The educational needs of healthcare managers and executives in the key strategic areas of healthcare

Management approaches used by many healthcare organizations lag behind those of similar competitive industries. The authors of this article report findings from an exploratory study of executives' perceptions of training needs in managerial strategy. The authors asked executives to rate the level of knowledge required for each of five key areas in strategic management and then to assess actual levels of knowledge in the field. They found that (a) strategic management is vital in this competitive industry, (b) there is a disconnect between what healthcare managers should know and what they actually know about the tasks of strategic management, and (c) more resources need to be devoted to strategic management training and the development of managers at all levels of healthcare organizations.     

The Educational Needs of Healthcare Managers and Executives in the Key Strategic Areas of Healthcare

Management approaches used by many healthcare organizations lag behind those of similar competitive industries. The authors of this article report findings from an exploratory study of executives' perceptions of training needs in managerial strategy. The authors asked executives to rate the level of knowledge required for each of five key areas in strategic management and then to assess actual levels of knowledge in the field. They found that (a) strategic management is vital in this competitive industry, (b) there is a disconnect between what healthcare managers should know and what they actually know about the tasks of strategic management, and (c) more resources need to be devoted to strategic management training and the development of managers at all levels of healthcare organizations.     

Who should lead a healthcare organization: MDs or MBAs?

Debates often arise about who is best suited to manage a healthcare organization. Therefore, we argue that an examination of the ability of healthcare organizations' chief executive officers (CEOs) to make strategic decisions is warranted. Is the most appropriate leader the medically educated CEO, whose training in patient care allows him or her to be most cognizant of the quality-of-care needs of the organization? Or is it the managerially educated CEO, whose training makes him or her most aware of the organization's financial needs? This article presents a study involving senior managers from two integrated healthcare organizations. The study revealed that no significant differences exist between medically educated and managerially educated senior managers in their ability to make strategic decisions that maximize the net income or the quality of care of the healthcare organization. The debate that pits the "MDs" against the "MBAs" is misdirected. Characteristics other than educational degree appear to have a stronger influence on a CEO's ability to make successful strategic decisions. Therefore, candidates' educational background should not play such an important role in the processes for selecting CEOs.     

Teaching evidence-based management: where do we go from here?

Recently we talked with executive directors of healthcare organizations about the sources of information they use when conducting research. The responses were very similar. They preferred "googling," reading trusted trade journals, and reading more generic business literature such as Harvard Business Review. When asked if they ever read and used healthcare management research, they said the articles were often inaccessible. First, as CEOs faced with the responsibility for their organization's performance, they want to know whether there is anything in the research that will help them run their organizations better. Unfortunately, as observed by Gary Mecklenburg in this issue, the focus in healthcare research is too frequently on research implications, not on what a CEO wants and needs to know. As a result, the research is not always relevant. Further, by the time the research is conducted and published (it is not infrequent for more than a year to elapse from submission to actual publication in a journal, and by then the data may be two or more years old), executives have moved on to other decisions. As one of the CEOs observed, there is a gap between what she needs to know and what the health management literature has to say. Second, managers have limited time, and information needs to be succinct and to the point if it is to be useful. Research articles are very time consuming to read, and as the CEOs commented, time is a precious resource. Research articles frequently devote considerable space to conceptual development and methods, and even when managerial implications are addressed, managers     

Bridging the gap: academic and practitioner perspectives to identify early career competencies needed in healthcare management

Healthcare organizations, health management professional associations, and educational institutions have begun to examine carefully what it means to be a fully competent healthcare executive. As 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.     

Quality improvement in the curriculum: a survey of AUPHA programs

During the past decade, healthcare organizations have responded to a changing and unstable healthcare environment by implementing Quality Improvement initiatives. The goal of these activities is to improve system performance and outcomes, both administrative and clinical. Many of the models for Quality Improvement have been adopted from the manufacturing sector and with modification, implemented within healthcare systems. Healthcare managers must now be able to compute run-charts, use statistical process control to measure variation within processes, develop flow-charts, and be knowledgeable about the development and interpretation of customer satisfaction surveys. Although Quality Improvement has been readily adopted by healthcare organizations, information is lacking about the preparation of new healthcare managers in regard to these modalities. A survey was created to assess the extent that students are being prepared to use the tools of Quality Improvement. The instrument was administered to undergraduate, graduate, and executive healthcare management member programs of the Association of University Programs of Health Administration. The results of the survey provide information about what is currently being taught in healthcare administration educational programs.     

Exploring dual commitment among physician executives in managed care

The growth of a medical management specialty is a significant event associated with managed care. Physician executives are lauded for their potential in bridging the clinical and managerial realms. They also serve as a countervailing force to help the medical profession and patients maintain a strong voice in healthcare decision making at the strategic level. However, little is known about their work loyalties. These attitudes are important to explore because they speak to whose interests physician executives consider and represent in their everyday management roles. If physician executives are to maximize their effectiveness in the healthcare workplace, both physicians and organizations must view them as credible sources of authority. This study examines organizational and professional commitment among a national sample of physician executives employed in managed care settings. Data used for the analysis come from a national survey conducted through the American College of Physician Executives in 1996. The findings support the notion that physician executives can and do express simultaneous loyalty to organizational and professional interests. This dual commitment is related to other work attitudes that contribute to success in the management role. In addition, it appears that situational factors increase the chances for dual commitment. These factors derive from a favorable work environment that includes both organizational and professional socialization in the management role. The results of the study are useful in specifying the training and socialization needs of physicians who wish to do management work. They also provide a rationale for collaboration between healthcare organizations and rank-and-file physicians aimed at cultivating physician executives who are credible leaders within the healthcare system.     

Building an understanding of the competencies needed for health administration practice

Rapid change in the healthcare environment has pressured healthcare organizations, health management professional associations, and educational institutions to begin examining more carefully what it means to be a fully competent healthcare executive. As a result, interest in healthcare management core competencies has increased. Most competency development initiatives seek to build consensus and typically result in the generation of five or six broad competency domains--but consensus around what? Most competency initiatives are based on literature reviews and consensus-building efforts. Typically, such efforts in healthcare management have involved defining general competency domains and attempting to specify representative behavioral exemplars that demonstrate mastery of the general competency domain. This study describes an approach that used a purposeful sample of ACHE affiliates who represent different geographic regions and health industry segments to construct a framework composed of critical healthcare issue clusters. A panel of healthcare executives then specified five sets of entry-level behavioral competencies that would be required to address the clusters of critical issues. Although the behavioral competencies identified by the executives in this study are anchored to a framework, their empirical association with performance has not been tested. Before implementing broad curriculum redesign, the effect of these competencies on performance should be established. Additionally, competencies should be examined in the context of potential moderating influences such as specific educational program focus, educational delivery format, and type and preparation of students entering healthcare management education programs. Competency, competencies, competency models, and competency-based training are all Humpty Dumpty words meaning only what the definer wants them to mean. The problem comes not from malice [or] stupidity... but instead from some basic procedural and philosophical differences among those racing to define the concept and to set the model for the way the rest of us will use competencies (Zemke 1982).     

Managing strategic outsourcing in the healthcare industry

Hospitals and healthcare systems are facing increased financial difficulties because of the Balanced Budget Act of 1997 and managed care. As a result, healthcare executives face the challenge of reducing costs while maintaining quality patient care. One of the strategic tools healthcare executives use to meet this challenge is outsourcing. Even though outsourcing has many benefits, outsourcing will fail if not managed successfully. Senior executives must choose outsourcing managers who have the necessary leadership capabilities. Managing outsourcing requires an understanding of outsourcing strategy, the benefits and risks of outsourcing, the evaluation process, and the methods to managing strategically. With appropriate management, strategic outsourcing should provide healthcare executives with a viable strategy for controlling costs and maintaining quality patient care.     

Advancing the state of the art in healthcare strategic planning

A recent survey of the state of strategic planning among healthcare organizations indicates that planners and executives believe that healthcare strategic planning practices are effective and provide the appropriate focus and direction for their organizations. When compared to strategic planning practices employed outside of the healthcare field, however, most healthcare strategic planning processes have not evolved to the more advanced, state-of-the-art levels of planning being used successfully outside of healthcare. While organizations that operate in stable markets may be able to survive using basic strategic planning practices, the volatile healthcare market demands that providers be nimble competitors with advanced, ongoing planning processes that drive growth and organizational effectiveness. What should healthcare organizations do to increase the rigor and sophistication of their strategic planning practices? This article identifies ten current healthcare strategic planning best practices and recommends five additional innovative approaches from pathbreaking companies outside of healthcare that have used advanced strategic planning practices to attain high levels of organizational success.     

Politically connected: increasing the political competency of healthcare executives in health policy

In this article we provide a teaching frame of reference for healthcare management students, to more effectively engage in the health policy-making process. We show how future executives can direct or transfer their management skills and abilities to the health policy arena. In doing so, healthcare executives attain a proactive stance in the political process, which is essential to the overall strategic management of healthcare organizations. Using organization theory as a pedagogical tool, we outline the similarities and differences in the management of hospitals versus state legislatures. We identify areas of common ground, and suggest components to frame political advocacy strategy for healthcare executives that strengthen their political competency. Thus, the article provides a teaching framework for health services management students about key intersections between management and policymaking.     

Perceptions of management development in selected hospitals

Today health care executives are managing organizations that are complex and require a higher degree of financial management, medical knowledge, and general business skills. The skills and academic background required to manage health care facilities have been debated by practitioners and academicians over the years. This study will examine executives' perceptions of management development activities in their organizations. To assess these perceptions, an eight-item questionnaire was mailed to 587 executives. Forty-two percent were returned. The data showed that a majority of the respondents indicated that the management development programs in their organizations were well received and that the morale of managers had improved. The pressures and challenges facing health care organizations will require managers and executives to make use of a wide range of skills if they are to be successful.     

Leadership in diversity

As principal change agents, healthcare leaders are well positioned to integrate diversity into their institutions' organizational structure. Thus healthcare leaders must be competent in handling diversity issues. Diversity refers to any characteristic that helps shape a person's attitudes, behaviors, perspective, and interpretation of what is "normal." In the healthcare ministry, diversity encompasses the cultural differences that can be found across functions or among organizations when they merge or partner. Managers and supervisors will have to be familiar with the nuances of diversity if they are to be effective. Those managers who are not adept at incorporating diversity into human resource management may incorrectly evaluate subordinates' capabilities and provide inappropriate training or supervision. As a result, some employees may be underutilized. Others may resist needed direction, overlook instructions, or hide problems such as a language barrier. If executives, marketers, and strategic planners are to develop relevant healthcare services that take into account the needs of their constituencies, they will need to determine how different groups understand and access healthcare. Healthcare leaders who know how to uncover cultural dynamics and challenge cultural assumptions will go far in enabling their staff and managers to confront personal attitudes about community residents. Ultimately, quality of service delivery will be improved.     

Info system evangelists

Top executives of healthcare organizations are recognizing the crucial role information systems play in realizing their strategies and fostering the productivity required for success. Modern Healthcare's eight annual survey of information system trends shows the boardroom and executive suite are becoming important checkpoints for clearance of information technology.     

The changing managerial role of physician executives

A survey of tasks performed by a sample of 517 physician executives from the AMA Masterfile was carried out to determine the role played by this group of administrators in health care organizations. In contrast to the findings of previous studies, physician executives appear to have responsibilities in general management as well as clinical management and do not focus primarily on physician and medical staff issues. No significant differences were found among respondents from hospitals, government, academic organizations, group practices/HMOs, and physician executives who spend more than 90 percent of their time in administration. Tasks identified as important for the future but not currently being done were primarily in the category of external activities such as "changing regulations and legislation" and "communicating goals to the public." These results identify an important boundary-spanning role for physician executives in balancing managerial and professional issues of cost, quality, and access in health care organizations. The implications of these findings for the educational needs of physician executives are discussed.     

Characteristics and educational needs of senior health service managers in Australia.

A conflict between perceived management skill and educational deficiencies led to a survey of Australian hospital chief executive officers, directors of medical services, directors of nursing, and other managers of equivalent status in an effort to improve the caliber of senior health officials in the future. The results are outlined and analyzed in this article. Although measurement of their characteristics is mainly of interest to Australians, the information on the background, process, and education for management has much wider relevance.     

Getting off the bandwagon: an academic health center takes a different strategic path

Focusing on one state university academic health center (AHC) located in a rural setting in the southeastern United States, this case study investigates the strategic response to the increasingly turbulent and competitive environment in the healthcare industry. The qualitative research reported here involved a review of pertinent documents and archival data and interviews with key informants including AHC executives and staff, community leaders, and others. Additional information was obtained from published sources, including a literature review that covers a five-year period ending in 1997 and searches conducted using the key words "academic medical or health center." The AHC in this case study demonstrates how it is possible to respond proactively to changes in the environment without sacrificing the multiple missions of the institution. This AHC implemented strategies that ensure access for both inner city and rural underserved populations while providing venues for primary care training and educational programs. In addition, the AHC positioned itself to compete more effectively by implementing a continuous quality improvement program that is aimed at maximizing quality while controlling costs. Administrators in not only AHCs but also other healthcare organizations, such as community hospitals and competing systems, should consider the findings from this case study useful in evaluating existing strategies and possible alternatives. In particular, the use of an affiliation strategy for growth in a resource-poor environment may encourage organizations located in rural areas to consider innovative expansion strategies to develop integrated systems of care.     

Access to capital--a growing concern

Access to capital over the next ten years will be one of the biggest challenges healthcare organizations will face as they strive to remain competitive and serve their communities. Meeting the growing needs for capital will require a disciplined and honest assessment of the capital sources that will be available and the best ways of positioning an organization to maximize their uses. It is incumbent on chief executive officers and other senior leaders to create a disciplined process for allocating capital and conveying how that process will be linked to the organization's strategic plan. All of the credit constituencies "buying" healthcare need to fully understand how the organization is positioning itself for future growth and success, and detailed bond marketing plans need to be implemented well before the actual sale of a new bond issue. Large and small healthcare providers will have sufficient access to capital in the future if investors believe that senior hospital executives have a credible plan and are disciplined enough to execute it.     

Health care executive education and training

This paper examines the new situation of unprecedented change in the health care field--in which yet greater demands are in place for executive performance--and studies the educational and learning resources available to health care executives. The virtual transformation of the field requires new skill sets, competencies, and knowledge for high performing executives. How well is the field as a whole doing in providing appropriate learning opportunities? How well are health care organizations doing in effectively utilizing these resources of the field? What are the most crucial and immediately pertinent competencies needed; what are the topics of prime interest? And, are the overall learning efforts cost-effective with efficacious means of evaluation? These are the questions addressed by this article ... with the answers drawn from health care executives themselves.     

Hay/Modern Healthcare compensation survey

Compensating increases for hospital senior managers this year show that more healthcare providers are investing in their management teams as a whole, rather than just in the top dog. While the average base salary for chief executive officers is still higher than for other top hospital executives, CEOs' average raises were surpassed by other managers' average increases, according to the 1990 Hay/Modern Healthcare Compensation Survey.