We surveyed the chief executive officers (CEOs) of US hospitals and health care systems to determine (1) how they came to be CEO [career path], (2) why they chose to be CEO, and (3) their concerns for the future. Our goal was to develop understanding and thereby to improve communication between managers and care providers. Six hundred seventy CEOs responded. There was a male predominance (88%); all other demographic measures reflected the general population. Over 90% had master degrees; 9% had doctorates (half were MD). Regardless of background—finance, operations, administration, or care provision—virtually all prior work experience was within the health care industry. Forty percent had been hospital CEO less than 5 years; 35% had over 10 years' tenure. Reasons to become CEO included personal advancement = 31%; serendipity = 23%; in 4%, hospital administration was a family tradition. Many (23%) wrote of the “challenge” and then explained their desire to match their talents with “good work.” Altruism was reported as the primary reason to become CEO in 26% and was subtext in over half of all other respondents. Commonly expressed future concerns were reimbursement/cost issues (77%) and shortages of critical personnel (66%), both reflecting imbalance between resources and commitments; lack of national health policies (33%), contradictory obligations and ineffective systems (33%), under- or uninsured patients (27%), and unfunded mandates (27%) all speak to system-wide dysfunction. Twenty-two percent were concerned about loss of public confidence in the health care system. Open conflict with their own physicians was reported in 11%. The repeated message from the CEOs was powerlessness to do what the physicians, the public, and the government expect them to do. Hospital CEOs have highly diverse educational and work backgrounds. This results in differing worldviews and approaches to problem solving compared to care providers. However, there is remarkable similarity in core values and in future concerns. System-wide dysfunction—contradictory requirements, regulatory burdens, partisan and self-destructive behaviors, resource constraints, and focus on short-term costs—weigh heavily and equally on CEOs and providers. These commonalities can be used to convert an adversarial relationship into a collegial one. Effective alliance of managers and care providers could turn their diversity of talents and experience into a powerful tool for solving health care problems.
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