16 dr sudarshan-ballal-clinicians-as-healthcare-administrators_ncas_2011
Clinicians as healthcare administratorDr. H. Sudarshan Ballal MDMedical Director & Chairman Medical Director - MHEPL
Gist of talk Introduction Ingredients of a successful hospital Advantages and disadvantages of clinician administrator Difficulties in transition Ideal situation Conclusion
Who should lead the Hospital? OR MD MBA A billion dollar question
IntroductionIn the early 20th century, many hospitals were run by clinicians.Today the vast majority of them are run by non-clinicians likeMBA‟s & MHA‟s.The debate, clinician vs. non-clinician as an administrator of ahospital was succinctly covered by the Fortune Magazine in1970 and the Editorial declared……………"The time has come for radical change ... The management of medical careis too important to leave to doctors who are, after all, not managers tobegin with."
IntroductionHowever, the pendulum now seems to be swinging more towardsthe „Clinician Leader‟ as many believe that HEALTHCARE IS TOOIMPORTANT TO BE LEFT TO NON CLINICIANS
Ingredients of a successful hospital• 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
Can clinicians afford not to be administrator ofhospitalsClinicians used to run hospitals.Now they run behind administrators with concerns which theadministrators 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 whonever entered the portals of any medical college.
Can clinicians afford not to be administrator ofhospitalsClinicians are told they “DO NOT SEE THE BIG PICTURE”.The big question really is, CAN THEY AFFORD NOT TO BETAUGHT TO SEE THE BIG PICTURE
Disadvantages & advantages ofa clinician being administrator
Disadvantages of Clinician-administrator• Not well versed with the complexities of business & financial issues of todays health care business Case Mix
Disadvantages of Clinician-administrator• 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.
Advantages of a 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.
Difficulties in transitionfrom clinician to 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.
Ideal administrator of a hospitalIs it necessary to be a MD/MHA of MBA to be a hospitaladministrator?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 hospitals 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 hospitalIs 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”.
Conclusion 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.