Open management in the hospital

How employees want the future of hospital management.

Hannes Sommer
Hannes Sommer
Founder & Managing Director Sinceritas Executive Search

More than ever, hospital employees are becoming a valuable asset worth preserving. Hospitals are suffering from both demographic change and a shortage of skilled staff. However, the fewer employees have to take on tasks, the more dissatisfaction increases. The nursing shortage has been a topic of discussion for years and the excessive demands placed on employees in understaffed positions are well known. But young doctors are also complaining about the workload, according to a survey by the Young Doctors' Working Group of the Hartmannbund:

Survey: Young doctors are losind their job satisfaction 

It is therefore not only important to attract new specialists to hospitals and make the jobs attractive. It is just as essential to retain the existing workforce.

The management style in the hospital plays an important role here. In a survey conducted by Sinceritas survey conducted by Sinceritas, employees across all sectors stated that they prioritize open management and transparent communication.  

This means that this type of personnel management is desired and is not yet sufficiently present. However, it is up-to-date and is also mentioned in job advertisements for chief physicians as a "cooperative management style", as seen at Klinikum Worms  or for applicants.

Leadership style in the hospital

An open or cooperative leadership style can be understood in opposition to an authoritarian (also autocratic) or hierarchical leadership style.

To put it briefly, a manager in an authoritarian management style determines tasks, gives criticism from above (top down) and sets working hours, even for short periods of time, depending on the situation. There is no provision for employees to have a say.

This can be an advantage because decisions have to be made quickly in hospitals and the duty roster has to be constantly adapted to staff shortages and medical needs. As a result, employees may not feel left alone and are not held accountable. (A difficulty of the laissze-faire style, which will not be discussed further here).

However, as the above-mentioned survey by the Young Doctors' Working Group of the Hartmannbund shows, it is important for employees to have a "reliable duty rota" and regular working hours. They also want "respectful interaction" between colleagues, less bureaucracy and "smart digitalization".

Furthermore, it is also important to work across departments in hospitals. With an authoritarian management style that may not allow opinions from other departments, important information could be lost. Interdisciplinary cooperation enables great gains to be made in diagnosis and care.

In contrast to the authoritarian style, open management in hospitals is based on the principles of transparency, communication and participation.

This also increases employee motivation and a sense of belonging to the company.

In a microsociological study on leadership in hospitals from 2018, the author even comes to the conclusion that the indifferent and authoritarian leadership style can weaken the performance effectiveness of a hospital. 

It examines "social leadership styles" that are characterized by respectful interaction with one another.  According to the study, these not only lead to increased "health-related well-being" and stronger loyalty to the company, but also to better work performance.

In this detailed study, only the medical-nursing area is examined. In the Sinceritas survey

mentioned above, both doctors and nurses as well as administrative staff stated that they wanted to prioritize open management.

It is striking that the latter actually prioritized open management the most. Therefore, it is worth having a look at the different needs in the professional groups.

Perspective of doctors

As mentioned above, a work-life balance is more and more expected of young doctors. Many benefits in hospital therefore also promise free scheduling.

However, an open interaction with management or superiors in the hospital is a desire that must break down familiar hierarchies. Decisions should no longer be made solely by the doctor at the highest level of the hierarchy.

"Transparent teamwork increases employee satisfaction and thus the attractiveness of the employer for new employees," concludes the magazine praktischArzt.

Satisfied employees will also treat patients in a more balanced manner. What's more, a transparent approach to information will also be helpful for patients. 

The fact that hierarchical, authoritarian communication can be demotivating also applies to communication between doctors and nursing staff.

Nursing perspective

In nursing, this is not only about communication with doctors, but also with nursing management. In both cases, an open management style can lead to more trust. This goes hand in hand with the feeling of not being left alone in the current shortage of skilled nursing staff. If difficulties are communicated more openly, motivation and therefore loyalty to the company can be strengthened. See also: dos and don'ts in personnel communication

A study conducted by the Hans Böckler Foundation in 2022 concluded that up to 300,000 nursing staff could be recruited by re-entering or increasing their workload, "... - if working conditions in the care sector improve significantly."

In addition to salary levels, this also includes "binding duty rosters" and better "staffing levels". Finally, another point is "appreciative and respectful treatment of superiors, collegiality and equality with the medical profession."

The relationship with superiors and especially with doctors is a recurring theme for nursing staff. An interesting article on Doctors and nurses: a chronic conflict recounts case studies and concludes that good, transparent communication is one way to resolve this conflict.

After all, hospitals are all about ensuring and optimizing patient care. Transparency and participation enable doctors and nurses to communicate better and work together in order to achieve this.

A hospital can also offer its employees courses that teach successful communication, as can be seen in the example of further training courses at Klinikums Stuttgart.

But administrative staff also have to meet the demands of everyday hospital life, and the positions are understaffed.

Perspective of the administration 

Digitalization can play a role in communication with administrative staff by supporting decentralized decisions and thus strengthening the decision-making authority and the right of all employees to have a say. In general, digital tools make it easier to share information and make decisions at different hierarchical levels. Of course, sensitive data must be protected and confidential information secured. 

Some employees may also be resistant to change. Winning them over to the change and thus leading the entire company into new communication should therefore be part of the task of such a structural change. 

Implementing open management also requires additional resources for training, technology and communication.

For the administration, however, it could make things much easier and increase efficiency. 

Recommendations for action

As the desire for open management runs through all areas of the hospital, it makes sense to involve everyone in any changes. An initial survey of all employees, for example, could be a first step. Workshops on bottom-up communication (as opposed to top-down) are recommended for management positions. 

Finally, employees from all areas and all levels of the hierarchy should be able to make suggestions and, ideally, discuss them with each other. This requires human, time and financial resources. It could therefore make sense to combine these new communication structures with digitalization. Communication channels in hospitals must always be adapted to the time and personnel pressures, as described here.

Even with individual measures, for example on the website, open corporate management can become a hospital's guiding principle and will reach employees as a first step. However, 

it is essential that managers exemplify and actively promote this new type of leadership and communication. Otherwise, there is a risk that the desired effect will not occur and that employees' trust in the management will be damaged.


Open management, as opposed to authoritarian management, is important for hospital employees. This means that employees can be retained, and new employees can be recruited. Hospitals are already approaching this. For example, under the heading of sustainability, which includes not only ecological but also social aspects. For example  Sustainable corporate governance at Charité: Sustainability - Charité – Universitätsmedizin Berlin

Or through a broad definition of compliance, as at Theresienkrankenhaus

In theory, then, hospitals are open to a new form of corporate governance and the task now is to implement it. This requires resources, further training and the willingness of all employees. 

After all, open management requires communication at eye level, employee participation and transparent decision-making. This can improve the quality of healthcare because employees are more satisfied and more knowledge can be pooled. 

Open corporate governance cannot necessarily be measured in key figures, but it can certainly lead to an increase in performance. Combined with "smart digitalization", this could also mitigate the difficulties of staff shortages or the demographic increase in older patients. 

There are challenges that need to be overcome, but it is an investment in the future of healthcare.