The Uniqueness of U.S. Healthcare Management: A Linguistic Analysis 197 ARTICLES The Uniqueness of U.S. Healthcare Management: A Linguistic Analysis of Competency Models and Application to Health Administration Education John W. Huppertz, PhD, Martin Strosberg, PhD, Stacey Burns, MBA, & Imran Chaudhri, MBA Abstract Faculty in healthcare administration education programs frequently discuss whether their curricula contain the right balance between general manage- rial and healthcare-specific content. Some take the position that a good, basic management education prepares students for any setting, healthcare included. Others consider healthcare so unique that students need significant context and exposure to the industry. Although most educators believe that some mix of general managerial and healthcare-specific skills are needed, no con- sensus has emerged regarding how much of each is optimal. In this study, we content-analyzed five well known competency models, to assess the general managerial and healthcare-specific qualities articulated by the industry’s lead- ers. Competencies were classified as either specific to healthcare or common to most any industry. Results showed that less than 25% of the competencies contained any mention of healthcare, suggesting that educational needs of health administration students can be satisfied by mostly general managerial content. However, some unique characteristics of healthcare institutions require managers to obtain deeper theoretical knowledge of the context in which these organizations operate. Students must understand why healthcare organiza- tions behave as they do, and the search must continue for the right proportion of general versus specific content in healthcare-management programs. Please address correspondence to: John W. Huppertz, PhD, Union Graduate College, 80 Nott Terrace, Schenectady, NY, 12308, [email protected] 198 The Journal of Health Administration Education Summer 2014 Introduction The optimal proportion of healthcare-specific content that healthcare man- agement education programs should include in their curricula has prompted debate among faculty, program directors, and administrators. Inside their programs, faculty members often discuss whether students need more or less educational content that is specific to healthcare versus generalized manage- ment education that can apply to a variety of industries and settings. From time to time, evidence of these discussions appears in public (AUPHA Open Forum, 2013), demonstrating that no consensus has yet emerged. However, there has been no systematic attempt to measure the ratio of general versus specific content in healthcare management education, much less to define what that ratio should be. Thus the debate turns on individual opinion and respective department or school philosophies. The U.S. healthcare industry has often been characterized as unique. Its size, complexity, regulatory requirements, and structure have led observers to declare that it stands apart from other industries as well as from healthcare systems of other countries (Shi & Singh, 2010). The assertion of uniqueness has influenced the education, supervision, and career development of healthcare managers and leaders for many years. Specialized programs in schools of business, health sciences, medicine, and public health have focused their cur- ricula on the challenges of managing complex healthcare systems to deliver a quality product to a vast and diverse market in a fast-changing environment. Yet others remain convinced that healthcare operates for the most part like any other business, albeit with certain industry-specific aspects that require managers to develop particular knowledge. Under this view, the basic tools employed by most businesses can be used for managing healthcare organiza- tions. For example, Swayne, Duncan, and Ginter (2008, p. 9) suggest that with some customization the same kind of strategic management used in business applications “does seem to provide the necessary processes for health care organizations to cope with the vast changes that have been occurring.” As a result, some have questioned how much of the healthcare manager’s job involves unique responsibilities found only in the healthcare industry, and how much is transferable from any business or organizational setting (Bois- soneau & Kirkman-Liff, 1991). Healthcare executives engage in managerial activities that are specific to healthcare, yet many of their job duties are present in nearly all industries. For example, all managers need good communication, leadership, teamwork, and interpersonal skills no matter what industry they serve (Blair & Hunt, 1986; Clement, et al., 2010). Furthermore, as corporate institutions, healthcare organizations must comply with the same regulations The Uniqueness of U.S. Healthcare Management: A Linguistic Analysis 199 that govern all businesses and incorporated nonprofit entities. All healthcare organizations must follow Generally Accepted Accounting Principles (GAAP), they must comply with the reporting requirements of the Sarbanes-Oxley Law, and they must establish human resource policies and workplace safety practices that conform to federal and state rules governing employers. On the other hand, meeting the needs of patients and ensuring a commu- nity’s health require a managerial focus found only in the healthcare industry. The healthcare management profession and health administration education programs have created and adopted competency models that articulate the industry’s needs and its expectations of the managers and leaders it employs. Because these models have been developed by healthcare industry insiders, it makes sense to assume that the competencies they contain are specific to healthcare. However, to our knowledge, no one has critically examined these sets of competencies to determine which are exclusive to healthcare managers and leaders, but not necessarily essential for executives in other industries. Of the competencies a healthcare manager should be expected to master, how many should focus specifically on healthcare? This question has important implications for healthcare management educators. If most of the competencies required of executives are unique to healthcare, then programs need to ensure that their curricula are appropriately designed to deliver this content, and a greater proportion of faculty with specific healthcare expertise is needed. However, if healthcare executives mostly need to exhibit managerial skills that are commonly found across many industries, then programs can either outsource portions of their curricula to general man- agement education programs, or employ faculty who have expertise in the discipline they teach regardless of their healthcare experience. As Weil (2013) observes, most healthcare management educators do not have MHA degrees and/or professional experience as healthcare administrators, and individuals with diverse backgrounds do the job of educating future healthcare leaders (Ginter, Menachemi, & Morrisey, 2009). Is this cause for concern? In this paper, we first examine the general versus specific nature of man- agement in healthcare, briefly reviewing the literature on the topic. We then analyze five well known competency models to measure their healthcare-specific content. We conclude by highlighting aspects of the industry that distinguish it from other kinds of businesses, to suggest some areas of industry-specific instruction necessary to develop good healthcare managers and leaders. Healthcare Management Competencies Though some prominent scholars and medical statesmen have argued that healthcare should not be considered a business (Arrow, 1963; Relman, 2005), 200 The Journal of Health Administration Education Summer 2014 all agree that its institutions must be run efficiently. For years, healthcare administrators have applied lessons learned from successful businesses in other industries. The application of management principles and business education to healthcare delivery dates back to the 1920s, and the field grew rapidly in the 1950s and 60’s (Hilsenrath, 2011; Weil, 2013). Healthcare delivery organizations, especially hospitals, have borrowed a great deal from manage- ment theory and practices developed for firms in many different industries. Adoption of these practices has been encouraged by management researchers inside and outside healthcare, resulting in improved quality and efficiency for those who embrace them (Gawande, 2010; Griffith, 2007, 2009). In addition, management experts have recommended that healthcare administrators ex- amine the business models of companies in other industries (e.g., Christensen, Grossman, & Hwang, 2009). This is not a new trend. Some years ago, hos- pitals began adopting Lean, Six-Sigma, and Process Improvement programs, all of which were originally developed for manufacturing applications. The business press has periodically published reports of hospital executives visit- ing Toyota factories in Japan where they have learned methods such as Root Cause Analysis, Kaizen, and Value Stream Mapping (Wysocki, 2004), ideas which have become commonplace in healthcare today. A number of scholars have noted that healthcare management requires both general and specific competencies, drawing a distinction between context-specific knowledge, skills, and abilities that apply to healthcare set- tings, and context-free disciplines that apply across many different kinds of organizations (Blair & Hunt, 1986; Clement,