Common Competencies for All Healthcare Managers: The ...

1 Common Competencies for AllHealthcare Managers: The Healthcare LeadershipAlliance ModelMaryE. Stefl, PhD, professor and chair. Department of Health Care Administration,Trinity University, San Antonio, Texas - - .EXECUTIVE SUMMARYT oday's Healthcare executives and leaders must have management talent sophisti-cated enough to match the increased complexity of the Healthcare are expected to demonstrate measurable outcomes and effectiveness andto practice evidence-hased management. At the same time, academic and profession-al programs are emphasizing the attainment of Competencies related to workplaceeffeaiveness. The shift to evidence-based management has led to numerous efforts todefine the Competencies most appropriate for Healthcare Leadership Alliance (HLA), a consortium of six major profession-al membership organizations, used the research from and experience with their indi-vidual credentialing processes to posit five competency domains Common among allpracticing Healthcare managers: (1) communication and relationship management,(2) professionalism, (3) leadership, (4) knowledge of the Healthcare system, and(5) business skills and knowledge.

2 The HLA engaged in a formal process to delin-eate the knowledge, skills, and abilities within each domain and to determine whichof these Competencies were core or Common among the membership of all HLAassociations and which were specialty or specific to the members of one or more HLAorganizations. This process produced 300 competency statements, which were thenorganized into the Competency Directory, a unique and interactive database that canbe used for assessing individual and organizational Competencies . Overall this workhelps to unify the field of Healthcare management and provides a lexicon and a basisfor collaboration among different types of Healthcare article discusses the steps that the HLA followed. It also presents the HLAC ompetency Directory; its application and relevance to the practitioner and academ-ic communities; and its strengths, limitations, and more information on the concepts in this article, please contact Dr.

3 Stefi Competencies FOR ALL Healthcare MANAGERSP eter Drucker (2002) has said thatlarge Healthcare institutions may bethe most complex in human history andthat even small Healthcare organiza-tions are barely manageable. Some timehas passed since Drucker's observation,but the complexity of Healthcare orga-nizations, along with the demands onmanagers and leaders, has not dimin-ished in any way. Today, executives inall Healthcare settings must navigate alandscape influenced by complex socialand political forces, including shrinkingreimbursements, persistent shortages ofhealth professionals, endless require-ments to use performance and safetyindicators, and prevailing calls for trans-parency. Further, managers and leadersare expeaed to do more with 1999, the Society of Health-care Strategy and Market Developmentand the American College of HealthcareExecutives have been producing Future-scan, a compendium of Healthcare trendsand projections for the next five years.

4 InFuturescan 2008, the publication's execu-tive editor, Don Seymour, reflected onthe past ten years in Healthcare :society appears to be sending a clear,overarching message to the nation'shospitals: Take care of more peoplewho have growing expectations andmore complex medical needs v^-hileproviding increasingly sophisticatedcare with relatively fewer an environment of escalated publicdemand, it is only l gica! to questionthe competence of Healthcare lead-ers and managers. As noted in Griffith(2007), the increased difficulty of run-ning a Healthcare organization has ledto the need for managers with moresophisticated questions now become. Havemid- and senior-level managers beenkeeping pace with changing demands?Are Healthcare academic programs at-tracting sufficient numbers of students 'and adequately preparing them to oper-ate effectively in this dynamic environ- 'ment? These concerns were the focus ofthe 2001 National Summit on the Fu-ture of Fducation and Practice in Health 'Management and Policy.

5 Principallyfiinded by the Robert Wood JohnsonFoundation, this conference broughttogether practitioners, policymakers,and educators to examine the effective-ness of Healthcare administration andthe role of academic preparation andcontinuing professional developmentin tackling the current and future chal-lenges of Healthcare Summit's deliberations focusedon evidence-based approaches (seeKovner 2001 ) to developing manage-ment talent, including how to measurethe outcomes of health managementeducation (Griffith 2001) and howto determine whether administrationstudents and practicing managers hadacquired the Competencies necessary toperform effectively in their COMPETENCY MOVEMENTThe emphasis on measurable outcomesand Competencies did not happenovemight. The widespread acceptanceof evidence-based medicine was anatural precursor to an evidence-basedapproach to Healthcare management(Kovner and Rundall 2006).

6 Also, thedevelopment and promotion of compe-tencies for graduate medical education(Batalden et al. 2002) set the stage forhealthcare Healthcare MANAGEMENT 53:6 NOVEMBER/DECEMBER 2008 More broadly, higher educationhas struggled with the issue of compe-tency-based education for some time(Calhoun et al. 2002; Westera 2001).The main idea behind this initiative is todesign curricula based on the roles thatgraduates will assume after complet-ing their degree and to incorporate thespecific knowledge, skills, and abilities(KSAs) that future employees will to promote Competencies havebeen undertaken in numerous fields,including public health (Council onLinkages Between Academic and PublicHealth Practice 2001) and the healthprofessions (IOM 2003). The controver-sial Spellings report (issued in 2006 bythe Secretary of Education's Commis-sion on the Future of Higher Educationconvened by Secretary of EducationMargaret Spellings) pushes universi-ties nationwide to measure studentoutcomes and then make these resultsavailable to the meet the needs of healthcareadministration, a number of univer-sity programs have developed a set ofcompetencies ( , Cherlin et al.)

7 2006;Shewchuk, O'Connor, and Fine 2005;2006; White, Clement, and Nayar 2006)or competency models ( , Campbellet al. 2006) for their students. A reviewof these efforts is beyond the scope ofthis article, but note that these variousprograms typically use a similar pro-cess for developing their Competencies :(1) existing competency literature isreviewed, (2) subjea matter experts(either faculty or practitioners) are ap-proached to provide depth and contentvalidity, and (3) a survey of practi-tioners is condurted. In other words,academic programs take steps to ensurethat their competency models are tiedwitb the realities and needs of health-care management practice. However,little evidence shows a link betweenactual performance and competencyattainment (Bradley 2003), an area ofinquiry tbat clearly needs more atten-tion as competency models continue from this work in academia,the National Center for Healthcare Lead-ership has expended considerable effortin creating a competency model that canbe applied to professional developmentand to academic programs (Calhounet al.

8 2004; NCHL 2005). In addition,many Healthcare associations have usedexpert opinion and job analysis surveysto delineate the KSAs that form the basisfor their credentialing exams. However,these KSAs were not usually shared withtbe broader Healthcare HEALTHCARELEADERSHIP ALLIANCEThe Healthcare Leadership Alliance(HLA) is a consortium of major profes-sional associations in the healthcarefield: American College of HealthcareExecutives (ACHE); American College of PhysicianExecutives (ACPE); American Organization of NurseExecutives (AONE); Healthcare Financial ManagementAssociation (HFMA); Healthcare Information and Manage-ment Systems Society (HIMSS); and Medical Group Management362 Common Competencies FOR ALL Healthcare MANAGERSA ssociation (MGMA) and its educa-tional affiliate, the American College ofMedical Practice Executives (ACMPE).Together, these associations representmore than 100,000 management profes-sionals.

9 II 'In response to concerns about theadequate preparation of healthcaremanagers and administrators, the HLAconvened the Competency Task Force toexamine the credentialing and certifica-tion processes of its member organiza-tions. First meeting in late 2002, theTasii Force was composed of a repre-sentative from each organization' and afacilitator (this author). The Task Forcewas charged with a straightforwardresponsibility: Determine if there weremanagement Competencies shared by allmembers of the HLA organizations. Ifso, the Task Force would determine howthese Competencies could be used toadvance the the Credentialing andCertification ProcessesI ask Force work began with an exchangeof information regarding each associ-ation's credentialing and certificationprocesses. Five of the six organizationshad well-established processes, whileAONE was considering launching itsown certification program.

10 ^ Certifica-tion programs are designed to ensurethat individuals in a professional posi-tion meet the basic educational, skill,and/or experiential requirements oftheir respective profession (Raymond2001 ). Thus, credentialing or certifica-tion exams should be job-related andshould be designed to test whether theprofessional possesses the KSAs essentialfor his or her job. For large organiza-tions, certification exams are typicallyobjective, with questions constructedfollowing the job analysis associations (ACHE, HFMA,HIMSS, and ACMPE) used well-established psychometric processes(job analysis surveys or role delineationstudies, review by subject matter experts,and content analysis) to determinethe KSAs for their certification exams(NCCA 2007). All engaged reputablepsychometric firms to ensure the reli-ability and validity of their ACPE's certification process wasslightly different from that employedby the rest of the group.