The role of business administrators in hospitals has undergone a fundamental shift amid rising healthcare costs and increasing pressure to improve efficiency: from a support function to an active management role. As Head of Business Administration at a large Swiss hospital, the author observes that professional insights often receive insufficient consideration in decision-making processes, even though these roles possess a deep understanding of processes and areas of tension in everyday hospital life. This study examines the conditions that must be created to enable business economists to better exert their influence in the tension between efficiency and effectiveness. To this end, the author develops interventions in three areas of impact and derives four key areas of action from them: role, chain of command, visibility, and trust. The result is a practical white paper on how to address economic issues in hospitals in a more targeted and sustainable manner.