Share this article on:


Black, Stephen A. D.Sc., P.T., ATC/L, NSCA-CPT

ACSM's Health & Fitness Journal: March-April 2008 - Volume 12 - Issue 2 - p 28-30
doi: 10.1249/01.FIT.0000312417.06958.7f

LEARNING OBJECTIVES • To provide an overview of the role and responsibility of a medical fitness facility director

• To highlight the current needs and obstacles of medical fitness facility directors

• To categorically identify the major areas of accountability for a medical fitness facility director

Being a medical fi tness director has its challenges and rewards. Highlighted in this article are critical success factors identifi ed by current directors with helpful suggestions and solutions provided.

Stephen A. Black, D.Sc., P.T., ATC/L, NSCA-CPT, is the owner of Rocky Mountain HPC, Inc, located in Boulder, CO. Steve has 30 years of experience in the development, implementation, and operation of health-related facilities. He has worked with hospitals, health clubs, and organizations worldwide, providing expertise and education on a wide variety of wellness/fitness and sports medicine-related topics. In his spare time, Steve enjoys an athletic lifestyle competing in marathons and triathlons.

For organizations committed to strengthening their capacity for care with a medically integrated fitness and wellness center, the facility director is the quarterback. Their ability to put together a winning team and call the appropriate plays will determine success or failure of the facility (1,2).

The fundamental skills of an effective director are synonymous with those of an effective leader. Leadership/directorship for tomorrow is changing from the top-down style of management to a collegial approach where all become counterparts (2). Working together creates the compassion for work and productivity that both sides seek. Directors who have created this style of management have names on the front door such as Cisco, UPS, Home Depot, Lowes, Wal-Mart, et al. These directors are change agents and strive to become not only recognized within the organization but also recognized leaders. Ten traits that epitomize this type of director are discussed in brief below. Incorporate these into your facility and your personal daily efforts, and watch productivity and profitability grow. Using leadership as an acronym, the following are qualities of collegial leadership:

  • L = listening. Good listening is required to understand employee attitudes and motivators. Listening to your employees will highlight what they need to be successful and happy. Get to know your employees by asking a lot of open-ended questions. Asking questions allows for listening and a better understanding of employee attitudes, motivators, and issues. Get to the issues that confront them and enable them to find solutions. Be sure to provide credit to the employee that identifies a problem and solves it rapidly.
  • E = enthusiasm. Employees want to be motivated. This begins with positive energy and commitment. Personal ills and corporate pressures are unimportant to employees. They are concerned about number one-themselves. In good times and bad, expressing a positive and energetic attitude is imperative. Goal line energy produces positive results.
  • A = awareness. Be aware of issues that are nonverbal. Directors must have a keen sense that denotes when staff is happy, frustrated, tired, or overwhelmed. Sense the issues, and eliminate them quickly so that the organizations stay in harmony.
  • D = decisive. Employees loathe procrastinators, even if they are a procrastinator! They want quick, decisive, and meaningful replies. Directors do not ponder; they make quick decisions to difficult problems and find immediate solutions.
  • E = equal. Nothing will destroy the harmony or collegial relationships within an organization faster than unequal treatment. Directors do not treat employees differently based on title, age, race, or religion. Directors understand that everyone in the organization is equal. Use the principle that the sum of the parts is greater than the whole. Remember, there is no I in team!
  • R = reward. Adults desire more than just money with work. They desire recognition and kudos for a job well done. However, in today's marketplace, employees, although happy, are looking for more contentment from their current job. This sense of pride and self-worth is a large issue for most people. If people feel that they make a difference, they will care about the organization's objectives. If not, apathy emerges. Simply put, the job affects the person, and the person affects the job. So what can be accomplished to gain a better sense of company pride and loyalty? Establish a reward system, and watch the attitudes soar!
  • S = shallow mission/vision. Directors understand the reasons for having corporate and divisional mission and vision statements. These statements enable employees to understand who the organization is, where it is going, and how everyone will get there. The missions are the playbook to future success.
  • H = hypocrite. Directors make decisions and stick to them. They understand that reversing decisions make them a hypocrite. Future directors take action when they offer action. For example, if a director decides pay cuts are necessary to preserve profits, they too take a cut. Leading by example creates a happier employee and fosters loyalty. Contradicting the effort creates dispassion, disbelief, and attrition.
  • I = isolate. Directors believe in teamwork and team play. Every employee counts toward the bottom line. Directors do not isolate themselves from the team and do not isolate the team from each other. Again, there is no I in team.
  • P = positive communication. In good times and bad, directors create positive communication and feedback to employees. Positive and meaningful communication creates loyalty and mutual exchange of ideas and attitudes. When ideas are fresh and positive, profits and productivity soar, as does customer/member satisfaction.

According to a recent survey commissioned by the Medical Fitness Association (MFA) and conducted by The Radial Group, most responding medical fitness facilities directors identified more than 900 needs in their current role. Approximately 400 needs were identified by directors with 5 years of experience or less in their current position. There were three distinct areas in which they felt deficient. They included human resources, health care integration, and finance.

Back to Top | Article Outline


The Human Resources Management function includes a variety of activities, and key among them is deciding staffing needs and whether to use independent contractors or to hire employees, recruiting and training the best employees, ensuring that they are high performers, dealing with performance issues, and ensuring that personnel and management practices conform to various local and federal regulations. Activities also include managing employee benefits and compensation, employee records, and personnel policies. It is the director's, or their designee's, responsibility to always ensure that employees have-and are aware of-personnel policies that conform to current regulations. These policies often are in the form of employee manuals that the human resource department is responsible for producing and providing. The facility must conform to the institution's standards and state and federal regulations. Typically, organizations consider human resources as playing a major role in staffing, training, and helping to manage employees so that everyone is performing at maximum capability in a highly fulfilling manner.

Back to Top | Article Outline


Health care integration can be difficult. Richard Evans, executive director, Synergy Health at Exeter Hospital in Exeter, NH, offers the following tips for hospital center success:

  • Avoid duplicating the hospital's employee benefit system for wellness center employees, if possible.
  • Have a physician champion to rally other physicians to refer patients to the facility and help the medical staff at the facility understand the mission of the facility.
  • Don't let the hospital dictate staffing levels. To be successful, the staffing needs need to conform to the member-staff ratio as outlined in the strategic plan for the facility.
  • Market the facility just as you would any successful business. Drive business (membership sales) by encouraging strong referrals. The fitness facility can't afford to operate on the typical hospital reimbursement model. Even if the facility is not for profit, it still needs to generate revenue to cover the budget.

Judy Sewing, a principal with Meritage Healthcare Strategies, suggests that medical fitness center directors focus on providing a continuum of care within the community health system. Incorporating The Medical Fitness Model: Standards and Guidelines with general best business practices can ensure the success of a medically integrated heath and fitness center.

  • Differentiate on the basis of medical orientation and integration.
  • Provide a nonintimidating environment for the unfit.
  • Provide a personalized approach to meeting wellness goals.
  • Track/measure outcomes of programs.
  • Think like a retail operation.
  • Focus on communication with members and their physician.
  • Be visible in the community.
Back to Top | Article Outline


Last but certainly not least is the ability of the medical fitness facility director to manage the financial well-being of the facility. Although a Master of Business Administration degree is not necessary, it certainly would enhance the ability to develop, manage, and grow the financial solvency of the facility. The health and fitness market is now estimated to be in excess of $16 billion annually. The entire industry is currently on target to reach the 50 million-member milestones by 2010. According to the MFA's latest figures, the medical fitness industry currently has well more than 875 medically integrated health and fitness centers, with more than 3 million members projected to reach more than 4 million by 2010 (3). With those kinds of numbers, the facility director better have a good handle on the financials for today and projected out to at least 5 years.

Developing and overseeing the financial plan is estimated to take an average of 100 hours to research, compile, and manage. Creating and compiling the 5-year financial plan with forecasts including 5 years of month-to-month break-even analysis, operating budgets, income statements, balance sheets, cash flow analysis, and key financial ratio analysis can take more than 20 hours of work by the director or their designee. Fortunately, there are various software programs that can assist the director in developing, managing, and overseeing the financial aspect of the facility (4). The following are some of the key elements of the financial plan:

  • Financial plan-a comprehensive strategy designed to help the organization achieve specific financial goals and prepare for unexpected challenges or events.
  • Financial forecast-a forecast of the expected financial position and the results of operations and cash flows based on expected conditions.
  • Operating budget-portion of the budget that deals with the day-to-day activities and expenses. Incorporates the income statement and all noncapital budget items including personnel salaries, fringe benefits, professional development, supplies, administrative expenses, and so on. The operating budget must be micromanaged and reviewed daily to avoid surprises and forecast unforeseen circumstances. They will occur!
  • Income statement-a summary of income and expenses. It shows the financial progress of the organization over a period. It gives a clear picture of profitability or losses incurred.
  • Cash flow analysis-an analysis of the cash inflows and outflows of the facility. Cash flow analysis often is used to raise capital for growth and to retire old debt and is used by lenders or investors to evaluate the ability of a business to repay obligations.

There are other financial principles to be aware of, but these are the basics. After mastering these, the director can move into areas such as member billing analysis, return on memberships, nondues revenues, and third-party reimbursement, to name a few. Understandably, this is an area of emphasis for the director and requires numerous hours of learning and review.

Back to Top | Article Outline


In conclusion, there are not enough hours in the day to effectively manage a medical fitness facility. Between learning to lead and managing the organization and its staff, overseeing the financial operation and navigating the health system's operations, time runs short (5). The daily tasks are impossible without a competent staff to delegate tasks to, sufficient employee assistance to operate the facility, and an accountability system to keep the operation running smoothly. However, with prior planning, a competent mentor, and a little luck, the director will ultimately be successful.

Back to Top | Article Outline


Being a Medical Fitness Facility Director can be a challenging and rewarding profession. Long hours, multitasking, and time management are a must for someone engaged in this position. Skills in leadership, finance, and human resources are highlighted in this article to give the reader assistance in their day-to-day responsibilities as a director. Helpful resources are suggested and provided for further assistance in the role of Medical Fitness Facility Director.

Back to Top | Article Outline


1. Black, S.A. How to operate an on-site hospital fitness center. Available at Accessed December 1, 2006.
2. Black, S.A. How to operate an on-site medical fitness center. Fitness Management Magazine. 30-33, January 2003.
3. Medical Fitness Association. The Medical Fitness Model: Standards and Guidelines. Richmond: The Medical Fitness Association, 2007.
4. Aspen Information Systems. Visual ClubMate. Houston: Aspen Information Systems, 2003.
5. Plummer, T. Making Money in the Fitness Business. Los Angeles, CA: Leisure Publications, Inc. 1999.

Successful; Leader; Integration; Facilitate; Finance

© 2008 American College of Sports Medicine