An assessment tool for developing healthcare managerial skills and roles

This article is based on a study to identify, and by doing so help develop, the skills and roles of senior-level healthcare managers related to the needs of the current healthcare environment. To classify these roles and skills, a qualitative study was conducted to examine the literature on forces in the healthcare environment and their impact on managers. Ten senior managers were interviewed, revealing six roles as the most crucial to their positions along with the skills necessary to perform those roles. A pilot study was conducted with these senior managers to produce a final assessment tool. This assessment tool helps managers to identify strengths and weaknesses, develop in deficient areas, and promote competence in all areas as demanded by the market and organization. This tool can be used by organizations in the recruitment process and in the training process.     

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care.

OBJECTIVES: To examine patient satisfaction with and recommendation of a hospital, with a special focus on the correlation of these measures to patient ratings of interpersonal and technical performance of the hospital. DESIGN: Telephone survey of patients with four specific conditions after their discharge from hospitals. SETTING: Accredited district teaching hospitals and above, nationwide in Taiwan. PARTICIPANTS: A total of 4945 patients from 126 hospitals diagnosed with or undergoing procedures related to stroke, diabetes mellitus, Caesarean section, or appendectomy were interviewed by telephone. MAIN OUTCOME MEASURES: Overall patient satisfaction and recommendation were measured by single-item questions. Interpersonal skills were measured by three items: doctors' explanation, attitude, and caring. Technical skills were measured by another three items: hospital equipment, clinical competence, and outcome of treatment. RESULTS: Interpersonal skills were as influential or more influential than clinical competence on patient satisfaction for three of the four disease categories. In contrast, technical competence was a more influential predictor for recommendation for patients in all four disease categories. CONCLUSION: The preliminary results imply that a hospital with high percentage of patient satisfaction does not necessarily receive a high level of recommendation. This finding provides new insights for researchers and for hospital managers who devote resources exclusively for achieving the highest possible levels of patient satisfaction.     

Managerial functions of college and university foodservice managers

This study examined managerial roles in college and university foodservice at three organizational levels. The study population included foodservice managers at National Association of College and University Food Services (NACUFS) member schools with a minimum annual budget of +3 million. The 999 managers from 80 colleges and universities who participated were categorized into three groups: assistant, associate, or director of foodservice; unit manager; and manager reporting to unit manager. They rated 51 activity statements on importance and time demand. Maintaining standards of quality was rated most important and most time demanding by all three groups of managers. Perceived importance and time demand of activities increased as managerial level increased. Activity statements were categorized into Mintzberg's 10 managerial roles. Significant differences in importance and time demand ratings among the three managerial groups were indicated for all 10 roles. However, perceived importance and time demand of roles increased as managerial level increased with two exceptions. Disturbance handler and leader roles were rated more time consuming by lower level managers.     

Comparative attributes of effective health services managers and definitions of organizational effectiveness in Australia, the UK and the USA.

This paper explores and contrasts the perceptions of 855, mainly health services managers and 1452 students from three major English-speaking countries regarding the attributes needed for becoming effective managers in their country. Also addressed are country differences and similarities in the perceived relevance of particular indicators of organizational effectiveness. Despite Australia's British heritage, respondents from this country were found to be more similar to those from the USA, than those from the UK, in their views regarding the attributes of effective managers. Australian and American respondents rated 'nurturing' personality skills relatively highly, as they did 'classical' management skills. UK respondents rated 'classical' management skills as more important than 'political' skills.     

An investigation of physician assistant and medical student empathic skills

Empathic skill levels in allied health professionals are associated with both patient satisfaction and compliance. These skills have been related to clinicians' educational backgrounds. The primary purpose of this study was to compare the empathic skill levels of health care students having different educational preparation but a similar practice orientation. The secondary purpose was to examine these students' self-perceptions of their own empathic skill levels. The subjects were physician assistant and medical students. Reliability was increased by using four different published instruments to obtain multiple measures on both subject self-ratings and an observer ratings of the subjects. Medical students rated themselves significantly lower (p less than 0.001) than the observers on one instrument, and physician assistant students rated themselves the same as the observers. The scores on observer-rated instruments were consistently higher for physician assistant students than for medical students, but these differences were not statistically significant.     

Competent kids: children and adolescents with a chronic illness

The social and personal competence of children and adolescents with a seizure disorder or an orthopaedic condition was assessed by parents and teachers. The contributions to these assessments of characteristics of the child, the intensity of the illness, and the child's temperament were explored using a hierarchical regression model. Parents and teachers rated all children as functioning fairly well. Children with a seizure disorder were perceived as significantly less competent than were their healthy peers (P less than 0.05). Across health status groups, children received higher competence scores from their parents than they did from their teachers (P less than 0.05). Competence scores did not differ according to the age of the child. The patterns of variables that predicted ratings of competence differed according to illness type and rater. Indicators of illness intensity explained a larger share of the variance in competence ratings for children with a seizure disorder (25%) than for children with an orthopaedic condition (5%). For children in this latter group, temperament explained a much larger proportion of the variance in both parents' (29%) and teachers' (42%) ratings of competence than did the illness intensity variables.     

Pathways of influence: Chinese parents' expectations,parenting styles,and child social competence

This study examines relations among Chinese parents' expectations for children's development of social–emotional skills, parenting styles, and child social competence. A total of 154 parents with preschool-aged children from mainland China completed questionnaires measuring their timing of expectations for children's mastery of social–emotional skills, value placed on social–emotional skills, parenting styles, and child social competence. Parenting styles were found to mediate the effects of parental expectations on child social competence. Parents with earlier expectations reported higher levels of authoritative parenting, which, in turn, related to better parent-reported child social competence. Parents who placed more value on social–emotional skills were more likely to adopt an authoritative parenting style, and subsequently, they reported children having better social competence.     

Perceptions of competency attainment in community dietetics: academic Plan IV vs. dietetic internship

A national survey of Plan IV representatives, internship directors, and dietetic interns was conducted to determine the perceived level of competence in community dietetics upon completion of academic coursework. Interns also rated their perceived competence in community dietetics near the end of internships. All major and specific responsibilities from the ADA Role Delineation and Verification for Entry-Level Positions in Community Dietetics were included in the survey questionnaire. Completed questionnaires were received from 447 dietetic interns (60%), 47 internship directors (57%), and 59 Plan IV representatives (39%). Highly significant differences were found among the three groups, with Plan IV representatives' expectations highest and students' lowest. Work experience prior to internship affected mean ratings on selected responsibilities. Unlike the results of the previous studies in clinical dietetics and foodservice systems management, the ratings in community dietetics did not reach their highest until the last month of the internship. Findings from all three areas of dietetic practice suggest that students' perceived competence is considerably lower upon completion of Plan IV than after completion of an internship, indicating need for defined work experience. Different teaching techniques, i.e., lecture vs. hands-on, could be related to different ratings of perceived competence within and between practice areas.     

Next generation leadership: a profile of self-rated competencies among administrative resident and fellows

Healthcare executives and program faculty have voiced concerns that early careerists lack needed competencies for future leadership in the increasingly complex healthcare industry. However, empirical studies of early careerists' competency levels are limited. We sought to describe administrative fellows' and residents' (n = 78, response rate 73.6%) self-rated competency in several key areas and assess how these ratings differed by individuals' gender, age, prior work experience, year of graduate training, and type of degree program. Respondents rated their competence particularly high (41.7% of respondents rated themselves "A") in the domain of interpersonal and emotional intelligence, which included being an effective team leader and member, coaching and developing others, self-awareness, and self-regulation. Lower ratings were in the domains of facilities management and in development and fundraising. Compared to males, females rated their competency in the financial skills domain lower (P-value = 0.04). Age, prior work experience, year of graduate training, and type of degree program were not significantly associated with self-rated competency in any area. These results provide early evidence that may help program faculty and preceptors consider pedagogical approaches that reflect students' vocalized needs and may help to design strategies that effectively cultivate next generation leadership.     

Managerial work behavior and hierarchical level: implications for the managerial training of first-line supervisors

Mintzberg proposed that managers at all levels enact ten roles. There is, however, a relative importance ascribed to the various roles given the manager's location in the hierarchy. Like Mintzberg's ideas on the utility of ten roles, we found that managers at all levels, to varying degrees, need the three skills proposed by Katz. We have argued that a variety of roles and skills describe what managers do. At the same time, the predominance of one role or skill over another may be influenced by the location of the manager in the hierarchy. The question is not whether roles would be enacted at different levels or whether skills will be required, but whether one role or skill or a set of roles and skills will be predominant for the first-line supervisor. The first-line supervisor's work requires that he or she be predominantly proficient in the areas of human and technical skills in order to fulfill supervisory responsibilities. Current empirical research supports this assertion; however, the continuing study of managerial roles and skills and other variables such as functional specialty will offer other opportunities for the study of first-line supervisors. For example, will the predominance of the roles and skills that we have discussed vary if the supervisor is a line or staff manager or if the supervisor works in a production or service related organization? Organizations adapt to change to meet the expectations of those within and outside the organization with something at stake. Organizations need managers to facilitate the realization of organizational goals, so organizations need to continuously train managers, targeting appropriate roles and skills given each manager's location in the hierarchy. The preceding pages should provide resource materials to individuals and organizations interested in evaluating and designing the training and development of first-line supervisors. This roles-and-skills information can be productively utilized to assist the organization with its management training, particularly of first-line supervisors.     

Perception of competency attainment in foodservice management: academic Plan IV vs. dietetic internship

A national survey of 487 dietetic interns (61%), 63 internship directors (76%), and 68 Plan IV representatives (45%) utilized ADA entry-level role responsibilities in foodservice systems management. Student respondents rated perceived competence at the start and near completion of the internship. Program directors rated expected competence at the start of the internship. The three groups differed significantly on mean responses, with interns' ratings lowest and Plan IV representatives' ratings highest. Interns' mean ratings suggested that work experience just prior to starting an internship increased competence somewhat, regardless of type of work. Work during college was not included in the analysis. Interns' mean ratings also suggested that competence peaked some weeks before internship completion. Level of competence averaged about 6 on a scale of 0 to 7 at that time. Starting competence averaged about 2.5 to 3, indicating that Plan IV contribution is substantial but internship experience is essential for entry-level performance. Foodservice systems management competence levels compare very favorably with those previously reported for clinical dietetics.     

Medical student interviewing skills and mother-reported satisfaction and recall

BACKGROUND: Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes. OBJECTIVES: To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations. METHOD: Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice. RESULTS: Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01). CONCLUSIONS: Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.     

Work stress, smoking habits and competence in supporting clients to cease smoking--a survey among Finnish nurses

This paper describes results of a survey of Finnish nurses (n=882), their views of themselves as employees, their experiences of work stress and their competence to guide clients in smoking cessation. Nurses' skills to guide clients were fairly good but they had a lack of knowledge of smoking cessation centers and nicotine substitutions. The more positive the nurses' views were of themselves as employees, and the less they had experienced work stress related to their clients, the better they evaluated their skills and knowledge to guide clients to cease smoking. The results can be used to develop nurse education by providing a stronger knowledge base of smoking cessation. Nurses' view of themselves as employees could be strengthened by providing them with positive feedback from colleagues and managers.     

An evaluation of social skills in children with and without prenatal alcohol exposure

Background The goal of this study was to examine social skills deficits among children with and without prenatal alcohol exposure (PAE) who were both referred to a respite programme. Methods Thirty‐seven children with PAE and 23 non‐exposed children (aged 3 to 8 years) were evaluated on the Social Skills Rating System (SSRS) by their caregivers and respite workers. Results As compared with the non‐exposed children, those with PAE showed more deficits on caregiver ratings of responsibility, hyperactivity, internalizing problems and overall social skills, as well as respite worker ratings of hyperactivity. The social skills among the PAE group were not related to home placement variables. Among both groups, caregivers rated social skills lower than respite workers, and among the PAE group, girls tended to display more social skills deficits than boys. Conclusions The SSRS is useful in identifying unique social skills deficits among children with PAE.     

Global overall rating for assessing clinical competence: what does it really show?

Context  Single-item global overall ratings are often used as a method of assessing learners' clinical competence at the end of a clerkship. The purpose of this study was to identify which aspects of clinical competence are assessed through these ratings.
Methods  At the end of a clinical clerkship in primary health units, 106 Year 4 students are routinely assessed by faculty staff of three disciplines (obstetrics and gynaecology, internal medicine, paediatrics), using a single global numeric rating (on a scale of 0–10). Faculty scores across disciplines for each learner are averaged to produce a global overall rating (GOR). In this study, the same students were assessed by the same faculty staff 2 weeks later using a newly developed, more detailed form composed of 13 domains, of which six related to technical skills and seven to humanistic skills, each scored on a scale of 0–10. Scores for each domain across disciplines were averaged as global itemised ratings (GIRs). Statistical analysis included Cronbach's α coefficient and Pearson's correlation coefficients. Statistical significance was set at P  ≤ 0.05.
Results  The internal consistency of GIR items was high (α coefficient = 0.935). Global overall rating scores were higher than most technical domains of GIRs and lower than the humanistic domains of GIRs. The highest significant correlations were found between the GOR and the technical domains of the GIR.
Conclusions  When faculty staff attribute a global single-item overall rating to a student's clinical competence, they tend to focus more on technical skills.     

Relationship of candidate communication and organization skills to oral certification examination scores

This study investigated the relationship between candidate's proficiency in communication/organization and ability measures derived from judges' oral examination ratings on a medical specialty certification examination. Judges who rated candidates on the oral examination also provided a separate rating for candidates' communication/organization skills. ANOVA was used to examine differences among levels of communication/organizational skills with respect to candidates' ability measures on the oral examination. There was a statistically significant increase in oral examination measures for candidates with higher levels of communication/organization skills. This supports the hypothesis that candidates who were more proficient in organizing and presenting their responses were more likely to have better performance on the oral examination. Given communication and oral examination ratings were provided by the same judges, future research should investigate whether these preliminary findings generalize to situations in which communication ratings are obtained from independent ratings during and outside the oral examination.     

Jordanian mothers' perceptions of their children's social competence: an examination of family factors and demographic variables

Children's social competence is an area of research that receives minimal attention from Jordanian researchers. It is important to investigate this area of development so as to provide parents with information about the nature of social competence and possible factors affecting its development. This research study examined Jordanian mothers' perceptions of their kindergarten children's social competence: individual and social attributes. Perceptions were investigated in relation to family size, child's gender, mothers' education level, and marital status. Social competence ratings were obtained from 726 mothers who responded to the study's two-part questionnaire developed by the researcher. The results revealed an average level of social competence ratings by mothers on the total scale with higher ratings for children's social attributes compared to individual attributes. Significant results were found between the study's variables and mothers' perceptions of children's competencies. Mothers who are married, with the least number of children, and with higher education levels rated competencies higher compared to their counterparts. Significant differences were also found for gender with mothers rating the social competence of girls higher than boys. Directions for future research include investigating social competence using multiple sources of data.     

Child psychiatric skills in primary healthcare--self-evaluation of Finnish health centre doctors

OBJECTIVE: To study Finnish general practitioners' (GP's) perceptions of their child psychiatric skills. METHODS: The study sample consisted of physicians (n=755) working in health centres situated in the special response area of the Tampere University Hospital, Finland. They were requested to assess their competence in 16 areas on a four-step Likert scale. The response rate was 66.1% (n=499). RESULTS: Physicians evaluated their child psychiatric skills as inadequate on many issues. The ability to identify depression was poorer the younger the child in question. Only a minority (14%) felt they were well able to identify a depressed infant. Many physicians considered themselves poorly skilled in assessing the relationship between infant and parents (39.8%), in assessing a child's need for psychiatric treatment (42.7%) and in identifying a child with attention-deficit disorder (40.7%). A majority (75.9%) rated their skills poor in co-operating with daycare personnel or school staff in matters concerning a child with conduct disturbance. Only 26.8% could assess the necessity of taking a child into custody. Women gave higher ratings of their skills in identifying depressed infants and in assessing the infant-parent relationship than men, whereas men assessed their skills as better in cases in which there were problems in co-operation with parents. CONCLUSIONS: In order to provide good psychiatric services for children, attention should be paid to the GPs' child psychiatric skills.     

Assessing facilitator competence in a comprehensive communication skills training programme

Objectives  Evidence suggests that the most important component of communication skills training (CST) is experiential learning through role-play sessions that rely on facilitators to guide learners. However, there is little published evidence about processes of assessing facilitator competence in CST. This paper reports on the development and application of procedures to assess facilitator competence in a large-scale CST programme.
Methods  Thirty-two novice facilitators in a large CST programme were audio-recorded while facilitating small-group CST training sessions in order to explore whether the training they had received had prepared them to competently facilitate. Audio-recordings were assessed using the Comskil facilitator assessment coding system. Facilitators were rated as having achieved basic competence, advanced competence or expert competence.
Results  Facilitation tasks that were most frequently coded as being used always included inviting the learner to give feedback first and inviting all group members to give feedback. The facilitation task coded least frequently as being used always was involving group members in solving problems. Of the 32 facilitators, 18 reached at least a basic level of competence. Psychosocially trained facilitators and MD facilitators differed in their use of five facilitation tasks.
Conclusions  Modest training and minimal practice does not result in complete facilitator competence. Some facilitation skills appear to be more easily acquired than others. These findings highlight which skills should be prioritised in the further training of novice facilitators. A long-term project currently underway will study whether facilitator competence improves with practice and regular feedback.     

A Comparison of Self-Reported Health Education Competencies Among Selected School Health Educators In the United States and Taiwan, R.O.C

Results from a preliminary, cross-national study examining perceived competence of school health educators in Taiwan, R.O.C., and in Florida are reported. The study used the Self-Assessment for the Health Educator instrument, developed by the National Task Force on the Preparation and Practice of Health Educators, Inc., which specifies 79 skills in seven competency areas. School health educators from Taiwan and Florida rated their own perceived competence regarding each skill, and assessed the perceived usefulness of each skill in health education practice. Responses from the two groups were similar on six of seven competency areas regarding usefulness of the items. Yet, teachers from Taiwan expressed greater perceived competence than the Florida teachers in five of seven areas. However, within both groups, teachers rated perceived usefulness higher than their own perceived level of competence. Inservice training, amount of formal training, and years of professional experience affected levels of perceived confidence in both groups. Initial results suggest the self-assessment instrument may prove useful as a tool for examining professional competence in other countries, but more extensive research is needed to determine the instrument's applicability in cross-national comparisons.