By virtue of clinical experience, the consultant is also the clinician who stays the longest in the multidisciplinary team. The clinical responsibility of the psychiatrists comes under the umbrella of professionalism which in turn is characterized by self-regulation—using one' own judgement and professional freedom or autonomy. Professional autonomy may result from intensive education or personal responsibility. On the other hand, a manager (even though a professional, highly educated, and to some degree autonomous individual) still tells other people what to do. The conflict produced within an individual between being a clinician and subsuming some degree of freedom and autonomy to be a manager is quite important. Successful managers and clinicians are able to combine these disparate skills and deal with the conflicts caused by the competing demands. The pressures related to clinical services—delivery of these services and development of new services—have to be resolved by the clinician-manager. The position of such an individual is strengthened by virtue of clinical training which enables him or her to identify the therapies which are evidence based and are likely to be successful and acceptable. The clinician is also better placed to differentiate between demands and needs, and to be able to recommend services according to needs of individual patients and their communities.
Psychiatrists often have the advantage of training in group work. Thus they are able to identify factions within such a setting and are able to identify clearer objectives and outcomes from meetings. Managing colleagues is not easy for clinicians, particularly when there is argument over the allocation of resources, but if the patients' needs are to be met then the clinician has to have the skills to fight for them.
A manager must avoid processes of demotivation which may well be related to stress within the team, manifested by absenteeism, increased sick rates, lateness, poor communications, non-participation, poor quality of work, and sudden bursts of anger. There are many reasons for demotivation including lack of recognition, boredom, lack of involvement in decisions, poor communication, lack of development, and work overload.(4) A good manager will listen, delegate appropriately, provide training, involve staff in decision-making, encourage ideas and suggestion, give praise where due, and treat people as individuals. In health-care settings the motivation of individuals is often more than simple financial self-interest and public recognition plays a very important role.
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