Hospital CEOs Should Be Non-Physicians

Hospital managers should stay put for at least five to 15 years in their jobs to enable them to accomplish their tasks and fulfill the long-term goals they have set in healthcare, said Health Minister Seyed Hassan Qazizadeh Hashemi on Monday. 

He stressed that the executive affairs of hospitals should be assigned to non-physician CEOs and not medical specialists whose role as educationists should be focused “on imparting practical skills and knowledge to the hospitals,” IRNA reported.

“Unfortunately Iranian hospitals are still run through outdated and high-handed methods. In most of the hospitals, usually a physician is appointed executive director and head of the hospital, and all decisions are taken only by him. There is no group decision,” noted Hashemi on the sidelines of a meeting of educational deputies of Iranian universities of medical sciences at Tehran’s Shahid Beheshti University of Medical Sciences.

Most developed countries like Canada, France, UK, and Germany have a board of directors at their hospitals comprising medical specialists and physicians and a non-physician executive director whose task is to implement plans and decisions taken by the board of directors. 

Also the vast majority of US hospitals are led by non-physicians. In 2014, only 5% of hospitals were led by physicians, according to a study by the American College of Physician Executives. 

Today’s extremely complex healthcare operates in a constantly changing environment, requiring complex and demanding professional healthcare management. Therefore, in order to manage hospitals in a competent manner, the need for non-physician CEOs who possess various managerial skills as well as be familiar with problems in healthcare is strongly felt. 

The skills and ideas that the board brings to the table provide a fresh approach with significant patient benefits. In other words, the board of directors is charged with overseeing and directing clinical elements of management, in partnership with a non-physician CEO, who has extensive business education and experience, and is responsible for the non-clinical side of keeping hospitals running (IT, personnel and budgeting issues).

Of the 550 state-run and 350 private hospitals in Iran, only a handful are headed by board of directors. 

The ministry has proposed a plan to enhance the quality of care and treatment services in hospitals through establishing a board of directors comprising qualified physicians chosen through a professional qualification exam.

The Health Ministry had planned to change the current traditional system of management in at least 20% of all state-run hospitals, but this has not happened yet. 

Currently, some hospitals have board of directors but final decisions are still made by the CEOs. 

  Educational Hospitals 

Hashemi also said that at present there are 250 educational or teaching hospitals (affiliated to universities of medical sciences) across the country. About 30% of all state-run hospitals in Tehran Province are educational hospitals. 

He opined that the number of educational hospitals could be reduced to 150 by merging them so as to create a larger medical system. 

“As an example, there are 17 educational hospitals affiliated to Tehran University of Medical Sciences (TUMS) and the number can be reduced to one or two big hospitals through mergers.”

Currently, many hospital administrators believe that hospital consolidation helps improve efficiency, access to care as well as quality of care, and ensures cost savings, because they can rationalize service delivery and coordinate care more effectively in an integrated system. 

Reimbursement challenges, spiraling healthcare costs, and a slow economic recovery are driving the latest wave of hospital consolidation globally. Health insurance companies and provider systems are forming partnerships in the consolidation field with the goal of reducing healthcare costs and improving quality. 

Earlier, the health minister said teaching hospitals are not completely funded by the government and they raise a part of their budget through medical bills paid by patients. 

“When educational hospitals rely on earnings from patients’ bills, they cannot achieve their goal of professional ethics,” he maintained.

With the implementation of the 2014 Health Reform Plan, more than 10 million people were covered by insurance, and people’s share of medical costs in university hospitals declined from 37% to 8%.