What you need to know if you work in healthcare and want to transition to an administrative role

Healthcare administration is often taken for granted despite its critical role in ensuring the smooth operation and efficiency of healthcare organizations. From managing financial resources to ensuring compliance with regulations and overseeing workers, healthcare administrators are vital to the success of hospitals, clinics, nursing homes, and other healthcare establishments.

Making the transition from a clinical role to an administrative role can be challenging but also rewarding. There are healthcare courses in Canada, such as at the University of Ottawa, that enable you to integrate your healthcare knowledge into business management. These courses offer you a chance to use your skills and knowledge to improve productivity in healthcare in a way that matters.

This blog post will discuss the essential things you should know to ensure a successful transition into a healthcare administration role.

The importance of healthcare administrators

Healthcare administrators are responsible for the overall management and operation of healthcare organizations, such as hospitals, clinics, nursing homes, and private practices. They ensure that these facilities are run efficiently and effectively and provide high-quality care to patients.

They are responsible for numerous aspects, including managing financial resources, developing and implementing policies and procedures, overseeing staff hiring and training, and ensuring compliance with industry laws and regulations. They work closely with other healthcare professionals, including doctors, nurses, and support staff, to ensure that the healthcare organization can meet the needs of its patients and the community it serves.

Besides managing the day-to-day operations of healthcare organizations, healthcare administrators also play a crucial role in shaping the direction and strategy of these facilities. They work with leadership teams to develop long-term plans and goals and use data and analysis to inform decision-making and improve patient care.

To efficiently transition to an administrator’s role, there are numerous aspects to understand. These include: (a) understanding the healthcare industry and its various stakeholders; (b) developing strong business and financial acumen; (c) understanding financial reporting and analysis tools; (d) knowing healthcare reimbursement and payment systems; (e) building leadership and management skills; (f) developing leadership skills through training and experience; (g) acquiring knowledge of healthcare regulations and compliance; (h) acquiring technical skills and knowledge related to healthcare administration, and (i) networking and building professional relationships. All of these will be elaborated on below.

Understand the healthcare industry and its various stakeholders

Before transitioning to this field, you must understand several aspects of the healthcare industry, including its organizations and stakeholders. Some of them are:

1. Healthcare organizations

The healthcare industry includes various organizations with unique characteristics and challenges. Some of the most common types of healthcare organizations include:

• Hospitals: Hospitals are large complex healthcare facilities that offer inpatient and outpatient services. They may be public, private, or non-profit, and specialize in areas such as children’s care, cancer treatment, or surgery.

• Clinics: Clinics are smaller healthcare facilities that typically provide outpatient care. Some general clinics offer a range of services or specialize in areas such as women’s or mental health.

• Nursing homes: Nursing homes provide long-term care to individuals unable to live independently due to physical or mental disabilities. They provide medical care, rehabilitation, and assistance with daily activities and chores.

• Private practices: Private practices are healthcare facilities owned and operated by individual healthcare professionals, such as doctors and dentists. They usually provide medical services in specialized areas.

Each type of organization has unique characteristics and challenges, and you must adapt to their management and leadership requirements to meet specific needs.

2. Key players in the healthcare industry 

The healthcare industry has numerous stakeholders. You must understand their roles and interaction level to succeed in your role. Some of these stakeholders are:

• Patients: Patients are the priority of the healthcare system. You must put their needs at the forefront of all decision-making.

• Healthcare providers: This includes doctors, nurses, and other professionals who deliver patient care. They ensure patients receive the proper care and information while working with their families to develop treatment plans.

• Payers: Payers are organizations that cover the costs of healthcare services for patients, including private insurance companies, Medicare, and Medicaid.

• Regulators: Regulators are government agencies that oversee the industry and ensure it operates in a way that is safe and fair for patients.

• Professional associations: These are the organizations/groups representing specific healthcare professions’ interests. They advocate for changes to healthcare policy and provide education and resources to their members.

• Suppliers: Suppliers are companies that provide products and services, such as pharmaceuticals, to healthcare organizations.

These stakeholders play unique roles in the success of the healthcare industry. You must be able to manage and navigate relationships with each of them to help the industry grow.

Develop strong business and financial acumen

Healthcare organizations generate revenue from various sources, including patient fees, insurance payments, and government funding. However, they also incur expenses, such as salaries for staff, the cost of supplies and equipment, rent, and utilities.

One of a healthcare administrator’s main challenges is ensuring that the organization generates enough revenue to cover its expenses and remain financially stable. This may involve negotiating contracts with payers, implementing cost-saving measures, and finding ways to increase efficiency. It could also mean reaching out to individual donors and NGOs for financial aid.

They must also ensure their organization complies with laws and regulations related to healthcare finance, such as the Health Insurance Portability and Accountability Act (HIPAA). This involves working with legal and compliance experts to develop policies and procedures and ensuring that the organization follows all regulations.

Understand financial reporting and analysis tools

As a healthcare administrator, knowing your way around financial reporting and analysis is vital to tracking the organization’s financial performance, identifying money problems, and creating solutions. Some standard financial reporting and analysis tools include:

• Budgeting: This involves creating a financial plan for the organization that outlines the expected expenses for a specific period. This helps the organization prioritize its needs and ensures minimal spending.

• Forecasting: Forecasting involves predicting future financial performance based on past performance and other relevant factors. This helps the organization predict future trends and make plans for them.

• Financial statements: Financial statements are reports, such as balance sheets and income statements, that provide information about the organization’s financial performance, such as its income, expenses, profit (or loss), and net worth.

• Ratios and metrics: Ratios and metrics are numerical indicators, such as ROIs, which help measure the organization’s financial performance and compare it to industry benchmarks.

Know healthcare reimbursement and payment systems

Most healthcare organizations generate revenue by billing payers, such as insurance companies and government programs, for the services they provide to patients. However, payers can choose to reimburse healthcare organizations in different ways, including:

• Fee-for-service

Payers opting for a fee-for-service system pay healthcare organizations for each service they provide. This means they’re paid for their services, whether medically necessary or not.

• Value-based

Value-based systems are different. Here, payers will only reimburse healthcare organizations based on the quality and outcome of the care they provide rather than the volume of services they offer. This encourages providers to focus on delivering quality care that improves patient outcomes.

Healthcare administrators should learn the art of negotiating and maximizing revenue by billing payers accurately. They must also familiarize themselves with the reimbursement system that their organization uses and any recent changes or updates to the system.

Build leadership and management skills

Healthcare administrators are responsible for leading the organization through its growth. To achieve this, they must develop these skills:

• Communication

They’ll need to communicate regularly with stakeholders, including patients, healthcare providers, and other administrators. It’s essential they learn the best way to convey their vision and goals while listening to and addressing the concerns of others.

• Decision-making

Healthcare administrators often face complex and sometimes urgent decisions that can significantly impact the organization. They should develop decision-making skills to help them make effective choices that align with their organization’s goals and values.

• Team management

Healthcare administrators are responsible for leading and managing teams of healthcare professionals. This involves setting clear expectations, delegating tasks, and providing support and guidance to team members.

• Emotional intelligence

Emotional intelligence is the ability to recognize and understand your emotions as much as you acknowledge the emotions of others. It’s the ability to use this awareness to manage relationships and navigate challenges. It’s common to encounter strong emotions from patients, families, and colleagues. However, it’s the healthcare administrator’s job to manage these emotions effectively.

Develop your leadership skills through training and experience

Some of the most effective ways to develop your leadership and management skills as a healthcare administrator include:

• Formal education

Pursuing a degree or certification in healthcare administration or a related field can provide you with a foundation in the principles and practices of effective leadership. Many universities and professional organizations offer programs specifically designed for aspiring healthcare administrators, and you can enrol in these courses to sharpen your skills.

• On-the-job training

Experience is an excellent way to develop your leadership and management skills. Look for opportunities to take on additional responsibilities and projects within your current role, or consider seeking new positions that offer more opportunities for leadership and management.

• Mentorship

Consider working with a mentor with experience in the intricacies and challenges of healthcare administration. However, you should only work with mentors with the skills and knowledge you want to develop, and stay open to their guidance and feedback.

Acquire knowledge of healthcare regulations and compliance

Familiarizing yourself with the laws and regulations that apply to healthcare organizations is a huge part of your role. It is even more important that your organization complies with these regulations as non-compliance with fundamental laws can lead to fines, legal action, and damage to the organization’s reputation. Some essential laws and regulations that apply to healthcare organizations include:

• HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects the privacy of a patient’s personal and medical information. HIPAA requires healthcare organizations to protect patient information and report any privacy breaches.

• The Affordable Care Act

The Affordable Care Act (ACA) is a federal law that aims to increase the accessibility and affordability of healthcare. The ACA’s provisions apply to healthcare organizations, such as the requirement to cover certain preventive services without cost-sharing and the requirement to report specific data to the government.

• State regulations

Besides these federal laws, healthcare organizations must also comply with state regulations, which may vary from state to state. These regulations may include requirements for licensure, reporting, and quality improvement.

Acquire technical skills and knowledge related to healthcare administration

As a healthcare administrator, you must understand electronic health records (EHRs) and other healthcare technology and how to use these tools to improve the organization’s overall operation.

• Electronic health records

EHRs are digital systems that store and manage patients’ medical records. They allow healthcare providers to access and update patients’ medical information in real time, reducing errors and improving the efficiency of care.

• Data analytics

Data analytics involves data and analysis to inform decision-making and improve patient care. Healthcare administrators can use data analytics to identify trends and patterns in patient care and areas for improvement.

• Quality improvement and process improvement techniques

Quality improvement and process improvement techniques are methods used to identify and address problems in healthcare processes and systems to improve the quality and efficiency of care. Some standard techniques include the Six Sigma methodology, Lean manufacturing, the Plan-Do-Check-Act (PDCA) cycle, and business process management (BPM).

Networking and building professional relationships

Building relationships with other healthcare professionals and administrators can be valuable for healthcare administrators. These activities can help you to stay up-to-date on industry trends and best practices, learn from experienced seniors, and expand your professional network. Some ways to build relationships with other healthcare professionals and administrators include:

• Joining relevant organizations and associations

Many professional organizations and associations offer resources, networking opportunities, and professional development opportunities for healthcare administrators. Joining these organizations can connect you with others in your field and give you access to valuable resources.

• Networking

Networking involves building relationships with others in your field through social events, meetings, and other informal gatherings. It’s also a great way to build relationships with other healthcare professionals and administrators and learn from their experience.

Conclusion

A healthcare professional looking to transition into an administrative role should be aware of the various administrative options within the industry. These include management, human resources, finance, and information technology, each requiring different skills and knowledge.

Assessing your strengths and interests can help determine which administrative role fits you best. You should also research the specific requirements for the role you’re interested in, such as education, experience, and certifications. Some roles may require a master’s degree in healthcare administration or a related field, while others may only require a bachelor’s degree and relevant work experience.

You should also know the challenges of the organizations where you’re seeking a role. Administrative positions in healthcare can be high-stress and fast-paced, so you need to prepare for the job’s demands. Ultimately, you should understand the various roles, the requirements and expectations of the position, and the demands and challenges of the job.