It is not psychoanalysis but the management of health care that is “the impossible profession”. To manage, really, really manage we must it appears know the problem, the really, real problem. But in health care it is predominantly the clinician who (depending on your view) identifies problems or conjures them up. So the non‐clinician manager is always following, never leading the production process. The solution, according to Valerie Iles, is to know oneself and assume leadership. Knowing others is also central. Thus the motivation of oneself and the key players in any situation is a vital insight in framing and resolving health care problems. Given this managerial ideal of understanding, the manager can really manage health care.
This sensitivity to motivation produces an unexamined result. Together with a technical solution ‐ utilising the 7s framework for excellence for instance ‐ it appears that the manager must also work towards a moral solution. The principal moral imperative is nowhere explicated but it is implicit in the moral authority of the author ‐ it is: to work for patients efficiently and effectively as part of an organisation. It is the manager’s task, then, to detect any deviation from this superordinate goal and, through personal leadership and correct motivation, set up the conditions for rational change.
Whether or not any of this will work in the NHS of today and tomorrow rather misses the point. “How to manage” books like this offer an internally consistent recipe for the impossible profession. They enable managers to feel more confident and effective and, through perhaps a self‐fulfilling prophecy, managers may actually become more effective. Whether a manager will really examine her or his motivation when wanting to deflate a consultant surgeon’s plans for expansion or get a senior clinician to stick to their job plan is another matter. It is likely that the manager’s situation would, however, be more tractable if this did happen. It would also reduce work stress and might win support for the hardest management tasks which Valerie Iles identifies as the “simple‐hard” tasks.
So, somewhat against my initial prejudice, I enjoyed reading this book. The minor pieties can be overlooked when taken in context. The “case studies” ‐ examples of “airport fiction” and quite readable ‐ duly deliver their moral parables, and the technical tools are deployed with a light touch. I do not know if Ms Iles’ approach to really managing health care really works, we have no direct evidence that it does, but the openness and ethical nature of her recommendations make me wish it so.
