Federal Conference of Austrian
Hospital Managers (BUKO) and Karl Landsteiner Institute of Hospital Organsiation2
E-mail: [email protected]
1 From the German version of Wikipedia - the free encyclopaedia.
2 This article is not the official position of these organsiations but reflects the personalopinions of the author.
The cover of Hospital 5/2005 posed the question: “Medical Director - A model for the future?”.Without dwelling on the detail of the articles featured in that issue, this contribution sets out one expert’s position in this debate.
Europe has a range of models on how and by whom hospitals should be run. In the German speaking countries, advocates of clinician-managed hospitals are on the increase, mainly within the medical profession itself. They argue not only that doctors should be involved in hospital management, for instance as members of the board, but they should be appointed to the post of hospital director. Is this a valid argument?
To avoid any misconceptions, it should be noted from the outset that hospitals cannot function properly in the absence of inter-professional, multidisciplinary teamwork. It goes without saying, therefore, that senior management must have access to medical, nursing, pharmaceutical, technical and other expertise. This can take many forms, for example, appointing nursing, medical and administrative representatives to the board, holding hospital conferences, and establishing advisory committees or other mechanisms. Notwithstanding these qualifications, management should be the function of generalists rather than medical professionals.
To begin with, let us define management1: “The role of management is linked to effectiveness, systematisation, professionalisation, targeted control and efficient economic activity. The task of a manager is to plan, implement, monitor and adapt measures aimed at furthering the goals of the organisation or company and all its stakeholders, utilising all operational resources available to him.”
Management is, therefore, a superordinated role encompassing communications, control, strategy and a significant element of economics. The role of the manager is to see the “big picture” and take a global view of the range of issues he faces. As well as learning the fundamental tenets of business and economics, students of business, hospital management or economics acquire global management expertise. Doctors, on the other hand, even in their basic training, are imbued with the notion that their primary concern is to meet an obligation to the individual patient. They are socialised to find individual solutions to specific problems. Clearly then, managers and doctors work within different professional cultures.
Running a hospital department is undeniably a highly responsible management position (unfortunately, the process of appointing medical directors tends to attach more importance to specialist knowledge than organisational and leadership ability). Medical departments, wards and the individual patient are where management functions requiring medical, specialist or nursing expertise take place. It is in these settings that decisions requiring “medical expertise and experience of day-to-day medicine” or “an understanding of the priorities in the daily routine” are taken. However, the administrative side of the hospital does not need input from a specialist consultant, nor does its board need a doctor “to represent the interests of the medical profession”. After all, there is nothing to say mechanics or Formula 1 drivers must sit on the boards of car companies.
Hospitals face a growing number of challenges, including: the increasing scope and range ofservices, stagnant or even declining levels of funding, more exacting - evidence-based - quality demands, staff shortages, competition with other hospitals and demands to optimise service processes. To meet these challenges and realise its goals, a hospital must have excellent, highly qualified staff. It also needs one outstanding senior manager with an exceptional personal profile and an outstanding insight into management. The latter is best acquired by studying business administration or hospital management although it is also important to have several years’ experience in frontline health services. It is irrelevant whether a person trained as a doctor, nurse or technician before taking a course in management. A person who qualified as a doctor or nurse before acquiring a management qualification can become an excellent hospital director. Hospital specialists with a qualification in business or administration, i.e. commercial directors, are best suited to the requirements of the modern generalist. The dominant approach in many countries is to give the commercial director overall administrative responsibility. I believe this trend will prevail and become the model for the future.