In the last few years, my work has taken me across the length and breadth of India & some countries abroad. From tier-one cities to the rural heartlands, I’ve had the privilege of sitting down with hospital owners—sometimes in their glass cabins, sometimes over a simple cup of tea in their OPDs.
What started as professional meetings soon turned into friendly human conversations. They opened up—not just about KPIs and strategy—but about fear, fatigue, hope, and more
Whether it was a 100-bed hospital in Bihar, a 30-bed setup in Trivandrum, or an ambitious new clinic in Nairobi, the challenges echoed the same tune.
Running a hospital isn’t just administration—it’s survival. And most of that battle is invisible to the outside world.
So here’s what I’ve learned—compiled from years of these candid, off-the-record chats.
These are the truths that rarely make it into annual reports or leadership books.
1. You’re Not Just Running a Hospital-Its more
A hospital doesn’t stop. There are no “after hours.” From the moment you walk in, you’re managing power backups, emergency surgeries, supply chains, oxygen levels, billing escalations, and HR all at once.
One Hospital Administrator in Bihar told me:
“Sometimes, I feel like I’m running a power plant, a hotel, and a crisis center—just happens to have doctors too.”
Even a minor failure—like a power cut in the ICU—can snowball into a life-and-death emergency. You can’t afford mistakes, but you also can’t prevent them all. The pressure is relentless.
2. Leadership in Healthcare Is Lonely—and Emotional
In corporate meetings, you’re the strategist. But in real life, you’re the punching bag, the confidante, and the last one standing when everyone else leaves.
I remember a mid-sized hospital owner in Lucknow saying:
“My kids ask why I don’t come home on weekends. How do I explain that I had to fire someone’s father and reschedule 3 surgeries?”
Being a hospital leader means choosing between the lesser of two heartbreaks—every single day.
3. Staff Shortage Is a Nightmare No One Talks About Enough
Forget beds—the real crisis is finding (and keeping) good doctors and nurses. One of my international clients in East Africa said they were offering double the standard salary, and still had a 50% nurse attrition rate.
In India, it’s no better. A COO once told me:
“The young doctors join, then quit after their 7-10 night duties. They don’t want the burnout—but healing comes with no shortcuts.”
Many hospitals are now hiring in-house psychologists and even offering meditation breaks, just to slow down the bleeding.
4. Financial Pressure Is the Silent Killer
Here’s something people don’t realize: even a full hospital can go broke. You may have 70% occupancy, but if 50% are insurance or low-pay patients, you’re losing money every day or a bad recovery cycle
A finance head from a chain hospital in Gujarat told me:
“Every ICU bed we run costs might cost ₹15K per day, but we charge ₹15K only just to stay ‘market competitive’. And patients still say we’re expensive.”
You’re constantly stuck between ethics and economics. Raise your rates, and you lose trust. Don’t, and you bleed dry.
5. Crisis Isn’t a Department. It’s the Whole Game.
During the second COVID wave, a small hospital in Bihar told me how they had oxygen left for just 2 hours.
The owner being a politician himself too, called the district collector, who then rerouted a tanker from another city.
“It felt like wartime,” she said, “I wasn’t thinking like a doctor—I was thinking like a soldier.”
Hospitals today need a crisis plan not just for pandemics, but for floods, fire audits, cyberattacks, mob protests, and even fake WhatsApp forwards.
6. One Tweet Can Undo 10 Years of Goodwill
This is a harsh reality: perception beats performance.
A hospital saved 4 out of 5 patients in a major trauma case. The family of the 5th went public, and suddenly the hospital was branded “killers” on social media.
Many owners now invest in PR firms and legal teams just to stay afloat in the court of public opinion.
Further, Having a large marketing team or big ad spend budget has become a necessity in growing competition.
7. Technology can be a Double-Edged Sword
Digitisation is a lifesaver—until it fails. A server crash or ransomware attack can stall OPDs, diagnostics, OT scheduling, and even patient monitoring. Data Leaks is another major threat.
“We had a tech outage during a surgery. Everything was backed up—except the blood bank dashboard,” one I.T Head of a hospital confessed.
Healthcare CEOs now spend almost as much time with IT vendors & digital teams, as they do with clinicians.
So, What’s the Way Forward? Insights from the Trenches
Based on these stories and lessons from the field, here are a few practical suggestions for those leading—or preparing to lead—healthcare facilities:
1. Hire for Heart, Not Just Skill
You can train skills. You can’t train empathy. And in healthcare, empathy is everything.
2. Build a Crisis Manual Now
Don’t wait for the fire drill. Cross-train your staff, define escalation protocols, and prepare like a storm is coming—because it is.
3. Prioritise Staff Wellbeing
Breaks, mental health days, praise, even small gestures of kindness can go a long way. Burnout kills more careers than incompetence.
4. Balance Reputation & Reality
Invest in honest communication with your patients. Be proactive online. Monitor sentiment. In today’s world, PR (Public Relations) is preventive care.
5. Stay Rooted in Purpose
Numbers matter. But never forget: the mission is healing. That’s your north star when the spreadsheets don’t make sense.
Final Thoughts: Beyond White Coats and Balance Sheets
Hospitals are places of hope. But they’re also battlegrounds for administrators trying to do the impossible—heal with limited resources, under public scrutiny, in a system that never stops moving.
So the next time you hear someone say, “Why is hospital management so tough?”—share this with them.
It’s not just a job.
It’s not just a business.
It’s a calling.
If you found this article insightful, share it with a healthcare leader you admire.
And if you’re one of them—thank you. The world runs on your quiet courage.
Oh Yes, This one concept might read interesting to you. Virtual Hospital CEO
