What are your core competencies? (Book Review).

Leadership for the Future: Core Competencies in Healthcare (2002). Austin Ross, Frederick J. Wenzel, and Joseph W. Mitlyng. Foundation of the American College of Healthcare Executives. Chicago: Health Administration Press. 389 pages hardcover. $60.

In the foreword to this book, Howard Zuckerman describes healthcare as undergoing continuous change characterized by turbulence, volatility, and uncertainty. So true! The health sector represents about half of the SRA's members and a large segment of all research dollars. In the past 40 years, we have witnessed the creation of Medicare and Medicaid, the evolution of health insurance from catastrophic hospital care to health promotion and prevention services. We have moved from initiatives of expanded access to mandatory cost controls and capitated incentives of managed care and reduced lengths of stay, to the shifting policy arenas of state government and business purchasers. I believe we all have much to learn from the health sector and leadership competencies is one application of skills that research administrators might find useful.

Management exists in the context of its organization, but the pace, dependence on technology, and culture have several points of similarity in any business sector. Even if your area of research administration does not deal with health, you will discover applicable lessons about leadership and the core competencies needed for a dynamic 21st century in the recent book by Ross, Wenzel and Mitlyng.

Competencies are driven by an organization's environment, competitors, and constituencies. This book recognizes the organizational history and culture, system factors, personal leadership abilities, and key knowledge areas that form the base upon which competence develops in management and executive teams. Personal leadership skills often transcend the field of practice and include core competencies such as decisionmaking, risk-taking, mentoring, teambuilding, and conflict resolution. The authors use a case-study format to build a foundation of common scenarios and discussion material as a way to motivate self-assessment.

Chapter 1 reviews the evolution of healthcare management but those in other sectors could create a similar milestone progression. Leaders must be developed and the authors reviewed literature from the past 20 years to identify key traits for leadership. Executives do not need personal competence in every area but they must create a well-rounded management team with an essential core of knowledge and abilities. Chapter 2 is a very brief review of competencies as they appeared in the 1980s and progressed to the current period. Core competencies (behaviors or performance) are described as a set of interrelated skills that are defined, characterized, and broadly applicable across an environment. The essential elements of the leader include creating a vision, energizing people, setting direction, and selecting a course of action. Research into critical core competencies in healthcare by Hudak et al. in 1997 (p.27) enumerated six subsets or domains of management knowledge that form a critical core: leadership and strategy, relationships, resource, functional, stakeholder, and patient care or customer. Physician research identified performance domains that specified financial, human resources, planning and marketing, information, and risk management as well as governance, business operations, and professional responsibility. Academic programs in health administration listed six key areas of competence, namely, leadership, critical thinking, analytic competence, management competence, political and community development, and communications competence. Thus, the leadership domains converge.

Part II moves from general background to organizational (system) competence and includes Chapters 3 through 10. Governance, the focus of chapter 3, is an excellent review of the role of the board in carrying out the mission, vision, and strategic planning without getting into management. There is also a review of the strategic planning process. Chapter 4 on strategy development focuses on that ongoing collage of vision, values, and capabilities presented to meet customer needs. Chapter 5, Physician Relationships, may not be applicable to nonhealth or non-academic settings. The lesson for all in this chapter, though, is recalling that the scientific and technical component of your team may have values and interests that differ from those of business executives and you must learn these similarities and differences to work effectively, viewing the relationship as a partnership. Chapter 6 moves to Ethics and Values and a discussion on acceptable behavior. As we deal more with complex issues, compliance programs are an expected norm and this chapter discusses elements such as written policies and procedures, designated oversight, due diligence, effective communication of standards, monitoring and reporting, and appropriate response when problems are detected. These are not dissimilar to the issues we experience in research administration. Chapter 7, Quality and Value Enhancement, reviews the crucial buy-in required of executives for continuous quality improvement--the commitment to value by allocation of resources; recognition of teaming between business, technology, and scientific branches; work with the front lines and developing shared vision. Chapter 8 deals with public health arid community but community involvement may be important to other areas of the research enterprise. Chapter 9, Health Policy and the Law, reminds us that the political process is the same for all sectors. The chapter provides a good review of the stakeholders, processes, and movement from values to policy. Substantial government regulation s make it imperative that organizations and executives have competency in the formation of policy, laws, and regulations. Chapter 10 is specific to new paradigms in health care and not apropos of leadership in general.

Part III reviews selected personal leadership competencies and ways in which executives can enhance their mastery in these areas. Chapter 11, Decision Making, relates the importance of fact-gathering, logic, and intuition in the process. Some flexibility in deviating from normal procedures allows executives to display style changes in accomplishing decisions. Executives should spend the most time on strategic issues and delegate other responsibilities. Open discussions and debates help the team move and accept decisions. Three basic principles of decision making (p. 235) apply broadly to all executives:

1. Believe in the process in order to deal with day-to-day decisions.

2. Look to instinct for the right time to act on key issues.

3. Recognize when to challenge the usual decision-making approach.

Leadership is about knowing when to follow protocol and when to try something new. Chapter 12, Risk Taking, cautions executives not to move too fast but to benchmark and use due diligence when the risks are unusually high. Five environmental factors are described that add risk to decisions and often shanghai the process; namely, volatility (or competition) in the marketplace, new payment systems, speed of communications, technology applications, and downsizing managerial capacity. Risks need to be weighed as they relate to strategy and the assumption of any new course of action. Chapter 13, Team Building and Evaluation, is an excellent summary of shared power and flexibility. It describes the skill, balance, discipline, and horizontal integration necessary to make a cohesive team. We are reminded that team goal-setting creates identification with the mission, builds confidence and trust, promotes debate, and identifies with team success. Chapter 14, Conflict and Confrontation, is the least developed chapter in the book. Chapter 15, Professional Mentoring, the cornerstone of team building, offers several tips about being a good mentor. Managing Your Career, Chapter 16, appropriately describes continuing education as essential for growth and continuing competence. The message here is clear-know your leadership style, what motivates you, how to network, and plan your growth.

Part IV presents ten competency-based knowledge areas appropriate for healthcare executives. Except for mentioning health specifically in two, these are applicable to all who lead complex organizations. The brackets [] suggest other non-healthcare applications by the reviewer. Leaders and developing managers need at least a significant understanding--if not personal competence--in these areas. Specifically, personal core competencies (p. 297) include:

a. Governance and organizational dynamics

b. Human resources principles and practices

c. Financial management and economics

d. Strategic planning and marketing

e. Technology and information systems

f. Communications and public relations 

g. [Understanding global problems and benchmarks of your sector] Community health and managerial epidemiology

h. Quantitative analysis and modeling

i. Legal and ethical issues

j. Organizational and [sector] healthcare policy

The epilogue posits the authors' leadership priorities for the future. Certainly we will still be struggling with issues of resource allocation and finding the energy to remain competent. We will face continuing opportunities and challenges but the principles of leadership will remain even though our demographics will differ. The book concludes with a list of suggested readings and should leave you re-energized to return (or start) your continuing education plan to achieve new core competencies.

Molly A. Anthony, PhD, Managing Director, psPORA, recently completed her contract as the Director of Research and Grants Administration, Department of Radiology, University of Virginia. Dr. Anthony focuses on program development, organizational design, and research management for organizations serving the public interest in health and human services. Her career in public health included research, teaching, nutrition leadership, program evaluation, perinatal consultation and federal project officer; she also has hospital and hospital association experience. Dr. Anthony received her PhD from Michigan State University, College of Social Science, in research methods, public administration and health policy. She is a member of the SRA Editorial Review Board and currently serves as journal editor.