Hospitals are in a constant state of change. Shortened

RESEARCH Current Research Are Registered Dietitians Adequately Prepared to Be Hospital Foodservice Directors? MARY B. GREGOIRE, PhD, RD, FADA; KAROLINE SAMES, MS, RD; REBECCA A. DOWLING, PhD, RD, FADA; LINDA J. LAFFERTY, PhD, RD, FADA M. B. Gregoire is a professor and chair, Department of Apparel, Educational Studies, and Hospitality Management, Iowa State University, Ames. K. Sames is assistant general manager, Venison America, Hudson, WI; at the time of the study, she was a graduate student, Department of Clinical Nutrition, Rush University, Chicago, IL. R. A. Dowling is vice president of Support Services and L. J. Lafferty is director of Food and Nutrition Services, Rush University Medical Center, Chicago, IL. Address correspondence to: Mary B. Gregoire, PhD, RD, FADA, Chair, Department of Apparel, Educational Studies, and Hospitality Management, Iowa State University, 31 MacKay Hall, Ames, IA 50011-1120. E-mail: mgregoir@iastate.edu Copyright 2005 by the American Dietetic Association. 0002-8223/05/10508-0003$30.00/0 doi: 10.1016/j.jada.2005.05.007 ABSTRACT Objective To determine perceived importance of selected competencies for the role of hospital foodservice director and explore whether registered dietitians (RDs) are perceived competent in these areas. Design Data were collected through a mailed questionnaire. Subjects A random sample of 500 hospital foodservice directors and 500 hospital executives to whom the directors report. Analysis 2, Mann-Whitney, and Kruskall-Wallis tests were used to examine differences among ratings by and demographic characteristics of foodservice directors and the executives with whom they work. Results All competencies were perceived to be important for someone in the role of hospital foodservice director. RDs were perceived to be somewhat competent in all areas studied but were only perceived to be competent to expert in a few of the areas. Directors who were RDs and hospital executives who had worked with RDs rated the competence level of RDs higher than did non-rd directors and hospital executives who had not worked with RDs. Conclusions Unique competencies appear to be important for those aspiring to become hospital foodservice directors. Hospital executives who had worked with RDs perceived the competency level of RDs to be higher than did executives who had not worked with RDs. Often, areas rated as most important for the role of hospital foodservice director were not areas in which RDs were perceived to be highly competent. Additional competency development may be needed to better prepare RDs to assume the role of hospital foodservice director. J Am Diet Assoc. 2005;105:1215-1221. Hospitals are in a constant state of change. Shortened patient lengths of stay, reduced hospital census, and downsizing have challenged hospital foodservice directors to add new skills to their repertoire to aid in reaching overall institution goals (1). Despite this needed transformation in dietetics practitioner roles, the 2000 Committee on Dietetic Registration Dietetics Practice Audit found that the dietetics profession had changed very little compared with the 1989 and 1995 studies of a similar nature (2). In their recent study on current and future practices in hospital foodservice, Silverman and colleagues (3) reported that hospital foodservice directors expected to serve meals to fewer inpatients, employ less staff, have smaller expense budgets, and generate more revenue in the future. Many of the directors (61%) indicated they expected changes in their management responsibilities, as well; many anticipated assuming the management of additional departments. Results of several studies (4-6) have suggested the importance of various management skills for foodservice directors and many industry experts are predicting that food- and nutrition-services directors must increase their management and business skills to thrive in today s health care arena (7). The American Dietetic Association (8) has stated the position that effective management of health care food and nutrition services is best accomplished by dietetics professionals with competence in management; foodservice systems, including food science, safety, and quality; and nutrition in health and disease, including medical nutrition therapy. Limited data exist identifying competencies most important for those holding the position of hospital foodservice director. Perceptions of those currently working in this position as well as perceptions of hospital executives who hire and supervise these directors would be beneficial. Also of interest are perceptions of how well prepared a registered dietitian (RD) is to assume the foodservice department leadership role. The purpose of this study was to determine perceived importance of selected competencies for the role of hospital foodservice director and explore whether RDs are perceived competent in these areas. 2005 by the American Dietetic Association Journal of the AMERICAN DIETETIC ASSOCIATION 1215

METHODS Sample The sample consisted of foodservice department directors and the administrator to whom the director reported in general, medical surgical hospitals of 100 beds or larger. A total of 500 hospitals were randomly selected; 100 from each of four categories: 100 to 199, 200 to 299, 300 to 399, 400 to 499, and 500 or more beds. Mailing labels for these facilities were generated from a list purchased from the American Hospital Association. Instrument Development A questionnaire was developed for data collection. The first section contained a list of 39 competency statements relevant to the position of foodservice director that were compiled from previous research (2,9-11) and information gathered through a modified Delphi process (11 foodservice directors in the first round and eight in the second round). The final questionnaire asked respondents to rate the importance of each statement on a four-point scale (1 not important, 2 of little importance, 3 important, 4 very important). Additionally, executives and directors were asked to rate their beliefs on how competent they believed RDs were for each statement using a fourpoint scale (1 not competent, 2 some knowledge, 3 competent, 4 expert). The second section requested demographic information about the hospital and the director/executive completing the questionnaire. The questionnaire was pilot tested with a convenience sample of four food and nutrition department directors and four hospital executives. The questionnaire was modified slightly based on feedback from pilot test participants. Data Collection The project was reviewed and granted exemption status by the university s Institutional Review Board before data collection. A cover letter and questionnaire were mailed to each hospital foodservice director and chief operation s officer in February 2003. The chief executive officer was asked to complete the questionnaire if the foodservice director reported to her/him or to give the questionnaire to the executive who directly supervised the foodservice director. A preaddressed, postage-paid return envelope was included in the packet to encourage response. Three weeks after the initial letter was sent, a follow-up mailing was sent to nonrespondents. Data Analysis Analysis of data was accomplished using the SPSS for Windows (version 10.1, 1999, SPSS Inc, Chicago, IL). Descriptive statistics were calculated for all variables. 2, Mann-Whitney, and Kruskall-Wallis tests were used to examine differences among ratings by and demographic characteristics of foodservice directors and their executives. These nonparametric analyses were used as data did not meet the assumptions necessary for the use of parametric statistics. Statistical significance of P.05 was used for all tests. Table 1. Demographic information of hospital executives and foodservice directors surveyed regarding perceived importance of selected competencies for the role of hospital foodservice director Characteristic Executives Directors n % n % Sex Male 106 70.7 78 40.8 Female 44 29.3 113 59.2 Age (y) 30 7 4.7 2 1.1 31 40 20 13.3 34 17.9 41 50 62 41.3 80 42.1 51 60 51 34.0 63 33.2 60 10 6.7 11 5.8 Level of education Associate s degree 1 0.7 23 12.0 Bachelor s degree 23 15.1 89 46.4 Master s degree 119 78.3 67 34.9 Doctorate degree 6 3.9 4 2.1 Other 3 2.0 9 4.7 Time on job (y) 5 62 40.8 51 26.6 5 10 41 27.0 53 27.6 11 20 38 25.0 47 24.5 21 30 9 5.9 35 18.2 30 2 1.3 6 3.1 Experience (y) 5 6 3.9 4 2.1 5 10 9 5.9 11 5.8 11 20 48 31.6 51 26.7 21 30 57 37.5 94 49.2 30 32 21.1 31 16.2 RD a Yes 8 5.2 93 48.4 Current director is RD (administrator only) Yes 72 47.4 Worked with RD as director No 40 26.5 34 34.7 Yes 111 73.5 64 65.3 a RD registered dietitian. RESULTS Questionnaires were sent to 500 foodservice directors and 500 hospital executives. A total of 346 returned questionnaires (35% response) were usable for data analysis; 193 directors (39%) and 153 executives (31%) responded. Approximately 90% of those responding worked in not-forprofit hospitals that ranged in size from 100 beds to 500 beds. Respondent Characteristics Foodservice directors tended to be women (59%) with the largest percentage of respondents between ages 41 and 50 years (42%) (Table 1); 46% held a bachelor s degree, and 35% had attained a master s degree. Length of employ- 1216 August 2005 Volume 105 Number 8

ment in current position ranged from 5 years to 30 years, although 92% of directors reported having 10 years experience in health care or related industries. Approximately half (48%) of the foodservice directors reported being an RD. ( Foodservice director refers to the entire group of foodservice directors who responded and includes both RD and non-rd directors.) Hospital executives tended to be men (71%) between ages 41 and 50 years (41%). A majority of executives (78%) held a master s degree (Table 1). The largest proportion of executives (41%) reported having held their current position for 5 years; however, most executives (92%) who responded had 10 years experience in health care or related industries. Although only 5% of executives were RDs, 47% worked with an RD as the current director of food and nutrition services at their facility, and 74% had worked with an RD as a director at some time in their career. 2 analysis was used to explore differences among demographic characteristics of directors and executives. Results suggest foodservice directors in larger hospitals have a higher level of education than those in small hospitals, foodservice directors who are RDs tend to have a higher level of education than those who are not RDs, and women are more likely than men to be RDs. Importance Ratings Foodservice directors and hospital executives rated most of the competencies important or very important (Table 2). Acting as an effective team leader was rated the most important competency by both groups. Competencies rated least important by directors and executives also were similar and included, serves a clinical nutrition resource to medical staff, interprets research for use in practice, participates in the education of dietetic students, and conducts research. Ratings of importance by foodservice directors and hospital executives differed significantly (P.05) for several variables. The most notable difference was for the statement, analyzes financial information for decision making, which executives rated much less important than did directors. Foodservice directors rated manages all aspects of clinical nutrition services and demonstrates ethical practice in the health care setting as less important and rated several other management-related competencies as more important than did the executives (see Table 2). RD status of foodservice directors also influenced importance ratings for several variables. Ratings by directors with RD status were higher in all cases where significant differences in ratings were found. Competency Ratings Foodservice directors and hospital executives mean ratings for all competency statements were higher than 2.0, suggesting RDs are perceived by both groups of respondents to have at least some competence in all areas listed (Table 3). Fewer than half of the statements received a rating of 3.0 or higher by either the foodservice directors or the hospital executives, which suggests RDs often are perceived as being somewhat less than competent in many of these areas. RDs were perceived by both foodservice directors and hospital executives to be most competent in areas such as, demonstrates ethical practice in the health care setting, serves as clinical nutrition resource to medical staff, assures operations are compliant with regulatory guidelines, demonstrates ability to communicate, and practices self-regulation. Mann-Whitney analyses of ratings indicated that hospital executive and foodservice director ratings differed significantly (P.05) for nine items, as shown in Table 3, including areas such as ethical practice, team leadership, managing foodservice operations, risk management, and budgeting. In all cases, hospital executives perceived RDs to be more competent than did the foodservice directors. Foodservice directors who held RD status rated RDs as more competent than did those directors without RD status for operational management statements, including managing foodservice operations, analyzing financial information, doing strategic planning, managing change, and responding to threats and opportunities. Hospital executives who had worked with an RD also rated RDs as being more competent than did those who had not worked with an RD for 15 of the statements (Table 3), in all cases mean ratings of competence were higher when the executive had worked with an RD. DISCUSSION Results of this study suggest only about half of the foodservice departments represented in this study were under the direction of an RD. These results are similar to those reported by other researchers (3,4,12). Such findings are of concern to the dietetics profession as they are not consistent with the position of the American Dietetic Association that effective management of health care food and nutrition services is best accomplished by dietetics professionals (8). Although many (58.8%) of the hospital executives had 20 years of industry experience, 40.8% of executives had held their current job 5 years and 67.8% had been in their position 10 years. By comparison, 83.4% of foodservice directors had held their current job 5 years. Such results might suggest that the hospital executive to whom the foodservice director reports often has been in his/her administrative position for less time than has the director. Few of the hospital executives held the RD credential, suggesting RDs may be remaining in their position as foodservice director rather than being promoted into higher-level hospital administrative positions. Directors who reported being RDs tended to have a higher level of education than those who were not RDs. Also, more female directors than male directors reported being RDs. These data are consistent with membership data from the American Dietetic Association that show dietitians often have earned a graduate degree and that dietetics is a woman-dominated field (13). Hospital executives and foodservice directors gave all but six competencies an importance rating of 3.0 or higher; this suggests most competencies listed on the questionnaire were important to very important for the position of hospital foodservice director. Executives and directors both rated acts as an effective team leader as the most important competency and conducts research as the least important of the competency statements. These findings are similar to those of Dowling and col- August 2005 Journal of the AMERICAN DIETETIC ASSOCIATION 1217

Table 2. Importance ratings a of competency statements for the role of hospital foodservice director Competency statement Executives Directors n Mean SD b n Mean SD Acts as effective team leader 153 4.0 0.22 193 4.0 0.22 Assures current operations are compliant with government and regulatory agency guidelines 153 3.9 0.26 193 3.9 0.38 Demonstrates leadership 152 3.9 0.31 192 3.9 0.30 Demonstrates ability to communicate effectively verbally c 153 3.9 0.32 193 3.9 0.35 Develops operational budgets c 153 3.9 0.36 193 3.9 0.31 Manages all aspects of foodservice operations 151 3.9 0.41 193 3.8 0.38 Demonstrates ability to coach and develop others 152 3.9 0.36 192 3.8 0.43 Demonstrates ability to manage change c 150 3.9 0.36 192 3.8 0.37 Acts as effective team member c 153 3.8 0.37 192 3.8 0.37 Demonstrates ethical practice in the health care setting d 151 3.8 0.37 192 3.7 0.49 Assures ongoing operational measurement and process improvement c 153 3.8 0.43 193 3.7 0.45 Demonstrates ability to communicate effectively in writing c 153 3.8 0.44 193 3.8 0.40 Performs human resource functions within the legal, cultural, and union environment c 153 3.6 0.52 193 3.7 0.52 Demonstrates timely response to operational threats and opportunities 151 3.6 0.52 192 3.7 0.49 Demonstrates effective time management cd 153 3.6 0.48 193 3.8 0.43 Develops capital budgets 153 3.6 0.56 193 3.7 0.47 Effectively manages projects c 153 3.6 0.51 193 3.6 0.49 Demonstrates political astuteness in maintaining functional relationships with other professionals c 152 3.5 0.55 192 3.5 0.61 Demonstrates understanding of job analysis 150 3.5 0.57 190 3.5 0.52 Develops revenue generating opportunities 152 3.5 0.61 192 3.6 0.49 Performs duties efficiently within the organizational governance structure c 152 3.5 0.53 190 3.5 0.52 Demonstrates knowledge of human behavior to business practice 150 3.5 0.56 191 3.5 0.55 Creates business plans incorporating both financial and operational data cd 152 3.4 0.62 192 3.5 0.56 Demonstrates awareness of environment of care issues such as workplace violence d 151 3.4 0.57 192 3.5 0.52 Implements risk management strategies c 153 3.4 0.58 193 3.4 0.59 Understands service delivery systems at different sites across the continuum of care 150 3.4 0.60 191 3.4 0.57 Manages all aspects of clinical nutrition services d 152 3.4 0.74 191 3.1 0.84 Demonstrates understanding of principles of strategic planning and applies them cd 153 3.3 0.59 193 3.6 0.53 Practices self-regulation of professional development cd 152 3.3 0.57 188 3.4 0.59 Demonstrates proficiency in computer software usage c 152 3.3 0.52 193 3.4 0.56 Performs negotiation tasks cd 152 3.2 0.70 192 3.4 0.69 Applies knowledge of marketing principles to decision making cd 153 3.1 0.60 193 3.3 0.59 Demonstrates understanding of payment and reimbursement models and their effects on providers 152 3.0 0.70 191 3.0 0.71 Demonstrates knowledge of factors that affect information services cd 152 2.9 0.68 191 3.1 0.63 Serves as clinical nutrition resource to medical staff 152 2.8 0.91 190 2.8 0.81 Analyzes financial info for use in decision making cd 153 2.8 0.44 193 3.9 0.31 Interprets research for use in practice 152 2.6 0.82 192 2.8 0.75 Participates in education of dietetic students c 152 2.6 0.75 193 2.7 0.76 Conducts research 153 2.3 0.81 192 2.4 0.78 a Scale: 1 not important, 2 of little importance, 3 important, 4 very important. b SD standard deviation. c Ratings of foodservice directors with registered dietitian status differ significantly (P.05) using Mann-Whitney comparison from ratings of directors without registered dietitian status. d Executive and director ratings differ significantly (P.05) using Mann-Whitney comparison. leagues (4) in which management skills received the highest ranking of 14 skills for a successful food and nutrition services director and research received the lowest ranking by both hospital executives and food and nutrition services directors. Other studies (14,15) also stress leadership as the most important skill required in the health care setting today and in the future. A significant difference (P.05) in response was found between hospital executives and foodservice directors in the rating of importance of several business skill-related 1218 August 2005 Volume 105 Number 8

Table 3. Rating a of competency level of registered dietitians (RDs) for the role of hospital foodservice director Competency statement Executives Directors n Mean SD b n Mean SD Demonstrates ethical practice in the health care setting c 126 3.5 0.53 170 3.4 0.65 Serves a clinical nutrition resource to medical staff d 126 3.4 0.69 170 3.4 0.76 Assures current operations are compliant with government and regulatory agency guidelines 129 3.3 0.69 170 3.2 0.75 Demonstrates ability to communicate effectively verbally 129 3.3 0.60 171 3.3 0.63 Practices self-regulation of professional development 127 3.3 0.60 168 3.4 0.67 Manages all aspects of clinical nutrition services d 126 3.3 0.72 169 3.2 0.79 Participates in education of dietetic students d 126 3.3 0.71 170 3.2 0.71 Demonstrates ability to communicate effectively in writing 129 3.2 0.64 171 3.3 0.63 Acts as effective team member 129 3.2 0.68 171 3.0 0.82 Acts as effective team leader c 129 3.1 0.78 171 2.8 0.84 Demonstrates effective time management 129 3.1 0.67 171 3.0 0.68 Demonstrates leadership 127 3.1 0.77 170 2.9 0.77 Effectively manages projects 129 3.1 0.68 171 3.0 0.71 Demonstrates ability to coach and develop others c 127 3.0 0.84 169 2.9 0.82 Demonstrates political astuteness in maintaining functional relationships with other professionals 127 3.0 0.71 170 3.0 0.76 Manages all aspects of foodservice operations cde 128 3.0 0.89 170 2.7 0.95 Assures ongoing operational measurement and process improvement 128 3.0 0.73 170 2.9 0.78 Performs duties efficiently within the organizational governance structure 125 3.0 0.66 167 2.9 0.69 Demonstrates ability to manage change d 126 3.0 0.79 170 2.9 0.79 Understands service delivery systems at different sites across the continuum of care c 125 2.9 0.71 169 2.7 0.80 Demonstrates knowledge of human behavior to business practice e 125 2.9 0.70 170 2.7 0.75 Demonstrates proficiency in computer software usage 129 2.8 0.58 170 2.9 0.62 Demonstrates understanding of job analysis e 129 2.8 0.74 170 2.7 0.74 Demonstrates awareness of environment of care issues such as workplace violence e 127 2.8 0.73 169 2.7 0.73 Implements risk management strategies ce 128 2.8 0.68 171 2.6 0.80 Demonstrates timely response to operational threats and opportunities de 126 2.8 0.74 168 2.8 0.76 Interprets research for use in practice d 127 2.8 0.77 170 2.8 0.79 Develops operational budgets ce 129 2.8 0.75 170 2.5 0.92 Analyzes financial information for use in decision making de 129 2.7 0.86 168 2.6 0.92 Performs human resource functions within the legal, cultural, and union environment e 129 2.7 0.82 169 2.6 0.87 Develops capital budgets ce 129 2.7 0.81 170 2.4 0.92 Conducts research d 125 2.7 0.75 170 2.6 0.80 Develops revenue generating opportunities ce 127 2.6 0.79 169 2.4 0.78 Creates business plans incorporating both financial and operational data e 127 2.6 0.84 169 2.4 0.80 Performs negotiation tasks 127 2.5 0.73 166 2.5 0.84 Demonstrates understanding of principles of strategic planning and applies them de 129 2.5 0.81 170 2.6 0.74 Applies knowledge of marketing principles to decision making e 128 2.5 0.75 170 2.4 0.75 Demonstrates knowledge of factors that affect information services 127 2.5 0.77 169 2.5 0.75 Demonstrates understanding of payment and reimbursement models and their effects on providers e 127 2.4 0.82 170 2.4 0.83 a Scale: 1 not competent, 2 some competence, 3 competent, 4 expert. b SD standard deviation. c Executive and director ratings differ significantly (P.05) using Mann-Whitney comparison. d Ratings of foodservice directors with RD status differ significantly (P.05) using Mann-Whitney comparison from ratings of directors without RD status. e Ratings of hospital executives who have worked with an RD differ significantly (P.05) using Mann-Whitney comparison from executives who had not worked with an RD. competencies. Most of the competencies rated as significantly more important by directors are stated in the knowledge, skills, and competencies for dietitians in the 2002 Commission on Accreditation for Dietetic Education Accreditation Handbook (16). The amount of emphasis given to these competencies in didactic programs was not studied in this project. One of the lowest rated competencies for importance by August 2005 Journal of the AMERICAN DIETETIC ASSOCIATION 1219

hospital executives was analyzes financial information for use in decision-making ; however, foodservice directors gave this competency the third highest rating for importance. One possible explanation for these disparate findings is a difference of interpretation of the competency statement by executives and directors. Whereas executives may view this competency as referring to technical aspects of data management, like report generation, directors may have taken this statement to mean the use of that information to make decisions. Hospital executives and foodservice directors agreed that demonstrates ethical practice in the health care setting and serves as clinical nutrition resource to medical staff were the two areas in which RDs were most competent. Such results are not surprising because the American Dietetic Association has marketed RDs as nutrition experts for many years. These results are consistent with those reported by Karp and Lawrence (17) that employers and RDs rated RDs as highly competent for ethical performance. Of concern to RDs should be the relatively lower ratings given by both hospital executives and foodservice directors for the competence level of RDs on many of the management-related competencies, such as budget preparation, business plan creation, strategic planning, negotiation, marketing, human resource management, and financial analysis. RDs were rated as being competent (mean 3.0) on less than half of the statements listed. In all instances where a significant statistical difference was found between the rating of competency of RDs by hospital executives and foodservice directors, the directors rated the competency of RDs as lower than did executives. Such results are interesting because they may also suggest that RDs may not be confident about their abilities in these management-related areas. Of particular interest are the findings that often those competency statements that were rated as most important by hospital executives were not ones that executives perceived RDs to have high levels of competence in (such as developing operational budgets, managing foodservice operations, and managing change) and conversely often those competencies rated least important by the executives were those in which they perceived RDs to have the highest levels of competence (such as serving as a clinical nutrition resource, practicing self-regulation, and managing clinical nutrition services). Such findings should be of concern to the dietetics profession as they suggest that competency areas in which RDs excel are not those areas that are considered most important by hospital executives. This finding should motivate dietetics practitioners and educators to identify competencies perceived as important by potential employers to assist RDs to be competitive for and successful in hospital foodservice management positions. RDs who serve as directors of food and nutrition service departments need to know what competencies are important to the hospital executives to whom they report. When hospital executives responses were sorted based on if they had experience working with an RD, analysis resulted in significant differences for the rating of several competencies. In all cases, hospital executives who had experience with RDs rated the competence of RDs as significantly higher than did those with no experience working with RDs. Such results may be very important because they suggest that as hospital executives work with RDs, their perceptions of competency of RDs increases. As the number of RDs in the role of foodservice director decreases, fewer opportunities will exists for hospital executives to work with RDs, and this could lead to decreased opportunity for executives to become acquainted with the skills and competencies of RDs and their qualifications for the role of foodservice director. Hospital executives may be less likely to hire an RD for the position of foodservice director if they have little prior knowledge of an RD s competence for that position. Such perceptions may influence the number of dietetics positions in health care in the future. Hospital executives without experience with RD foodservice directors and non-rd foodservice directors may not provide the same advocacy for nutrition care in health care organizations as would those with an understanding of the skills and abilities held by RDs. This is of particular concern to the dietetics profession in times of serious health care financial constraints, like those currently being faced, because the loss of advocacy could result in a loss of dietetics positions and influence in health care. Limitations of this study must be considered when analyzing conclusions drawn from this study. One limitation of this study is the response rate (overall 35%), which may cause a bias in data due to unknown differences between those who choose to respond and those who chose not to respond. Also one must consider that data collected for this study are based on perceptions of competency of RDs; actual competence was not measured. Leadership and operations management skills were identified as some of the most important competencies needed for a hospital foodservice director, yet RDs often were not perceived as being highly competent in these skills. Future research could explore if these skills are being effectively taught in dietetics education programs. The availability of continuing education opportunities for RDs who want to further develop their skills in these areas should be determined. Research also could explore perceptions held by dietetics educators of importance of these competencies and competence of RDs to perform in the role of foodservice director. CONCLUSIONS Unique competencies appear to be important for those aspiring to become hospital foodservice directors. The position of hospital foodservice director should be perceived as a viable and desirable career choice for RDs. Those seeking career opportunities as hospital foodservice directors should review the competencies perceived to be important for this position and evaluate their personal skills and abilities in these areas. Further education may be needed to prepare for these management positions. Ratings by hospital executives and foodservice directors suggest that often RDs are perceived to be only somewhat competent in many of the areas examined in this study. Further, many of the areas perceived as important by hospital executives were not those in which RDs were perceived competent. Such results suggest the need for additional educational opportunities for dietetics professionals. Dietetics educators may need to explore 1220 August 2005 Volume 105 Number 8

further if students are being adequately prepared for the role of hospital foodservice director. Those planning continuing and graduate education opportunities for RDs may want to provide coursework designed to help enhance the competency of dietitians in management-related areas. Researchers might explore if the amount of academic preparation in management areas contributes to RDs not being hired to assume the role of hospital foodservice director. References 1. Fiedler K. When to say yes. Food Manage. 1998;21: 10. 2. Rogers D, Loenberg B, Broadhurst C. 2000 Commission on Dietetic Registration dietetics practice audit. J Am Diet Assoc. 2002;102:270-292. 3. Silverman MR, Gregoire MB, Lafferty LJ, Dowling RA. Current and future practices in hospital foodservice. J Am Diet Assoc. 2000;100:76-80. 4. Dowling RA, Lafferty LJ, McCurly M. Credentials and skills required for hospital food and nutrition department directors. J Am Diet Assoc. 1990;90:1535-1540. 5. Sneed J, Burwell EC, Anderson M. Development of financial management competencies for entry-level and advanced-level dietitians. J Am Diet Assoc. 1992; 92:1223-1229. 6. Nettles MF, Gregoire MB, Partlow CG. Relevance of competencies to graduate education and experience in foodservice management. J Am Diet Assoc. 1993; 93: 877-880. 7. Schuster K. Presidential predictions. Food Manage. 2000;35:41-45. 8. Position of the American Dietetic Association: Management of health care food and nutrition services. J Am Diet Assoc. 1997;97:1427-1430. 9. Griffin B, Dunn JM, Irvin J, Speranza IF. Standards of professional practice for dietetics professionals in management and foodservice settings. J Am Diet Assoc. 2001;101:944-946. 10. Commission on Accreditation for Dietetic Education. Section IV: Knowledge, skills, and competencies for dietitians. In: Accreditation Handbook. 10th ed. Chicago, IL: American Dietetic Association; 2002;38-47. 11. Robbins C, Bradley E, Spicer M. Developing leadership in healthcare administration: A competency assessment tool. J Healthcare Manage. 2001;46:188. 12. Nettles M. Analysis of the decision to select a conventional or cook-chill system for hospital foodservice [dissertation]. Manhattan, KS: Kansas State University; 1995. 13. Bryk JA, Kornblum TH. Report on the 1999 membership database of the American Dietetic Association. J Am Diet Assoc. 2001;101:947-953. 14. Adamson BJ, Lincoln MA, Cant RV. An analysis of managerial skills for the current and future health care environment. J Allied Health. 2000;29:203-213. 15. Sentell JW, Finstuen K. Executive skills 21: A forecast of leadership skills and associated competencies required by naval hospital administrators into the 21st century. Mil Med. 1998;163:3-8. 16. Commission on Accreditation for Dietetic Education. Accreditation Handbook. Chicago, IL: American Dietetic Association; 2002. 17. Karp SS, Lawrence ML. Uses of new competencies to assess entry-level dietitians. J Am Diet Assoc. 1999;99:1098-1100. APPLICATIONS Adequate Preparation vs Thought Processes It s not the Preparation, It s the Strategy This article was written by Kathleen W. McClusky, MS, RD, FADA, a professional issues delegate in Orlando, FL. doi: 10.1016/j.jada.2005.06.016 Leadership is a major issue in management. This is clear from the top ranking it received from hospital administrators and registered dietitians (RDs) in the research discussed in the article by Gregoire and colleagues (1). As the article points out, the American Dietetic Asssociation (ADA) has stated in its position paper on management that RDs are uniquely qualified to direct foodservice departments (2). While foodservice directors and hospital administrators agree on the broad issue of leadership, there are different levels and perceptions of leadership (3). This may be why some aspects of leadership were perceived differently by department heads and hospital administrators. A foodservice department head has several leadership roles: leading associates; leading by building relationships with other hospital departments; and leading by managing up. First, today s skillful department head must manage foodservice associates the traditional activity of managing down. In the best situation, the department head selects, hires, trains, leads, and inspires associates to do their jobs correctly, fully participate, and behave respon- August 2005 Journal of the AMERICAN DIETETIC ASSOCIATION 1221