Nancy Borkowski and Gloria J. Deckard Department of Health Policy and Management, Florida International University, Miami, Florida, USA, and

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1 The current issue and full text archive of this journal is available at wwwemeraldinsightcom/ htm in professional development of healthcare managers Gulcin Gumus Department of Health Policy and Management, and Department of Economics, Florida International University, Miami, Florida, USA Nancy Borkowski and Gloria J Deckard Department of Health Policy and Management, Florida International University, Miami, Florida, USA, and Karen J Martel Alere, Inc, Pembroke Pines, Florida, USA 329 Abstract Purpose As a profession, healthcare management values commitment to lifelong learning and continuous professional development Individual participation, however, is voluntary and healthcare managers choose to participate based in part on perceptions of organizational support (rewards, promotion and recognition) as well as on individual values As women are narrowing the career attainment gap, participation in development activities may play a critical role This paper aims to present a pilot study which assesses the in male and female healthcare managers participation in professional development activities and perceived organizational support Design/methodology/approach An exploratory survey was ed to current and past members of three professional associations who share similar missions to provide educational and networking opportunities for their members in the southern region of Florida Findings The findings suggest that women healthcare managers are less likely to pursue professional development activities than their male counterparts even when the outcome (ie obtaining professional certification) is associated with career advancement and salary increases Furthermore, men are more likely than women to attend multiple continuing education programs when paying out of pocket Research limitations/implications This pilot study is one of the first attempts to account for the factors that explain gender in pursuing personal development activities Rather than conclusive judgments, it provides directions for further research Practical implications As professional and leadership competencies become more ingrained in the industry, women may need to recognize and commit to development activities associated with healthcare leadership and management Originality/value Competencies gained through professional development activities may impact career attainment Keywords Professional development, Professional qualifications, Paper type Research paper The authors would like to thank Heather J Rohan, RN MBA FACHE, Chief Executive Officer of Aventura Hospital and Medical Center in Miami, Florida for providing us with feedback on the practical applications of our study Leadership in Health Services Vol 22 No 4, 2009 pp q Emerald Group Publishing Limited DOI /

2 LHS 22,4 330 I Introduction In today s complex and dynamic environment, healthcare managers need to achieve and maintain professional competence in order to perform successfully To do so, they must participate in professional development which includes many types of learning opportunities, ranging from obtaining higher education degrees and/or professional certifications/licenses, attending conferences to on the job training and/or workshops The cornerstone of such professional development activities lies in the identification of competencies (ie skills, knowledge, abilities and actions) by numerous consulting groups, professional associations, healthcare organizations and educational programs The development of competency based learning models has been a growing trend in both academic health care education and professional development programs (Deckard, 2008; Dye and Garman, 2006) For example, the Healthcare Leadership Alliance (HLA, 2009), a consortium of six major professional membership organizations, identified through job analyses and research, 300 competencies (either skills or areas of knowledge) within five categories: (1) leadership; (2) communications and relationship management; (3) professionalism, structure and functions; (4) business knowledge and skills; and (5) knowledge of the healthcare environment From this framework, the American College of Healthcare Executives (ACHE, 2009) developed a Healthcare Executive Competencies Assessment Tool to assist managers in identifying areas of strength as well as areas in which they may wish to improve performance Thus, healthcare managers can currently access competency lists and assessments to guide their professional development The decision to participate in professional development activities is voluntary and therefore intrinsic to the individual s professional functioning, or professionalism The HLA defines professionalism as the ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and community, a service orientation, and a commitment to lifelong learning and improvement The appreciation of lifelong learning was identified by Drucker (1959) as a characteristic of the knowledge worker, ie workers who own the means of production: their own brainpower The knowledge worker appreciates that learning and work are not distinct Success in the work of healthcare managers means not only keeping current with developments in the field but also keeping personal knowledge, skills and competencies current through professional development However, since most professional development is voluntary, healthcare managers must choose to participate, and this choice can be influenced by perceived organizational/career benefit as well as individual professional values The extent to which managers participate in professional development may be explained, in part, by Expectancy Theory (Vroom, 1964), which suggests that individuals through self-interest, adopt courses of action perceived as maximizing the probability of desirable outcomes for themselves In other words, expectancy theory states that individuals make rational choices based on expected pay-offs Vroom suggested that individual choices are affected by three factors:

3 (1) the person must believe that through his/her own efforts he/she is more likely to achieve desired levels of performance; (2) the person must believe that achieving the desired level of performance will lead to an outcome or reward; and (3) the person must value the outcome or reward Similarly, Porter and Lawler (1968) developed a theoretical model which suggests that the expenditure of a person s effort will be determined by expectations that an outcome will be achieved and the degree of value placed on an outcome in the person s mind Other researchers found that the value an organization places in investing in their employees personal and professional development to be a significant factor for individual s participation (eg Lee and Bruvold, 2003) In other words, does the individual perceive that personal and professional development is encouraged and valued in the workplace based on positive outcomes for this behavior? Positive outcomes may take the form of salary increases and/or advancement in the organization after obtaining an advanced degree or something as simple as reimbursement for continuing education or memberships in professional organizations Thus, the benefit of reimbursed professional development activities and perceived positive organizational outcomes (an expectation) encourage individual professional development An economic perspective suggests individuals will purchase that quantity of educational and training (ie professional development activities) that equates marginal benefits with marginal costs (O Keefe et al (2006, p 5) Healthcare managers, thus, may pay out-of-pocket for professional development activities based on expectation of marginal benefits (rewards and recognition) Over the years, in career attainment and barriers to achieving senior level positions for women in business and healthcare organizations have been explored (ACHE, 2006, 2008; Lantz, 2008; Oakely, 2000) Although the ACHE (2008) study reports improvements in the proportion of women employed in health care management and attaining senior level positions, fewer women than men aspire to become CEOs within the next 15 years of their careers Lantz (2008) reviewed the available data/information and published literature on gender and executive leadership in healthcare and concluded that key organizational-level issues remain serious challenges As the 2008 ACHE report on career attainment notes, career aspirations are achieved by involvement in professional associations, which often entails various professional development activities to remain current This pilot study examines participation in professional development activities by healthcare managers in conjunction with perceived organizational support which, in turn, influences the individual s expectations that increased knowledge, skills and competencies will be met with organizational rewards and recognition Further analysis explores attendance in conjunction with out of pocket payment and the reasons for attending continuing educational activities Responses are analyzed separately for males and females to identify any gender in relation to the study variables 331 II Methods An electronic survey was ed to current and past members of three health management professional associations during July 2008 The professional associations

4 LHS 22,4 332 share similar missions to provide educational and networking opportunities for healthcare managers and are located in the southern region of the state of Florida The Presidents of each association sent an initial and a follow up message to current and past members encouraging participation in this study by completing the survey The survey was exploratory in nature and was designed for the organizations to collect information concerning professional development needs of their members The survey included limited demographic characteristics, to allow more detailed information on participation in professional development activities in the past year and the type of activities undertaken (ie hold a professional certification, attend conferences, etc) Questions also addressed perceived organizational support, employer reimbursement, perceived rewards and recognition for development activities; out of pocket contributions to continuing education activities and reasons for participation Questions relating to employer reimbursement allowed the researchers to gauge whether individuals perceived career pay-off of professional development activities and are willing to engage in them even in the absence of employer reimbursement One hundred and eight (108) individuals completed the survey, for a response rate of 16 percent Respondents who indicated that they were employed in non-management positions were excluded, limiting the sample only to healthcare managers and executives (N ¼ 92) Data were analyzed using descriptive statistics and t-tests to examine in means and mean proportions Despite the low response rate, a comparison of the descriptive statistics between our sample and the member population provided in Table I reveals consistency in terms of the observable characteristics with two exceptions First, the men in our sample are more likely to hold ACHE certification compared to the member population Second, women in senior management are underrepresented in our sample while men in senior management are over represented as compared to the member population The ACHE certification denotes commitment to professional development and thus, the higher number in the respondent sample represents those most likely to take advantage of the member organizations educational activities The higher number in senior level positions is also consistent with a response bias towards those who participate in continuing professional development Due to the potential selection bias, the results and discussion that follow provide pilot data which should be viewed as such and point to the need for further research to extend understanding of gender regarding professional development III Results Table I reflects the demographic information of the study s respondents as well as member population Of 92 respondents included in the sample, 50 were female and 42 were male Half of the respondents were 50 years of age or older with men being slightly older ( p, 005) A total of 79 percent of the men held senior management positions compared to only 36 percent of the women This difference is statistically significant ( p, 001) and may be partly due to the fact that the men are somewhat older than the women Regardless of gender, 62 percent of the individuals are working in hospitals, while the remaining 38 percent are in non-hospital settings such as managed care organizations, outpatient facilities, or home health care centers Seventy-four percent of respondents held professional certification displaying an overall commitment to professional competency The gender difference in certification

5 Members All Women Men Sample Members Sample Members Sample Age þ Highest degree obtained Doctorate Master s Bachelor s or other degrees Position Senior level management Middle or entry level management Employment setting Hospital Non-hospital Certifications Holds certification(s) in their field Holds ACHE certification Holds other kind of certification n Table I Descriptive statistics is statistically significant (88 percent of men versus 62 percent, p, 001) Of the participants holding certification, 42 percent reported that they are either board certified in healthcare management by or hold a Fellow designation in the American College of Healthcare Executives (ACHE) Interestingly, the gender difference in terms of ACHE certification is much greater than the in terms of all other certifications The proportion of managers with ACHE certification is 62 percent among men in the sample and only 26 percent among the women This difference is statistically significant ( p, 001), but the difference in terms of all other certifications is not (26 percent of men versus 36 percent of women) in professional certification are further examined in Table II by age, position, employment setting, and employer reimbursement Individuals who hold certification are generally older and in senior level positions Women in middle/entry level management are less likely to hold certifications compared to their male counterparts (63 percent versus 78 percent) This gender difference is more pronounced with senior managers (61 percent versus 91 percent, p, 001) Although men working in hospitals are more likely to hold certifications compared to women employed by hospitals (81 percent versus 65 percent, respectively), in non-hospital settings, this gender difference is greater and statistically significant (58 percent among women versus 100 percent among men, p, 0:01) Among women, 63 percent hold professional certification if their employer pays for certification and/or licensure fees, while among men this figure is 84 percent This same pattern remains when the sample is divided according to the status of employer s reimbursement for continuing education courses (65 percent for women versus 88 percent for men)

6 LHS 22,4 All Women Men 334 Table II Holds certification(s) in their field All *** By age * þ By position Senior level management *** Middle or entry level management By employment setting Hospital Non-hospital *** Current employer pays either fully or partially for certification/licensure fees continuing education courses n Notes: *, **, *** indicate statistically significant between sexes at 10 percent, 5 percent, and 1 percent significance levels, respectively Differences between sexes are tested using a t-test Table III presents participation in professional development activities such as educational programs, workshops, or conferences when paying for any portion of these activities out-of-pocket Employee s personal payments indicate commitment to professional development activities beyond those reimbursed by employers Approximately two thirds of the participants said they paid out-of-pocket to attend professional development activities and the responses did not differ between male and female managers (68 percent and 65 percent, respectively) When out-of-pocket payment is analyzed by gender and setting, a higher percentage of male managers employed in a hospital setting and a higher percentage of female managers employed in non-hospital settings participate More interestingly although not statistically significant, 78 percent of men in middle/entry management said they attend events by paying out-of-pocket while this figure is only 63 percent for women in middle/entry level positions The bottom section of Table III provides the number of events attended by those managers who participated in at least one event by paying out-of-pocket in the past year Overall, 67 percent of women and 88 percent of men attended three or more events and this gender difference is statistically significant ( p, 010) The fact that men attended a higher number of events by paying out-of-pocket in the past year holds when the sample is divided by employment setting or position Female managers are less likely to have attended more than two events by paying out-of-pocket in the past year regardless whether they work for hospitals or for non-hospital facilities, and are in senior or middle/entry level positions In an attempt to understand the gender in the willingness to pay out-of-pocket for development activities, the respondents were asked the motivating reasons for doing so They could select one or multiple reasons Eighty-eight percent of the participants selected for my personal professional development, 53 percent related that they believe attending such events is important for staying current in my

7 Yes Attendance No All (n ¼ 90) Women Men Hospital Women Men Non-hospital Women Men Senior level management Women Men Middle or entry level management Women Men Number of programs attended past year by paying out-of-pocket Among those who did attend at least one event: 1 or 2 3 or more All (n ¼ 53) * Women Men Hospital Women Men 6 94 Non-hospital Women Men Senior level management * Women Men Middle or entry level management Women Men Notes: *, **, *** indicate statistically significant at the 10 percent, 5 percent, and 1 percent significance levels, respectively; Differences between sexes are tested using a t-test 335 Table III Attendance in educational programs/workshops/ conferences by paying out-of-pocket field, 43 percent wanted to network with associates, and 17 percent wanted to combine the conference with personal vacation time Although there are gender in the reasons selected, they are not statistically significant Motivating factors were also explored in terms of employees perception of organizational support The survey included four questions on the expectation of recognition evident by salary increases and/or advancement within the organization Only 24 percent of the managers surveyed believed that obtaining an advanced degree is associated with a salary increase in their institution An even smaller proportion of managers, 10 percent, stated that earning an advanced degree is recognized with a promotion in their organizations These numbers may reflect that a master s degree is

8 LHS 22,4 336 the standard credential for today s healthcare manager (Bureau of Labor Statistics, 2008) and that 89 percent of respondents already held a Master s degree When the managers were asked whether obtaining licensure/certification is recognized with a salary increase, almost half answered yes However, advancement related to obtaining licensure/certification was perceived to be very unlikely with only 17 percent of the respondents stating that their organizations promote individuals upon obtaining licensure/certification Although none of the gender are statistically significant, women are less likely to perceive recognition either with a salary increase or a promotion for earning an advanced degree or a salary increase for obtaining a licensure/certification in their field However, women are more likely to perceive that obtaining licensure/certification is recognized in the form of a promotion This is interesting, considering that female managers are less likely to hold certifications compared to their male counterparts despite the fact that they perceive a higher value for this achievement (ie promotion) than men Table IV presents the current employer s reimbursement for different types of professional development activities (either fully or partially) and how these differ by gender and position A total of 75 percent of the individuals report their employer provides tuition for college level courses and 68 percent report continuing education courses are covered While these two benefits do not display statistically significant gender, the following three benefits do ( p, 005) A smaller proportion of women report that their employer covers: licensure/certification fees (38 percent versus 60 percent); All Women Men Table IV Professional development activities reimbursed by the current employer Does your current employer provide the following in your benefit package? (fully or partially) Tuition for college level courses Senior level management Middle or entry level management Continuing education courses Senior level management ** Middle or entry level management Certification and/or licensure fees ** Senior level management * Middle or entry level management Attendance at annual conference/meeting of professional organization(s) ** Senior level management ** Middle or entry level management Membership in professional organization(s) ** Senior level management Middle or entry level management n Notes: Differences between sexes are tested using a t-test *, **, *** indicate statistically significant at 10 percent, 5 percent, and 1 percent significance levels, respectively

9 attendance at annual conferences or meetings of their professional organizations (62 percent versus 81 percent); and membership in professional organizations (46 percent versus 67 percent) Most of these significant by gender prevailed when the analysis focuses on managers in senior level positions IV Discussion Within our pilot study: female managers reported that they are less likely to hold professional certifications even when their employer reimburses for the associated costs, and although both female and male managers report that they attend professional development activities and pay for them out-of-pocket, male managers attend a higher number of such events 337 Thus, our findings suggest that male managers perceive greater personal positive benefits/outcomes (ie career advancement associated with higher income) from professional development activities than female managers Male managers on-going involvement with a professional association is evident by the higher proportion (62 percent versus 26 percent by female managers) reporting that they hold certification through ACHE Since ACHE requires continuing education hours (and other related professionalism activities) over a three-year period for members to qualify for re-certification, the difference in number of activities between males and females may be associated with this value In addition, for this study s population, men in senior positions are more likely to work for employers who reimburse for professional development activities compared to women in senior positions Unfortunately, due to data limitations of this pilot study, we are not able to address these factors In future research, more comprehensive analysis is needed to examine the in male and female healthcare managers participation in professional development while controlling for other contributing factors such as age, educational attainment, experience, and seniority within the institution Among senior managers, the gender are statistically significant regarding continuing education courses ( p, 005), certification and/or licensure fees ( p, 010), and attendance at annual conferences/meetings ( p, 005) Among middle/entry level managers, however, the opposite pattern emerges With the exception of attendance at annual conferences/meetings, women in middle/entry positions are more likely to work for employers who reimburse for professional development activities compared to men in such positions As noted, female managers are less likely to hold professional certifications even when their employer reimburses for the associated costs, and they perceive salary increases and career advancement for obtaining a licensure/certification V Conclusion Although the gap between men and women in healthcare management career attainment has narrowed, this pilot study highlights in professional development which may allow the gap to continue As previously noted, expectancy theory proposes that an individual s motivation to perform is the product of:

10 LHS 22,4 his/her perception that personal performance is directly related to achieving the desired outcome; the perception that personal efforts will positively influence performance; and the desire for a particular outcome 338 Our findings reflect that women healthcare managers choose less frequently to pursue professional development activities than their male counterparts even when the outcome (ie obtaining professional certification) is associated with perceived career advancement and salary increases These choices may be due to in career plans and desires [for attaining roles as CEOs] can result from psychological bases such as childhood socialization patterns, sociological factors such as perceived or real discrimination or even consciously chosen goals like preferences for more time with family (ACHE, 2008, p 21) However, as professional and leadership competencies become more ingrained in the field, women will need to recognize and pursue more development activities associated with healthcare leadership and management Given the exploratory nature of our survey, our findings cannot be regarded as conclusive but an indication of the need to further study gender in professional development and the impact on career advancement References American College of Healthcare Executives (2006), A comparison of the career attainments of men and women healthcare executives, available at: wwwacheorg/pubs/research/ genderstudy_execsummarycfm (accessed June 10, 2009) American College of Healthcare Executives (2008), A racial/ethnic comparison of career attainments in healthcare management, available at: wwwacheorg/pubs/research/ researchcfm (accessed June 10, 2009) American College of Healthcare Executives (2009), available at: Bureau of Labor Statistics, US Department of Labor (2008), Occupational outlook handbook, edition, medical and health services managers, available at: wwwblsgov/oco/ ocos014htm (visited June 10, 2009) Deckard, G (2008), Contemporary leadership theories, in Borkowski, N (Ed), Organizational Behavior, Theory, and Design in Health Care, Jones and Bartlett, Sudbury, MA, pp Drucker, P (1959), Landmarks of Tomorrow, Harper & Brothers Publishers, New York, NY Dye, CF and Garman, AN (2006), Exceptional Leadership: 16 Critical Competencies for Healthcare Executives, Health Administration Press, Chicago, IL Healthcare Leadership Alliance (2009), available at: wwwhealthcareleadershipallianceorg (visited June 10, 2009) Lantz, PM (2008), and leadership in health administration: 21st century progress and challenges, Journal of Healthcare Management, Vol 53 No 5, pp Lee, CH and Bruvold, NT (2003), Creating value for employees: investment in employee development, International Journal of Human Resource Management, Vol 14 No 6, pp Oakely, JG (2000), -based barriers to senior management positions: understanding the scarcity of female CEOs, Journal of Business Ethics, Vol 27 No 4, pp

11 O Keefe, S, Crase, L and Dollery, B (2006), Worker s willingness to participate in training and education: a comparison, Working Paper, No , School of Economics, University of New England Porter, LW and Lawler, EE (1968), Managerial Attitudes and Performance, Irwin, Homewood, IL Vroom, VH (1964), Work and Motivation, John Wiley & Sons, New York, NY About the authors Gulcin Gumus, PhD is an Assistant Professor with the Department of Health Policy & Management, and Department of Economics at the Florida International University, Miami, Florida She received her PhD in Economics from Cornell University Before joining the FIU faculty, she was at the University of Miami in Coral Gables, Florida and at IZA, Institute for the Study of Labor in Bonn, Germany Her research interests include topics in health economics and labor economics Gulcin Gumus is the corresponding author and can be contacted at: gumusg@fiuedu Nancy Borkowski earned her DBA in Health Services Administration from Nova Southeastern University and is visiting faculty in the Department of Health Policy and Management at Florida International University Dr Borkowski is board certified in healthcare management as a Fellow of the American College of Healthcare Executives (FACHE) with over 23 years of industry experience In addition to her faculty appointment, Dr Borkowski continues to consult with and serve on many healthcare related companies boards Gloria J Deckard, PhD is an Associate Professor with the Department of Health Policy & Management at the Florida International University, Miami, Florida She received her PhD in Psychology from the University of Missouri Kansas City Dr Deckard is active in community and professional organizations associated with healthcare management education, services and policy Her research interests include organizational and professional work environments, community access programs and medical homes Karen J Martel, MHSA is the Director of Quality Utilization Management/Case Management/URAC at Alere, Inc, Sunrise, Florida Prior to joining Alere, Ms Martel was the Regional Director of Case Management for Quality Oncology, Inc in Sunrise, Florida and Nurse Manager for Roche Professional Service Centers, Inc, Miami, Florida She received her Master s degree in Health Services Administration (MHSA) from Florida International University, Miami, Florida 339 To purchase reprints of this article please reprints@emeraldinsightcom Or visit our web site for further details: wwwemeraldinsightcom/reprints