How to be a great health care administrator

How to be a great health care administrator

In no other field is unity and collaboration between administrators and frontline staff more important than in health care. Unfortunately my own experience is that the disconnect and mistrust, especially from doctors and nurses, towards hospital administration is growing larger all the time.

Let me start off by saying that I have intimate experience of both sides of the divide. Obviously as a physician first and foremost, my loyalty is usually with “my own people” (as it should be). It took years to become a doctor, I consider it an honor to be one, and I enjoy my job. I’ve been fortunate enough to work with some very good administrators, but along the way I’ve also met some who leave a lot to be desired.

I’m going to try to take an objective view here. The biggest shortcoming of the worst ones — and by “worst” I mean the ones who fail to grasp what frontline medicine is all about — is that they seem to view health care as all about numbers and statistics. These administrators obsess over the figures, go over patients’ health statistics and metrics as if they were browsing over a shopping list, and fail to properly understand the reasons why barriers exist to achieving what they want. Most importantly, their focus on numbers comes way ahead of any concern or perception about the realities of the coalface. This applies almost exclusively of course to the “non-clinical” administrators. At this point, one could make the argument that the job of any administrator is to make sure the organization is intact and numbers balance. True to an extent.

But if you look around at the best and most successful companies out there — whether it be Apple or Wegmans — companies with stellar reputations and generally high customer satisfaction, you will notice that the leaders of these companies are just as focused on the end-user experience as they are on any numbers. Yes, their companies make a lot of money, but they also consider the customer experience to be the crucial part of the service they provide.

Furthermore, these organizations are known for treating their workers well and making sure conditions are first rate. In other words, they understand what the real deal is. My advice for all health care administrators is to do the same, and then some. When you see a number or statistic in health care, remember that this is a real person on the line. Their visit to the hospital was quite possibly the lowest point in their life for both them and their family. It may have changed them profoundly and they will vividly remember everything that happened. When you are looking at their length of stay, discharge time or hospital bill — always keep this in mind.

The best health care administrators I’ve seen have been the ones who have regularly “walked the factory floors,” gaining an understanding of what their frontlines are all about — talking to patients, doctors and nurses. This in addition to solid organizational skills and business acumen. There’s a common misconception that it has to be a choice between these two:  connecting versus being a numbers person. It’s perfectly possible to balance.

As a reader of many autobiographies of famous people, this is a trait of many great leaders. I once worked with a hospital CEO in Florida, albeit in a smaller hospital, who could frequently be seen roaming around the medical units, heartily greeting people and chatting to them. He even put his personal cell phone number in every room on a sign that read something like “I hope your stay is good. Please call me directly with any concerns.” How refreshing. While this is obviously not replicable everywhere, he was a popular leader who was also achieving good results (and in case you are wondering, his phone wasn’t rung nearly as much as you may think). Similarly I remember the CEO of the hospital where I did my residency in Baltimore taking impromptu walks around the hospital, shaking hands and getting to know the staff and their everyday jobs.

Health care administrators, remember that your “workers” are among the most dedicated, caring and hard-working professionals that you could ever meet. They deserve to be treated well. You are not only doing your own work a great disservice, but also yourself, if you miss this opportunity to grasp the heroic work that goes on all around you. Making painful and unpopular decisions is part of leading any organization or entity, but that isn’t to be worn as a badge of honor or mean that you have to spend most of your day in the office.

As for the doctors and nurses, I would say that it’s sometimes all too easy to harbor negative feelings towards administration and see it as an “us versus them” fight or the “white coats versus the suits,” We can also take the initiative to bridge the divide and reach out with our concerns. Knowing and being friends with many administrators, they do have a very important job to do too and are just as human as the rest of us. That doesn’t mean that we will always get our own way (nobody ever does) but collaboration is the only way forward for health care. Let’s all work together. It starts with having the best and most sincere leaders in place.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

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  • DeceasedMD

    the difference between wegmans and apple and HC is who teh customer is. In HC kind of like FB with the user of services as the object not the customer. All depends who is really paying the big bucks for the services.

  • buzzkillerjsmith

    Dr. D. has drunk the Koolaid. Non-physician admins having any power whatsoever over docs is completely illegitimate and I for one will never be convinced otherwise. They should be working for us.

    Next case.

    • rbthe4th2

      Considering some of the egos’ I’ve seen, I have cause to doubt this. Other professions do have competant admins, and health care could be that way also. Doctors are not special, and that mentality is one of the reasons we have us vs. them with patients and HCP’s.

      • buzzkillerjsmith

        Please see the response above.

        • rbthe4th2

          and the response above is why a good number of people are starting to distrust doctors more and more each day. A graduate degree is all docs have and there is no excuse they don’t submit like everyone else.

          In the end that is ALL docs have: a graduate degree from college and training. No more or no less than any other profession has.

          • buzzkillerjsmith

            I guess I know where you stand on this.

          • rbthe4th2

            Logic and facts. The world is changing, for good and/or for bad. Medicine and its culture has to adapt to that. We’ve learned that many of us can read medical information and understand it. Just because doctors had power in the past, doesn’t mean they’ll get it in the future. They will have to adapt to the new world view.

    • Joe

      I have to disagree with you here. I’ve worked with good and bad of both types and painting non-physician admins as “completely illegitimate” is using way too broad a brush. I’ve found far, far too many physicians who know absolutely nothing about business operations being entrusted with the keys to the kingdom. Dirty Harry’s famous quote of “A man’s got to know his limitations” applies here. Non-physician admins do fine when they understand theirs. My experience is that many of them do so and are open to education from the physician side. Granted, I have worked primarily in smaller community hospitals, so my sample size might be biased a bit.

      • buzzkillerjsmith

        Therefore docs should hire admins to run the business side and the admins should tell the docs when they are running it into the ground.

        Thanks for agreeing with me.

        • rbthe4th2

          It was insurance admins who took my questions to my doctor to ask what his medical reasons based in research for denying me surgery was. Because they controlled the purse strings, I got surgery because the doc could blow me off but he couldn’t blow them off.

          Sorry, when it comes to patients not getting care, admins can be supportive.

          • buzzkillerjsmith


        • Joe

          And when the docs refuse to listen to the admins when they explain how and why the physicians are running it into the ground? This is about good management. Nothing about being a physician guarantees that a person has good managerial skills. It’s often quite the contrary.

          • buzzkillerjsmith

            You and I might be talking about different things. It is fine for non-docs to run hospitals. I’m talking about running medical groups. The docs should hire the admins. The admins should have good admin skills but should not supervise the docs. That leads to gross perversions of incentives.

            If the docs don’t listen to competent money guys, then they are idiots and deserve to go out of business. As is their right.

            One caveat, though, is that market manipulation has eroded the medical group business model. Not a fair playing field at all.

            I have also stated many times at this blog and elsewhere that MDs should not work for hospitals. I’m not going to take the time to go over all the mis-incentives.

          • Joe

            Yes, and I apologize for misreading you. My experience with administrators is strictly hospital-based. I concede that I have never worked with anything like a medical group and have no clue as to many of the dynamics there. From the outside looking in, there always seems to be a lot of internal and external bad blood.

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