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The medical industry is a complex web of patient care facilities and workers, with the chief goal of caring for patients in a cost-effective manner. To this end, the organizational structures in healthcare tend to focus on efficiency and oversight. Though many hospitals may differ in framework — particularly between large and small organizations or those with for-profit or non-profit missions — most follow accepted models of hierarchy well-established in the business realm.
A board of directors is invariably at the top of most organizational structures in healthcare. This board may be formed by a vote of trustees in a founding organization or by stakeholders in the hospital franchise. Typically, it contains more-tenured hospital professionals like doctors and researchers, but many also are stocked with local lawyers, entrepreneurs, politicians and even celebrities who might help to lend the hospital a competitive edge.
A hospital's president or CEO is usually responsible for answering to the board and carrying out its funding, regulatory and research initiatives. This chief often serves as a member or even the chairman of the board of directors, to give the actual facilities and its workers at least one chair at the table. Many non-profit facilities will stack a board to suit its particular mission. For instance, the board of a Catholic hospital will often have faith and medical leaders serving, each focused on a different element of the mission.
The president will usually have an administrative cabinet. This small cadre of specialists often includes a chief financial officer, a medical examiner and a general litigation counsel. These top executives may have small staffs, such as the admissions staff under the comptroller. Their duties in the organizational structures in healthcare are mainly to serve the president and board, not to serve as direct patient care providers.
Alongside administrative leaders in a president's closest staff are other top executives devoted to patient care or day-to-day hospital operations. A chief operations officer maintains the departments not directly related to patient care. A chief medical officer often provides leadership to those departments that do provide services to patients. Many hospitals also assign a chief nursing executive. All other departmental leaders are arranged under one or all of these three top executives.
Hospitals most often are arranged for patient care by specialty, with services like diagnostic, therapeutic, emergency and in-patient care. These are operated in separate departments, with directors and assistant directors at the helm of each. Under a director or vice president of diagnostics in the chain of command, for example, would be more directors or assistant directors of key specialized services like imaging, intensive care and the emergency room.