What is a NHS hospital manager (and what do they do)?

What is a NHS hospital manager (and what do they do)?

What is a hospital manager?

A hospital manager is an important health professional, whose role is to ‘manage’ (i.e. organise) all aspects of a hospital. Their responsibilities are broad in scope and include maintaining:

• Clinical activity (getting through the work)
• Performance (against national and local standards
• Financial balance
• Professionalism of staff (including governance).

Why do you need them?

Hospitals are big, complicated and expensive – and paid for by your taxes. Therefore they require a team of skilled administrators to supervise the work – both emergency and planned care – and manage the institution efficiently.

Career Structure

There is a management hierarchy and career structure. Managers can progress from team leader (like a senior secretary) all the way up to and including the most senior manager called the Chief Executive Officer (CEO).

• Team leader/admin manager (senior secretary)
• Department – e.g. cardiology (‘medical’, i.e. non-surgery) or orthopaedics (surgery)
• Division – e.g. medical or surgical departments
• Senior Management Team – including CEO.

As you progress up the management ladder the amount of responsibility that you hold (and your pay) increases.

But. What does a NHS hospital manager do?

Hospital management levels
Team leaders/administration (‘admin’) managers help organise teams of doctors, nurses and other staff  ‘at the coalface’ (on the wards and in clinics). They also work with more senior managers; who organise a department (group of similar doctors and nurses; including their ward and clinics) or division (group of similar departments).

The middle tier managers need to be able to complete all tasks of admin managers, but also deal with financial management. This person is then accountable for the RTT and financial performance of the department or division. Some of these managers also take part in a ‘manager on call/manager of the day’ rota (see below).

As well as being accountable for the financial health of the service, they are also required to look at cost improvement or waste reduction plans – in an attempt to make savings within services.

‘Above’ them is the Senior Management Team (SMT; including the CEO), who make the bigger decisions in a hospital.

Some of the SMT are also ‘executive directors’ and on the Executive Board (like the Board of Governors in a school). The objective of all is to maintain and/or improve the local (and whole hospital) performance of the clinical  services.

Meetings
With any role you take, there are a number of meetings that you are required to attend. The more senior you are, the more senior the meetings become. For example, higher levels of manager meet the Deputy Chief Operating Officer/Chief Operating Officer (DCOO/COO) regularly. These are the very senior managers, and part of the SMT, which advises the CEO.

At all levels managers work in a triad with a consultant (senior doctor) and senior nurse, and each must understand and support all staff in their grouping. They meet regularly, often daily. Their offices will probably be near each other. Why don’t you go and meet them.

Example
Team leaders and departmental managers make sure that the team they are working with achieve the NHS’s 18 week target (RTT, referral-to-treatment). This is one of the NHS’s key performance targets. It states that 92% of patients who are referred by their GP to the hospital see a consultant (senior doctor) and start treatment (if needed) within 18 weeks (about four months).

Skills of hospital manager

The skillset is broad. But all managers are expected to ‘know their business’; and this is specific for each level of management, and for the focus of each department. Admin managers are expected deal with patient level detail; and the more senior managers need to know the overview of the business.

Hospital manager of the day/on call

The manager of the day role is an additional task for middle tier managers. This requires the identified manager to spend the day supporting the hospital, by creating flow within the organisation (especially to clear the corridors in A&E and allow ambulances to release patients). Part of this role is to facilitate discharges, ensuring patients that are due for discharge, do go home. This could involve a wide range of tasks, from encouraging doctors to write prescriptions for patients to take home, to sorting out facilities in their home.

Doctors and managers

It is fashionable amongst some doctors to show little respect to managers, and even blame them for all the problems in the hospital and their own department. A good doctor is a ‘managerial clinician’ and a good manager is a ‘clinical manager’. They need to respect each others skills and experience, and be courteous to each other. Both should work with the nurses and allied health professionals, to improve care in their department – and the hospital as a whole.

As a doctor you should know the manager of your department (and their boss if necessary) and be on first name terms. They can be very helpful to you, and sort out any problems you have, to make you a more effective doctor.

Note. If a doctor talks about ‘the trust’ as an object that is nothing to do with them, they may be a disrespectful and arrogant. Avoid them. But if you cannot, educate them. We – the staff – are the trust.

Are there ‘too many managers’?

No. This is a widely held myth. All large organisations need management to organise them, and keep the organisation focussed on their primary task – i.e. for the NHS, the health of 67m people in the UK.

Of 1.5m NHS employees, about 30,000 (and stable) are managers = 2% (ref). Whereas the average across all organisations – e.g. JLR or Marks and Spencer – in the UK is 9.5%. Maybe if we had more and better paid managers, productivity would improve.

So the NHS if anything is under-managed.

Summary

We have described what is a NHS hospital manager – and what do they do. It is a good and rewarding career. Why don’t you look into it?

Other resource

Many managers do a NHS training scheme. This can be done at the same time as working in the NHS.

Written by Kirean Dingley – Operations and Performance Manager

Last Reviewed on 23 June 2024