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Required knowledge, skills and abilities from healthcare clinical managers' perspectives.

INTRODUCTION

The ever-increasing uncertainty that confronts the U.S. health services industry is placing an enormous demand on providers of care and those who lead and manage delivery systems (Hudak, Brooke, Finstuen, & Riley, 1993). Jobs in the healthcare industry are in a constant state of change, requiring a workforce that is not only prepared to adjust quickly to the changing environment but to simultaneously maintain or improve overall organizational performance.

An essential determinant of healthcare organizational performance is management competence. Studies have examined the knowledge, skills, and abilities of top-level executives, primarily in hospital settings. However, there is a need for expanding that perspective of the requisite knowledge, skills and abilities beyond the hospital setting. We seek to explore those determinants beyond that previous studied and expand the perspective of managerial competence.

REVIEW OF THE LITERATURE

Review of the literature found that healthcare education studies focused on managerial skills related to business management. "The general human resources literature typically refers to competencies through the acronyms SKA or KSA, sometimes defined as skills, knowledge, and ability or knowledge, skills and abilities. Competencies have also been referred to as skills, knowledge, and attitudes (or aptitudes), with ability being subsumed under skill" (Shewchuk, O'Connor, & Fine, 2005, p. 33).

Many fulfilling those managerial roles do not appear to possess proper management qualifications or managerial experience in healthcare. If the healthcare industry is to effectively manage the growth of this customer base, managers need to possess the requisite skills and abilities to meet the changing business needs (Mathews, Tozer, & Walker, 2004). Although the labor shortages have been particularly problematic in the nursing fields and other allied health professions, there has also been some speculation surrounding a potential executive leadership shortage. Furthermore, there have been concerns that those in the youthful workforce cohorts will be poorly prepared for their new roles (S. Collins, Matthews, McKinnies, K. Collins, & Jensen, 2009).

The literature on the subject of managerial skills in healthcare is extensive focused on the hospital environment. There is overwhelming consensus that business-related analytical skills and functional abilities remain critically important ingredients for success in managing health care organizations. However, there is strong evidence of concern among practitioners that an exclusive focus on quantitative analysis, functional specialization, and the calculative rationality of the "bottom line" may not adequately prepare new managers to be adaptive, collaborative and team-builders. These managers will be needed to lead health care organizations of the future.

The hospital industry will have to seek, hire, and retain highly qualified individuals that have a breadth of knowledge of both business and healthcare in order to remain competitive. Organizations must recruit, hire, and train individuals that possess a multitude of managerial skills (Hurley & Brewer, 1991). "In the last 100 years, technology has blossomed, healthcare has spread to near universality, and delivery organizations have exploded in size, complexity and sophistication" (Griffith, 2007, p. 11). However, novice managers often find their new roles frustrating, and consistently encounter situations that stress and strain their managerial abilities. Their inexperience and lack of knowledge contribute to a resounding lack of leadership among health care professionals. Lack of managerial development and skills often leads to employee frustration, disenfranchisement from the health care organization, and, in some cases, resignation from the health care system (Weston et al., 2008). Without formal preparation for management roles and responsibilities, novice managers learn by trial and error and thus frequently mishandle employee issues, which cause both the manager and the employee to become discouraged in the workplace. This has severely affected the management of relationships, the clarity of communication, the ability to create effective working environments, and excellence in practice.

CURRENT STUDY: RESEARCH OBJECTIVES

This study focuses on expanding previous research to another segment of the healthcare delivery systems that of managers, supervisors and directors within a broader scope of healthcare organizations. The study asked healthcare managers, supervisors and directors to rate the importance of 50 knowledge, skills, and ability (KSA) concepts perceived as being necessary for successfully managing their current type of healthcare organization. The significant changes in healthcare delivery and financing have placed tremendous stress on the system and the workers and executives in it. It is now an opportune time for further research on executive management in the healthcare industry, especially organizations that focus on a variety of organizational types. Regardless of delivery setting, in order to remain competitive and profitable, organizations must have executive managers prepared with the right knowledge, skills, and abilities and that correlate for success in their position (Hurley & Brewer, 1991).

This study addresses the gap in research by identifying the necessary knowledge, skills, and abilities for executives in a broader segment of the healthcare delivery system. Additionally, we examined the KSAs of healthcare management groups to more clearly define the domains of their positions that contribute to their success. It also examines the role of gender, age, education, years in health care and years of experience in healthcare management as factors that could influence the necessary skills needed for effective management. Since researchers have conducted many studies examining the knowledge, skills, and abilities of top-level executives, primarily in hospital settings, however, the research on executives is lacking in its focus on the knowledge, skills, and abilities of managers, supervisors and directors in a broader range of healthcare settings. This study filled that gap in research by identifying the necessary knowledge, skills, and abilities for managers, supervisors and directors in broader segments of the healthcare delivery system. We examined the knowledge, skills, and abilities of healthcare management group not extensively studied thus providing a baseline of data to examine and understand how these skills and abilities prepare these executives to be successful in their roles.

METHODOLOGY

The targeted population for this study was current managers, supervisors, and executives in a healthcare setting. The participants were selected from current and former students and faculty within a graduate program in health administration. In addition to these participants, this study utilized a snowball technique and requested that the primary participants forward the email to at least three colleagues that meet the criteria for the study.

In addition, this study utilized a panel of experts to review the instrument for comprehensiveness and completeness. The expert panel included, healthcare executive directors and others currently involved in a managerial function within a in a variety of sizes of healthcare organizations. Twenty-five healthcare experts reviewed the survey for completeness, readability, and verbiage. Additionally, the expert panel provided feedback on the data elements to determine both applicability and relevance to the healthcare necessary skills and knowledge set. The final set of KSAs is presented in Table 1.

RESULTS

Table 2 describes the demographics of the sample. The majority were females at 78.9.2% while Caucasians represented 88.1% of the sample. The majority was 41 years or older (77.1%) while 90.8% had a bachelor's degree or better. The average experience in health care was 24.7 years and average years in their current position was 8.5. Almost 70% of the sample was classified as middle management based on respondent position titles.

Table 3 shows the means for the 50 KSAs. Effective leadership (6.81), creating a positive work environment (6.74), effective management of conflict (6.71) and multi-tasking (6.71) had the highest importance ratings. Following closely behind was motivating others (6.63), empathy for patient/client concerns (6.56), sensitivity to staff problems (6.56), and work is consistent with personal ethics (6.51). The lowest rated items were: bond covenants (2.32), managing media relations (3.93), facility/plant management (4.14), components of marketing techniques (4.49), and utilization of a global business perspective (4.56).

When considering the statistical error of .54, the first 14 KSAs are statistically equivalent, effective leadership through use of computer technology. Bond covenants were the lowest rated item. Conduct market research, management of account receivables, managing media relations, and facility/plant management were the next lowest cluster of items.

Table 4 reviews the importance of the skills domains. Respondents rated the importance of organizations skills (6.63), business administration skills (6.36), and interpersonal skills (6.21) as the three most important domains given the statistical error of .55. The next most important was communication skills (6.08) followed by board relation skills (5.08) and fund raising skills (4.48).

A series one-way ANOVAs were run with the 50 KSAs serving as dependent variables and the demographics of years in current position, age, years of experience in healthcare, education, and gender serving as the fixed factors. Years in current position, was recoded into three categories: 1-4 years, 5-10 years, and over 10 years. Age was recoded into three categories: 25-40 years, 41-52 years, and over 52 years. Years of experience in healthcare was recoded into three groups: 3-20 years, 21-30 years, and 31-45 years. Finally, education was grouped as follows: high school/associates degree, bachelor's degree, and masters/doctorate. Tables 5-9 report these results.

Table 5 indicates that those who were in their position 1-4 years rated healthcare regulations, audits for clinical compliance with Medicaid/Medicare regulations, visibility to patients/clients of your organization, and diversity as less important than those 5-10 years. Those in their position over 10 years rated contracts/agreement, facility/plant management, communicating organizational vision to stakeholders, project management techniques, and public speaking as less important than those who were in their current position 5-10 years.

Table 6 shows that those 25-40 years old rated financial statements and critical ratios, effective implementation of clinical programs, state and federal healthcare regulations, accreditation standards, external networking, and managing media relations as less important that those 41-52 years and in some instances those over 52 years. Respondents 25-40 and 41-52 years rated bond covenants as less important than those respondents over 52 years.

Table 7 indicates that those with 3-20 years of experience in healthcare rated facility/plant management, risk management, project management techniques, ethical business practice, and ability to conduct healthcare risk assessments as less important than those with 31-45 years experience and in some instances those with 21-30 years experience. For bond covenants, those respondents with 21-30 years of experience in healthcare rated them as less important than those 31-45 years of experience.

Tables 8 shows that those respondents with a high school or associates degree rated audits for financial compliance with Medicaid/Medicare regulations, components of marketing techniques, and public speaking as less important than with a bachelor's or masters/doctorate.

Table 9 reviews the results for gender. Women rated effective implementation of clinical programs, accreditation standards, sensitivity to staff problems, creative problem solving, empathy for patient/client concerns, visibility to the patient/clients of your organizations, effectively managing conflict, risk management, project management techniques, work is consistent with personal ethics, motivating others, leading organizational change, delegate work, run effective meetings, consider ethical implications in clinical decisions, ability to be decisive, management diversity in the workplace, and utilization of research skills as more important than men.

Nine of the items that women rated as more important than men involved management/leadership skills: effective implementation of clinical programs, accreditations standards, creative problem solving, risk management, project management techniques, leading organizational change, ability to be decisive, managing diversity in the workplace, and utilization of research skills. Seven of the items that women rated as more important were interpersonal in nature: sensitivity to staff problems, empathy for patient/client concerns, visibility to the patients/clients of your organization, effectively managing conflict, motivating others, delegate work, and run effective meetings. Two were concerned with ethics: work is consistent with personal ethics and consider ethical implications in clinical decisions.

Table 10 shows that there were some demographic differences based on a series of one-way ANOVAs conducted on the 6 domains. For the business administration domain, those 25-40 years rated business administration skills as less important than those 41-52 and over 52 years old. Those who had between 3-20 years experience in healthcare rated business administration skills as less important than those in the business for 21-30 and 31-45 years. For gender, men rated organizational, communication, and interpersonal skills as less important for women.

An initial Principle Component factor analysis with a Varimax rotation was run on the 50 KSA variables. It was found that 7 items did not load on any factor. They were work with governing body, strategic planning techniques, facility/plant management, multi-tasking, ethical business practices, use of computer technology, and ability to be decisive. These items were removed for the second factor analysis. Seven interpretable factors evolved which explained 61.5% of the variance. Only factor loadings of .40 or better are reported in Table 11.

The first factor labeled External Stakeholder Domain explained the most variance at 28.0%. The second factor called Personal Ethos Domain accounted for 9.8% of the variance while the third factor, Communicating Change Domain, accounted for 6.4% of the variance. Factor 4, Clinical Compliance Domain accounted for 5.9% of the variance while factor 5, Managerial Tasks Domain, accounted for 4.6% of the variance. The last two factors, Dollars and Cents Domain and Ethics and Quality Domain each accounted for roughly 3% of the variance.

The rationale for choosing the above mentioned factor names were:

External Stakeholder Domain: These factors focus on areas related to how the organization is viewed by outside entities. These skills not only help establish the organization's image within the community but also establish necessary relationships that allow the organization to exist or continue to operate within external guidelines/requirements.

Personal Ethos Domain: These factors demonstrate the personal internal skills necessary to help manage from within the organization. These skills help develop internal relationships to help the organization focus on organization efficiencies.

Communicating Change Domain: These focus on how communication is shared both within and external to the organization. With a myriad of external stakeholder requirements, there is a need to not only effectively plan and implement these requirements but manage and communicate so that the organization can be as effective as possible.

Clinical Compliance Domain: Internal processes to maintain practices that meet external stakeholder requirements, like documentation, clinical and financial standards. Additionally there can be opportunities to develop and implement new programs that increase the efficiencies/revenue to meet internal customer needs.

Managerial Tasks Domain: These are primary managerial tasks to organize and manage personnel that create a positive environment within the organization.

Dollars and Cents Domain: The domain demonstrates the requisite knowledge of finance and how to interpret and manage the cash necessary to meet financial obligations but also make a profit.

Ethics and Quality Domain: These factors focus on creating an environment where the actions of the employees are conducted in an ethical manner. Additionally focused on tasks that are not only completed within requirements but also strive to meet a quality measure in the delivery of care and program outcomes within the organization.

CONCLUSIONS AND RECOMMENDATIONS

Even though there have been a substantial amount of studies conducted on the knowledge, skills and abilities of hospital managers, this study further clarified and expanded the KSAs across a wider spectrum of supervisors, managers and executives. Additionally, the identification of seven interpretable factors has evolved which explained 61.5% of the variance in this study. These factors further define those KSA clusters that supervisors, managers, and executives identify as being most important for their success.

Those respondents that were employed earlier in their career focused on regulatory compliance and patient interaction than those later in their career. Those later in their career focused more on those factors that continued to contribute the organizational continuation. This could demonstrate the increased commitment to the organization and its continued success but further research would be required to confirm this perspective.

The gender findings are perplexing. Women rated organizational KSAs more important than men and the skills were focused on traditional managerial tasks. Women could possible no longer shy away from tasks/behaviors that have traditionally have been associated with male dominate virtues of strength and power in executive roles within healthcare organizations.

Therefore, a key factor to success with these respondents was longevity in the business and age of the respondents. The more successful hospital managers, not surprisingly are the seasoned veterans. This conclusion indicates that education may well be a key variable that can help lead younger managers to success more quickly. An appreciation of the fundamentals of basic strategic thinking and leadership development is crucial. This industry cannot wait for the years to pass for a manager to accrue the necessary skills to become successful given the pressures of the healthcare delivery for the U.S. population.

Healthcare education programs can use these results of this study to evaluate curriculum and address the key KSAs to prepare future executives to be effective and successful in managing in a healthcare environment. In addition, current board of directors of the healthcare organizations should use the results of this study in two ways. First, the KSAs identified as contributing to the success of the supervisors, managers, and executives should be used to evaluate potential candidates moving into this management role within the healthcare organization. Second, the board of directors should use these results to evaluate the level of competence of the current supervisors, managers, and executives to identify potential areas of strengths or gaps in the KSAs identified in this study.

Further opportunities for research, based on the results of this study, include the changes in healthcare delivery as a resulted of current changes in the laws from the federal government. There should be a focus to solicit perspectives from supervisors, managers, and executives under-represented by this study, to increase minority and multi-cultural representation. Additional study on the changes in the knowledge, skills, and abilities of future supervisors, managers, and executives appears to be warranted to address the needs of these changing healthcare demographics. In this current study, nearly 98% of the respondents were Caucasian, which suggests further research should evaluate any changes in the responses to the identified KSAs as the ethnic representation shifts over the next 5 to 20 years.

Validation of the newly identified domains, External Stakeholder Domain, Personal Ethos Domain, Communicating Change Domain, Clinical Compliance Domain, Managerial Tasks Domain, Dollars and Cents Domain and Ethics and Quality Domain should be conducted especially as it applies to other types of organizations. These domains may vary in importance based on the levels within the organizations or the types of organizations being studied.

Further expansion of the list of the key knowledge, skills, and abilities for supervisors, managers, and executives needs to be explored. One of the limitations identified was the finite list of KSAs and the potential for KSAs that are required to be successful yet not addressed in the current survey instrument. The survey instrument used in this study provided a comprehensive list of KSAs but the list was not exhaustive and further research to add to those already identified appears warranted.

REFERENCES

Collins, S., Matthews, E., McKinnies, R., Collins, K., & Jensen, S. (2009). Chief executive officers in US hospitals: an examination of workforce demographics and educational issues. Health Care Manager, 28(2), 134-141.

Griffith, J. R. (2007). Improving preparation for senior management in healthcare. The Journal of Health Administration Education, 24(1), 11-32.

Hudak, R. P., Brooke, P. P. J., Finstuen, K., & Riley, P. (1993). Health care administration in the year 2000: Practitioners'. Hospital & Health Services Administration, 38(2), 181.

Hurley, R. E., & Brewer, K. P. (1991). The continuing care retirement community executive: a manager for all seasons. Hospital & Health Services Administration, 36(3), 365-381.

Mathews, P., Tozer, L., & Walker, R. (2004). Management responsibilities in the retirement village industry: a New Zealand study. Contemporary Nurse: A Journal for the Australian Nursing Profession, 17(3), 251-260.

Shewchuk, R. M., O'Connor, S. J., & Fine, D. J. (2005). Building an understanding of the competencies needed for health administration practice. Journal of Healthcare Management / American College of Healthcare Executives, 50(1), 32-47; discussion 48.

Weston, M., Falter, B., Lamb, G., Mahon, G., Malloch, K., Provan, K., Roe, S., et al. (2008). Health Care Leadership Academy: A Statewide Collaboration to Enhance Nursing Leadership Competencies. The Journal of Continuing Education in Nursing, 39(10), 468.

Michael Stowe, University of St. Francis

James Haefner, University of St. Francis

Robert J. Behling, University of St. Francis
Table 1: Knowledge, Skills, and Ability Items

Effective leadership                 Effective implementation of
                                     clinical programs

Creating a positive work             Risk management
environment

Effective managing conflict          Quality assessment of patient
                                     outcomes

Multi-tasking                        Prepares budgets for department/
                                     organization

Motivating others                    Communication organizational
                                     vision to stakeholders

Empathy for patient/client           Public speaking
concerns

Ability to be decisive               Health information management

Sensitivity to staff problems        Knowledge of healthcare issues

Work is consistent with personal     External networking
ethics

Creative problem solving             Contracts/agreements

Run effective meetings               Economic analysis and application
                                     to decision making

Ethical business practices           Ability to develop a mission
                                     statement

Measuring performance of             Utilization of research skills
department/organization employees

Use of computer technology           Ability to conduct healthcare risk
                                     assessment

Delegate work                        Conduct organizational assessments

Lead organizational change           Financial statements and critical
                                     ratios

Consider ethical implication in      Audits for clinical compliance
clinical decisions                   with Medicare/Medicaid regulations

Accreditation standards              Utilization of a global business
                                     perspective

Strategic planning techniques        Audits for financial compliance
                                     with Medicare/Medicaid regulations

Visibility to the patient/clients    Components of marketing techniques
of your organization

Knowledge of integrated healthcare   Facility/plant management
delivery systems

Manage diversity in the              Managing media relations
marketplace

State and Federal health care        Management of account receivables
regulations

Work with organizational governing   Conduct market research
body

Project management techniques        Bond covenants

Table 2: Sample Demographics

Characteristic           Frequency    Percentage    Mean

Gender:
Male                         37          21.1        --
Female                      138          78.9

Ethnicity:
African-American             6            3.4
Asian                        5            2.8        --
Caucasian                   155          88.1
Latino/Latina                9            5.1
Other                        1            .6

Age:
25-40 years                  39          22.9       44.0
41-52 years                  71          41.8
Over 52 years                60          35.3

Education:
High School or
Associates Degree            16           9.2        --
Bachelors                    87          50.3
Masters or Doctorate         70          40.5

Years of Experience in
Health Care:
3-20 years                   51          34.0       24.7
21-30 years                  55          36.7
31-45 years                  44          29.3

Years Experience in
Current Position:
1-4 years                    45          30.0        8.5
5-10 years                   68          45.3
Over 10 years                37          24.7

Job Title:
Executive                    15           9.2
Middle Management           114          69.9
First Line Supervisor        21          12.8
Staff                        13           7.9

Note. Percentages may not add to 100% due to rounding errors.

Table 3: Knowledge, Skills, and Ability Means

Knowledge, Skills, and Ability Items                              Mean

Effective leadership                                              6.81
Creating a positive work environment                              6.74
Effective managing conflict                                       6.71
Multi-tasking                                                     6.71
Motivating others                                                 6.63
Empathy for patient/client concerns                               6.56
Sensitivity to staff problems                                     6.56
Work is consistent with personal ethics                           6.51
Ability to be decisive                                            6.49
Creative problem solving                                          6.47
Ethical business practices                                        6.37
Run effective meetings                                            6.36
Measuring performance of department/organization employees        6.31
Use of computer technology                                        6.26
Delegate work                                                     6.24
Lead organizational change                                        6.17
Consider ethical implication in clinical decisions                6.06
Accreditation standards                                           5.99
Manage diversity in the marketplace                               5.97
Visibility to the patient/clients of your organization            5.96
Knowledge of integrated healthcare delivery systems               5.96
Strategic planning techniques                                     5.93
State and Federal health care regulations                         5.92
Work with organizational governing body                           5.81
Quality assessment of patient outcomes                            5.80
Effective implementation of clinical programs                     5.79
Project management techniques                                     5.76
Risk management                                                   5.72
Prepares budgets for department/organization                      5.70
Communication organizational vision to stakeholders               5.61
Public speaking                                                   5.57
Health information management                                     5.54
Knowledge of healthcare issues                                    5.47
External networking                                               5.27
Economic analysis and application to decision making              5.21
Contracts/agreements                                              5.12
Financial statements and critical ratios                          5.09
Audits for clinical compliance with Medicare/Medicaid             5.05
  regulations
Ability to conduct healthcare risk assessment                     5.03
Utilization of research skills                                    4.96
Ability to develop a mission statement                            4.93
Conduct organizational assessments                                4.92
Audits for financial compliance with Medicare/Medicaid            4.65
  regulations
Utilization of a global business perspective                      4.56
Components of marketing techniques                                4.49
Facility/plant management                                         4.14
Managing media relations                                          3.93
Management of account receivables                                 3.88
Conduct market research                                           3.81
Bond covenants                                                    2.32

Note. All KSA items were on a 7 point scale with anchors being "not at
all important" and "critically important." The F value was significant
at p [less than or equal to] .01. Based on Tukey Kramer post hoc
multiple comparisons, differences between means greater than .54 are
significant at p [less than or equal to] .05.

Table 4: Skills Rating

Skills                            Mean

Organizational skills             6.63
Business administration skills    6.36
Interpersonal skills              6.21
Communication skills              6.08
Board relations skills            5.08
Fund raising skills               4.48

Note. Skills were rated on a 7 point scale with the anchors being "not
important at all" and "critically important." The F value was
significant at p [less than or equal to] .01. Based on Tukey Kramer
post hoc multiple comparisons, differences between means greater than
.55 are significant at p [less than or equal to] .05.

Table 5
One-Way ANOVAs of 50 KSAs with Years in Current Position as the
Fixed Factor

KSA                                  Significant Post Hoc Tests

State and Federal healthcare         Those in their position 1-4 years
regulations                          rated healthcare regulations as
                                     less important (5.60) than those
                                     in their position 5-10 years
                                     (6.33)

Audits for clinical compliance       Those in their position 1-4 years
with Medicaid/Medicare regulations   rated clinical compliance as less
                                     important (4.58) than those in
                                     their position 5-10 years (5.63)

Accreditation standards              Those in their position 1-4 years
                                     rated accreditation standard as
                                     less important (5.44) than those
                                     in their position 5-10 (6.76) and
                                     over ten years (6.46)

Contracts/agreements                 Those in their current position
                                     over 10 years rated contracts as
                                     less important (4.64) than those
                                     in their position 5-10 years
                                     (5.59)

Facility/plant management            Those in their current position
                                     over 10 years rated plant/facility
                                     as less important (3.57) than
                                     those in their position 5-10 years
                                     (4.59)

Visibility to the patients/          Those in their current positions
clients of your organization         1-4 years rated visibility as less
                                     important (5.49) than those in
                                     their position 5-10 years (6.32)
                                     and those in their position over
                                     10 years (6.19)

Communicating organizational         Those in their position over 10
vision to stakeholders               years rated communicating
                                     organizational vision as less
                                     important (4.95) than those in
                                     their position 1-4 years (5.84)
                                     and those in their position 5-10
                                     years (6.04)

Project management techniques        Those in their current position
                                     for over 10 years rated project
                                     management as less important 5.22)
                                     than those in their position 5-10
                                     years (6.06)

Public speaking                      Those in their position over 10
                                     years rated public speaking as
                                     less important (5.08) than those
                                     in their position 5-10 years
                                     (5.94)

Diversity                            Those in their position 1-4 years
                                     rated diversity as less important
                                     (5.53) than those in their
                                     position 5-10 years (6.21) and
                                     those in their position over 10
                                     years (6.38)

Note. All KSA items were on a 7 point scale with anchors being "not at
all important" and "critically important." The F value was significant
at p [less than or equal to] .05. Based on Tukey's-b post hoc multiple
comparisons, differences between means were significant at p [less than
or equal to] .05.

Table 6
One-Way ANOVAs of 50 KSAs with Age as the Fixed Factor

Financial statements and critical    Those 25-40 years rated financials
ratios                               as less important (4.49) than
                                     those 41-52 years (5.38) and those
                                     over 52 years (5.37)

Bond covenants                       Those 41-52 years 2.06) and those
                                     25-40 years (2.10) rated bond
                                     covenants as less important than
                                     those over 52 years (2.83)

Effective implementation of          Those 25-40 years rated clinical
clinical programs                    programs as less important (5.10)
                                     than those 41-52 years (5.89) and
                                     those over 52 years (6.08)

State and federal health care        Those 25-40 years (5.38) and those
regulations                          41-52 years (5.74) rated health
                                     care regulations as less important
                                     than those over 52 years (6.47)

Accreditation standards              Those 25-40 years rated
                                     accreditation as less important
                                     (5.08) than those 41-52 years
                                     (6.15) and those over 52 years
                                     (6.36)

External networking                  Those 25-40 years rated networking
                                     as less important (4.87) than
                                     those over 52 years (5.54)

Lead organizational change           Those 25-40 years rated leading
                                     change as less important (5.64)
                                     than those 41-52 years (6.27) and
                                     those over 52 years (6.32)

Managing media relations             Those 25-40 rated media relations
                                     as less important (3.28) than
                                     those over 52 years (4.03) and
                                     those 41-52 years (4.1)

Note. All KSA items were on a 7 point scale with anchors being "not at
all important" and "critically important."  The F value was significant
at p [less than or equal to] .05. Based on Tukey's-b post hoc multiple
comparisons, differences between means were significant at p [less than
or equal to] .05.

Table 7
One-Way ANOVAs of 50 KSAs with Years of Experience in Healthcare as
the Fixed Factor

Bond covenants                       Those with 21-30 years experience
                                     rated bond covenants (2.13) as
                                     less important than those with
                                     31-45 years experience (2.88)

Facility/plant management            Those with 3-20 years experience
                                     (3.84) and those with 21-30 years
                                     experience (3.89) rated
                                     facility/plant management as less
                                     important that those with 31-45
                                     years experience (4.73)

Risk management                      Those with 3-20 years experience
                                     rated risk management (5.31) as
                                     less important than those with
                                     31-45 years experience (6.09)

Project management techniques        Those with 3-20 years experience
                                     rated project management as less
                                     important (5.35) than those with
                                     31-45 years experience (6.05)

Ethical business practice            Those with 3-20 years experience
                                     rated ethical business practices
                                     as less important (6.16) than
                                     those with 31-45 years experience
                                     (6.64)

Ability to conduct healthcare risk   Those with 3-20 years experience
assessments                          rate health risk assessment as
                                     less important (4.45) than those
                                     with 21-30 years experience (5.17)
                                     and those with 31-45 years
                                     experience (5.37)

Note. All KSA items were on a 7 point scale with anchors being "not at
all important" and "critically important."  The F value was significant
at p [less than or equal to] .05. Based on Tukey's-b post hoc multiple
comparisons, differences between means were significant at p [less than
or equal to] .05.

Table 8
One-Way ANOVAs of 50 KSAs with Education as the Fixed Factor

Audits for financial compliance    Those with a high school/associate
with Medicaid/Medicare             degree rated financial compliance as
regulations                        less important (3.56) that those
                                   with a bachelors' degree (4.74) or
                                   those with a masters/doctorate
                                   (4.81)

Components of marketing            Those with a high school/associate
techniques                         degree rated marketing techniques as
                                   less important (3.38) than those
                                   with a bachelors' degree (4.53) or
                                   those with a masters/doctorate
                                   (4.69)

Public speaking                    Those with a high school/associate
                                   degree rated public speaking as less
                                   important (4.88) than those with a
                                   bachelors' degree (5.45) or those
                                   with a masters/doctorate (5.83)

Note. All KSA items were on a 7 point scale with anchors being "not at
all important" and "critically important." The F value was significant
at p [less than or equal to] .05. Based on Tukey's-b post hoc multiple
comparisons, differences between means were significant at p [less than
or equal to] .05

Table 9
One-Way ANOVAs of 50 KSAs with Gender as Fixed Factor

Effective implementation of          Men rated effective implementation
clinical programs                    of clinical programs as less
                                     important (5.27) than women (5.93)

Accreditation standards              Men rated accreditation standards
                                     as less important (5.41) than
                                     women (6.13)

Sensitivity to staff problems        Men rated sensitivity as less
                                     important (6.16) than women (6.69)

Creative problem solving             Men rated creative problem solving
                                     as less important (6.16) than
                                     women (6.55)

Empathy for patient/client           Men rated empathy as less
concerns                             important (6.22) than women (6.64)

Visibility to the patients/          Men rated visibility as less
clients of your organization         important (5.41) than women (6.07)

Effectively managing conflict        Men rated conflict management as
                                     less important (6.43) than women
                                     (6.78)

Risk management                      Men rated risk management as less
                                     important (5.27) than women (5.82)

Project management techniques        Men rated project management as
                                     less important (5.30) than women
                                     (5.86)

Work is consistent with personal     Men rated personal ethics as less
ethics                               important (6.22) than women (6.58)

Motivating others                    Men rated motivating others as
                                     less important (6.38) than women
                                     (6.70)

Leading organizational change        Men rated leading change as less
                                     important (5.76) than women (6.25)

Delegate work                        Men rated delegating work as less
                                     important (5.78) than women (6.34)

Run effective meetings               Men rated effective meetings as
                                     less important (5.81) than women
                                     (6.49)

Consider ethical implications in     Men rated ethical clinical
clinical decisions                   decisions as less important (5.46)
                                     than women (6.19)

Ability to be decisive               Men rated decisiveness as less
                                     important (6.14) than women (6.57)

Manage diversity in the workplace    Men rated diversity as less
                                     important (5.38) than women (6.10)

Utilization of research skills       Men rated research skills as less
                                     important (4.44) than women (5.04)

Note. All KSA items were on a 7 point scale with anchors being "not at
all important" and "critically important."  The F value was significant
at p [less than or equal to] .05. Based on Tukey's-b post hoc multiple
comparisons, differences between means were significant at p [less than
or equal to] .05.

Table 10
One-Way ANOVAs of Skill Domains with Demographic Items as Fixed
Factors Domain

Domain                 Factor                 Result

Business               Age                    Those 25-40 years
administration                                old rated business
                                              administration
                                              skills as less
                                              important (5.95)
                                              than those 41-52
                                              years old (6.44) and
                                              those over 52 years
                                              old (6.57)

Business               Years of experience    Those with 3-20
administration         in healthcare          years of experience
                                              rated business
                                              administration
                                              skills as less
                                              important (6.04)
                                              than those with
                                              21-30 (6.53) and
                                              those with 31-45
                                              years of experience
                                              (6.61)

Organizational         Gender                 Men rated
skills                                        organizational
                                              skills as less
                                              important (6.35)
                                              than women (6.70)

Communication skills   Gender                 Men rated
                                              communication skills
                                              as less important
                                              (5.57) then women
                                              (6.23)

Interpersonal skills   Gender                 Men rated
                                              interpersonal skills
                                              as less important
                                              5.51) than women
                                              (6.41)

Note. All skills categories were on a 7 point scale with anchors being
"not at all important" and "critically important." The F value was
significant at p [less than or equal to] .05.

Table 11: Rotated Component Matrix, Highest Loadings

                                            External     Personal
                                          Stakeholder      Ethos
KSA                                          Domain       Domain

Conduct Marketing Research                    .752
Ability to Develop Mission Statement          .746
Managing Media Relations                      .728
External Networking                           .601
Knowledge of Healthcare Legal Issues          .593
Utilization of Research Skills                .591
Conduct Organizational Assessments            .586
Components of marketing Techniques            .537
Economic Analysis and Application to          .537
Decision Making
Contracts/Agreements                          .497
Ability to  Conduct Healthcare Risk           .471
  Assessments
Utilization of Global Perspective             .433
Knowledge  of Integrated Healthcare           .407
  delivery systems
Effective Leadership                                       .742
Motivating Others                                          .752
Empathy for Patient/Client Concerns                        .727
Work is Consistent with Personal Ethics                    .598
Creative Problem Solving                                   .754
Visibility to  the  Patients/Clients of                    .505
  Organization
Effectively Managing Conflict                              .455
Communicating organizational vision to
  stakeholders
Project management techniques
Public speaking
Lead organizational change
Risk management
State and federal health care
  regulations
Implementation of clinical programs
Audits for financial compliance with
  Medicare/Medicaid Regulations
Measuring performance of
  department/organization employees
Delegate work
Run effective meetings
Creating a positive work environment
Financial Statements and Critical
  Ratios
Management of Accounts Receivables
Prepare Budgets for
  Department/Organization
Bond Covenants
Quality assessments of patient outcomes
Ability to conduct health care risk
  assessment
Health information management
Risk management

                                                            Clinical
                                          Communicating    Compliance
KSA                                           Change         Domain

Conduct Marketing Research
Ability to Develop Mission Statement
Managing Media Relations
External Networking
Knowledge of Healthcare Legal Issues
Utilization of Research Skills
Conduct Organizational Assessments
Components of marketing Techniques
Economic Analysis and Application to
Decision Making
Contracts/Agreements
Ability to  Conduct Healthcare Risk
  Assessments
Utilization of Global Perspective
Knowledge  of Integrated Healthcare
  delivery systems
Effective Leadership
Motivating Others
Empathy for Patient/Client Concerns
Work is Consistent with Personal Ethics
Creative Problem Solving
Visibility to  the  Patients/Clients of
  Organization
Effectively Managing Conflict
Communicating organizational vision to         .759
  stakeholders
Project management techniques                  .755
Public speaking                                .709
Lead organizational change                     .618
Risk management                                .434
State and federal health care                                 .713
  regulations
Implementation of clinical programs                           .587
Audits for financial compliance with                          .585
  Medicare/Medicaid Regulations
Measuring performance of
  department/organization employees
Delegate work
Run effective meetings
Creating a positive work environment
Financial Statements and Critical
  Ratios
Management of Accounts Receivables
Prepare Budgets for
  Department/Organization
Bond Covenants
Quality assessments of patient outcomes
Ability to conduct health care risk
  assessment
Health information management
Risk management

                                          Managerial     Dollars
                                             Tasks      and Cents
KSA                                         Domain        Domain

Conduct Marketing Research
Ability to Develop Mission Statement
Managing Media Relations
External Networking
Knowledge of Healthcare Legal Issues
Utilization of Research Skills
Conduct Organizational Assessments
Components of marketing Techniques
Economic Analysis and Application to
Decision Making
Contracts/Agreements
Ability to  Conduct Healthcare Risk
  Assessments
Utilization of Global Perspective
Knowledge  of Integrated Healthcare
  delivery systems
Effective Leadership
Motivating Others
Empathy for Patient/Client Concerns
Work is Consistent with Personal Ethics
Creative Problem Solving
Visibility to  the  Patients/Clients of
  Organization
Effectively Managing Conflict
Communicating organizational vision to
  stakeholders
Project management techniques
Public speaking
Lead organizational change
Risk management
State and federal health care
  regulations
Implementation of clinical programs
Audits for financial compliance with
  Medicare/Medicaid Regulations
Measuring performance of                     .800
  department/organization employees
Delegate work                                .658
Run effective meetings                       .621
Creating a positive work environment         .408
Financial Statements and Critical                          .803
  Ratios
Management of Accounts Receivables                         .789
Prepare Budgets for                                        .755
  Department/Organization
Bond Covenants                                             .419
Quality assessments of patient outcomes
Ability to conduct health care risk
  assessment
Health information management
Risk management

                                          Ethics and
                                            Quality
KSA                                         Domain

Conduct Marketing Research
Ability to Develop Mission Statement
Managing Media Relations
External Networking
Knowledge of Healthcare Legal Issues
Utilization of Research Skills
Conduct Organizational Assessments
Components of marketing Techniques
Economic Analysis and Application to
Decision Making
Contracts/Agreements
Ability to  Conduct Healthcare Risk
  Assessments
Utilization of Global Perspective
Knowledge  of Integrated Healthcare
  delivery systems
Effective Leadership
Motivating Others
Empathy for Patient/Client Concerns
Work is Consistent with Personal Ethics
Creative Problem Solving
Visibility to  the  Patients/Clients of
  Organization
Effectively Managing Conflict
Communicating organizational vision to
  stakeholders
Project management techniques
Public speaking
Lead organizational change
Risk management
State and federal health care
  regulations
Implementation of clinical programs
Audits for financial compliance with
  Medicare/Medicaid Regulations
Measuring performance of
  department/organization employees
Delegate work
Run effective meetings
Creating a positive work environment
Financial Statements and Critical
  Ratios
Management of Accounts Receivables
Prepare Budgets for
  Department/Organization
Bond Covenants
Quality assessments of patient outcomes      .741
Ability to conduct health care risk          .530
  assessment
Health information management                .524
Risk management                              .511
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Author:Stowe, Michael; Haefner, James; Behling, Robert J.
Publication:Academy of Health Care Management Journal
Geographic Code:4EUFR
Date:Jul 1, 2011
Words:6549
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