LEADERSHIP COMPETENCE ESSAY ASSIGNMENT PAPERS: PROFESSIONAL COMPETENCIES, AND PERSONAL SKILLS AND RESPONSIBILITIES
LEADERSHIP COMPETENCE ESSAY ASSIGNMENT PAPERS: PROFESSIONAL COMPETENCIES, AND PERSONAL SKILLS AND RESPONSIBILITIES
Leadership competence essay assignment papers: professional competencies, and personal skills and responsibilities
This chapter presents the personal competencies a leader must develop, build, and maintain to be successful. It also discusses leadership knowledge, skills, and abilities and the ability–job fit a leader has with his or her organizational environment. Emphasis is placed on the understanding that health leaders work in a highly complex environment with a very educated and interdisciplinary workforce. Based on the complexity and diversity of the health industry workforce, leadership competence in leading people begins with understanding the elements of motivation, influence, and power as combined with the ability to communicate to those diverse audiences. Leadership success is often based on the leader’s capabilities in terms of motivation, influence, power, interpersonal relationships, communication, and inspiring teams. The chapter begins with a summary of leadership competencies from experts in the industry.
LEARNING OBJECTIVES 1. Describe the complexity of the healthcare industry in terms of workforce, environment, and societal expectations, and explain how a health leader’s mastery of competencies, influence processes, motivation, interpersonal relationships, and communication capabilities is necessary to successfully navigate that complexity. 2. Explain how the complexity of the health workforce may lead to communication failure and conflict, and summarize the use of quality communication and conflict management skills to successfully motivate subordinates, build interdisciplinary teams, and lead a health organization based on commitment rather than compliance or resistance. 3. Predict the outcomes of continuous use of the avoiding and competing strategies in a health organization, as compared to the compromising, accommodating, and problem-solving strategies; predict the outcomes of face-to-face communication as compared to use of the memoranda communication channel and media to disseminate ambiguous and urgent messages. 4. Analyze the health leader competencies in terms of the knowledge, skills, and abilities discussed in this chapter, differentiating the competencies described here with those not discussed; support your assessment. 5. By combining several theories and models, design an influence, power, and motivation leadership model for use in health organizations focused on subordinate commitment; modify this model for use with an interdisciplinary health team or group, and explain why this modification was necessary. 6. Evaluate competencies (knowledge, skills, and abilities) found in leadership practice concerning situational assessment, interpersonal relationships, influence processes, motivation, and communication necessary to successfully lead healthcare organizations; support your evaluation.
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COMPETENCIES IN THE HEALTH PROFESSION As noted by Dr. Mary Stefl, a forerunner in academic education and a leading author in competency development in health care, “health executives in all professional settings must navigate a landscape influenced by complex social and political forces, including shrinking reimbursements, persistent shortages of health professionals, endless requirements to use performance and safety indicators, and prevailing calls for transparency.”1 Furthermore, she notes that leaders and managers are expected to continually do more with less. Developing competencies that are specific to the role an individual plays in the health setting aids healthcare organizations in communicating to executives the skills necessary for leading in these changing times. Baldrige National Quality Award criteria also hold leadership competencies and the application of sound, moral, and effective leadership in high regard. Today’s healthcare executives and leaders must have management talent sophisticated enough to match the increased complexity of the healthcare environment.1 Competencies in health care are important because they set professional standards by adding to the value of health education. Competencies are skills, knowledge, and attitudes that allow a health professional to perform to standards set within the profession. Establishing and implementing these competencies are based on education, training, and professional development. The health administration profession began to explore the concept of competency-based education to produce qualified healthcare executives in the 1990s. Early careerists in the health professions were taught that competencies in the health profession were composed of four key points that would assist graduates in achieving competence in executive positions: technical skills such as finance and human resources; a perceptive view of the industrial aspects in health care such as clinical process and various healthcare institutions; the explanation of analytic and conceptual concepts; and the interpretation of and acknowledgment of emotional intelligence.2,3 Calhoun, Vincent, Calhoun, and Brandsen also have been leaders in the health education process for developing competencies. They have suggested that “during the last decade there has been a growing interest in adopting a competency-based system in various areas of education, training, and professional development.”4 As a result, they list a number of competency initiatives that include calls for the following: 1. both curricular content and process review in health administration and related training programs; 2. rethinking and reform of current educational practices; and 3. evidence-based, outcomes-focused education in health management; and policy education.4 They also suggest that competencies in healthcare administration optimize organizational effectiveness by better equipping students with more than just the textbook information needed to succeed in the industry. However, they have suggested that in spite of governmental mandates and accrediting body specifications for education’s improvement, the debate about the use of competency models, the competencies themselves, and competency-based education (CBE) still continues in a number of postsecondary educational settings—both within and outside the professions.4,5 Competencies can also be described as a characteristic of a person that results in effective performance on the job. As a result, professionals are better prepared for excellence in the working world of the health professions. Competencies can also be thought of in terms of actual performance. A person can have the education and training to be a hospital administrator, but actually performing the job involved is another matter altogether. Mastery of specific competencies related to healthcare administration is the true measure of performance in the workplace. In health care, competencies are used to define discipline and specialty standards as well as expectations.6 The competency validation process should begin in the academic setting. Setting formal standards as a profession will give leaders clear direction on what they should be doing to be a successful leader within their organization. However, it is important to note that both the academic world and healthcare organizations need to be on the same page in terms of accepted competencies and expectations. The need for competencies has been an issue throughout the healthcare industry for decades. During the twentieth and twenty-first centuries there has been a growing interest in competency-based systems in various areas of education, training, and professional development. As a result, a number of competency initiatives have been undertaken across the health professions, including administration and medicine. Organizations that are able to hire leaders with competencies in healthcare management benefit from the ability of a leader to more quickly tackle the specifics of his or her job, retain staff who thrive under leadership that has the skills of collaboration and team building, and maintain a ready pool of exemplary employees competent to move up and through an organization, strengthening its quality of service as well as operations. The reason competency is important in healthcare administration is that health care continues to change and require a highly skilled workforce that readily adapts for lifelong learning. A prerequisite for ensuring this is the identification and specification of skill sets or competencies that accommodate those transformation processes. Additionally, leaders should recognize the development of competencies as a continual process that results in continual improvement. The focus on individual leadership competencies in health care is a continuation—and product—of earlier work by dozens of healthcare icons, including Abraham Flexner, Dr. Ernest A. Codman, Avedis Donabedian, and John R. Griffith (to name only a small handful). ABRAHAM FLEXNER Abraham Flexner is credited with shepherding in the scientific age of medicine. In 1910 he wrote Medical Education in the United States and Canada. This seminal piece of healthcare literature was used at that time as the basis to close more than 60 of the United States’ 155 operating medical schools that were still basing medical education on anachronistic practices. Flexner found that some medical schools were still awarding medical degrees based on apprenticeships and teaching students with woefully outdated and irrelevant curricula, and that none of the medical schools based their education on any one particular standard. As a result, Flexner recommended that all physicians needed formal didactic education, that this education be conducted in a university setting by skilled medical educators, that it conform to a recognized curriculum, and that standards and practices (early terms for competencies) be developed that would allow for uniform learning outcomes regardless of where any medical student earned a degree. Flexner’s report also recommended that physician education be based on both a scientific foundation and empirical knowledge. Using this methodology, it may be suggested that medical students of the era were the first of their generation to be taught to think critically; that is, to transcend the gaps between knowledge and abilities in the development of new skills.7,8
ERNEST A. CODMAN In 1917, Dr. Ernest A. Codman wrote A Study in Hospital Efficiency as Demonstrated by the Case Report of the First Five Years of a Private Hospital. Codman practiced medicine in the early 1900s during the start of the industrial revolution, and the U.S. healthcare system’s burgeoning interest in standardization (another early precursor term for competence). Today, Codman is credited with developing the “end results” methodology, which was a precursor to outcomes assessment. Codman’s end results methodology involved studying the delivery of patient care practices that resulted in more favorable outcomes (such as lower morbidity and mortality). However, unlike his contemporary Abraham Flexner, Codman’s efforts to improve patient outcomes in the Boston hospital in which he practiced were not met with approbation from peers. In fact, Codman was eventually asked to resign his medical position from the Massachusetts Medical Society for advocating policies and practices that none of his colleagues thought prudent or necessary. However, there was a growing trend within U.S. health care to meet the quality demands of a rapidly growing and more discerning patient base. As a result, the American College of Surgeons (an early precursor to the American Medical Association) eventually adopted Codman’s end result methodology as an early quality process to deliver better care. Today, we refer to this collective process of a population of providers all evaluating and treating patients in a similar way that results in the most favorable outcomes as standards of practice.9,10 AVEDIS DONABEDIAN Avedis Donabedian’s work in health care is most commonly associated with the construct of quality. Donabedian published three volumes on healthcare quality and divided quality assessment into three focal areas: structure, process, and outcome. Since the 1960s there have been numerous efforts at measuring and improving quality by assessing the clinical process by way of the Healthcare Effectiveness Data and Information Set (HEDIS) measure and the Institute for Healthcare Improvement’s (IHI’s) 100,000 Lives Campaign, which was promoted to spur healthcare organizations to systematically use evidence-based guidelines for specific medical issues. Other quality improvement efforts have led to the employment of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which is a general healthcare satisfaction survey of care, and the Hospital Based Inpatient Psychiatric Services (HBIPS), which is a set of core psychiatric measurements developed in concert with the Joint Commission, the National Association of Psychiatric Health Systems (NAPHS), the National Association of State Mental Health Program Directors (NASMHPD), and the NASMHPD Research Institute.11,12 Although the aforementioned may seem like an alphabet soup of professional organizations and jargon, the key for early careerists is to recognize that these professional organizational metrics do, in fact, flow from the current knowledge, best practices, standards, and outcomes assessment within the field. As such, these professional organizations provide the “variables, measures, and operationalization” that competencies are evaluated through. JOHN R. GRIFFITH John R. Griffith has been an educator and scholar in the health professions for over 50 years. He is a past chair of the Association of University Programs in Health Administration (AUPHA), and has previously served as a commissioner for the Accrediting Commission on Education in Health Services Administration (now called the Commission on Accreditation Healthcare Management Education [CAHME]). His textbook, The Well-Managed Health Care Organization, is necessary reading for those candidates wanting to take the Board of Governors exam in order to become Board Certified in Healthcare Management through the American College of Healthcare Executives (ACHE). Finally, the material developed by the Griffith Leadership Center is strongly considered by a variety of professional organizations, university programs, and other entities as practical guidance from research and as advisory/best practices for the profession.13 COMPETENCY ASSESSMENT TOOLS AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES The American College of Healthcare Executives (ACHE) has developed a Competencies Assessment Tool that healthcare executives can use in assessing their expertise in critical areas of healthcare management. The competencies are derived from the Healthcare Leadership Alliance (HLA), and the self-assessment is designed to help identify areas of strengths and weaknesses to develop a personal development plan. The competencies in this self-assessment tool comprise a subset relevant to management and leadership tasks typically performed by affiliates of the ACHE, regardless of work setting or years of experience. ACHE suggests its competency self-assessment can be a powerful tool in facilitating feedback about gaps in skills necessary for optimizing performance.14 HEALTHCARE LEADERSHIP ALLIANCE The Healthcare Leadership Alliance (HLA)—a consortium of six major professional membership organizations—used the research from and experience with its individual credentialing processes to posit five competency domains common among all practicing healthcare managers. The organizations of the HLA are the American College of Healthcare Executives (ACHE), American College of Physician Executives (ACPE), American Organization of Nurse Executives (AONE), Healthcare Financial Management Association (HFMA), Healthcare Information and Management Systems Society (HIMSS), Medical Group Management Association (MGMA), and its educational affiliate, the American College of Medical Practice Executives (ACMPE). The necessary competencies they have developed are: 1. Communication and relationship management 2. Professionalism 3. Leadership 4. Knowledge of the healthcare system 5. Business skills and knowledge NATIONAL CENTER FOR HEALTHCARE LEADERSHIP The Robert Wood Johnson Foundation created the Health Research and Development Institute, which revolves around creating a foundation for qualified leadership within U.S. health systems. To align initiatives with current shortcomings in the healthcare administration field, a group of 200 professionals gathered in 2001 at the National Summit on the Future of Education and Practice in Health Management and Policy. This group also identified specific facets of the overall healthcare administration problems. Deficiencies in expenditures, cost, quality, and patient satisfaction; difficulty attracting young professionals and leaders; lack of clear collegiate accreditation in health care administration; insufficient practical experience; lack of support for young managers; failure to provide opportunities for advancement for women and minorities in management positions; and a shortage of individuals being prepared for senior management positions of healthcare systems were the main focuses on improvement in education and training that came out of this summit. In response to this, the Robert Wood Johnson Foundation funded two grants, one of which established the National Center for Healthcare Leadership (NCHL). This center was seen as a formal structure to carry out the mission of encouraging stronger managerial leadership in the healthcare field. This group encourages broad participation throughout various career stages, establishes baseline data for the industry, identifies core competencies for superior performance, identifies best means for career preparedness, and strengthens values and diversity levels within the talent pool for executive management throughout the country. The NCHL succeeded in developing a protocol for evaluating organizational culture, aligning human resource systems with the organization’s competency model, creating the most widely used health leadership competency model (the Lifelong Learning Inventory [LLI]), and other projects to develop graduate students in health management education programs.15 The LLI can assist leaders in self-assessing their stage of professional competence.16,17 ASSOCIATION OF UNIVERSITY PROGRAMS IN HEALTH ADMINISTRATION The Association of University Programs in Health Administration (AUPHA) lists five core competencies of healthcare professionals: communication and relationship management, leadership, professionalism, knowledge of health care, and business skills. These are defined as follows: 1. Communication and relationship management: A healthcare executive should be able to communicate clearly and respectfully with patients, customers, industry leaders, partners, department heads, and hospital workers. He or she should be able to create meaningful relations with peers, and promote constructive interaction between individuals and groups in all situations. 2. Leadership: For obvious reasons, a healthcare leader needs to have the ability to create a shared vision for and inspire his or her entire team. He or she must also be able to create and implement a strong organizational plan for his or her hospital or institution. 3. Professionalism: A hospital executive must maintain the utmost professional, ethical, and moral conduct at all times, thereby setting a high standard of excellence for his or her team members. 4. Knowledge of health care: A good healthcare executive is on top of healthcare system policies, the latest innovations in healthcare technology, and the ever-changing political landscape of the industry. 5. Business skills: Business skills are needed to run a hospital like a business. Healthcare leaders need to have a good grasp of business principles, systems thinking, and business management in order to reach the higher levels of healthcare employment.
THE COMPLEX AND DYNAMIC HEALTH ENVIRONMENT The health industry exists in a very dynamic environment. If the environment were static (i.e., not changing), the workforce homogenous and consistent, and the technology of health simple, the need for and the value of leaders would be much lower than they are in reality. In effect, the real dynamic and complex environment of health necessitates competent and motivated leaders. Because the environment, workforce, technology, and systems are complex and dynamic, leadership in the health realm is essential. Also, societal expectations for health organizations and health professionals are very high; in truth, the expectations are for these organizations and professionals to be error free or flawless. How long would a pharmacy director keep his or her job if even 5%, or 3%, of that section’s work was erroneous? How successful would a physical therapy director or branch chief of the clinic be if new therapies and technologies were adopted 5 or 10 years after a competitor had adopted them? Would the director of the supply chain for a hospital be successful if that person did not keep up with the new medical and surgical items needed for the hospital to meet the professional or national standard of care? Of course, the responses in these scenarios would not be favorable; in fact, failure in these areas would be career minimizing for these hypothetical individuals. Clearly, the dynamic environment of the health industry requires competent leaders throughout the organization, from chief executive officer to section or branch director. In today’s health industry, the need for professionalization and competence are especially important. Competence means recognizing and having the ability to utilize the capabilities associated with leadership. It requires mastery of the special skills and learning from experiences that are required to become a “professional.” Many organizations in the United States focus on increasing the competence of professionals of health organizations. Many of these organizations or associations are populated by executives in the profession who are committing their time and resources for the causes that are important to them. Without this kind of interdisciplinary exchange, increasing competence levels of the industry, one leader at a time, might not be achievable. THE COMPLEX AND HIGHLY EDUCATED WORLD OF THE HEALTH WORKFORCE The health workforce is a complex assortment of individuals characterized by different backgrounds, educational experiences, certifications, specialties, and work locations. Reviewing the workforce reports from the federal government’s Health Resources and Services Administration, Bureau of Health Professions division,18 provides some appreciation of the diversity and heterogeneity of the health workforce. As a whole, the health workforce accounts for nearly 12 percent of the total U.S. workforce.19 Leaders in the health sector must be able to foster a culture that is conducive to change and growth as well as develop the full potential of their staff members and volunteers. Understanding culture is a big part of this effort. Put simply, a major component of culture is the human element. Culture includes the sum total of knowledge, beliefs, art, morals, laws, customs, and shared patterns of behaviors, interactions, cognitive constructs, and affective understanding that are acquired by a particular society through socialization.20 These shared patterns distinguish the members of one group from the members of another group. Studies have found that the values that vary from one culture to another significantly influence the constitutional effectiveness of the organization. Each of these groups has its own specialized training, norms, beliefs, and values, which may differ from those espoused by other groups. In stable times, such individual dynamics may be masked and subgroups submissive; in contrast, in turbulent times, these internal groups may seek some degree of autonomy. Moreover, the training, education, and experience of health administrators, doctors, nurses, allied health professionals and other paraprofessionals may result in the presentation of certain cultural concepts that are unique and may be expressed in different ways, such as aggressive needs for autonomy or increased advocacy for patient care versus financial survivability of the healthcare organization.21 Mechanisms that reinforce norms and behaviors arise when the leader focuses attention on specific, high-priority goals and objectives. These characteristics are taught by the leaders and, in turn, adopted by the staff and the supporters of the organization. In a reciprocal relationship, the culture influences leadership as much as leadership influences culture. The adroit leader in a health organization has a direct impact on the culture, which can affect how decisions are made with respect to fundraising, volunteers, and placement within the organization.22 For a leader in this complex world, the important issues are threefold: (1) the leader’s ability to focus a diverse group of individuals toward the mission, vision, and tasks of the organization; (2) the leader’s ability to determine which individuals, with their unique sets of knowledge, skills, and abilities, should be employed, where, and how they should be utilized to the greatest value of the organization; and (3) the leader’s use of the skills of communication and motivation, as well as culture development and maintenance to create systems and processes that are effective, efficient, and efficacious so that the organization can be successful within the environment in which it performs its mission. These leadership challenges are salient for leaders throughout the industry regardless of their level in a specific organization. As leaders progress upward in responsibility and accountability in a health organization, the complexity widens and deepens. Those are rather large leadership tasks! The myriad of specialties in the health workforce underline the advancement and specialization of the application of knowledge, skills, abilities, and technologies of the industry. Multidisciplinary teams, whether in clinical, administrative, or allied health, are becoming more prevalent in the delivery of care, administration of health organizations, and improvement of health status of communities. Understanding the different knowledge, skills, abilities, and perspectives each health professional brings to an issue, opportunity, or challenge that the organization faces is important for leaders. Effective handling of this need is essential so that the proper mix of professionals can be formed into a team, proper resources can be provided, and appropriate expectations can be set for the multidisciplinary team. Learning about each discipline and knowing which capability each type of health professional can competently perform will allow the leader to make the most efficient use of the most valuable resource—people. Table 5-1 presents a simple summary of a current snapshot of the health workforce. These various specialties and disciplines all have different education, licensure, credentialing, and licensure maintenance requirements. Therefore, different professional associations and societies, and credentialing and accreditation associations, have been developed to provide a set of standards for each distinct profession. These associations and societies also provide valuable connections and updates concerning the macro- and micro-environmental forces that are changing the health industry. A recent collaboration of five professional associations has created five domains that encompass a total of 300 competencies for the health leader and manager. An extract of competencies, focusing on leadership and management from Domain 2: Leadership, is provided in Table 5-2. Although this table focuses on the Leadership domain, leaders should possess the competencies identified in each domain. The professional associations involved in the collaboration to create this list of competencies are essential to leaders and managers in the health industry. The associations’ mission or charter (a reason to exist, a purpose), taken as a whole, is to keep their membership—that is, the leaders, managers, and stakeholders of the health industry—current on changing environmental forces. One of the many ways they perform this mission is to maintain close relationships with the legislative, judicial, and political entities of U.S. society. Health industry leaders should seek membership in these associations and certification as appropriate to their career track and personal career goals. This is a sincere and strong recommendation. Table 5-3 lists some of these associations, as well as provides contact information for the National Center for Healthcare Leadership and the Association of University Programs in Health Administration. Health leaders should become members and earn the appropriate certification from a professional association of the health industry. The associations and societies listed in Table 5-3 are the best known in the industry for leadership careers. For example, the NCHL provides essential services and information for the health leader. AUPHA and CAHME provide instructors of health industry leadership and management students with the standards and specialty certification for their programs. In addition, specialty associations exist to serve women, Asian, and African American health leaders and managers. Of note, recognized universities may be regionally accredited as institutions of higher learning, whereas specific colleges and specific programs are specialty accredited, such as with health administration regarding CAHME. Other specialty accrediting bodies for health industry leadership and management programs include the Council on Education for Public Health (CEPH)32 and the Association to Advance Collegiate Schools of Business (AACSB).33 Many leaders come from clinical or technical programs, backgrounds, and practical experiences. These leaders include, but are not limited to, physicians, physical therapists, pharmacists, occupational therapists, audiologists and speech pathologists, optometrists, and nurses. For would-be health leaders, maintaining membership and certification for your clinical or technical specialty is important, but securing membership in one of the professional leadership and management health associations—the one that provides the best fit for you—is also important for your personal growth, professional development, and upward career mobility. Not only are your leadership knowledge, skills, and abilities important, and not only is the environmental scanning support important, but the broader network of similar leaders that you will develop can also assist you and your organization greatly throughout your career. Table 5-1 Health Workforce Specialty Categories and Disciplines Category Specialties Medicine • Physicians of medicine (MD) and physicians of allopathic medicine (DO) • Many specialties, such as neurology, pathology, radiology, psychiatry, and surgery (e.g., thoracic, cardiac, orthopedic) • Many specialties, such as pediatrics, family medicine, obstetrics and gynecology, internal medicine, ophthalmology, and cardiology Nursing • Registered nurses (RN) • Advance practice nurses (NP or APN) • Licensed practical and vocational nurses (LPN) Dentistry • Dentists of surgery (DDS) and dentists of medical dentistry (DMD) • Dental hygienists • Dental assistants Nonphysician clinicians • Physician assistants (PA) and podiatrists (DPM) • Chiropractors • Optometrists and opticians Pharmacy • Doctors of pharmacy (PharmD) • Pharmacists • Pharmacy technicians and aides Mental health • Psychologists • Social workers • Counselors Allied health • Physical therapy, occupational therapy, speech-language pathology and audiology, and respiratory therapy • Various technicians and technologists (lab
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