Hospital CEOs - Do We Need a Licensure Program?

Are there too many rogue hospital CEOs?

According to Kevin MD, yes.

And the magic solution? Creating a licensing requirement.

Or, of course, we could also solve the problem by requiring all hospital administrators to be physicians.

Like cosmetologists, lifeguards, and plumbers - should we require those who manage our hospitals to pass a licensure exam?

When you position the debate within the rarified realms of electricians and pedicurists (service professionals whose lines of work arguably blend art and science - and yes, I'm poking fun at that particular inter-doc debate), it seems eminently reasonable to get cracking on implementing a board requirement for hospital CEOs.

But do we need licensing (systemic solution), or a more careful selection process for hospital and healthcare CEOs (individual, site specific solution)?

Drew at Our Own System has a great point here, that can be summed up in two highly relevant terms: "due diligence."

Boards need to be taking a microscopic look at executive candidates (and a macroscopic look at community impact, etc), pushing beyond the resume and phone calls to references. Could any level of aggressive HR due diligence have uncovered this? Perhaps.

I've never hired someone without at least a meal conversation. I always check references and preferably in person, at the very least via email with phone followups. My list of questions is often 2 pages. And this is for entry/mid-level positions or personal service providers.

Everyone's style is different, but I've found arranging to have coffee or lunch with a reference or associate of the candidate is a great way to read between the lines (same goes if you've received a committee or board invite - get to know the chair over a meal).

Gut instinct about whether or not a potential manager is a 'good person' or 'likeable' or even 'high achieving' doesn't cut it at any level of recruiting and hiring, particularly in the upper echelons of the executive suite.

You can, however, gain valuable insights by following gut instincts when talking to a reference (and a candidate)- are there unusual pauses? Do they exhibit hesitancy in answering questions? In person, it's even easier to see when a reference is uncomfortable - body language, vocal cues, and facial expressions are windows into the soul, or at least the calculating mind.

But back to hospital administration.

While it's not a horrible idea to implement licensing requirements for hospital CEOs, we should look more closely at the costs and benefits:

1. What would such a requirement achieve?
2. How would a hospital CEO licensing body be run?
3. How would it improve healthcare administration at the 'field' level and the individual hospital site level?
4. Would other hospital executives also need to be certified for us to know they're 'capable' of managing a healthcare organization?
5. Would hospital CEOs need to sit for reaccredidation (I can see JCAHO slavering over the possibility of a hospital management certification spinoff)...

Here's my basic response to the debate - posted over at Kevin MD's entry as a comment:

Hospital CEOs should be licensed.

Right.

Because of course licensure will prevent people from being crooks or 'rogues.'

A degree or certification instantly ensures we place individual interest above organizational integrity in all industries (law, medicine, nonprofit administration, etc.), including hospital administration.

Sure.

A degree, certification, or license doesn't prevent someone from abusing the law. It raises the bar on barriers to entry, a point Drew makes at Our Own System here:
http://ourownsystem.com/2008/08/06/a-licensed-health-care-executive/.

But I'd argue many hospital executive teams (CEOs included) need courses on financial management, governance, community/staff relations, logistics/supply chain optimization, consumer-centric care planning/delivery, trends and innovation, and organizational behavior before they need to pass a pithy licensing exam that gives them a frameable certificate.

That's the cynical view. Healthcare management licensure isn't unheard of...There are models that work within subsectors of the healthcare administration industry, including long-term care. Many job ads for these facilities include a requirement for current state licensure.

It all essentially boils down to what we're really talking about here - better management of hospitals in general (fiscal responsibility, ethical operations, etc.) or raising the quality of hospital executives via raising barriers to entry? Or are we talking about both?

We need to diagram the issue out and look at each component separately to take a stab at accurately assessing potential for improvement.

Also, of course, there's the pesky implementation factor to be considered...exactly what US healthcare needs is another layer of administrative complexity (read: cost) thrown in the middle of the whole tangled web.

Licensure = certification bodies. Certification bodies = staff, paperwork, etc.

Going after the creation of state licensure requirements means lobbying, which means devoting a heck of a lot of money and time to speaking with our elected representatives to get bills on the ground.

I'm not a hospital executive, but it is a career path I'm considering. If licensure becomes a requirement, of course I'll participate. However, it's also one more incentive to get an MBA rather than a Master of Hospital Administration, or similar degree.

That being said, such an initiative could also be nurtured in these programs. Nursing students study for the NCLEX prior to graduation, and then sit for the boards. Master of Hospital Admin students could do the same for relevant licensure.

Even if we consider the long-term ROI rather than short-term, again I'd argue one of the central issues here is education rather than licensure.

Do you agree? Disagree? Should we require licensing for hospital CEOs? As one of the smartest guys I know says often: "Discuss amongst yourselves."