Bridging the Gap: Academic and Practitioner Perspectives to Identify Early Career Competencies Needed in Healthcare Management

Transcription

1 Bridging the Gap 367 Bridging the Gap: Academic and Practitioner Perspectives to Identify Early Career Competencies Needed in Healthcare Management Richard M. Shewchuk, PhD, Stephen J. O Connor, PhD, FACHE & Da id David J. Fine, M.H.A., FACHE Abstract Healthcare organizations, health management professional associations, and educational institutions have begun to examine carefully what it means to be a fully competent healthcare executive. A s a result, an upsurge in interest in healthcare management competencies has been observed recently. The present study uses two critically important groups of informants as participants: health management practitioners and faculty. Using the nominal group process, health administrators identified critical environmental issues perceived to have an impact on healthcare executives today. These issues were employed in a card-sort assessment and a survey was administered to a nationwide sample of health administrators. These data were used to create a map and five clusters of the environmental landscape of healthcare management. These clusters of environmental issues provided a framework for having groups of administrators and faculty members generate and rank perceived behavioral competencies relative to each cluster. Implications for healthcare management practice, education, and research are discussed. Introduction Interest in health administration core competencies has accelerated recently as healthcare organizations, health management professional associations, and educational institutions have begun to question what it means to be a Please address correspondence to: Richard M. Shewchuk, Ph.D., Professor, Department of Health Services Administration, University of Alabama at Birmingham, Webb Building 5th Floor, rd Avenue South, Birmingham, AL , Phone: , Fax: , shewchuk@uab.edu

2 368 The Journal of Health Administration Education Fall 2006 fully competent healthcare executive. Competencies have been defined as a cluster of related knowledge, skills, and attitudes that: 1) affect a major part of one s job (a role or responsibility), 2) correlate with performance on the job, 3) can be measured against well accepted standards, and 4) can be improved by training and development (Lucia & Lepsinger 1999, p. 82). A defined set of core competencies can be useful in the following: 1) workforce planning (Calhoun, Davidson, Sinioris, Vincent, & Griffith 2003), 2) management and health system performance improvement, 3) coaching, counseling, mentoring (Ross, Wenzel, & Mitlyn 2002), 4) career development and succession planning (Huller & Bacorn 2003), 5) management recruitment, selection, and assessment, 6) determining educational content for training/curriculum design and accreditation activities, 7) creating organizational competitive advantage (Pralahad & Hamel 1990), and 8) in further professionalizing the field of healthcare management. Purpose of the Study The purpose of this study is to develop healthcare management competencies from the perspective of practitioners and academicians utilizing a common framework. The framework that is employed is the perception of critical environmental issues facing healthcare managers. Two key informant groups, healthcare management practitioners and academicians, responded to these critical issue domains in terms of the competencies required of those individuals entering the field. Competency Development Numerous organizations have been actively identifying competencies and developing competency models. These include the National Center for Healthcare Leadership (NCHL) (2006), the Healthcare Leadership Alliance (HLA) (2005), and others (Dye & Garman 2006; Saint Louis University 2006). The Commission on Accreditation of Healthcare Management Education (CAHME) recently stated, in the proposed revision to the Criteria for Accreditation Criterion I.A.3., that each graduate health administration program will select a competency model for its curriculum that is related

3 Bridging the Gap 369 to its mission and the types of jobs graduates enter upon completion of the Program (CAHME 2006, p. 1). Shared Framework for Competency Development We believe that the field is benefiting greatly from the recent discussions and proposals surrounding competency development for health management practice. A major obstacle is that a common shared framework for competency development does not exist. The problem of being frameworkless is that competencies derived from different research initiatives cannot be evaluated. Most competency development activities focus heavily on what the experts and the field s own literature says is important, without thinking about the process for coming up with these and why. Moreover, key competency domains are typically generated first, then illustrations or examples are derived as to how one might demonstrate mastery of the particular competency domain. Often the studies provide no empirical evidence and deal less with a competency, but more with style or latent traits. When the domains are so general and removed from specific contexts and actual behaviors, they have almost no meaning in terms of relating them to important outcomes (Wrightsman 1973). There is no doubt that this type of research is important; however, is it capable of providing results that are readily translational or disseminatable? The goal of competency research is to change healthcare management practice and education for the better. This is a laudable goal indeed. Unfortunately, this goal will not be easily accomplished. The present study uses two critically important groups of informants as participants; opinion leaders from a variety of organizational settings in healthcare management practice and academicians from health administration educational programs. Our study is large in terms of numbers of participants (a national sample of healthcare executives) and the variety of healthcare organizational settings they represent, and is considerably more rigorous and systematic in its data collection approach. Like previous studies, we too in part, used a qualitative approach to data collection; however, ours is based on the rigorous and systematic nominal group process method as developed by Delbecq, Van de Ven, and Gustafson (1975). Because competencies are not global (i.e., do not fully transcend organizational context or management career trajectory), we anchor their development in key environmental issue clusters and specify them for people who are newly entering the field of healthcare management. We use the qualitatively derived data as input into a series of quantitative

4 370 The Journal of Health Administration Education Fall 2006 methods (multidimensional scaling and hierarchical cluster analysis) that are described more fully below, as a way to understand more deeply and comprehensively the key issues in the healthcare environment. This research serves as the basis (framework) for identifying the skills, knowledge, and abilities (SKAs) that early-career healthcare managers must possess in order to manage effectively in a healthcare environment. Furthermore, we utilize a nationally-derived sample of health administrators and faculty affiliated with graduate-level academic programs in healthcare management. By doing so, we are able to ascertain clearly how each of these groups view the changing healthcare environment and what they consider to be the SKAs required by health administrators. We can then compare the rank-ordered SKAs developed by health administrators and by healthcare academicians and look for similarities, differences, and gaps between the two. A key recurring theme is a perceived gap between what health administration programs are teaching and their real world application (Griffith 1999). We believe that this perceived gap might persist to the extent that health administration practitioners are excluded from the front-end of this process. The research reported here seeks to overcome this potential bias in defining area core competencies and their associated SKAs by going directly to health administrators and asking what issues are important to them. Moreover, previously used research methodologies have been criticized for attempting to develop competencies without the benefit of an overarching framework. This research seeks to overcome that criticism too. As academic programs examine ways to better prepare future healthcare administrators, it is incumbent upon them to improve the flow of information from practitioner to student. Much prior work relies on the opinions of a small number of experts which can lead to systematic biases in results, especially in the absence of an overarching framework to help guide competency development. Methodological gaps have created the need for a broader perspective on what issues are key to health administration education, before competencies/skas can be enumerated. Research Questions The overall objective of this study is to develop an understanding of the similarities and differences in how critical healthcare issues are perceived by constituent groups of healthcare executives and healthcare academicians. These perceived issues serve as a framework for competency development and for comparisons between healthcare executives and healthcare academicians with respect to the array of core knowledge and key SKAs that

5 Bridging the Gap 389 The next step will be to see if these individually articulated competencies join or hang together in such a way that they comprise broader latent competency domains or constructs. It is at this point that the process will conclude with the development of true core competencies. All of the research we have done to date has been on an empirical basis. Previous competency research efforts provide little or no empirical evidence at any level. Most previous competency research begins with the identification of core competency domains by examining the literature and by asking key stakeholders for their expert opinions. From these competency domains, examples of behavioral competencies/skas are determined. However, this is done in the absence of a common framework for development and without asking the field of healthcare managers for their input. This has become the Achilles Heel of health management competency research. Implications This study ultimately seeks to reconcile the differences in the way critical healthcare issues and the SKAs needed to effectively deal with these issues are perceived by two important groups who are responsible for the quality of management in healthcare organizations (health administration practitioners and academicians). We have found that these groups are not very much different in their perceptions. The study also represents an initial effort to examine these differences in a systematic, comprehensive fashion, as opposed to the simple reliance on the perspectives of small numbers of opinion leaders. The administrative impact of these results includes: Providing a mechanism that could, if implemented, create a stronger nexus between health administration practitioners and faculty. Eventually, this would lead to enhanced preparation of individuals who enter the field so that they would be well-equipped to face the challenges of a dynamic healthcare environment. Logically, this should enhance the developmental trajectories of healthcare executives through the course of their careers. Specifying, refining, and updating the essential healthcare practice domains and the true core competencies necessary to address these so that our health administration curricula are in tune with the realities of health administration practice. The Commission on Accreditation of Healthcare Management Education (CAHME) (2006) will be requiring graduate programs in health administration to choose a competency model for its curriculum that is related to its mission and the types of jobs graduates enter upon comple-

6 390 The Journal of Health Administration Education Fall 2006 tion of the Program (p. 1). This means that graduate programs will have to develop their own competency model or use one that has already been developed. The efforts of NCHL (2006), HLA (2006), Saint Louis University (2006), Garman and Dye (2006), and ourselves has resulted in a core body of competencies and competency domains. Although these models will continue to be refined and validated, the basic derivation work has been largely accomplished. Now may be the time for AUPHA, CAHME, and other related stakeholders to hold the next Summit conference to begin planning for how competencies and competency models should be integrated into curricula, how competencies should be assessed, and to decide how much discretion programs will have in determining the competency models they choose. Ultimately, we can begin to link the derived core competencies to any number of outcomes related to health management careers, healthcare organizations, and the communities they serve. Examples of these types of outcomes could include issues such as financial performance, patient and employee satisfaction levels, community health status, and outcomes, among others. In the present study, competencies have been developed by health management practitioners and academicians in terms of their relationship to a framework of critical healthcare issue domains. Doing so provides a logical foundation for subsequent research that could examine how a specific competency relates to a relevant outcome. It is further observed that these competencies bear a general resemblance to those developed by others. This convergence may suggest that basic health management competencies have already been largely determined. However, before the field rushes to incorporate these competencies into curricula and to assess them among students, caution must be exercised in assuming the value of such competencies, especially in the absence of empirical evidence showing how they relate to outcomes of interest. Only those competencies explaining meaningful variation in outcome performance should be emphasized in any curriculum redesign efforts. If competencies can be scientifically validated, attention would then need to be given to how they would be assessed in different contexts. Authentic behavioral assessments could be carried out through role playing, case studies or vignettes, case competitions, situational responses, or simulations. An evidence-based approach can provide a framework that would facilitate both competency assessments of students to gauge how well they are doing in achieving curriculum objectives, and practitioner self-assess-

7 Bridging the Gap 391 ments to gauge how well they are developing professionally. Knowledge of self performance can point to areas in need of further development. The outcomes of programs that address validated competencies and their ongoing authentic assessment over time have potential to benefit managerial and healthcare organization effectiveness. References Aldenderfer, M. S., & Blashfield. Cluster Analysis. Beverly Hills, CA: Sage Publications, Calhoun, J. G., Davidson, P. L., Sinioris, M. E., Vincent, E. T., & Griffith, J. R.. Toward an Understanding of Competency Identification and Assessment in Health Care Management. Quality Management in Health Care, 11(1) (2002): Commisson on Accreditation of Healthcare Management Education, Draft Criteria for Accredition, Delbecq, A. L., Van de Ven, A., & Gustafson, D. H. Group Techniques for Program Planning. Gleview, IL: Scott Foresman, Dye, C. F., & Garman, A. N. Exceptional Leadership: 16 Critical Competencies for Healthcare Executives. Chicago, IL: Health Administration Press, Elliott, T., & Shewchuk, R. M. Problem Solving Therapy for Family Care Givers of Persons with Severe Physical Disabilities. In T. Radnitz (Ed.) (pp ), Cognitive-Behavioral Interventions for Persons with Disabilities. New York, NY: Jason Aaronson, Inc., Griffith, J. R. Can You Teach the Management Technology of Health Care Administration? A View of the 21st Century. Andrew Pattullo Lecture delivered at the AUPHA Annual Meeting on June 20, 1998, in Washington, DC. Published in Journal of Health Administration Education. Vol. 16 (1999), Healthcare Leadership Alliance. HLA Competency Directory User s Guide. Obtained from Healthcare Leadership Alliance [web page] org (2005) (Accessed July 22, 2006). Huller, B., & Bacorn, C. (2003). VHA High Performance Development Model. Presented at the 2003 Annual Meeting of the Association of University Programs in Health Administration, Nashville, TN, June, Kruskal, J. B., & Wish, M. Multidimensional Scaling. Beverly Hills, CA: Sage Publications, Lucia, A. D., & Lepsinger, R. The Art and Science of Competency Models: Pinpointing Critical Success Factors in Organizations. San Francisco, CA: Jossey-Bass/Pfeiffer, 1999.

8 392 The Journal of Health Administration Education Fall 2006 National Center for Healthcare Leadership. Competency Integration in Health Management Education: A Resource Series for Program Directors and Faculty. Guidebook 1: Curriculum Mapping, Analysis, and Planning. Chicago, IL: National Center for Healthcare Leadership, Pralahad, C. K., & Hamel, G. The Core Competence of the Corporation. Harvard Business Review, 68(3) (1990), Ross, A., Wenzel, F. J., & Mitlyng, J. W. Leadership for the Future: Core Competencies in Healthcare. Chicago, IL: Health Administration Press, Saint Louis University. Saint Louis University Competency Model for Graduate Health Management Education. St. Louis, MO: Department of Health Management and Policy, Saint Louis University, Speece, D. L. Methodological Issues in Cluster Analysis: How Clusters Become Real. In H. L. Swanson and B. Keogh (Eds), Learning Disabilities: Theoretical Research Issues (pp ). Hillsdale, NJ: Erlbaum, Trochim, W. M. K. An Introduction to Concept Mapping and Planning and Evaluation. Evaluation and Program Planning, 12 (1989): Wrightsman, L. S. Social Psychology in the Seventies. Monterey, CA: Brooks/Cole Publishing Co., 1973.