The hospital is a theatre of operations where physicians battle managers – this rather martial metaphor of today’s hospital reality seemed indeed very apt at a recent symposium in Vienna where physicians and business administrators engaged in a ferocious verbal fight. Physicians are very poor managers who are clueless about business and economics, the business side declared. Humbug, the medical staff countered – physicians with clinical experience are the ideal hospital managers and it is MBAs that kill humanity in the hospital. The combatants took no prisoners.
While such fights may have a certain entertainment value for the detached onlooker, Dr Markus Schwarz, himself a physician with MBA training and head of the Vienna office of the international executive search consultancy Egon Zehnder, has little patience with such professional skirmishes. Whether a physician or an MBA leads a hospital, he says, is not at all the issue. The crucial factor that determines a hospital’s success is the skills of the people at the helm. ‘It’s not about basic training, but about the qualifications and leadership skills one acquires in the course of one‘s professional life,’ he explained in our European Hospital interview. ‘The person who understands the hospital as well as the necessity of long-term commercial success,’ he emphasises, ‘is the better manager.’ To understand the hospital means to acknowledge that a hospital is an organisation of experts – and experts, Dr Schwarz points out, need room – space in which to move, act and decide. Many managers with a business training, he concedes though, tend to set tight rules. In an organisation of experts, he is convinced this is not the adequate mode of operation.
An MBA, he underlines, does not necessarily mean a good manager. On the other hand, physicians who become managers have to develop an understanding of the overarching relationships and necessities in a hospital. They need to learn to look at medicine not from a demand point of view but from a resource angle. ‘A hospital manager has to weigh the interests of the individual patient and of all patients and the interest of the enterprise respectively,’ he says. There are indeed, he adds, examples of physicians who did not manage this change of perspective and are thus not good managers. Because hospital physicians are basically forced to assume management tasks, offering them the chance to acquire the necessary qualifications is of paramount importance – and those qualifications refer less to business issues than to personal and personnel development and leadership skills. ‘Seminars are only one component.
The most important things happen on the job,’ he confirms. Projects, process optimisation but also participation in professional associations – these are all good preparations for management functions. ‘Since healthcare systems differ enormously from country to country, different management skills are needed in different countries,’ Dr Schwarz points out. For example, in Austria, where hospital management is above all about managing existing resources, different skills are required than in Germany, for example, where managers have to explore and exploit new ways of healthcare provision as a business, or in Great Britain where efforts are underway to make the provision of healthcare more efficient using private business mechanisms.
No matter whether a hospital manager is a physician or an MBA by training – what is really important, Dr Schwarz concludes, is the personality: ‘The patient as a human being, and his or her health, must be close to the heart of any hospital manager. The manager has to be able to deal with a wide variety of employees and has to show a certain humility – to know that he is not omniscient.