Managers in hospitals: between aspiration and reality

Hospital managers are caught between medical expertise and economic efficiency. You can read more about this challenge in the following article.

Hannes Sommer
Hannes Sommer
Founder & Managing Director Sinceritas Executive Search

Hospital managers are caught between medical expertise and economic efficiency. Their actions influence the quality and reliability of patient care and must remain financially viable at the same time. The severe staff shortage and the increasing complexity and digitization of processes are placing greater demands on managers. This is just as true for hospital directors as it is for leading doctors in the respective clinics.

The clarity of professional training, years of practical training and the resulting logic of the hierarchy in the hospital nevertheless lead to bottlenecks in the workforce. There is a shortage of staff not only in nursing, but also at the highest levels of the medical profession, which is increasingly jeopardizing healthcare.

However, the measures being taken to counteract this are also changing hierarchical structures and working methods. At the same time, digitization is a great opportunity to relieve the burden on the workforce while maintaining a high level of medical care. After all, the German healthcare system is a global leader.

(Female) skills shortage in hospitals

The staff shortage is one of the biggest challenges facing managers. This affects nursing staff just as much as doctors. Both complain about the great physical strain of the profession, as PwC describes.
Chief physicians are also increasingly in short supply. This makes it all the more urgent to promote women to this position, as only 10% of posts are currently filled by women, even though more women study medicine on average. And although there are generally an above-average number of women in management positions in the German healthcare system. Although this still does not put Germany in a leading position internationally, the healthcare sector healthcare sector is changing in contrast to other sectors.

A change that politicians have supported with an initiative and a mentoring program for hospitals. As an example, female mentees at several hospitals were supported by experienced managers in developing a sustainable anchoring of equality-oriented organization and personnel development structures in hospitals. Topics included gender equality issues and the organization of working hours.
The higher the position in the hospital hierarchy, the greater the administrative burden. However, many doctors do not want to miss out on contact with patients. It is also becoming increasingly important for the younger generations to have a good work-life balance.

The hospitals themselves are therefore also taking unusual paths. Because too few women apply for the advertised positions for chief physicians, there are now hospitals where one position is split between two or even three chief physicians (as has been the case in Hamburg since 2021). Others may consider themselves suitable for a management position at an earlier stage. A course of study at the the Helmut Schmidt University of the Federal Armed Forces in Hamburg has set up a master's program on leadership in medicine.

On the one hand, it is therefore important to create different structural conditions for potential managers. Within a hospital, however, it is also a challenge for managers to motivate employees in uncertain times.

After all, the healthcare industry also has to cope in a VUCA and BANI world. These acronyms describe parameters in the Western world that are described as volatile, uncertain, complex and ambiguous. Or increasingly brittle, anxious, non-linear and incomprehensible. The uncertainty that these "volatile" and "brittle" conditions trigger among employees should at least be addressed to some extent.
The management style itself is therefore up for debate in order to continue to retain staff at a hospital and also to be attractive to prospective candidates.

Modern personnel management

In times of high volatility and uncertainty, what is considered appropriate must be decided again and again. The same applies to which strategies are used to reach younger generations. Further training on current topics is therefore beneficial for the management level.

In an interview with the auditing company EY - Germany, managers Dr. Thomas Wolfram and Rebekka Reckel talk about the difficulties faced by managers in hospitals and also advocate a coaching program. Their conclusion for a successful personnel policy, which they repeat "like a prayer wheel", is Honesty. Transparency. Commitment.  

This is less probable to be supported by an authoritarian management style. If hospital managers engage in open management, they are likely to retain employees or attract new candidates, as described here.

The Springer Hospital Report 2023 also talks about "transformational leadership" as a way of tackling the nursing crisis. This type of leadership therefore consists of four pillars: Idealized Influence, Inspirational Motivation, Intellectual Stimulation, Individualized Consideration.
The study also links to several studies that document the positive effect of this type of leadership.

Financial emergency in hospitals

In addition to staff shortages, financial bottlenecks are the next major challenge that hospital managers have to overcome. Even though politicians are trying to counteract this with a hospital reform that is still pending, more and more clinics are threatened with closure.

This is why hospital managers always need to have good business management skills. Unforeseeable pandemics, energy shortages or rising inflation also affect hospitals and need to be regulated and communicated. Just as employees should be treated with transparency, managers can hope for support. Because if communication is open, joint solutions can be created in the best case scenario. This could alleviate some of the pressure on managers to decide everything on their own.

In order to be able to provide care to all patients equally, managers need to be able to plan effectively and react quickly to possible uncertainties while working together with the staff. After all, between flat rates per case (Fallpauschalen), high energy costs, rising wage costs and staff shortages, patient well-being must ultimately always be guaranteed.

Future challenges and opportunities

The future of hospital management is influenced by a variety of factors, including technological developments, demographic changes, political decisions and social trends.

In addition, the increasing digitization of healthcare offers both challenges and opportunities for hospital leaders. The integration of technology into clinical processes can increase efficiency and improve patient care. It can also reduce the shortage of specialists. However, AI also places new demands on managers.

First of all, employees need to be found and retained. IT specialists are being sought throughout Germany and IT experts do not necessarily fit into everyday hospital life. People are therefore needed who can work at the interface between technology and medicine or who have attended a similar course of study.

Furthermore, it must be ensured that the technology is used sensibly and that data protection and security standards are adhered to. Employees and patients are highly concerned because there is always a part of the results of AI that is no longer understandable. It must also be ensured that the data is of high quality. In a world of VUCA and BANI, the task falls to hospital managers to both enable the infrastructure for digital applications and AI and to communicate their use in such a way that trust is established.


The expectations placed on hospital managers are therefore varied and demanding. They should not only coordinate clinical processes efficiently, but also ensure that patient care is of the highest quality. In addition, they must create a positive working environment that promotes employee motivation and commitment while ensuring compliance with legal regulations and guidelines. These requirements often involve ethical dilemmas and complex organizational challenges.

As a hospital is staff-intensive, moods need to be addressed, as do the changing work expectations of younger generations. Managers therefore need a clever personnel policy. This includes communication skills, conflict management, strategic planning, ethical decision-making and team management.

However, through the development of leadership skills, continuous leadership development and the ability to adapt to changing requirements, hospital managers can be effective leaders and have a positive impact on patient care and employee satisfaction. The self-development of managers and openness to feedback and criticism from lower hierarchical levels is helpful for a modern leadership personality. By implecation, this can also be seen as a great support for the management level in order to ultimately secure the prestige of a hospital and medical care.