Clinicians as healthcare administrator

Dr. H. Sudarshan Ballal MD Medical Director & Chairman Medical Director - MHEPL

Introduction

Ingredients of a successful hospital

Advantages and disadvantages of clinician administrator

Difficulties in transition

Ideal situation

Conclusion

Gist of talk

Who should lead the Hospital?

MD MBA

OR

A billion dollar question

In the early 20th century, many hospitals were run by clinicians.

Today the vast majority of them are run by non-clinicians like

MBA‟s & MHA‟s.

The debate, clinician vs. non-clinician as an administrator of a

hospital was succinctly covered by the Fortune Magazine in

1970 and the Editorial declared……………

"The time has come for radical change ... The management of medical care

is too important to leave to doctors who are, after all, not managers to

begin with."

Introduction

However, the pendulum now seems to be swinging more towards

the „Clinician Leader‟ as many believe that HEALTHCARE IS TOO

IMPORTANT TO BE LEFT TO NON CLINICIANS

Introduction

• The most important person in the healthcare industry is „THE

PATIENT‟ and the big question is how do we attract and take

good care of this VVIP.

• In my opinion the ingredients neeeded are

• Doctors

• Service

• Infrastructure & Support system

• Brand name

Ingredients of a successful hospital

Clinicians used to run hospitals.

Now they run behind administrators with concerns which the

administrators think are outrageous demands and for more….

money, space and people.

They used to take care of patients the way they were trained.

Now they are told how to take care of patients by people who

never entered the portals of any medical college.

Can clinicians afford not to be administrator of

hospitals

Clinicians are told they “DO NOT SEE THE BIG PICTURE”.

The big question really is, CAN THEY AFFORD NOT TO BE

TAUGHT TO SEE THE BIG PICTURE

Can clinicians afford not to be administrator of

hospitals

Disadvantages & advantages of a clinician being administrator

• Not well versed with the complexities of

business & financial issues of today's

health care business

Disadvantages of Clinician-administrator

Case Mix

• 'God complex' still exists and fail to

understand the changing equations of doctor

/ patient relationship, new business

development needs & strategies.

• May favor investments based on personal

preferences rather than on hospitals

business interests.

Disadvantages of Clinician-administrator

• Resist change (HIS)

• Egoistic – feel they are a cut about the

rest. Need not follow the rules applicable

to the rest of the employees.

• Valuable clinical time may be lost for

Administration issues (A constant patient

complaint)

• Very difficult to hire a 'Star clinician' but a

lot easier to hire a Administrator. Busy

clincians find it difficult to change their

practice locations frequently.

Disadvantages of Clinician-administrator

Becoming unpopular with colleagues as a result of difficult

service decisions made. Being considered a „TRAITOR TO THE

PROFFESION‟.

Being in the position of having to critically appraise colleagues‟

clinical practice and take action when necessary.

The job can sometimes be overwhelming, with the possibility of

burnout or ill-health if not tackled appropriately in time.

Problems in being accepted by non-medical managers.

Disadvantages of Clinician-administrator

Understands patients better since they are their life line.

Understands doctors better. Doctors would be more

comfortable and will have more trust in dealing with a fellow

clinician as administrator.

Continuity of service (very difficult for a busy clinician to

change locations)

Will understand the procedures better and could have valuable

contribution in coming up with feasible business strategies and

expansion.

Advantages of a clinician-administrator

Being in a position to attract resources for developments.

Having a major influence on developments and setting of

standards of clinical care.

Financial incentives and awards.

Gaining status within the trust.

Working on the broader canvas of the organization.

Advantages of a clinician-administrator

Major conflict is between having to give priority to the objectives

of the organization versus the objectives of individuals.

Difficulties with respect to lack of knowledge about the concepts of

management and lack of knowledge about technical matters, such

as statistics and finance.

Coping with conflicting demands.

Dropping the traditional case-by-case approach and adopting a

global view of the organization.

Loss of acceptance by clinical peers, combined with lack of

acceptance by new managerial peers.

Experience and formal training in management.

Major political dimension to management.

Difficulties in transition

from clinician to administrator

Is it necessary to be a MD/MHA of MBA to be a hospital

administrator?

Probably not.

There are many fine hospital executives who possess neither

degree. But I do think that all administrators should be

required to work closely with a panel of the hospital's

clinicians, focusing on how they can collaborate to improve

patient safety and health. Clinicians also should have a say in

how hospitals invest their surpluses.

Ideal administrator of a hospital

Is it necessary for a hospital administrators to be licensed?

Hospital administrators should be licensed. Doctors are

licensed, Accountants are licensed, dentists are licensed.

Common sense dictates that someone running a hospital

should be required to pass exams showing, not just that he or

she knows something about "management and

administration," but that he/she has a solid grounding in what

matters to patients-how to reduce errors and lift the quality of

care.

Ideal administrator of a hospital

In my opinion, there seems to be a barrier between the

medical fraternity and hospital administration.

It really does not matter who the administrator is as

long they take the medical fraternity along with them in

the decision making process.

Ultimately we all work for the most important person in the

health care scenario “THE PATIENT”.

Ideal administrator of a hospital

The Gap between Clinicians & Managers

Mending The Gap!

The vast majority of hospitals today are led by non-clinicians.

This is in sharp contrast to the turn of the 20th century, when

most of the hospitals were clinician led.

As the pendulum swings back towards the clinician leader,

there is a strong and appropriate opportunity for clinicians to

reinsert themselves into a leadership role.

In fact the time has perhaps never been more appropriate than

today.

Conclusion

In the current health care system that is complex, troubled,

and challenging, the clinician leader brings in a unique set of

skills to the business of medicine.

The successful physician leader, however, must understand the

business of medicine as well as or better than the practice of

medicine.

Training, developing, and equipping our future clinician leaders

with the necessary skill sets will be one of medicines' many

challenges in the future.

Conclusion

In conclusion, I feel it really does not matter who runs the

hospital as long as there is no feeling of Us vs. Them but

everyone should work as „WE‟ the team.

Conclusion

THANK YOU