It is clear that if clinicians do not manage their own environment and resources, there are a number of others who are perfectly willing to do so. Managers must be capable of managing change by paying attention to the environment and yet have the ability to question the wisdom of the day without giving in. Managers must be aware that their role and their primary task are the same, i.e. to deliver good-quality health care for the benefit of their patients.

Successful managers achieve their aims by demonstrating enterprise and initiative, and by thinking analytically as well as influencing strategically. (3) Managers have to be aware of their own strengths and weaknesses, and must have team members around them who can complement their skills.

Leadership skills are not always hereditary, as has been demonstrated time and again in political dynasties. Some skills can be acquired but others cannot be learnt. It is vital that managers work with their teams to develop clear aims which can be achieved by co-operation and careful planning.

Some of these characteristics overlap and are present in the same individual, and individuals may change their roles as they develop and gain personal growth. The success of the team depends upon leadership qualities, which have often been described as democratic, and the team structure. Although democratic leadership may be easy when there is plenty of time to perform given tasks, a dictatorial style is vital when decisions have to be made urgently. Unfortunately, this is the style that appeals to most people if they want to demonstrate their position or power. There are problems in both approaches, and a good skilled clinician will use either or both by working within the constraints of the team.

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