Evaluation of physicians as hospital managers

Abstract

BACKGROUND: It is indisputable that hospital administrators especially chief executive officers (CEOs) have been playing more and more significant roles in hospital management since they kind of determine the performance of hospitals as captains do on the ship. Unsurprisingly, the discussion of what excellent hospital managers look like and where they come from is becoming more heated in recent years. Although some countries such as US and UK started hiring non physicians as hospital senior managers last century, aiming to leverage their business skills in order to improve hospital financial performance such as revenue and margins and control operation cost, there is a lack of enough evidence to show they perform better comparing with traditional physician executives regarding successful execution and management. In addition, how to cultivate hospital top managers in a both effective and efficient way is still under the question.

OBJECTIVES: To review the citations in order to evaluate physicians as hospital leaders in terms of clinical performance of hospitals, and try to figure out the factors which may be accountable for the manpower planning of hospital managers.

METHODS: MEDLINE (OvidSP) and PUBMED were used for systematically selection for key words, and the reference list of the results was also further examined to identify relevant articles. SWOT (strengths, weaknesses, opportunities, threats) analysis on the basis of the data retrieved to illustrate the positive and negative, as well as internal and external factors relevant to physicians as hospital managers.

RESULTS: 352 citations in total were searched at the first beginning and 16 articles were covered in this paper. It is agreed that leadership, business acumen, experience, the ability to manage up and down effectively and so on are consisted of the essential hospital CEO’s skill set, as same as CEO’ in other industries. Management education in health care appears to be generally considered crucial and necessary. There is, however, no clear consensus with regard to when in the medical education continuum, how, and for how long managerial education should be provided. MBA or MHA background is not as useful and helpful as we used to consider in terms of physician managers’ career development program.

CONCLUSION: There is still a shortage of evidence indicating who is more suitable for the hospital administration position, physicians or non physicians because it is agreed that the standards of assessing hospital performance and accordingly evaluating hospital executives’ performance are still not clear and unified . However, it will be better if hospital managers have dual competencies in both clinical and business fields. Either medical-oriented or business-oriented is insufficient for extraordinary hospital leaders. In addition, the managerial capabilities of medical directors are the key to success. In responds to this consensus, when and how physicians are trained as business managers is critical because it is difficult for non physicians such as MBAs to be educated clinical skills. And thus the timing of education related to business knowledge and skill for physicians and the impacts are twofold. On one hand, “too early” cannot achieve the outcome as good as expected since physicians still lack of enough clinical experience. On the other hand, “too late” will cause the problem that senior clinicians hesitate to change into managers because they have already put a lot of energy and time into clinical work. As a result, role of policy makers in healthcare Human Resource is necessary and vital so as to balance the costs and benefits and to develop an appropriate pathway. These findings could give some hints for the government, to take into consideration whether to invest in better training programs or to enact regulations on manpower planning of hospital executives with aim to gain the further success of hospital management.