Pure plays and hybrids: Acute trust management profile and capacity

Abstract

Objectives To identify the management populations of acute hospitals, and to consider how the composition of this critical but criticized group affects managerial capacity. Methods A multi-method study of six acute trusts, involving 1200 managers in setup interviews, focus groups and a survey. Interviews with senior managers identified the key middle management groups in their trusts. The workforce information offices at two trusts estimated the management numbers from their databases. The findings were compared with the NHS Information Centre data on the number of ‘managers and senior managers’ across the service. Results The management population of an acute trust includes ‘pure plays’, whose roles are mainly managerial, and ‘hybrids’, whose roles combine managerial and clinical duties. Together, pure plays and hybrids comprise around 30% of staff in an acute trust, and even this may be an underestimate. Hybrid managers typically outnumber pure plays by four to one. NHS Information Centre data indicate that only 3% of all NHS employees are ‘managers and senior managers’. Conclusions In a climate of cost reductions and radical change, acute trusts have challenging management agendas. Policy to ‘cut management’, if focused on pure plays, increases the managerial burden on hybrids, diluting their clinical focus, and potentially jeopardizing the change agenda along with quality and safety of patient care. To strengthen management capacity, acute trust leadership and management development programmes must target the full ‘hybrids and pure plays’ population, and particularly hybrids who comprise the majority.