Panel have heard the analogy quoted of the Clinical Director being akin to the Chairman and the General Manager being akin to the Chief Executive.
`Normally a Chief Executive would be responsible to the Chairman of a Board. To what extent do you think that analogy held good when you were a General Manager?
`A. I do not think it was that clear. I was quite clear that I was accountable for the quality of the work that I did to the Clinical Director, and to a large extent, he did guide and direct my work, although it was more of a partnership than perhaps otherwise. But I was also clear that I was responsible to the Chief Executive as a manager.' [135]
116 In her statement and in response to questions, Miss Salmon indicated that she encountered practical difficulties, particularly with one part of the team: `There was a degree of tension between myself and ... the head of the perfusionists ... he did not feel that I should be managing the team' although she `was not aware of any difficulty with the actual clinical delivery of the service.' [136]
117 Miss Salmon described the position of the general manager in terms of relationships with those higher in the hierarchy of management:
`Q. The second point is actually at WIT 0109 0014, the last sentence in paragraph 55, where you talk about the culture at the time was one in which personal relationships with an individual Executive Director was possibly more important than hierarchical relationships.
`Perhaps you could provide me with some explanation of that sentence?
`A. It was my view at that time that, particularly with Dr Roylance and perhaps with other executive directors, that because you were a General Manager did not necessarily mean that you were somebody whose opinion would be particularly listened to or respected, but that there were individual managers who did have good relationships and who did have, so to speak, the ear of the Chief Executive.
`Q. So are you saying, to use a colloquialism, your face fitted or it did not?
`A. I do not think it was so much a case of your face fitting, but there were individual people who, for whatever reason, but I could not explain to you because I do not know myself, had a good working relationship with Dr Roylance. I do not believe that I was one of those individuals.' [137]
<< previous | next >> | back to top
Footnotes
[134] `Directorate General Managers and Clinical Directors were responsible individually to Dr Roylance as Chief Executive and then to the Board'