Hospitals are not a simple company, hospitals are not a simple factory, hospitals cannot be runned in the same way. Hospitals do not work wood, do not work metal, do not work meat, do not work a unliving material. Hospitals work people, work patients. Hospitals are meant to treat patients. Hospitals do not work numbers. This is something a person with a diploma in company management does not understand. In fact, how can someone with that diploma manage a company without have previously worked in the field? How can someone manage what he does not know and totally understand? How can a non-doctor manage a hospital? How can a doctor who had never worked in a hospital manage one in the best way?
Hospitals do not work numbers, hospitals work people.
I found an article published in The Guardian by David Brindle in 2011 that talks exactly about this issue, and the fact that a recent research concluded that doctors would be the best option. Hospitals could have done better during the last 30 years if doctors were in charge. A change in NHS following a 1948 report led to the decrease of doctors in leadership places. “Men in suit” took over and started running budgets in hospitals. However, the failure of having doctors in leadership places in hospitals is lamented widely in the present day. Additionally, a research conducted by Amanda Goodall in USA found a link between leading hospitals and leadership by doctors.
The author of the study analysed the top 100 US Hospitals in several fields. For instance, of the top 100 cancer hospitals 51 were runned by qualified doctors. From the 6500 US hospitals only 235 had doctors as chief executives. These numbers mean that results could be even better if more hospitals were led by doctors. According to Amanda Goodall, doctor-led hospitals had quality scores 25% higher than other hospitals. The author says one interesting and important thing: “It seems that age-old conventions about having doctors in charge – currently an idea that is out of favour around the world – may turn out to have been right all along.”
Doctor-led hospitals had quality scores 25% higher than other hospitals.
Julian Le Grand, professor of social policy and former senior policy advisor to Tony Blair stated other important idea. Doctor-managers “have that great thing that they command the respect of their colleagues, which is a fundamental problem where chief executives come in from outside.” For me this is one main idea, and a major problem in today’s administrations boards in Portuguese hospitals. Some are runned by doctors who had never worked as a doctor in a hospital, had never seen a patient, do not understand how medicine works in “real life”, how important is the doctor-patient relationship. These doctors in leadership places are not recognized by their colleagues, these “doctors-like administrators” are not leaders. So… How can they know what a hospital needs? How did they get the chief-executive place? Why are these doctors and non-doctors running hospitals?
Since some years ago, administration boards are political places. They are chosen for that place because they are side by side with government program and ideas. Who would a government that does not invest in health care choose to run hospitals? Money is important, but health care also is. The best way to run a budget is to have someone in charge that knows a lot about the job. Only this person will know where to best spend the money. This is true for all companies, factories, and of course hospitals, I think. In the case of a hospital, if the chief-executive only knows about numbers, will run the hospital based in numbers. This is what we are seeing in Portugal. Administration boards only talk about numbers, and the disaster is becoming bigger and bigger. Unfortunately, other leading places are being chosen by political reasons. Who do you think they will choose? Leadership should defend workers, patients, and health care services before the government. Nowadays, this may not be the case in several hospitals.
Who would a government that does not invest in health care choose to run hospitals? Leading places in hospitals must not be political ones.
Do not forget that patients only come to the hospital to seek medical assistance. People go to the hospital to see the doctor. Health care professionals (doctors, nurses, health technicians…) are the only indispensable workers in a hospital, administrators are not.
An urgent change in hospitals leadership is necessary. Leading places in hospitals must not be political ones. A leader cannot be chosen, a leader is naturally born. If the hospital leadership is not respected by workers, nothing good will arise. If administration boards composed by non-doctors who only run based in numbers will keep being chosen, health care service will keep its descending quality route. Portugal is an example of this!
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Dr. Carlos Eduardo Costa Almeida
General Surgeon
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