Medical Management The primary goal of both private- and public-sector medical organizations is, of course, to provide the highest standard of medical care to their patients. This requires, of course, professionals who are trained in the latest scientific and medical techniques and both private and public health-care institutions in Great Britain in general accomplish this element of their task. However, providing quality health care is not simply a medical issue: It is also a question of management principles and in this area it is all-too-often the case that health-care organisations fail. It is perhaps inevitable that publicly run health-care institutions are even farther a field in their management style from the best run corporations than are privately run health-care institutions (which are legally constituted along the lines of other for-profit firms) and this fact has a number of important drawbacks for institutions that are a part of the NHS. However, it must be acknowledged that there are some advantages that institutions that are a part of the NHS have some advantages that privately run institutions do not.

It is certainly true, however, that while on the whole publicly administered health-care organizations have farther to go in terms of approaching a state of the most highly skilled management, both publicly and privately administered health-care institutions can improve their management strategies. While this is not a trivial task in any sense, neither is it an insurmountable one in no small measure because health-care organizations have the advantage of being able to borrow and borrow liberally from the advances that other firms have already made. Health-care organizations may be particularly aided in borrowing from the management strategies of high-tech firms because the two types of organizations share key management challenges.

Both high-tech firms and health-care organizations share the need to be able to meet the needs of an increasingly mobile workforce even as they are able to obtain from these same often-transient employees their best work. In our uncertain economic times, employees feel increasingly less loyalty to their employers and are more and more likely to consider themselves to be independent contractors whose fealty is to themselves alone. This means that every aspect of staffing at health-care organizations - from recruitment to retention - is increasingly difficult. This in turn means that senior managers must take on increasing responsibilities, especially in the arena of communicating with workers at every level and in every department of the organization.

The Centrality of Communication

This communication must be aimed at reconciling the different needs and stakes of various employees as well as of the patients themselves. Effective managers are those who create a work environment in which each employee is used to his or her best advantage but also feels that he or she is begin fulfilled. Balancing the needs of both employers and employees - while taking in to account people's skills - is a difficult task and requires well-developed communication skills. An effective manager must recognize the various individual needs and desires people and be able to facilitate communication about these issues. This is true regardless of the field, but is an issue that has generally received more attention within the sphere of private firms rather than publicly administered services. The managers at the NHS hospital in this study all too often failed to listen to attentively to their employees (or the patients), perhaps because they believed that the possible responses that they might make were so rule-governed that it did not matter whether they were attentive or not.

Good managers must understand how human needs cause people to act as they do and how their motivations and actions can be changed. In their book, Getting To Yes, William Ury and Roger Fisher emphasize the need to recognize these basic needs before moving on to other aspects of communication.

What is true for individuals remains equally true for groups and nations. Negotiations are not likely to make much progress as long as one side believes that the fulfillment of their basic human needs is being threatened by the other (49).

Communication is the act of sharing information through connections that we make with other people - whether in speech, writing, or through body language. Most of our daily communication is personal communication, a sharing of information with one person or perhaps a few people. Good communication skills include both the ability to convey one's own ideas clearly as well as to listen carefully to other people's ideas. And yet despite the centrality of good communication...

But what exactly do these good listening skills that a leader should have consist of?
First, a good manager demonstrates a sincere interest in what her or his workers have to suggest. Since "communication is a dynamic, reciprocal process" (Brownell 230), a good manager will be an attentive listener - striving to gain a more accurate understanding of what an employee is saying. The employee in turn will sense this attentiveness because the manager is providing appropriate feedback to what the worker is saying - something that is only possible through careful listening.

Managers must demonstrate a sincere interest in what others are saying; in other words, if someone expresses a concern about an issue that is important to the speaker, a yawn and a nod are not appropriate responses. These are typical human responses (especially toward the end of a busy day), and the manager must be particularly aware of this tendency to downplay the importance of what others have to say.

A good leaders develops "active" or "empathetic" listening skills. Much of the time spent by managers involves communication in one form or another - from internal memoranda and e-mails to telephone calls and meetings to personal interviews. Each one of these demands active listening. Stewart & Thomas (379) define active listening as "effective sensing, interpreting, and evaluating the other person's meanings" - a definition reflected in the anonymous maxim, "I know you believe you understand what you think I said, but I'm not sure you realize that what you heard is not what I meant" (Howell 9). The findings of this research have been that those in executive and supervisorial positions at NHS organizations are less likely to engage in these kinds of highly effective communication behaviors than are those at privately administered health-care organizations. This may be because of the inherent structure of each type of organization, its "corporate culture" or because of the differing backgrounds of the managerial staff at the two types of hospitals, with those at NHS facilities more likely to have spent their lives in government service and in highly bureaucratic organisations while those working for privately administered health-care organisations may not crafted their management philosophies in the private sector where competition (both in terms of competing against other health-car organisations for patients and in terms of competing against other organisations in terms of hiring and retaining the most highly qualified staff) is a more central concern.

Reengineering the Hospital

It often seems that many of today's businesses simply do not have the leadership that they need - or at least to both John Kotter, in his What Leaders Really Do and Michael Hammer and James Champy, in their revised book Reengineering the Corporation: A Manifesto for Business Revolution - argue this point. This is true not just within the arena of health-care but in general in our high-tech world. This should perhaps make those managers within the field of health-care who are struggling feel reassured that they are not alone; however, they should not be satisfied with struggling to meet their goals simply because others are given that there are clearly more efficient ways to manage both people and other resources than we see in today's publicly and privately run health-care organisations.

The problems that we see both within and outside of health-care result not of incompetence on the part of the entire managerial class but rather of a failure of many companies and their managers to make the changes necessary to keep pace with the rapid technological and human resources changes that are occurring in the business world. Hammer and Champy in particular argue that the primary problem with the management of both large and small companies today is the fact that companies are still using a mid-twentieth-century - and even in some ways a nineteenth-century view - of the process of work and of the relationship between employer and employee. Kotter argues that managers all too often manage without leading, failing to understand the complex ways in which staff relationships are created and maintained. (This is not necessarily different from Hammer and Champy's argument, for the traditional relationship between employer and employee was not characterized by…