Good managers know they are there to support front-line staff, to make life easier and more efficient for them. They should be like theatre sisters, working at the clinician's side, handing out the right tool for the job, anticipating what instrument will be requested next and quietly keeping control in the background. Above all, they will attempt to minimise any intrusion they may cause.
By contrast, bad managers want to interfere and if they can boss around a few consultants, that makes them feel powerful and important.
The more complicated the systems they create, the more they assure themselves of a job in the future. The more they persuade themselves that they are needed, the better they feel.
Unfortunately, and devastatingly for the NHS, poor management greatly increases the workload and stress placed on front-line clinicians.
There are management sins of omission and commission. If managers don't do their jobs properly, front-line staff are impeded; they won't have the tools for the job. When theatres are shut, notes lost, wards closed through lack of nurses, or too few rooms made available in outpatients, clinicians are less efficient. This is managerial omission.
There are management sins of commission too. Management activity inevitably interferes with the work of clinical staff. Every manager/staff interaction takes up clinicians' time and the more managers there are, the worse things become.
The more managers try to analyse, control, monitor, revalidate, or otherwise interfere with the activities of clinicians, the more doctors' productivity drops. How many hospital clinicians have had to reduce their outpatient commitment drastically when they become departmental directors?
How can we counteract this? Two more targets should be added for hospitals: ceilings for the percentage spend on managerial salaries and the time clinicians spend on management matters. Rein in these two areas, and sanity and efficiency might start to descend on our beleaguered NHS.