Nature of the Work:
Health services manager is an inclusive term for individuals in many different positions, who plan, organize, coordinate, and supervise the delivery of health care. Health services managers include both, the administrators managing or helping to manage the entire facility and health specialists and the managers in charge of specific clinical departments or services that are found only in the health industry.
The top administrator or chief executive officer (CEO) and the assistant administrators without specific titles are considered health care generalists. Although their titles may vary by type and size of institution, these managers set the overall direction of the facility. They also are concerned with community outreach, planning, policymaking, response to government agencies and regulations, and negotiating. Their range of knowledge is necessarily broad, including developments in the clinical departments as well as in the business arena. The job often includes speaking before civic groups, promoting public participation in health programs, and coordinating the activities of the organization with those of government or community agencies.
Institutional planning is an increasingly important responsibility for CEO's, who must assess the need for services, personnel, facilities, and equipment and recommend such changes as opening a home health service, for example, or closing a burn center. CEO's need leadership ability as well as technical skills in order to respond effectively to the community's requirements for health care while, at the same time, satisfying demand for financial viability, cost containment, and public and professional accountability.
CEO's have to be ready for the extensive oversight and scrutiny to which health facilities are subjected. Both past performance and plans for the future arc subject to review by a variety of groups and organizations, including consumer groups, government agencies, professional oversight bodies, insurance companies and other third-party payers, business coalitions, and even the courts. Preparing for inspection visits by observers from regulatory and accrediting bodies and submitting appropriate records and documentation are generally time consuming as well as technically demanding.
Some facilities may have one or more assistant administrators to aid the CEO and to handle day-to-day management decisions. There may be directors responsible for broad clinical areas such as nursing services or medical affairs and for other non-health areas such as finance, personnel, and information management.
Health specialists provide the day-to-day management of specialized departments like surgery, rehabilitation therapy, nursing, medical records, and so on. These managers have more narrowly defined responsibilities than the generalists to whom they report. Another characteristic of these specialists is the need to have specific training and/or experience in the field. For example, the director of physical therapy would invariably have been a staff physical therapist who has been promoted; a medical records administrator needs a bachelor's degree regardless ether amount of experience he or she possesses. These managers establish and implement policies, goals, objectives, and procedures for their departments; evaluate personnel and work; develop reports and budgets; and coordinate activities with other departmental heads, the top administration, and professional colleagues.
Although there are many common elements invaded in running a health facility, there are significant differences among settings that affect job duties. For example, hospital and nursing home management differ in important respects. The chief hospital administrator works with the governing board in establishing general policies and an operating philosophy and provides direction to assistant administrators and department heads who carry out those policies.
Nursing home administrators have many of the same management skills but are much more involved in detailed management decisions than hospital administrators. Administrative staffs in nursing homes are typically much smaller than those in hospitals nursing home administrators often have only one or two assistants, sometimes none. Nursing home administrators directly manage personnel, finance operations, and admissions. They analyze data and make daily management decisions in all of these areas. Because many nursing home residents are long-term, staying for months or even years, administrators must try to create an environment that nourishes residents' psychological, social, and spiritual well-being, as well as to tend to their health care needs. This long-term residency allows the nursing home administrator to have direct contact with the patients, something that few hospital administrators are able to do unless a problem arises.
In the growing field of group practice manager, managers need to be able to work effectively with the physicians who own the practice. Specific job duties vary according to the size of the group. While an office manager handles business affairs in very small medical groups, leaving policy decisions to the physicians themselves, larger groups generally employ a full-time administrator to advice on business strategies and coordinates the day-to-day management of the practice.
A small group of 10 or 15 physicians might employ a single administrator to oversee personnel matters, billing and collection, budgeting, planning, equipment outlays, advertising, and patient flow, whereas a large practice of 40 or 50 physicians would require a chief administrator and several business assistants, each responsible for a different functional area of management. In addition to providing overall management direction, the chief administrator would be responsible for assuring that the practice maintained or strengthened its competitive position. This is no small task, given the rapidly changing nature of the health care environment.
Assuring competitiveness might entail market research to analyze the services the practice currently offers and those it might offer; negotiating contracts with hospitals or other health care providers to gain access to specialized facilities and equipment; or entering joint ventures for the purchase of an expensive piece of medical equipment such as a magnetic resonance imager. Health services managers in health maintenance organizations perform all of the functions of those in large medical group practices.
Working Conditions:
Health services managers often work long hours. Facilities such as nursing homes and hospitals operate around the clock, and administrators and managers may be called at all hours to deal with emergencies. The job also may include travel to attend meetings or to inspect satellite health care facilities.
Employment:
More than half of all Health services managers work in hospitals. About a quarter of health services managers worked in nursing and personal care facilities and in offices of physicians. The remainder worked in outpatient care facilities, other health and allied services, medical and dental laboratories, and offices of dentists and other practitioners.
Training, Other Qualifications, and Advancement:
Knowledge of management principles and practices is the essential requirement for a position in this field, and such knowledge often is gained through work experience. Nonetheless, formal educational preparation is important, especially for those who wish to advance in the profession. For many chief administrative positions, a graduate degree in health services administration, nursing administration, or business administration is a decided asset. For all health specialist positions and some generalist positions, employers seek applicants who have had clinical experience, as nurses or therapists, for example, as well as academic preparation in business or health services administration.
Many hospitals are setting up separate ventures such as out-patient surgical centers, alcoholism treatment centers, and home health care services. When they operate at a profit, separate companies such as these can funnel needed revenue to the hospital. To operate and manage these subsidiary companies, hospitals look outside the health industry for managers with well-established skills in profit and loss analysis, marketing, and finance. Nonetheless, graduate education in health services administration remains a prerequisite for many upper level administrative positions within hospitals and their subsidiaries.
Academic programs in health administration, leading to a bachelor's, master's, or doctoral degree, are offered by colleges, universities, and schools of public health, allied health, and business administration. The various degree programs provide different levels of career preparation. The master's degree in hospital administration, health administration, public health, or business administration is regarded as the standard credential for many positions in this field. Educational requirements vary with the size of the organization and the amount of responsibility involved. Generally, larger organizations require more specialized academic preparation than smaller ones do.
To enter graduate programs, applicants must have a bachelor's degree. Some schools seek students with undergraduate degrees in business or health administration; however, many programs prefer those students with a liberal arts or social science background. Competition for entry to these programs is keen, and applicants need above-average grades to gain admission. The programs generally last between 2 and 3 years. They include up to 1 year of supervised administrative experience, undertaken after completion of course work in such areas as hospital organization and management, accounting and budget control, personnel administration, strategic planning, and management of health information systems.
New graduates with master's degrees in health or hospital administration may be hired by hospitals as assistant administrators. Others may have to start as managers of no health departments and work up to top administrative positions. Postgraduate residencies and fellowships are offered by hospitals and other health facilities; these are normally staff jobs.
Growing numbers of graduates from master's degree programs are also taking jobs in HMO's, large group medical practices, multi facility nursing home corporations, and clinics. Students should be aware, however, that mid-level job transfers from one setting to another may be difficult. Employers place a high value on experience in similar settings because some of the management skills are unique to each setting.
New recipients of bachelor's degrees in health administration usually begin their careers as administrative assistants or assistant department heads in larger hospitals, or as department heads or assistant administrators in small hospitals or in nursing homes.
The Ph.D. degree usually is required for positions in teaching, consulting, or research. Nursing service administrators are usually chosen from among supervisory registered nurses with administrative abilities and advanced education. Financing Administration was developing Medicare guidelines for nursing home administrators, but they had not been released.
Health services managers are often responsible for millions of dollars of facilities and equipment and hundreds of employees. To make effective decisions, they need to be open to different opinions and good at sifting through contradictory information. To motivate subordinates to implement their decisions, they need strong leadership qualities. Interpersonal skills are important in all settings, but nowhere more so than in medical groups, where success depends on developing a good working relationship with the physician owners. Tact, diplomacy, and communication skills are essential.
Like their counterparts in other kinds of organizations, health services managers need to be self-starters. In order to create an atmosphere favorable to good patient care, they must like people, enjoy working with them, and be able to deal effectively with them. They also should be good at public speaking.
Health services managers may advance by moving into more responsible and higher paying positions within their own institution; advancement occurs with promotion to successively more responsible jobs such as assistant or associate administrator and, finally, CEO. Health services managers sometimes begin their careers in small hospitals in positions with broad responsibilities, such as assistant administrator. Managers also advance by shifting to another health care facility or organization.
Job Outlook:
Employment of health services managers is expected to grow much faster than the average for all occupations through the year as health services continue to expand and diversify. Most job openings, however, will result from the need to replace managers who transfer to another field or stop working.
Hospitals will continue to employ the greatest number of health services managers, although the number of jobs will not be growing as fast as in other areas. Opportunities for managers in hospitals should be best in major medical centers as well as hospital subsidiaries that provide such services as ambulatory surgery, alcohol and drug abuse rehabilitation, hospice facilities, or home health care. Opportunities should be poor in small rural hospitals.
Employment in offices of physicians and other health practitioners, outpatient care facilities, health and allied services, and nursing and long-term care facilities will be growing the fastest and will provide many job opportunities.
Demand in facilities that provide ambulatory or outpatient care will be stimulated primarily by the expansion of HMO's and medical group practices, but continued growth of such facilities as urgent care centers, cardiac rehabilitation centers, diagnostic imaging centers, and pain clinics will play an important role, too. Ambulatory facilities such as outpatient surgical centers and after-hours clinics are expected to experience very rapid growth due to their convenience and competitive fee structure, generating additional management jobs.
With better medical care and healthier lifestyles, Americans are living longer than ever before. Very rapid growth is projected in the number of people 85 years of age and above and this is likely to exert strong pressure for an expansion of long-term care facilities and services not just nursing homes, but home health care, adult day care programs, life care communities, and assisted living arrangements. Opportunities for managers in the large and rapidly expanding nursing home sector should be highly favorable. Nursing home chains will need more management personnel at the corporate level to plan new facilities, acquire existing ones, and promote new services and activities.
Health service managers in hospitals will face very keen competition for upper level management jobs, a reflection of the pyramidal management structure characteristic of most large and complex organizations.
In nursing homes and other long-term care facilities, where a graduate degree in health administration is not ordinarily a requirement, job opportunities for individuals with strong business or management skills will continue to be good.
Related Occupations
Health service managers have training or experience in health and in management. Other occupations that require knowledge of both fields are public health directors, social welfare administrators, directors of voluntary health agencies and health professional associations, and underwriters in health insurance companies and HMO's.
