A Day in the Life of a Hospital Administrator

In the same way that a doctor is responsible for patients’ health, a hospital administrator is responsible for the health of a medical facility. The hospital system is no less complex than the human body. America’s 6,120 registered hospitals employ more than 7 million people, supply almost one million patient beds, and rack up nearly $1 trillion in expenses, according to the American Hospital Association. Hospital administrators are vital to the management of a hospital’s associated staff, patients, finances, and operations.

The day-to-day life of a hospital administrator varies according to the specific environment in which one works. The administrator of a small rural hospital will have a considerably different experience than one who works for a large network, such as the Cleveland Clinic, which in 2023, had 15.1 million patient encounters in their 23 hospitals and 276 outpatient locations on three continents. However, despite differences in scale, several fundamental duties remain the same. Read on to get a view of a day in the life of a hospital administrator.

Despite the name, hospital administrators only sometimes work in hospitals. Their skills apply to practically any organization in the medical field, such as private practices, home health centers, nursing homes, and insurance companies. Even within the hospital framework, there is room for variation. A hospital administrator may work for a small community hospital, a state-run hospital, or a network of American and international hospitals. Smaller operations will likely have only one hospital administrator, while large networks may employ a team of administrators.

The scale at which a hospital administrator works is mainly a function of both experience and preference. Still, regardless of the precise setting, the work environment is likely to be hectic. Hospital administrators are meant to oversee 24-hour, seven-days-a-week operations. Between staff meetings, fundraising events, conventions, and intrahospital negotiations, an administrator will never be sitting down for too long.

In a hospital setting, whether you’re a doctor or an administrator, no two days are going to be identical. Similar to general practitioners of emergency medicine, administrators have a wide range of competencies and rarely know what type of situation they will encounter next. That said, the principal responsibilities of a hospital administrator can be grouped into four areas: operations, finances, outreach, and development.

A hospital administrator is responsible for recruiting, hiring, and evaluating staff members. While this may be delegated to HR departments at larger hospitals, the processes must always be signed off on at the top. At smaller hospitals, administrators may even be in charge of the scheduling and training of staff. On top of staffing choices, a hospital administrator is in charge of setting facility-wide policy to advance a hospital’s overall goals.

A hospital administrator is responsible for designing and implementing a facility’s budget. They also help determine the cost and rates of the health services provided. At a research or teaching hospital, this includes budgeting the research and educational programs and guiding the overall direction of those efforts. How a hospital performs financially can be an indicator of hospital administrator performance as it directly correlates to keeping the facility healthy and running smoothly.

The primary role of a hospital administrator is to act as a liaison between a facility’s board of trustees, medical staff, and department heads. Negotiation and diplomacy are required skills to align each separate group of stakeholders toward implementing the policies and processes that meet the hospital’s wider goals. Outside of the facility itself, hospital administrators must also maintain an active relationship with the population the facility serves by hosting community events, engaging in philanthropy, and raising awareness of critical population health issues.

The work never stops, even when all the areas of a hospital are performing well, as a hospital administrator needs to constantly scan for what is coming up next. Hospitals can be large and slow-moving creatures, and it is critical to know about innovations and updates in medical technology, electronic health records, public policy regulations, health insurance changes, and financing options to steer them effectively.

To manage the overall health and day-to-day operations of a medical facility, hospital administrators must maintain a comprehensive body of knowledge across all aspects of healthcare. To this end, many hospital administrators have a master’s degree in healthcare administration and extensive experience at various facilities, both in support roles and as administrative executives.

Throughout their careers, hospital administrators must demonstrate strong communication and leadership skills that allow them to unify the many moving parts of a medical facility. They must not only be able to set facility-wide policies, but also communicate those policies in a way that secures buy-in from staff, trustees, patients, and the broader community. An intersectional knowledge of the issues affecting a hospital and the population it serves is critical. To best serve all affected parties, a hospital administrator must have a compassionate, detail-oriented, analytical mindset that is capable of weighing all considerations and the possible impacts a set of policies may have.

Running a hospital is not unlike running a city, and hospital administrators at times must strike a balance between the poise and charisma of a politician, the compassion and understanding of a nonprofit head, and the keen analytical skills and foresight of a savvy investor.

Hospital administrators can become board-certified in healthcare management by becoming a Fellow of the American College of Healthcare Executives (FACHE). While certification is not required to practice or advance in the field, it can act as a mark of distinction, expertise, and ongoing commitment to the profession. This credentialing process involves a multifaceted look at an applicant’s academic, professional, and civic experience, culminating in the Board of Governors Examination.

To be eligible to take the exam, applicants will need:

• A relevant master’s degree
• A current membership of at least three years with the ACHE
• A current position as a healthcare executive
• At least five years of work experience
• At least 36 hours of continuing education (12 of which must have been face-to-face through ACHE) completed in the last three years
• Two examples of civic or community activities in the last three years
• Two examples of healthcare-related activities in the last three years
• Two professional references, of which one must be a current FACHE who will perform a structured interview with the prospective fellow, and the other should be a senior-level (VP or higher) executive of the applicant’s organization

The exam itself consists of 230 multiple-choice questions, of which 200 are scored. Source material for the exam includes Health Administration Press books, healthcare journals, and other periodicals and textbooks. The ACHE recommends that applicants allot three to six months for study depending upon education level and depth of professional experience. The ACHE provides a reference manual for the exam, and a 12-week online tutorial is available for $495. Study tips from those who have passed the exam are also accessible on the ACHE’s website.

Once healthcare administrators have passed the exam, they must recertify every three years. To maintain their status as a FACHE, fellows must complete 36 hours of continuing education (12 of which must be face-to-face through FACHE) and demonstrate involvement in two civic or community activities and two healthcare-related activities within the recertification period. Instead of continuing education credits, a fellow may retake and pass the Board of Governors Examination.

Matt Zbrog

Writer

Matt Zbrog is a writer and researcher from Southern California. Since 2018, he’s written extensively about emerging issues in healthcare administration and public health, with a particular focus on progressive policies that empower communities and reduce health disparities. His work centers around detailed interviews with researchers, professors, and practitioners, as well as with subject matter experts from professional associations such as the American Health Care Association / National Center for Assisted Living (AHCA/NCAL) and the American College of Health Care Executives (ACHCA).