Clinical medicine, and especially psychiatry, cannot be practised in isolation. Psychiatrists operate within the internal systems of their employing organisations and the external systems within which those organisations exist. It is, therefore, important that psychiatrists understand the context within which they practise. It is even more crucial that medical managers not only understand the systems but are also able to leverage this understanding to bring about service improvements, within omnipresent resource constraints, to maximise quality of care for their patients.

This chapter is set out as a checklist of areas that psychiatrists should seek an understanding of if they are to operate effectively within the complex healthcare environment. The lead author (A.M.) has covered some of these issues, especially in relation to finances and operations, in a recent publication (Malik et al, 2015) but has outlined them here as well for completeness. The work of relevant opinion leaders from the world of business and healthcare management has been contextualised to mental health services using the authors’ experience and knowledge of working in and managing such services in the UK. The overall aim is to provide the reader with a comprehensive coverage of areas to consider while managing mental health services.

The level of detail that readers need to be aware of will depend on the type of organisation they practise in, as well as their formal and informal extra-clinical activities, both within and external to their employing organisation. Key questions are listed throughout the chapter, which we would suggest readers seek the answers to, to increase their understanding of their own services. These key questions could also be used as the basis for a reflective learning journal. The chapter also indicates why these areas are important and how understanding them could help the psychiatrist in service improvement. Psychiatrists need to develop good working relationships with operational managers and work alongside them to gain better understanding of and enhance the healthcare service they provide.

Since political devolution in 1999, there has been increasing divergence between the healthcare systems of the four component countries of the UK. While each country has a tax-funded, universal healthcare service with similar operating principles and values, there have been differing priorities and policies for healthcare. For the purposes of this chapter, the authors will focus on the English commissioning system.