Hospital Leadership

It is important for the HUC to have a basic understanding of the organizational structures of the hospital that they are employed within, and understand the basic roles of the senior leadership team. This section will review the basic hospital structure for Ontario public hospitals starting from the top positions on down.

Board of Directors

Public hospitals are independent corporations run by their own board of directors. The boards are responsible for day-to-day operational decisions on how to utilize the public funding they receive. Hospital boards are accountable to Ontario Health and the Ontario government for the quality and efficiency of the care they provide (Ministry of Health, 2023).

Many hospitals have formed partnerships with other hospitals, resulting in centralized management, which reduces overall costs. Hospital boards are either appointed or elected by their own memberships, with membership balanced between a variety of stakeholders, including local business leaders, government leaders, healthcare professionals, donors, and lawyers (Diligent team, 2018).

Chief Executive Officer

Hospital CEOs are appointed by the hospital’s board of directors or trustees.  They are ultimately responsible for managing the hospital and operating within the established budget (USCPrice, 2023).  CEOs of a centralized hospital system may oversee the management of several hospitals within the system and are ultimately responsible to the board of directors.

Other Members of the Executive Team

The remaining organizational structure within hospitals may differ; however, in most cases, you will also find the following executive management roles:

Chief of Staff (COS): a physician who oversees hospital care, acts as the liaison between physicians and hospital executives, and ensures that medical care is necessary and proper.

Chief Nursing Officer (CNO): an RN in a similar position to the COS for nursing staff, with a focus on nursing operations and protocols and the quality and delivery of patient care.

Chief Information Officer (CIO): the individual responsible for all health care technology infrastructure, patient information, and health care data security issues.

Chief Operating Officer (COO): the individual responsible for running hospital operations and executing the decisions of the CEO.

Chief Compliance Officer (CCO): the individual responsible for overseeing the organization’s regulatory compliance initiatives and internal policies and procedures (USCPrice, 2023).

Management and Staff

There may be many different layers of administration, management, and staff further down in the organizational chart depending upon the size of the hospital and the services provided. However, most hospitals will have at least one layer of manager above the health care service provider level.

Department Managers: the administrators who manage day-to-day operations of non-clinical hospital departments; for example, HR manager, IT services manager,  or HIM manager.

Patient Care Managers: the individuals who manage groups of professionals who provide patient care; for example, OR manager or inpatient surgery manager.  The majority of patient care managers are RNs or regulated health care professionals for the specific type of care provided in a department; for example, a medical radiation technologist may manage the diagnostic imaging department.

Health Care Service Providers

The vast majority of hospital workers are health care service providers, such as nurses, clerical, environmental workers, allied health care workers, laundry workers, and the many other people required in order for a hospital to function. They provide patient care, maintain records, and ensure that the hospital is able to deliver care to patients in an effective manner. Some types of providers may have designated leaders within their groups, such as team or clinical leads.

References

Diligent team. (2018, September 18). What is the composition of a hospital board of directors?  Diligent.

Ministry of Health. (2023, July 18). Ontario’s public hospitals. Government of Ontario.

USCPrice. (2023, November 17). Leadership in health care: How to advance into the hospital C-suite.