Leadership. The United States has a President; your local high school has a principal. IBM has a chairman of the board. And hospitals have administrators.

Obviously, it takes more than doctors and nurses to run a hospital; housekeepers, food services, technicians and accountants are but a few of the services that combine to become “the hospital.”

But who is the unsung organizer? Who is responsible for coordinating the multitude of services and people, to ensure that the hospital runs efficiently and that you receive the best possible health care?

The hospital administrator is an integral part of the health care team. Though not necessarily medically trained, administrators are highly educated experts, usually with many years of experience in health care administration. And simply stated their job is to manage all services that are necessary to provide and implement health care programs prescribed by physicians.

In a sense, the hospital administrator is an hotelier, since hospitals house paying guests, and those guests have needs. Administrators have to be business experts, knowledgeable about purchasing goods and equipment, authorizing repairs, while balancing budgets so that the hospital doesn’t run out of money.

As a troubleshooter and crisis manager, the administrator must make quick decisions when things go wrong. And in a hospital, mishaps are unpredictable and happen without warning. A cool head is always needed.

Since administrators must always be mindful of the patient, they are also part of and contributors to the health care team.

Finally, the administrator is a bureaucrat not by choice, but as a result of overwhelming governmental regulations and restrictions, and part of the job is to keep up to date with these regulations and to make sure they are met.

Conversely, hospital administrators are not necessarily physicians, and they are not directly involved in medical care. A good administrator leaves medicine to the doctors and administrating to the administrators. They are not magicians either, although they are often required to make the impossible appear commonplace and relatively easy to achieve.

And what makes a good administrator? Well, good administrators don’t sit in their offices all day; they are visible, walking through the hospital; talking to patients and staff; and looking at how things can be improved.

The administrator walks a tightrope between good business sense and providing quality health care. It is a constant juggle between expenses and fiscal integrity, and the need for keeping up with medical technology.

Hospital administrators have usually earned a business or hospital administration degree and then continued their education, acquiring expertise through the years by accepting positions with increasing amounts of responsibility.

When considering a hospital stay, don’t underestimate the ability of the administrator to influence both the quality of the health care you receive and the ability to intervene if that care does not meet your needs.

A good hospital administrator should be easily approachable and possess a ready ear for criticism and for praise and then act upon that information. They want to hear about the good and the bad. Don’t fear communicating with them.

Dr. Michael M. Warren is the Ashbel Smith professor of surgery at University of Texas Medical Branch Division of Urology. Write him at