common competencies for all healthcare …healthcareleadershipalliance.org/common competencies...

Common Competencies for AllHealthcare Managers:The Healthcare LeadershipAlliance ModelMaryE. Stefl, PhD, professor and chair. Department of Health Care Administration,Trinity University, San Antonio, Texas - - • .

E X E C U T I V E S U M M A R YToday's healthcare executives and leaders must have management talent sophisti-cated enough to match the increased complexity of the healthcare environment.Executives are expected to demonstrate measurable outcomes and effectiveness andto practice evidence-hased management. At the same time, academic and profession-al programs are emphasizing the attainment of competencies related to workplaceeffeaiveness. The shift to evidence-based management has led to numerous efforts todefine the competencies most appropriate for healthcare.

The Healthcare Leadership Alliance (HLA), a consortium of six major profession-al membership organizations, used the research from and experience with their indi-vidual credentialing processes to posit five competency domains common among allpracticing healthcare managers: (1) communication and relationship management,(2) professionalism, (3) leadership, (4) knowledge of the healthcare system, and(5) business skills and knowledge. The HLA engaged in a formal process to delin-eate the knowledge, skills, and abilities within each domain and to determine whichof these competencies were core or common among the membership of all HLAassociations and which were specialty or specific to the members of one or more HLAorganizations. This process produced 300 competency statements, which were thenorganized into the Competency Directory, a unique and interactive database that canbe used for assessing individual and organizational competencies. Overall this workhelps to unify the field of healthcare management and provides a lexicon and a basisfor collaboration among different types of healthcare executives.

This article discusses the steps that the HLA followed. It also presents the HLACompetency Directory; its application and relevance to the practitioner and academ-ic communities; and its strengths, limitations, and potential.

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

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COMMON COMPETENCIES FOR ALL HEALTHCARE MANAGERS

P eter Drucker (2002) has said thatlarge healthcare institutions may be

the most complex in human history andthat even small healthcare organiza-tions are barely manageable. Some timehas passed since Drucker's observation,but the complexity of healthcare orga-nizations, along with the demands onmanagers and leaders, has not dimin-ished in any way. Today, executives inall healthcare settings must navigate alandscape influenced by complex socialand political forces, including shrinkingreimbursements, persistent shortages ofhealth professionals, endless require-ments to use performance and safetyindicators, and prevailing calls for trans-parency. Further, managers and leadersare expeaed to do more with less.

Since 1999, the Society of Health-care Strategy and Market Developmentand the American College of HealthcareExecutives have been producing Future-scan, a compendium of healthcare trendsand projections for the next five years. InFuturescan 2008, the publication's execu-tive editor, Don Seymour, reflected onthe past ten years in healthcare:

society appears to be sending a clear,overarching message to the nation'shospitals: Take care of more peoplewho have growing expectations andmore complex medical needs v̂ -hileproviding increasingly sophisticatedcare with relatively fewer resources.

In an environment of escalated publicdemand, it is only lógica! to questionthe competence of healthcare lead-ers and managers. As noted in Griffith(2007), the increased difficulty of run-ning a healthcare organization has ledto the need for managers with moresophisticated capabilities.

The questions now become. Havemid- and senior-level managers beenkeeping pace with changing demands?Are healthcare academic programs at-tracting sufficient numbers of students 'and adequately preparing them to oper-ate effectively in this dynamic environ- 'ment? These concerns were the focus ofthe 2001 National Summit on the Fu-ture of Fducation and Practice in Health 'Management and Policy. Principallyfiinded by the Robert Wood JohnsonFoundation, this conference broughttogether practitioners, policymakers,and educators to examine the effective-ness of healthcare administration andthe role of academic preparation andcontinuing professional developmentin tackling the current and future chal-lenges of healthcare delivery.

The Summit's deliberations focusedon evidence-based approaches (seeKovner 2001 ) to developing manage-ment talent, including how to measurethe outcomes of health managementeducation (Griffith 2001) and howto determine whether administrationstudents and practicing managers hadacquired the competencies necessary toperform effectively in their roles.

THE COMPETENCY MOVEMENTThe emphasis on measurable outcomesand competencies did not happenovemight. The widespread acceptanceof evidence-based medicine was anatural precursor to an evidence-basedapproach to healthcare management(Kovner and Rundall 2006). Also, thedevelopment and promotion of compe-tencies for graduate medical education(Batalden et al. 2002) set the stage forhealthcare administration.

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More broadly, higher educationhas struggled with the issue of compe-tency-based education for some time(Calhoun et al. 2002; Westera 2001).The main idea behind this initiative is todesign curricula based on the roles thatgraduates will assume after complet-ing their degree and to incorporate thespecific knowledge, skills, and abilities(KSAs) that future employees will need.Efforts to promote competencies havebeen undertaken in numerous fields,including public health (Council onLinkages Between Academic and PublicHealth Practice 2001) and the healthprofessions (IOM 2003). The controver-sial Spellings report (issued in 2006 bythe Secretary of Education's Commis-sion on the Future of Higher Educationconvened by U.S. Secretary of EducationMargaret Spellings) pushes universi-ties nationwide to measure studentoutcomes and then make these resultsavailable to the public.

To meet the needs of healthcareadministration, a number of univer-sity programs have developed a set ofcompetencies (e.g., Cherlin et al. 2006;Shewchuk, O'Connor, and Fine 2005;2006; White, Clement, and Nayar 2006)or competency models (e.g., Campbellet al. 2006) for their students. A reviewof these efforts is beyond the scope ofthis article, but note that these variousprograms typically use a similar pro-cess for developing their competencies:(1) existing competency literature isreviewed, (2) subjea matter experts(either faculty or practitioners) are ap-proached to provide depth and contentvalidity, and (3) a survey of practi-tioners is condurted. In other words,academic programs take steps to ensure

that their competency models are tiedwitb the realities and needs of health-care management practice. However,little evidence shows a link betweenactual performance and competencyattainment (Bradley 2003), an area ofinquiry tbat clearly needs more atten-tion as competency models continue todevelop.

Aside from this work in academia,the National Center for Healthcare Lead-ership has expended considerable effortin creating a competency model that canbe applied to professional developmentand to academic programs (Calhounet al. 2004; NCHL 2005). In addition,many healthcare associations have usedexpert opinion and job analysis surveysto delineate the KSAs that form the basisfor their credentialing exams. However,these KSAs were not usually shared withtbe broader healthcare managementcommunity.

THE H E A L T H C A R EL E A D E R S H I P A L L I A N C EThe Healthcare Leadership Alliance(HLA) is a consortium of major profes-sional associations in the healthcarefield:

• American College of HealthcareExecutives (ACHE);

• American College of PhysicianExecutives (ACPE);

• American Organization of NurseExecutives (AONE);

• Healthcare Financial ManagementAssociation (HFMA);

• Healthcare Information and Manage-ment Systems Society (HIMSS); and

• Medical Group Management

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Association (MGMA) and its educa-tional affiliate, the American College ofMedical Practice Executives (ACMPE).

Together, these associations representmore than 100,000 management profes-sionals. II '

In response to concerns about theadequate preparation of healthcaremanagers and administrators, the HLAconvened the Competency Task Force toexamine the credentialing and certifica-tion processes of its member organiza-tions. First meeting in late 2002, theTasii Force was composed of a repre-sentative from each organization' and afacilitator (this author). The Task Forcewas charged with a straightforwardresponsibility: Determine if there weremanagement competencies shared by allmembers of the HLA organizations. Ifso, the Task Force would determine howthese competencies could be used toadvance the field.

Reviewing the Credentialing andCertification ProcessesI ask Force work began with an exchangeof information regarding each associ-ation's credentialing and certificationprocesses. Five of the six organizationshad well-established processes, whileAONE was considering launching itsown certification program.^ Certifica-tion programs are designed to ensurethat individuals in a professional posi-tion meet the basic educational, skill,and/or experiential requirements oftheir respective profession (Raymond2001 ). Thus, credentialing or certifica-tion exams should be job-related andshould be designed to test whether theprofessional possesses the KSAs essential

for his or her job. For large organiza-tions, certification exams are typicallyobjective, with questions constructedfollowing the job analysis studies.

Four associations (ACHE, HFMA,HIMSS, and ACMPE) used well-established psychometric processes(job analysis surveys or role delineationstudies, review by subject matter experts,and content analysis) to determinethe KSAs for their certification exams(NCCA 2007). All engaged reputablepsychometric firms to ensure the reli-ability and validity of their processes.The ACPE's certification process wasslightly different from that employedby the rest of the group. Following anon-site tutorial session, ACPE candidateswere tested by faculty experts using anin-basket exercise and requiring a verbalpresentation. All associations' certifica-tion exams were discriminatory; first-time pass rates ranged from 60 percentto 85 percent (Stefl 2003a).

In general, the certification processesof the HLA organizations were intendedto provide early careerists an opportuni-ty to demonstrate their competence. Atthe time of the Competency Task Force'sreview of KSAs, most HLA associations(except AONE) offered a fellowshipstatus for those with more senior-Ieve!accomplishments and contributions.Most associations (except HIMSS)awarded the Fellow status only after thatmember had attained certification andthe requisite competencies. Thus, theTask Force's review excluded the fellow-ship processes.

Identifying Common CompetenciesThe extensive review of the credentialingand certification processes of the HLA

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members revealed a number of overlap-ping and complementary competencies.The Task Force determined that theseKSAs clustered into five competencydomains that were common among themembership of all six associations (Stefl2003a):

1. Communication and RelationshipManagement: The ability to com-municate clearly and concisely withinternal and external customers,to establish and maintain relation-ships, and to facilitate constructiveinteractions with individuals andgroups

2. Leadership: The ability to inspireindividual and organizational excel-lence, to create and attain a sharedvision, and to successfully managechange to attain the organization'sstrategic ends and successful perfor-mance

3. Professionalism: The ability to alignpersonal and organizational con-duct with ethical and professionalstandards that include a responsibil-ity to the patient and community,a service orientation, and a com-mitment to lifelong learning andimprovement

4. Knowledge of the Healthcare Environ-ment: The demonstrated understand-ing of the healthcare system and theenvironment in which healthcaremanagers and providers function

5. Business Skills and Knoivledge: Theability to apply business principles,including systems thinking, to thehealthcare environment; basic busi-ness principles include (a) financialmanagement, (b) human resource

management, (c) organizational dy-namics and governance, (d) strategicplanning and marketing, (e) infor-mation management, (f ) risk man-agement, and (g) quality improve-ment

In keeping with the current focus onoutcomes and evidence-based manage-ment, these five domains were viewedas common competencies or compe-tency domains. While "competency"can be defined in a variety of ways, theTask Force adopted a definition fromRoss, Wenzel, and Mitlyng (2002):Competencies are clusters that "tran-scend unique organizational settingsand are applicable across the environ-ment. "That is, the domains identi-fied by the Task Force are generic anddemonstrable.

The Task Force viewed these com-petency domains as interdependent(see Figure 1). Because leadershipcompetencies are central to a healthcareexecutive's performance, the Leadershipdomain anchors the HLA model. Allother domains draw from the Leader-ship area, but the other competenciesalso feed and inform leadership. InFigure 1, the two-way arrows outside thecircles indicate that the other four do-mains draw from each other and shareoverlapping KSAs.

The identification of these fivedomains sends a powerful messageto the healthcare field: Healthcaremanagers in a wide range of positionsand settings share a common body ofknowledge and a common lexicon.Such a message can break down bar-riers between various health manage-ment professionals, provide a stronger

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F I G U R E 1The Healthcare Leadership Alliance Competency Model

Competency Domains

Communtcationand Relationship

ManagementProfessionahsm

BusinessKnowledge and

Skills

Knowledge ofthe HealthcareEnvironment

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 engendermutual respect and teamwork. Mostimportantly, the work itself suggests thata common background, expertise, andlanguage are shared by members of theC-suite, the practice management com-munity, and healthcare managers in arange of positions and settings (Rossilerand Stefl 2005).

Using the Dreyfus ModelMuch of the discussion regardingcompetencies attempts to distinguishthe performance expectations for

entry-level, mid-career, and senior-levelmanagers. In its deliberations, the TaskForce was guided by the skill acquisitionmodel developed by Stuart Dreyfus andHubert Dreyfus (1986). The Dreyfusmodel has been applied to the nursingfield (Benner 1984), and it guided thedevelopment of ACMPE's competencyand certification model. More recently,the Accreditation Council for GraduateMedical Education applied the model todevelop core competencies for medicalresidents (Batalden et al. 2002), and themodel has been discussed in relation to

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health administration education (Stefl2003b).

The original Dreyfus model outlinedfive stages for skill development: novice,advanced beginner, competent, profi-cient, and expert. As skills develop, theindividual's reliance on rules decreasesand the ability to make independentjudgments increases. By the time aperson reaches the proficient and expertlevels, he or she can recognize patternsin the environment and operate (at leastpartially) on intuition.

For example, an entry-level managerwill consult a policy manual to dealwith a distraught and angry patient orfamily member. A mid-level manager,however, is already thoroughly familiarwith the protocols governing the situ-ation and will employ strategies andresponses that have effeaively diffusedsimilar situations in the past. A se-nior-level executive will respond moreintuitively, recognizing patterns in thesituation and knowing implicitly whento apply rules and when to be morecreative. This intuitive and discrimina-tory knowledge can only come fromexperience and practice in applyingmanagement skills. Each manager inthis scenario is using KSAs in the Com-munication and Relationship Manage-ment domain.

When the situation is viewed interms of the Dreyfus model, the newmanager is acting as a novice, the moreexperienced manager is functioning atthe competent level, and the senior ex-ecutive is responding at the proficient orexpert level. Progressing from one skilllevel to another, especially from noviceto competent, typically requires experi-ence coupled with guided reflection.

This progression underscores the needfor mentoring throughout career stagesas well as the importance of continuedprofessional development and lifelonglearning.

The HLA Task Force recognizedthat the Dreyfus model could serve as aframework for individual developmentin all competency areas (Stefl 2003a).An individual who was competent inone domain (e.g.. Knowledge of theHealthcare Environment) could be anovice in another (e.g.. Professional-ism). Members who achieved certifica-tion by each HLA organization wereconsidered to be at the competent level.Members who sought Fellow statuswithin their respective associationscould operate at the proficient level. TheTask Force believed that the expert levelwas beyond the realm of testing or cre-dentialing. Experts are acknowledged bytheir peers and typically receive honorsor distinctions from their professionalassociations.

Organizing and Generating CompetencyStatementsAccording to Shewchuk, O'Connor,and Fine (2005), broad competencydomains have limited usefulness. Theirlack of specificity prevents any realapplication in the work setting or forcurricular design. Although core compe-tencies common among all healthcareexecutives engender understanding andcollaboration, they mask the differentexpectations for each type of healthcaremanager. For example, chief financialofficers are expected to have a widerrange of financial analysis competen-cies (a subset of the Business Skills andKnowledge domain) than are needed by

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the general membership of ACHE. Simi-larly, information systems managersare expected to have broader abilities intechnology design and implementationthan required of chief nursing officers.

Specialty competencies for themembership of each HLA associationwould likely complement the corecompetency domains. More specificKSAs within each domain would also beuseful. In fact, many of the competen-cies outlined by the individual associa-tions in their job analyses were moredetailed and unique to their own group.What was needed was a mechanism thatcombined and compared the variousKSAs and tbat determined wbich of thedetailed competency statements couldapply across the entire healthcare man-agement field. A competency directorywas conceived as a way to accomplishthose tasks.

A psychometric firm assisted tbeTask Force in developing the HLA Com-petency Directory.^ The firm reviewedthe competency statements from allHLA associations and, in the process,eliminated or combined overlappingKSAs and then prepared an initial com-petency listing. All competency state-ments were then organized accordingto the five competency domains (seeFigure 1).

The preliminary competency listingwas reviewed and expanded by a panelof experts (or subject-matter experts|SMEs|) during a two-day meeting inSeptember 2004. Each HLA associationnominated three of its members, oneof whom had some academic involve-ment/background, to serve on the SMEpanel. In general, panel members weresenior-level executives who were certi-

fied by tbe association they represented(except those assigned by AONE, whichhad no formal certification process) andwere actively engaged with the associa-tion and its professional activities. Theuse of SMEs is a standard prartice incompetency studies (NCCA 2007); ex-perts are often used to provide contentvalidity to the competencies identifiedin job analysis studies.

During the SME review meeting,other competencies were added to theinitial listing. Some of the added KSAswere clearly specific to an individualassociation, while others were moregeneric and thus were judged appro-priate to all healthcare managers. Thediscussion revolved around identifyingtbe appropriate domain for a specificcompetency and determining whether acompetency was common or specialty.Subsequent to this meeting, a seriesof webinar-enhanced conference callswas conducted with the Task Force, thepsychometric consultant, and the SMEpanels for each HLA association. Tbepurpose of these calis was to reviewand refine the individual competencystatements, determine whether thecompetency should be listed as a skill orknowledge, and categorize whether tbecompetency was common or specialty.Throughout this iterative process, twosurveys were administered to all SMEpanelists. These surveys allowed expertsto rank the perceived relevance of eachcompetency statement and to identifygaps or omissions in each competencydomain.

Competency statements were catego-rized as either knowledge areas or skills.All skills were coded using 11 actionverbs, such as "manage," "execute," and

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"develop." Finally, approximately 32 keywords were assigned to each of the coin-petenq'statements, including "technol-ogy," "physicians," and "outcomes." TheTask Force developed and assigned keywords and skill areas in an attempt to fitthe needs of association members.

THE HLA COMPETENCYDIRECTORYThe process resulted in the creation ofthe HLA Competency Directory,'' anExcel-based interactive tool, it con-tains a series of filters that allow theuser to sort by skills versus knowledge,core versus specialty, keyword, skillarea, or professional association. Thisdesign enables the user to customizesearches according to the user's need orcircumstance.

The Directory contains 300 compe-tency statements organized under thefive domains of the HLA model. Thevast majority (232 or 77.3 percent) ofthe skills and knowledge listed are com-mon to all the management professionsrepresented by the HLA associations;only 68 specialty competencies wereidentified. Table 1 shows the number ofcore and specialty competencies by thefive domains. Also, the table divides theBusiness Skills and Knowledge domaininto various functional areas.

Virtually all of the specialty com-petencies fail within the Business Skillsand Knowledge domain, providingfurther evidence that healthcare manag-ers in different roles share an extensivecommon knowledge and skill base.Because the Professionalism domain in-corporates ethical codes and standards,the lack of variance in this area suggeststhat a common value set for al! types ofhealthcare managers exists.

The Financial Management and In-formation Management functional areasproduced the highest number of spe-cialty competencies, reflecting the highlytechnical aspects ofthese functions.Even so, the number of core competen-cies in both areas is substantial. Fewerspecialty competencies were listed underRisk Management or Strategic Planningand Marketing. This may suggest thatthese areas are generic, or it may reflectthe lack of expertise in these categoriesamong those involved in developing thedirectory. Few specialty competencieswere noted under Other Business Skillsand Knowledge, reflecting the generalnature of this category. This functionalarea, for example, incorporates skillsand knowledge related to quantitativeand analytical decision making, projectmanagement, and systems thinking.

When the specialty competen-cies were examined, most (45 or 66.2percent) pertained to the membershipof two or more of the HLA associations.Twenty of the specialty competencieswere relevant only to ACMPE; thesecompetencies reflected the uniqueaspects of practice management. HIMSSclaimed the remaining three specialtycompetencies, which related to aspectsof the information technology field. Nocompetencies were unique to finan-cial managers, nurse executives, or thegeneral managers represented by ACHE.All otber specialty competencies wereclaimed by two or more associations.

M O D E L AND D I R E C T O R YA P P L I C A T I D N S

To the Practitioner FieldThe HLA model and the CompetencyDirectory offer a number of benefits

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TABLE 1HLA Core and

Domain

Specialty

COMMON COMPETENCIES FOR ALL

Competencies by Domain

Number Core

HEALTHCARE

Specialty

MANAGERS

Total

Communication and relationship management

Leadership I

Professionalism

Knowledge of the healthcare environment

Business skills and knowledge

Financiid immagetnem

Human resource management

Organizational dynamics and governance

Strategic planning and marketing

¡nformation management

Risk management ^

Quaiity improvement

Other business skills and Imowledge

Total

22232 3 ••

20

144

18

16

11

17

24

15

10

33

31

1

2

61

17

8

7

4

12

3

7

3

2524

2422

205

35

24

18

21

36

18

17

36

232 68 300

to healthcare management. First andforemost, this work helps distinguishand define the profession by providinga common framework and lexicon fora wide variety of healthcare managers.Acknowledging the fact that a commonbody of knowledge and skills exists canengender teamwork and mutual respect(Rossiter and Stefl 2005). The compe-tency domains and individual compe-tency statements can serve as the basisfor joint educational programming be-tween various professional associations.These KSAs are also helpful in clarifyingjob descriptions or in constituting workteams with complementary skills andknowledge. This project represented anunprecedented collaboration among theHIA organizations, an effort that canbe a model or a foundation for future

interprofessional teamwork amongthese associations, within the practicesetting, and within educational or aca-demic programs.

Other tangible benefits of this proj-ect include the following;

• AONE (2005) has produced a self-assessment tool that incorporatescompetencies for nurse executivesinto the HLA competency framework.These nurse executive competencieswere developed by AONE simulta-neous with but independent of theHLA model and the Directory. Con-sequently, this tool is more refleaiveof the clinical setting. The tool pro-vides space for respondents to ratetheir performance level—from noviceto expert on the Dreyfus scale—for

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each competency area. Respondentsare then encouraged to prepare adevelopment plan for areas in whichthey are lacking. Feedback has re-vealed that this tool has been valu-able in writing job descriptions andin conducting performance reviews(Thompson 2006). The tool is avail-able on the AONE website to mem-bers only.

• ACHE has produced the ACHEHealthcare Executive Competen-cies Assessment Tool 2008. This toolorganizes the 300 statements in theDirectory into convenient subcat-egories. For example, RelationshipManagement, Communication Skills,and Facilitation Skills are componentsof the Communication and Relation-ship Management domain. Like theAONE tool, the ACHE self-assessmentinstrument allows respondents torate their performance on a five-pointscale, ranging from novice to expert.This tool also provides resources forimprovement in each subcategory,directing users to available publica-tions, educational programming, self-study courses, and other assessmentmeans. ACHE encourages its affiliatesto use the tool, which is updated an-nually, for personal and professionalimprovement. Distributed to allACHE affiliates, the tool is availablefor download on the ACHE website:www. ache.org/pdf/nonsecu re/careers/competencies_booklet.pdf.

To the Academic CommunityThe HLA model and the CompetencyDirectory were originally envisionedto be useful for academic programs.

Effective in the fall of 2008, the Com-mission on Accreditation for HealthcareManagement Education's (2007) criteriarequire that graduate health adminis-tration programs adopt a competencymodel as the basis for curricular offer-ings. The HIA model has been con-sidered by many of these programs.Because programs will need to linkcourse content as well as individualstudent achievements to the model, thusfar few programs could adopt all 300statements in the Direaory. However,the five competency domains and thesubcategories listed in the ACHE assess-ment tool represent a framework thatprograms can readily use.

Drawing on the HLA model andassessments conducted at individualuniversities (Shewchuk, O'Connor, andFine 2005; 2006; White, Clement, andNayar 2006), four graduate programs^collaborated to produce a set of 30competencies (O'Connor et al. 2008).These competencies are more macrothan the HLA statements. For example,only one statement pertains to financialmanagement, a distinct difference fromthe 24 finance-specific competenciesfound in the Direaory. The intent ofthis collaborative project was to de-termine if a joint competency model,based on the HLA domains, could bedeveloped by the four separate entities.The programs involved were naturalpartners. Each had strong relationshipswith the practitioner community, eachoffered both full-time on-campus andexecutive program options, and threeof the four required a year-long ad-ministrative residency for on-campusstudents. All programs were located inthe southeastern United States and had

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COMMON COMPETENCIES FOR ALL HEALTHCARE MANACERS

students whose primary interest wasoperations.

In 2007, a web-based survey wasconducted with faculty, preceptors, andrecent graduates of the four universityprograms. Respondents were askedto indicate, on a five-point scale, howstrongly they felt new graduates neededeach of the 30 competency areas.Overall, 340 individuals responded,or 49,2 percent of the total number ofpeople contacted. Respondents indi-cated that all competencies were neces-sary, although some were judged moreimportant than others. However, ratingsof the individual competencies were re-markably consistent across respondentsfrom all four programs. Further, ratingsfrom all three respondent groups weresimilar, especially between faculty andpreceptors. '

These results provide a good fieldtest and validation of the HLA compe-tency model and demonstrate that themodel can be simplified and adaptedfor use in health administration gradu-ate education. The success of this col-laborative project may encourage otheruniversity programs to draw on the HLAmodel in the future.

Limitations and Future AdjustmentsThe HLA Competency Directory is awork in progress. Building consensusaround the 232 common competen-cies was an iterative process, with eachreview further refining the list. With thehealthcare industry changing rapidly,healthcare management competenciesclearly will require continual updat-ing and validation. Since the Directorywas made available in November 2005,many of the HLA associations have

conducted new job analyses, requiringany new information to be added to theDirectory.

The Directory may have otherlimitations. First, although physicianswere well represented in ACMPE's origi-nal job analyses and ACPE was a fullparticipant in delineating the compe-tency domains, clinical concerns mayhave been inadequately represented asa result of ACPE's nonparticipation inthe Directory's development (Griffith2007), Second, the SMEs chosen by theHLA associations may have unknowing-ly introduced some bias. In the future,the number of SMEs may be increasedor a general membership survey maybe conducted to further validate the '

competencies. Third, Griffith (2007)argues that the Directory lacks emphasison insurance and quality managementand measurement, and it does not ofïera clear distinction between skills andknowledge. All of these concerns may beeasily addressed in future versions of the 'Directory.

Future updates should also focuson specialty competencies, which wereunevenly distributed among the HLAassociations. The largest number ofspecialty KSAs was attributed to ACMPE(2003), which maybe a reflection of theorganization's extensive previous workon its Body of Knowledge for Medical Prac-

tice Management.

C O N C L U S I O NThe HLA common competencies makean important contribution to the grow-ing body of knowledge about competen- ,cies in healthcare management (Carmanand lohnson 2006), The HLA model,complete with the Dreyfus framework,

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can be used for individual and organiza-tional assessment, employee selection,and team development. In addition, themodel can be adapted for use in aca-demic programs, as demonstrated by thejoint project by healthcare administra-tion graduate programs. A unique anduseful tool for individuals and organiza-tions, the HLA Competency Direaorycan be used to foster collaboration andadvancement across the broad spec-trum of healthcare management. In thisenvironment of constant and dramaticchanges, these are important benefits.

N O T E S1. The members of the Task Force were

Cynthia A. Hahn, FACHE (ACHE),Roger Schenke (ACPE), Andrea Ros-siter, FACMPE (MCMA/ACMPE),Pamela Thompson, FAAN {AONE),Joseph Abel, PhD (HFMA), andJulianna Kazragys (HIMSS).

2. In October 2008, AONE launcheda certification program. For moreinformation visit www.aone.org.

3. ACPE did not participate in thisphase of the projea.

4. The HLA Competency Direaory andan accompanying User Guide can bedownloaded from www.healthcare-leadershipalliance.org.

5. Medical University of South Caro-lina, Trinity University, University ofAlabama-Birmingham, and VirginiaCommonwealth University

R E F E R E N C E SAmerican College of Medical Practice Execu-

tives (ACMPE). 2003. TheACMI^E Guideto the Body of Knowledge for Medical PracticeManagement ¡Online information;retrieved 7/25/08.1 www.mgma.com/workarea/showco ntenl. aspx? i d=3 9 9 0.

American Organization of Nurse Executives(AONE). 2005. "AONE Nurse ExecutiveCompetencies." Nurse leader 3 (1)- 15-21.

Batalden, P., D. Leach, S. Swing, H. Dreyfus,and S. Dreyfus. 2002. "General Compe-tencies and Accreditation in GraduateMedical Education." Heakh Affairs 21(5): 103-11.

Benner, P. 1984. From Novice to Expert: Promot-ing Excellence and Power in Clinical NursingPractice. Menio Park, CA: Addison*Wesley.

Bradley, E. H. 2003. "Use of Evidence in Imple-menting Competency-Based HealthcareManagement Training." Journal of HealthAdministration Educalion 20 (4): 287-304.

Calhoun, J. C , P. L. Davidson, M. E. Slnoris,E. T. Vincent, and J. R. Griffith. 2002. "To-ward an Understanding of CompetencyIdentification and Assessment in HealthCare Management." Quality Management inHealth Care \\ (1): 14-38,

Caihoun, I. G., E. T. Vincent, G. R. Baker, P. W.Butler, M. E. Sinoris, and S. L. Chen. 2004."Competency Identification and Model-ing in Healthcare Leadership." ¡oumal ofHealth Administration Education 21 (4):419-40.

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ÍOURNAL OF HEALTHCARE MANAGEMENT 53:6 NOVEMBER/DECEMBER 2008

P R A C T I T I O N E R A P P L I C A T I O

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

Peter Drucker's observations about the complexities of healthcare organizations cou-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. Healthcareleaders are well aware of the changing market forces, trends, and challenges in today'shealthcare environment. In the last ten years, leaders have confronted reduced operatingmargins, limited reimbursements, and escalated expenses under the increased scrutinyby the public in general and by governments (federal and state) in particular. Now morethan ever, everyone is focused on how healthcare organizations function and how wellleaders can balance margin and mission. With the emergence of evidence-based medi-cine, 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 healthcareleaders and managers are now being questioned.

This article resonates with the current environment in which leaders and managersmust operate. It offers a competency tool that can be highly effective in meeting ever-present challenges. For more than 30 years, educators, psychologists, and practitionerstumed to competency modeling to bridge the gap between intelligence and practicalapplication and outcomes. The job of a healthcare professional was evolving quickly,and competency modeling appeared useful, universal, and tied to corporate strategy. Thisarticle 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 compendi-um of common competencies for all healthcare leaders and managers. This tool, the HLACompetency Directory, is composed of 300 competency statements organized under fivedomains. Because the tool represents the background, expertise, and Ianguage commonamong 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 performingorganization. ^ ,

The tool can be powerful. It is interactive, enabling the user to assess his or her owncompetencies for a specific managerial position and to develop a professional improve-ment plan with the assistance of his or her immediate supervisor. Effective use of thistool can unite individual performance and organizational strategies to generate substan-tial payoffs for the organization. In addition, this competency model and directory canbe 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 frame-work. As Stefl observed, other programs have not yet adopted all 300 statements includedin the directory.

The potential of integrating this model into healthcare management programs isgreat and is encouraging to those of us who are committed to the profession and to theappropriate development of future leaders and managers.

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common competencies for all healthcare …healthcareleadershipalliance.org/common competencies...

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