I Have to Learn This, Too?

"If I had it to do all over, I would be a major in political science and a minor in psychology," says Green. "What you tend to end up doing is a lot of dispute resolution and communication facilitation. Getting people to talk to each other, to want to work with each other, and pull in the same direction."

Leaders without clinical experience often need a crash course in medical jargon to improve communication with staff and resolve conflicts. Linda Hunt, president and CEO of St. Joseph's Hospital and Medical Center in Phoenix, is one of a handful of hospital administrators who is also a registered nurse. Because she understands both the business side of administration and the clinical side of medicine, she can bridge the gap between leadership and caregivers at the 675-staffed-bed hospital. And she understands firsthand the ambivalence staff may feel toward hospital administrators.

"[When I was a nurse], I got more and more frustrated because I had people who didn't understand what it required to deliver care to a patient making decisions that weren't always in the best interest of the staff or the patients. That's when I made the decision to go back to school," Hunt says.

Even with a clinical background, many administrators struggle with physician relations--one of a hospital leader's most important jobs. Physicians are part customer, part partner, and part competitor. Many CEOs contend that the country's best MHA programs won't prepare a leader for navigating the dynamics of that relationship, not to mention negotiating their contracts--the only way to learn is by doing.

Specialty No. 4: Fundraising

Hunt's clinical experience gave her a leg-up in staff relations, but other CEO functions didn't come as naturally. Like asking for money.

"I've had to have a How to Raise Funds 101. I'd never really ever asked anybody for money. It's a lot harder than you realize. It's one thing to ask for $100, it's something else to ask for $10 million," Hunt says.

Under the tutelage of St. Joseph's head of philanthropy, Hunt has become much better in "asking for money," especially donor cultivation. With Hunt's help, the St. Joseph's Foundation brings in millions of dollars each year for the hospital, part of the Catholic Healthcare West system. As Hunt has learned, hospital supporters are more than faceless bank accounts. The people behind the money require ongoing relationship maintenance as well as follow-up, either with potential contributors or in the form of notification about what's been done with their money, Hunt says.

"Getting beyond who they are and what they represent to the real person, that was probably the toughest thing for me."

An Expanding Job Description

Here are a few other subspecialties that most healthcare leaders learn not in school but through work experience.

International policy: CEOs who manage hospitals in border states already deal with an array of cultural, language and immigration issues. As more hospitals expand their services globally, senior leaders will need to learn about international policy and to speak more languages. In Florida, Baptist Health South President and CEO Brian Keeley has learned functional Spanish, and most of his staff is bilingual or trilingual. He's also on the Honorary Consul General for St. Kitt's, which helps his South Florida hospital further bridge relationships with the Caribbean.

Information technology: Many organizations invest millions in IT implementation and advancement each year, meaning senior leaders must know much more than just how to power on their computers. "When you're spending $100 million a year, you can bet your boots that I'm very much involved in the IT side and I've really gone through the self-education," Keeley says.

Board education: Healthcare governance has become more hands-on at most institutions, requiring organizational leaders to educate their boards about topics that don't always come naturally to business experts. CEOs must not only be well-versed in topics such as transparency, mortality rates and technology, but they must also teach others. "Board members want my help in understanding what they should pay attention to and what they can safely leave to others," says Warren Green, president and CEO of LifeBridge Health.