The Stress of Hospital Management

The myriad of pressures physicians face and the danger of burnout on the front lines of medical care have been examined extensively—both before and after the pandemic.

But what about individuals on the administrative side, specifically those at the executive level? Recent research shows healthcare executives are increasingly at risk of burnout as they do their best—under extremely challenging conditions. Jeff Comer, PsyD spent two decades as CEO of large urban medical centers and small rural hospitals; today his work focuses on stress management for executives. In a recent essay, he explained eloquently the pressures healthcare administrators labor under. Here are some excerpts:

Leading hospitals is challenging and stressful, and it takes a significant toll on the personal side as well. But it is a tremendously important job. The decisions we make can literally determine whether a hospital survives or fails. The closure of a hospital, particularly in rural settings, can be devastating to the community who lose their doctors and the workers who lose their jobs. Unfortunately, the focus for stress management in health care typically centers around front-line workers, which is certainly necessary. However, administrators also need assistance managing stress. This in-and-of-itself causes stress because when are we supposed to find time to take care of ourselves? 

One of the reasons a hospital administrator’s job is so difficult is because there are so many stakeholders we must consider in our decisions. And frequently these varied stakeholders have different and even competing agendas. This can leave the administrator in the middle trying to figure out how to get stakeholders moving in the same direction. 

This scenario is further compounded with the multiple additional stressors administrators face.

1. First, administrators must achieve their goals, which is particularly challenging with today’s continually decreasing margins and ever-increasing satisfaction and quality targets. As a CEO, I still become frustrated when the targets frequently change for no apparent reason, leaving me scrambling to update and communicate strategy.
2. Second, administrators often hold the perception that they must always show strength and certainty. As the leader you are supposed to take definitive action, have all the answers, and display unwavering confidence. And yet, I can easily remember how many times as a CEO I walked into a room nervous and uncertain, hoping no one would notice.
3. Third, administrators work tremendously long hours. The average hospital administrator works a 12.5-hour day and then adds more hours on the weekend. This creates tremendous pressure and stress that carries well into the personal side of life. It also makes self-care quite difficult. I frequently get up at 3:45 in the morning to get a quick workout in for my mental well-being as much as anything.
4. Fourth, job security for administrators has hit a relative low with the average hospital administrator remaining on the job for an average of 18 months. Not only is losing a job stressful, but the resulting consequences of dealing with the job loss, beginning a job search, uprooting the family, and moving to a new location are stressful for you and the family. I once went to an ACHE seminar and an Interim CEO was speaking. She started her speech by saying, “We are ALL interim CEOs!” Quite true, but quite sad.

A final area of stress for administrators is that leading a hospital is a lonely job. Most of us do not expect this when we pursue this career. This hit me quite hard on a personal side when I realized that there is little glamor, and few thank-you’s in our roles. Hospital administrators often report a feeling of isolation with little meaningful and honest support….There are many other stressors affecting administrators – this list is far from exclusive, but the focal point is that administrators face tremendous stressors, many of which can feel uncontrollable and isolating.

The issues Dr. Comer discusses here are starting to receive the attention they merit. To learn more about the stressors that healthcare executives face, the documented danger of burnout in the medical C-suite and how changing the culture of medicine can help, read this powerful article by another experienced administrator who helps his colleagues cope, Steven Swanson, MD.