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What are your biggest challenges as an administrator?

January 12, 2012
by H. Steven Moffic, MD
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If you are a behavioral healthcare administrator and were asked, “What do you consider your most challenging issues in your role?,” how would you answer? (Take a minute to think of some of them).

Recently, I was asked to consult and comment on this as an item for a survey of psychiatrists who are mainly administrators in their everyday work. Now, here are the items in order (though it is unclear if they were listed in order of perceived importance), as this survey was near completion:

Fiscal Resources
Recruitment
Retention
Health Information Technology
Physical Plant
Regulation
Legal

When the survey would be completed, one would be asked to rank them.

I was not at all surprised that financial resources somehow was at the top of the list. I was mildly surprised that psychiatrist administrators identify “Physical Plant” as a challenging issue. Maybe that would be because we didn’t know much about that area. Legal made good sense because none of us want to get in trouble or have our organization get in trouble. The items on hiring and retention seemed important; it always has seemed more difficult to me to handle staff problems than patient problems.

However, it was what issues that had been left off that really surprised me. About a decade ago, I developed the guideline “Ethical Principles for Psychiatrist Administrators” because ethical conundrums of balancing organizational, financial, staff, and patient needs was often so difficult. Yet, “Ethics” was not listed in this survey. Do we now know how to resolve such issues without breaking a sweat, or do we no longer have anguish about putting such variables as “Fiscal Resources” first?

That got me thinking: what are we there for? To take care of patients competently and compassionately, right? But there was nary an item on “Quality of Care” or “Monitoring of Outcomes”. Was it just important to our organizations to thrive, or did we need to be sure our patients were thriving also?

To my reassurance, when I pointed out these omissions, the items were readily added. I also suggested a category of “Other”, which could capture other items we forgot to designate or unique items to a particular administrator.

How does this list of challenging items now look to you? What might you add? How would you rank them?
 

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...