This study explores the common administrative harms (AHs) experienced by hospitalist clinicians and administrative leaders, aiming to understand the challenges in identifying and measuring AH and to identify potential approaches to mitigate it. A qualitative study using a mixed-methods approach was conducted with 41 individuals from 32 organizations, including hospitalist clinicians, researchers, administrative leaders, and patient and family advisory council members. The study found that AH is pervasive and comes from all levels of leadership, with wide-reaching impact. Organizations lack mechanisms for identification, measurement, and feedback related to AH, and these challenges stem from a lack of psychological safety, workplace cultures, and ambiguity in who owns a decision. Organizational pressures were recognized as contributors to AHs. Participants noted that AH negatively impacts patients, the workforce, and organizations, and that it often results from decisions made in the setting of pressing issues, without considering the voice of the customer or balancing measures. The study also found that AH is challenging to measure and that there is a lack of leadership responsibility and accountability in AH. Solutions to mitigate AH include improved communication and collaboration, empowering clinicians to identify and address problems, and creating structures to measure and address AH. The findings suggest that AH is widespread with wide-reaching impact, yet organizations do not have mechanisms to identify or address it. The study underscores the potential for organizations to implement structures and processes aimed at measuring and addressing AH to enhance organizational decision-making.This study explores the common administrative harms (AHs) experienced by hospitalist clinicians and administrative leaders, aiming to understand the challenges in identifying and measuring AH and to identify potential approaches to mitigate it. A qualitative study using a mixed-methods approach was conducted with 41 individuals from 32 organizations, including hospitalist clinicians, researchers, administrative leaders, and patient and family advisory council members. The study found that AH is pervasive and comes from all levels of leadership, with wide-reaching impact. Organizations lack mechanisms for identification, measurement, and feedback related to AH, and these challenges stem from a lack of psychological safety, workplace cultures, and ambiguity in who owns a decision. Organizational pressures were recognized as contributors to AHs. Participants noted that AH negatively impacts patients, the workforce, and organizations, and that it often results from decisions made in the setting of pressing issues, without considering the voice of the customer or balancing measures. The study also found that AH is challenging to measure and that there is a lack of leadership responsibility and accountability in AH. Solutions to mitigate AH include improved communication and collaboration, empowering clinicians to identify and address problems, and creating structures to measure and address AH. The findings suggest that AH is widespread with wide-reaching impact, yet organizations do not have mechanisms to identify or address it. The study underscores the potential for organizations to implement structures and processes aimed at measuring and addressing AH to enhance organizational decision-making.