Common Competencies for All Healthcare Managers: the Healthcare Leadership Alliance Model

Common Competencies for All Healthcare Managers: The Healthcare Leadership Alliance Model

MaryE. Stefl, PhD, professor and chair. Department of Health Care Administration, Trinity University, San Antonio, Texas - - • .

EXECUTIVE SUMMARY Today's healthcare executives and leaders must have management talent sophisticated enough to match the increased complexity of the healthcare environment. Executives are expected to demonstrate measurable outcomes and effectiveness and to practice evidence-hased management. At the same time, academic and professional programs are emphasizing the attainment of competencies related to workplace effeaiveness. The shift to evidence-based management has led to numerous efforts to define the competencies most appropriate for healthcare. The Healthcare Leadership Alliance (HLA), a consortium of six major professional membership organizations, used the research from and experience with their individual credentialing processes to posit five competency domains common among all practicing healthcare managers: (1) communication and relationship management, (2) professionalism, (3) leadership, (4) knowledge of the healthcare system, and (5) business skills and knowledge. The HLA engaged in a formal process to delineate the knowledge, skills, and abilities within each domain and to determine which of these competencies were core or common among the membership of all HLA associations and which were specialty or specific to the members of one or more HLA organizations. This process produced 300 competency statements, which were then organized into the Competency Directory, a unique and interactive database that can be used for assessing individual and organizational competencies. Overall this work helps to unify the field of healthcare management and provides a lexicon and a basis for collaboration among different types of healthcare executives. This article discusses the steps that the HLA followed. It also presents the HLA Competency Directory; its application and relevance to the practitioner and academic communities; and its strengths, limitations, and potential.

For more information on the concepts in this article, please contact Dr. Stefi at [email protected].

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eter Drucker (2002) has said that The questions now become. Have P large healthcare institutions may be mid- and senior-level managers been the most complex in human history and keeping pace with changing demands? that even small healthcare organiza- Are healthcare academic programs at- tions are barely manageable. Some time tracting sufficient numbers of students ' has passed since Drucker's observation, and adequately preparing them to oper- but the complexity of healthcare orga- ate effectively in this dynamic environ- ' nizations, along with the demands on ment? These concerns were the focus of managers and leaders, has not dimin- the 2001 National Summit on the Fu- ished in any way. Today, executives in ture of Fducation and Practice in Health ' all healthcare settings must navigate a Management and Policy. Principally landscape influenced by complex social fiinded by the Robert Wood Johnson and political forces, including shrinking Foundation, this conference brought reimbursements, persistent shortages of together practitioners, policymakers, health professionals, endless require- and educators to examine the effective- ments to use performance and safety ness of healthcare administration and indicators, and prevailing calls for trans- the role of academic preparation and parency. Further, managers and leaders continuing professional development are expeaed to do more with less. in tackling the current and future chal- Since 1999, the Society of Health- lenges of healthcare delivery. care Strategy and Market Development The Summit's deliberations focused and the American College of Healthcare on evidence-based approaches (see Executives have been producing Future- Kovner 2001 ) to developing manage- scan, a compendium of healthcare trends ment talent, including how to measure and projections for the next five years. In the outcomes of health management Futurescan 2008, the publication's execu- education (Griffith 2001) and how tive editor, Don Seymour, reflected on to determine whether administration the past ten years in healthcare: students and practicing managers had society appears to be sending a clear, acquired the competencies necessary to overarching message to the nation's perform effectively in their roles. hospitals: Take care of more people who have growing expectations and THE COMPETENCY MOVEMENT more complex medical needs v^-hile The emphasis on measurable outcomes providing increasingly sophisticated care with relatively fewer resources. and competencies did not happen ovemight. The widespread acceptance In an environment of escalated public of evidence-based medicine was a demand, it is only lógica! to question natural precursor to an evidence-based the competence of healthcare lead- approach to healthcare management ers and managers. As noted in Griffith (Kovner and Rundall 2006). Also, the (2007), the increased difficulty of run- development and promotion of compe- ning a healthcare organization has led tencies for graduate medical education to the need for managers with more (Batalden et al. 2002) set the stage for sophisticated capabilities. healthcare administration.

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More broadly, higher education that their competency models are tied has struggled with the issue of compe- witb the realities and needs of health- tency-based education for some time care management practice. However, (Calhoun et al. 2002; Westera 2001). little evidence shows a link between The main idea behind this initiative is to actual performance and competency design curricula based on the roles that attainment (Bradley 2003), an area of graduates will assume after complet- inquiry tbat clearly needs more atten- ing their degree and to incorporate the tion as competency models continue to specific knowledge, skills, and abilities develop. (KSAs) that future employees will need. Aside from this work in academia, Efforts to promote competencies have the National Center for Healthcare Lead- been undertaken in numerous fields, ership has expended considerable effort including public health (Council on in creating a competency model that can Linkages Between Academic and Public be applied to professional development Health Practice 2001) and the health and to academic programs (Calhoun professions (IOM 2003). The controver- et al. 2004; NCHL 2005). In addition, sial Spellings report (issued in 2006 by many healthcare associations have used the Secretary of Education's Commis- expert opinion and job analysis surveys sion on the Future of Higher Education to delineate the KSAs that form the basis convened by U.S. Secretary of Education for their credentialing exams. However, Margaret Spellings) pushes universi- these KSAs were not usually shared with ties nationwide to measure student tbe broader healthcare management outcomes and then make these results community. available to the public. To meet the needs of healthcare THE HEALTHCARE administration, a number of univer- LEADERSHIP ALLIANCE sity programs have developed a set of The Healthcare Leadership Alliance competencies (e.g., Cherlin et al. 2006; (HLA) is a consortium of major profes- Shewchuk, O'Connor, and Fine 2005; sional associations in the healthcare 2006; White, Clement, and Nayar 2006) field: or competency models (e.g., Campbell et al. 2006) for their students. A review • American College of Healthcare of these efforts is beyond the scope of Executives (ACHE); this article, but note that these various • American College of Physician programs typically use a similar pro- Executives (ACPE); cess for developing their competencies: • American Organization of Nurse (1) existing competency literature is Executives (AONE); reviewed, (2) subjea matter experts (either faculty or practitioners) are ap- • Healthcare Financial Management proached to provide depth and content Association (HFMA); validity, and (3) a survey of practi- • Healthcare Information and Manage- tioners is condurted. In other words, ment Systems Society (HIMSS); and academic programs take steps to ensure • Medical Group Management

362 COMMON COMPETENCIES FOR ALL HEALTHCARE MANAGERS

Association (MGMA) and its educa- for his or her job. For large organizational affiliate, the American College of tions, certification exams are typically Medical Practice Executives (ACMPE). objective, with questions constructed following the job analysis studies. Together, these associations represent Four associations (ACHE, HFMA, more than 100,000 management profes- HIMSS, and ACMPE) used well- sionals. II ' established psychometric processes In response to concerns about the (job analysis surveys or role delineation adequate preparation of healthcare studies, review by subject matter experts, managers and administrators, the HLA and content analysis) to determine convened the Competency Task Force to the KSAs for their certification exams examine the credentialing and certifica- (NCCA 2007). All engaged reputable tion processes of its member organiza- psychometric firms to ensure the reli- tions. First meeting in late 2002, the ability and validity of their processes. Tasii Force was composed of a repre- The ACPE's certification process was sentative from each organization' and a slightly different from that employed facilitator (this author). The Task Force by the rest of the group. Following an was charged with a straightforward on-site tutorial session, ACPE candidates responsibility: Determine if there were were tested by faculty experts using an management competencies shared by all in-basket exercise and requiring a verbal members of the HLA organizations. If presentation. All associations' certifica- so, the Task Force would determine how tion exams were discriminatory; first- these competencies could be used to time pass rates ranged from 60 percent advance the field. to 85 percent (Stefl 2003a). In general, the certification processes Reviewing the Credentialing and of the HLA organizations were intended Certification Processes to provide early careerists an opportuni- I ask Force work began with an exchange ty to demonstrate their competence. At of information regarding each associ- the time of the Competency Task Force's ation's credentialing and certification review of KSAs, most HLA associations processes. Five of the six organizations (except AONE) offered a fellowship had well-established processes, while status for those with more senior-Ieve! AONE was considering launching its accomplishments and contributions. own certification program.^ Certifica- Most associations (except HIMSS) tion programs are designed to ensure awarded the Fellow status only after that that individuals in a professional posi- member had attained certification and tion meet the basic educational, skill, the requisite competencies. Thus, the and/or experiential requirements of Task Force's review excluded the fellow- their respective profession (Raymond ship processes. 2001 ). Thus, credentialing or certification exams should be job-related and Identifying Common Competencies should be designed to test whether the The extensive review of the credentialing professional possesses the KSAs essential and certification processes of the HLA

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members revealed a number of overlap- management, (c) organizational dy- ping and complementary competencies. namics and governance, (d) strategic The Task Force determined that these planning and marketing, (e) infor- KSAs clustered into five competency mation management, (f ) risk man- domains that were common among the agement, and (g) quality improve- membership of all six associations (Stefl ment 2003a): In keeping with the current focus on 1. Communication and Relationship outcomes and evidence-based manage- Management: The ability to com- ment, these five domains were viewed municate clearly and concisely with as common competencies or compe- internal and external customers, tency domains. While "competency" to establish and maintain relation- can be defined in a variety of ways, the ships, and to facilitate constructive Task Force adopted a definition from interactions with individuals and Ross, Wenzel, and Mitlyng (2002): groups Competencies are clusters that "tran- scend unique organizational settings 2. Leadership: The ability to inspire and are applicable across the environ- individual and organizational excel- ment. "That is, the domains identi- lence, to create and attain a shared fied by the Task Force are generic and vision, and to successfully manage demonstrable. change to attain the organization's strategic ends and successful perfor- The Task Force viewed these com- mance petency domains as interdependent (see Figure 1). Because leadership 3. Professionalism: The ability to align competencies are central to a healthcare personal and organizational con- executive's performance, the Leadership duct with ethical and professional domain anchors the HLA model. All standards that include a responsibil- other domains draw from the Leader- ity to the patient and community, ship area, but the other competencies a service orientation, and a com- also feed and inform leadership. In mitment to lifelong learning and Figure 1, the two-way arrows outside the improvement circles indicate that the other four do- 4. Knowledge of the Healthcare Environ- mains draw from each other and share ment: The demonstrated understand- overlapping KSAs. ing of the healthcare system and the The identification of these five environment in which healthcare domains sends a powerful message managers and providers function to the healthcare field: Healthcare 5. Business Skills and Knoivledge: The managers in a wide range of positions ability to apply business principles, and settings share a common body of including systems thinking, to the knowledge and a common lexicon. healthcare environment; basic busi- Such a message can break down bar- ness principles include (a) financial riers between various health manage- management, (b) human resource ment professionals, provide a stronger

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FIGURE 1 The Healthcare Leadership Alliance Competency Model

Competency Domains

Communtcation and Relationship Professionahsm Management

Knowledge of Business the Healthcare Knowledge and Environment Skills

Source: ^ 2005. M\ Rights ReservedbyMembtrrs of the HLA Competency Task Force: American College of Healthcare txeaiiives. American College of Physician Executives, American Organizalion of Nurse Executives, Heallhrare Pinancial Management Association, Healthcare Information and Management Systems Society, and the certiñcation body of the Medical Group Management Association—American College of Medical Practice Executives.

basis for collaboration, and engender entry-level, mid-career, and senior-level mutual respect and teamwork. Most managers. In its deliberations, the Task importantly, the work itself suggests that Force was guided by the skill acquisition a common background, expertise, and model developed by Stuart Dreyfus and language are shared by members of the Hubert Dreyfus (1986). The Dreyfus C-suite, the practice management com- model has been applied to the nursing munity, and healthcare managers in a field (Benner 1984), and it guided the range of positions and settings (Rossiler development of ACMPE's competency and Stefl 2005). and certification model. More recently, the Accreditation Council for Graduate Using the Dreyfus Model Medical Education applied the model to Much of the discussion regarding develop core competencies for medical competencies attempts to distinguish residents (Batalden et al. 2002), and the the performance expectations for model has been discussed in relation to

365 JOURNAL OF HEALTHCARE MANAGEMENT 53:6 NOVEMBER/DECEMBER 2008 health administration education (Stefl This progression underscores the need 2003b). for mentoring throughout career stages The original Dreyfus model outlined as well as the importance of continued five stages for skill development: novice, professional development and lifelong advanced beginner, competent, profi- learning. cient, and expert. As skills develop, the The HLA Task Force recognized individual's reliance on rules decreases that the Dreyfus model could serve as a and the ability to make independent framework for individual development judgments increases. By the time a in all competency areas (Stefl 2003a). person reaches the proficient and expert An individual who was competent in levels, he or she can recognize patterns one domain (e.g.. Knowledge of the in the environment and operate (at least Healthcare Environment) could be a partially) on intuition. novice in another (e.g.. Professional- For example, an entry-level manager ism). Members who achieved certifica- will consult a policy manual to deal tion by each HLA organization were with a distraught and angry patient or considered to be at the competent level. family member. A mid-level manager, Members who sought Fellow status however, is already thoroughly familiar within their respective associations with the protocols governing the situ- could operate at the proficient level. The ation and will employ strategies and Task Force believed that the expert level responses that have effeaively diffused was beyond the realm of testing or cre- similar situations in the past. A se- dentialing. Experts are acknowledged by nior-level executive will respond more their peers and typically receive honors intuitively, recognizing patterns in the or distinctions from their professional situation and knowing implicitly when associations. to apply rules and when to be more creative. This intuitive and discrimina- Organizing and Generating Competency tory knowledge can only come from Statements experience and practice in applying According to Shewchuk, O'Connor, management skills. Each manager in and Fine (2005), broad competency this scenario is using KSAs in the Com- domains have limited usefulness. Their munication and Relationship Manage- lack of specificity prevents any real ment domain. application in the work setting or for When the situation is viewed in curricular design. Although core compe- terms of the Dreyfus model, the new tencies common among all healthcare manager is acting as a novice, the more executives engender understanding and experienced manager is functioning at collaboration, they mask the different the competent level, and the senior ex- expectations for each type of healthcare ecutive is responding at the proficient or manager. For example, chief financial expert level. Progressing from one skill officers are expected to have a wider level to another, especially from novice range of financial analysis competen- to competent, typically requires experi- cies (a subset of the Business Skills and ence coupled with guided reflection. Knowledge domain) than are needed by

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the general membership of ACHE. Simi- fied by tbe association they represented larly, information systems managers (except those assigned by AONE, which are expected to have broader abilities in had no formal certification process) and technology design and implementation were actively engaged with the associa- than required of chief nursing officers. tion and its professional activities. The Specialty competencies for the use of SMEs is a standard prartice in membership of each HLA association competency studies (NCCA 2007); ex- would likely complement the core perts are often used to provide content competency domains. More specific validity to the competencies identified KSAs within each domain would also be in job analysis studies. useful. In fact, many of the competen- During the SME review meeting, cies outlined by the individual associa- other competencies were added to the tions in their job analyses were more initial listing. Some of the added KSAs detailed and unique to their own group. were clearly specific to an individual What was needed was a mechanism that association, while others were more combined and compared the various generic and thus were judged appro- KSAs and tbat determined wbich of the priate to all healthcare managers. The detailed competency statements could discussion revolved around identifying apply across the entire healthcare man- tbe appropriate domain for a specific agement field. A competency directory competency and determining whether a was conceived as a way to accomplish competency was common or specialty. those tasks. Subsequent to this meeting, a series A psychometric firm assisted tbe of webinar-enhanced conference calls Task Force in developing the HLA Com- was conducted with the Task Force, the petency Directory.^ The firm reviewed psychometric consultant, and the SME the competency statements from all panels for each HLA association. Tbe HLA associations and, in the process, purpose of these calis was to review eliminated or combined overlapping and refine the individual competency KSAs and then prepared an initial com- statements, determine whether the petency listing. All competency state- competency should be listed as a skill or ments were then organized according knowledge, and categorize whether tbe to the five competency domains (see competency was common or specialty. Figure 1). Throughout this iterative process, two The preliminary competency listing surveys were administered to all SME was reviewed and expanded by a panel panelists. These surveys allowed experts of experts (or subject-matter experts to rank the perceived relevance of each |SMEs|) during a two-day meeting in competency statement and to identify September 2004. Each HLA association gaps or omissions in each competency nominated three of its members, one domain. of whom had some academic involve- Competency statements were catego- ment/background, to serve on the SME rized as either knowledge areas or skills. panel. In general, panel members were All skills were coded using 11 action senior-level executives who were certi- verbs, such as "manage," "execute," and

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"develop." Finally, approximately 32 key The Financial Management and In- words were assigned to each of the coin- formation Management functional areas petenq'statements, including "technol- produced the highest number of spe- ogy," "physicians," and "outcomes." The cialty competencies, reflecting the highly Task Force developed and assigned key technical aspects ofthese functions. words and skill areas in an attempt to fit Even so, the number of core competen- the needs of association members. cies in both areas is substantial. Fewer specialty competencies were listed under THE HLA COMPETENCY Risk Management or Strategic Planning DIRECTORY and Marketing. This may suggest that The process resulted in the creation of these areas are generic, or it may reflect the HLA Competency Directory,'' an the lack of expertise in these categories Excel-based interactive tool, it con- among those involved in developing the tains a series of filters that allow the directory. Few specialty competencies user to sort by skills versus knowledge, were noted under Other Business Skills core versus specialty, keyword, skill and Knowledge, reflecting the general area, or professional association. This nature of this category. This functional design enables the user to customize area, for example, incorporates skills searches according to the user's need or and knowledge related to quantitative circumstance. and analytical decision making, project management, and systems thinking. The Directory contains 300 competency statements organized under the When the specialty competen- five domains of the HLA model. The cies were examined, most (45 or 66.2 vast majority (232 or 77.3 percent) of percent) pertained to the membership the skills and knowledge listed are com- of two or more of the HLA associations. mon to all the management professions Twenty of the specialty competencies represented by the HLA associations; were relevant only to ACMPE; these only 68 specialty competencies were competencies reflected the unique identified. Table 1 shows the number of aspects of practice management. HIMSS core and specialty competencies by the claimed the remaining three specialty five domains. Also, the table divides the competencies, which related to aspects Business Skills and Knowledge domain of the information technology field. No into various functional areas. competencies were unique to finan- Virtually all of the specialty com- cial managers, nurse executives, or the petencies fail within the Business Skills general managers represented by ACHE. and Knowledge domain, providing All otber specialty competencies were further evidence that healthcare manag- claimed by two or more associations. ers in different roles share an extensive common knowledge and skill base. MODEL AND DIRECTORY Because the Professionalism domain in- APPLICATIDNS corporates ethical codes and standards, the lack of variance in this area suggests To the Practitioner Field that a common value set for al! types of The HLA model and the Competency healthcare managers exists. Directory offer a number of benefits

368 COMMON COMPETENCIES FOR ALL HEALTHCARE MANAGERS

TABLE 1 HLA Core and Specialty Competencies by Domain

Domain Number Core Specialty Total

Communication and relationship management 22 3 25 Leadership I 23 1 24 Professionalism 23 •• 1 24 Knowledge of the healthcare environment 20 2 22 Business skills and knowledge 144 61 205

Financiid immagetnem 18 17 35 Human resource management 16 8 24 Organizational dynamics and governance 11 7 18 Strategic planning and marketing 17 4 21 ¡nformation management 24 12 36 Risk management ^ 15 3 18 Quaiity improvement 10 7 17 Other business skills and Imowledge 33 3 36

Total 232 68 300

to healthcare management. First and interprofessional teamwork among foremost, this work helps distinguish these associations, within the practice and define the profession by providing setting, and within educational or aca- a common framework and lexicon for demic programs. a wide variety of healthcare managers. Other tangible benefits of this proj- Acknowledging the fact that a common ect include the following; body of knowledge and skills exists can engender teamwork and mutual respect • AONE (2005) has produced a self- (Rossiter and Stefl 2005). The compe- assessment tool that incorporates tency domains and individual compe- competencies for nurse executives tency statements can serve as the basis into the HLA competency framework. for joint educational programming be- These nurse executive competencies tween various professional associations. were developed by AONE simulta- These KSAs are also helpful in clarifying neous with but independent of the job descriptions or in constituting work HLA model and the Directory. Con- teams with complementary skills and sequently, this tool is more refleaive knowledge. This project represented an of the clinical setting. The tool pro- unprecedented collaboration among the vides space for respondents to rate HIA organizations, an effort that can their performance level—from novice be a model or a foundation for future to expert on the Dreyfus scale—for

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each competency area. Respondents Effective in the fall of 2008, the Com- are then encouraged to prepare a mission on Accreditation for Healthcare development plan for areas in which Management Education's (2007) criteria they are lacking. Feedback has re- require that graduate health adminis- vealed that this tool has been valu- tration programs adopt a competency able in writing job descriptions and model as the basis for curricular offer- in conducting performance reviews ings. The HIA model has been con- (Thompson 2006). The tool is avail- sidered by many of these programs. able on the AONE website to mem- Because programs will need to link bers only. course content as well as individual student achievements to the model, thus • ACHE has produced the ACHE far few programs could adopt all 300 Healthcare Executive Competen- statements in the Direaory. However, cies Assessment Tool 2008. This tool the five competency domains and the organizes the 300 statements in the subcategories listed in the ACHE assess- Directory into convenient subcat- ment tool represent a framework that egories. For example, Relationship programs can readily use. Management, Communication Skills, and Facilitation Skills are components Drawing on the HLA model and of the Communication and Relation- assessments conducted at individual ship Management domain. Like the universities (Shewchuk, O'Connor, and AONE tool, the ACHE self-assessment Fine 2005; 2006; White, Clement, and instrument allows respondents to Nayar 2006), four graduate programs^ rate their performance on a five-point collaborated to produce a set of 30 scale, ranging from novice to expert. competencies (O'Connor et al. 2008). This tool also provides resources for These competencies are more macro improvement in each subcategory, than the HLA statements. For example, directing users to available publica- only one statement pertains to financial tions, educational programming, self- management, a distinct difference from study courses, and other assessment the 24 finance-specific competencies means. ACHE encourages its affiliates found in the Direaory. The intent of to use the tool, which is updated an- this collaborative project was to de- nually, for personal and professional termine if a joint competency model, improvement. Distributed to all based on the HLA domains, could be ACHE affiliates, the tool is available developed by the four separate entities. for download on the ACHE website: The programs involved were natural www. ache.org/pdf/nonsecu re/careers/ partners. Each had strong relationships competencies_booklet.pdf. with the practitioner community, each offered both full-time on-campus and executive program options, and three To the Academic Community of the four required a year-long ad- The HLA model and the Competency ministrative residency for on-campus Directory were originally envisioned students. All programs were located in to be useful for academic programs. the southeastern United States and had

370 COMMON COMPETENCIES FOR ALL HEALTHCARE MANACERS students whose primary interest was conducted new job analyses, requiring operations. any new information to be added to the In 2007, a web-based survey was Directory. conducted with faculty, preceptors, and The Directory may have other recent graduates of the four university limitations. First, although physicians programs. Respondents were asked were well represented in ACMPE's origi- to indicate, on a five-point scale, how nal job analyses and ACPE was a full strongly they felt new graduates needed participant in delineating the compe- each of the 30 competency areas. tency domains, clinical concerns may Overall, 340 individuals responded, have been inadequately represented as or 49,2 percent of the total number of a result of ACPE's nonparticipation in people contacted. Respondents indi- the Directory's development (Griffith cated that all competencies were neces- 2007), Second, the SMEs chosen by the sary, although some were judged more HLA associations may have unknowing- important than others. However, ratings ly introduced some bias. In the future, of the individual competencies were re- the number of SMEs may be increased markably consistent across respondents or a general membership survey may from all four programs. Further, ratings be conducted to further validate the ' from all three respondent groups were competencies. Third, Griffith (2007) similar, especially between faculty and argues that the Directory lacks emphasis preceptors. ' on insurance and quality management These results provide a good field and measurement, and it does not ofïer test and validation of the HLA compe- a clear distinction between skills and tency model and demonstrate that the knowledge. All of these concerns may be model can be simplified and adapted easily addressed in future versions of the ' for use in health administration gradu- Directory. ate education. The success of this col- Future updates should also focus laborative project may encourage other on specialty competencies, which were university programs to draw on the HLA unevenly distributed among the HLA model in the future. associations. The largest number of specialty KSAs was attributed to ACMPE Limitations and Future Adjustments (2003), which maybe a reflection of the The HLA Competency Directory is a organization's extensive previous work work in progress. Building consensus on its Body of Knowledge for Medical Prac- around the 232 common competen- tice Management. cies was an iterative process, with each review further refining the list. With the CONCLUSION healthcare industry changing rapidly, The HLA common competencies make healthcare management competencies an important contribution to the grow- clearly will require continual updat- ing body of knowledge about competen- , ing and validation. Since the Directory cies in healthcare management (Carman was made available in November 2005, and lohnson 2006), The HLA model, many of the HLA associations have complete with the Dreyfus framework,

371 JOURNAL OF HEALTHCARE MANAGEMENT 53:6 NOVEMBER/DECEMBER 2008 can be used for individual and organiza- American Organization of Nurse Executives tional assessment, employee selection, (AONE). 2005. "AONE Nurse Executive Competencies." Nurse leader 3 (1)- 15-21. and team development. In addition, the Batalden, P., D. Leach, S. Swing, H. Dreyfus, model can be adapted for use in aca- and S. Dreyfus. 2002. "General Compe- demic programs, as demonstrated by the tencies and Accreditation in Graduate joint project by healthcare administra- Medical Education." Heakh Affairs 21 (5): 103-11. tion graduate programs. A unique and Benner, P. 1984. From Novice to Expert: Promot- useful tool for individuals and organiza- ing Excellence and Power in Clinical Nursing tions, the HLA Competency Direaory Practice. Menio Park, CA: Addison*Wesley. can be used to foster collaboration and Bradley, E. H. 2003. "Use of Evidence in Imple- advancement across the broad spec- menting Competency-Based Healthcare Management Training." Journal of Health trum of healthcare management. In this Administration Educalion 20 (4): 287-304. environment of constant and dramatic Calhoun, J. C, P. L. Davidson, M. E. Slnoris, changes, these are important benefits. E. T. Vincent, and J. R. Griffith. 2002. "To- ward an Understanding of Competency Identification and Assessment in Health NOTES Care Management." Quality Management in 1. The members of the Task Force were Health Care \\ (1): 14-38, Caihoun, I. G., E. T. Vincent, G. R. Baker, P. W. Cynthia A. Hahn, FACHE (ACHE), Butler, M. E. Sinoris, and S. L. Chen. 2004. Roger Schenke (ACPE), Andrea Ros- "Competency Identification and Model- siter, FACMPE (MCMA/ACMPE), ing in Healthcare Leadership." ¡oumal of Pamela Thompson, FAAN {AONE), Health Administration Education 21 (4): 419-40. Joseph Abel, PhD (HFMA), and Campbell, C. R., A. M. T. Lomperis, K. N. Gil- Julianna Kazragys (HIMSS). lespie, and B. Arrington. 2006. "Com- 2. In October 2008, AONE launched petenq'-Based Healthcare Management Education: The Saint Louis University a certification program. For more Experience." Journal of Health Administra- information visit www.aone.org. tion Education 23 (2): 135-68. 3. ACPE did not participate in this Cherlin, E., B. Helfand, B. Elbel, S. H. Busch, • phase of the projea. and E. H. Bradley. 2006. "Cultivating Next Generation Leadership: Preceptors' 4. The HLA Competency Direaory and Rating of Competencies in Post-Graduate an accompanying User Guide can be Administrative Residents and Fellows." downloaded from www.healthcare- Journal of Health Administration Education 23 (4): 351-65. leadershipalliance.org. Gommission on Accreditation for Healthcare 5. Medical University of South Caro- Management Education (GAHME). 2007. lina, Trinity University, University of "Criteria for Accreditation." ¡Online infor- Alabama-Birmingham, and Virginia mation: retrieved 7/24/08.| www.cahme. o rg/Accreditation/Official CAHM EC riteria- Commonwealth University Iall2008andBeyond.pdf. Council on Linkages Between Academic and Public Health Practice. 2001. Core REFERENCES Competencies for Public Health Piofessionals. American College of Medical Practice Execu- [Online information: retrieved 7/24/08.| tives (ACMPE). 2003. TheACMI^E Guide www.trainingfinder.org/competencies. to the Body of Knowledge for Medical Practice Dreyfus, H., and S. Dreyfijs. 1986. Mind Over Management ¡Online information; Machine. New York: Free Press. retrieved 7/25/08.1 www.mgma.com/ Drucker, P. 2002. Managing in the Next Society. workarea/showco ntenl. aspx? i d=3 9 9 0.

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New York: Truman Talley Books, St. Programs in I lealth Administration, Martin's Griffin. Washington, DC, lune. Futvrescan 2008: HeaUbcare Trends and implica- Raymond, M. R, 2001. "lob Analysis and the tions 2008-2013. Chicago: Health Admin- Specification of Content for Licensure and istration Press and the Society of Health- Certification Examinations." Applied Mea- care Strategy and Market Development. surement in Education 14 (4): 369-415. Carman, A. N., and M. P. lohnson. 2006. Ross, A., F. I. Wenzel, and |. W. Mitlyng. 2002. "Leadership Competencies: An Introduc- Leadership for the Euture: Core Competencies tion. " ¡oumal of Healthcare Management 51 in Healthcare. Chicago: HAP. (1): 13-17. . Rossiter, A., and M. E. Stefl. 2005. "Using the Criffith. I. R. 2001. "Developing an Outcomes HIA Competency Directory to Develop Approach in Health Management Edu- Curriculum for Medical Practice Manage- cation," loumal of Heallh Administration ment." Presentation at the Annual Education (Special Issue): 125-30. Meeting of the Medical Croup Manage- . 2007, "Improving Preparation for Se- ment Association, San Diego, October. nior Management in Healthcare." loumal Shewchuk, R. M., S. |. O'Connor, and D. I. of Health Administration Education 24 (1): Fine. 2005. "Building an Linderstanding 11-32. of the Competencies Needed for Health Institute of Medicine (IOM). 2003. Health Administration Practice." Journal of Health- Professions Education: A Bridge to Quality. care Management 50 ( 1 ): 32-47. Washington, DC: National Academies . 2006, "Bridging the Gap: Academic Press. and I'ractitioner Perspectives to Identity Kovner, A. R. 2001. "The Future of Health Care Early Career Competencies Needed in Management Education: An Evidence- Healthcare Management." loumal of Based Approach." ¡ournal of Health Health Administration Education 23 (4): Administration Education (Special Issue): 366-92. 107-16. Stefl, M. B. 2003a. Report of the Competency Kovner, A. R., andT C. Rundall. 2006. "Evi- Task EoTce: Healthcare Leadership Alliance. dence-Based Management Reconsidered." Chicago: HLA. Erontiers of Health Seri'ices Management 22 . 2003b. "Expert Leaders for Health Care (3): 3-21, Administration." Healthcare Papers 4(1): National Center for Healthcare leadership 59-63. (NCHL). 2005. Healthcare Leadership Thompson, P. 2006. Communication to HLA Competency Model. Summary. |Online Task Force, August 15. information: retrieved 7/24/08.] U.S. Department of Education. 2006. A Test wv\rw. nchl.org/ns/documents/ of Leadership: Charting the Euture of U.S. CompetencyModel-short,pdf. Higher Education. Washington, DC: U.S. National Commission for Certifying Agencies Department of Education. ( NCCA). 2007. Standards for the Accredita- Westera, W. 2001. "Competencies in Educa- tion of Certification Programs. Washington, tion: A Confusion of Tongues." loumal of DC: NCCA. Currículum Studies 33 ( 1 ): 75-88. O'Connor, S., M. Stefl, D. Clement, and White, K. R., D. G. Clement, and P. Nayar. S. White. 2008. "A Collaborative Approach 2006. "Evidenced-Based I lealthcare Man- to Competency Model Development and agement Competency Evaluation: Alumni Validation." Presentation at the Annual Perceptions." loumal of Elealth Administra- Meeting of the Association of University tion Education 23 (4): 335-49.

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PRACTITIONER APPLICATIO

C. Angela Bontempo, FACHE, president and chief executive officer, Saint Vincent Health System, Erie, Pennsylvania

eter Drucker's observations about the complexities of healthcare organizations cou- P pled with Don Seymour's comments about society's do-more-with-!ess expectations of hospitals and health systems compel us to read this article by Mary Stefl. Healthcare leaders are well aware of the changing market forces, trends, and challenges in today's healthcare environment. In the last ten years, leaders have confronted reduced operating margins, limited reimbursements, and escalated expenses under the increased scrutiny by the public in general and by governments (federal and state) in particular. Now more than ever, everyone is focused on how healthcare organizations function and how well leaders can balance margin and mission. With the emergence of evidence-based medicine, the growth in the number of public-disclosure states, and public and private over- sight of errors and other events in hospitals, no wonder the competencies of healthcare leaders and managers are now being questioned. This article resonates with the current environment in which leaders and managers must operate. It offers a competency tool that can be highly effective in meeting ever- present challenges. For more than 30 years, educators, psychologists, and practitioners tumed to competency modeling to bridge the gap between intelligence and practical application and outcomes. The job of a healthcare professional was evolving quickly, and competency modeling appeared useful, universal, and tied to corporate strategy. This article presents a model that is a logical expansion of competency modeling. Stefl describes the competency work of the Healthcare Leadership Alliance (HLA). What should draw the reader's attention is the product of the H LA's efforts: a compendium of common competencies for all healthcare leaders and managers. This tool, the HLA Competency Directory, is composed of 300 competency statements organized under five domains. Because the tool represents the background, expertise, and Ianguage common among healthcare leaders and managers, it helps to align everyone involved in execut- ing the mission and the patient care, safety, and quality efforts in a highly performing organization. ^ , The tool can be powerful. It is interactive, enabling the user to assess his or her own competencies for a specific managerial position and to develop a professional improvement plan with the assistance of his or her immediate supervisor. Effective use of this tool can unite individual performance and organizational strategies to generate substantial payoffs for the organization. In addition, this competency model and directory can be used by academic programs and can inform the curricula in healthcare administration. In fact, some programs have already applied the model to their own competency framework. As Stefl observed, other programs have not yet adopted all 300 statements included in the directory. The potential of integrating this model into healthcare management programs is great and is encouraging to those of us who are committed to the profession and to the appropriate development of future leaders and managers.

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