Management Competencies

Experience of a Healthcare

Manager Context Health care organisations in New Zealand today face similar challenges to those in other highly developed countries (1, 2). With growing aging populations and increasing burden of chronic illnesses the demand for publically funded health and disabilities services continues to grow significantly (1). This increase in need coupled with the advancements in technology has driven the costs of providing publically funded healthcare services to unsustainable high levels (1, 2).

Public spending on healthcare has continued to rise at the rate of 6% per year over the last decade with 21% of share of public spending being on health in 2010 (2, 3). In a background of the global economic crisis, District Health Boards (DHBs) who are charged with the provision of publically funded health and disability services are increasingly having to re-engineer their systems and services to provide value in financially constraint environments (2).

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While this at a systems level may mean taking a “whole of systems” approach with integrated service models (2), at the unit-specific services level it also includes focused attention on productivity, quality, waste reduction and safety. Key Competencies of the Service Manager Management competence is an important determinant of healthcare organisational performance (5). Competence is an individual’s knowledge, skills and behaviours relevant to their practice and performance (6, 7).

Evidence from the Management Matter Research Project indicates that “higher management practice in hospitals is strongly correlated with hospitals’ quality of patient care and productivity outcomes” (8). It reported that improved management practice in hospitals were related to better clinical outcomes, increased patient satisfaction and better financial performance (8). The management role focused in this case is the service manager, a middle management role responsible for the strategic development and deliverables of the health service.

The role is also accountable for the operational budget and management of staff. This paper explores the experience of the service manager challenged with transforming the health service from a dysfunctional average performing unit to a high performing, progressive and highly respected and valued service. It discusses the competencies of effective management with some reflection by the health service manager on the management approach utilised.

Given the challenges of improving performance and developing a highly functional team, the service manager utilised the influential model of leadership style over the traditional reactive and transactional style as the predominant style of management (9, 10). This included engaging the workforce in developing a common vision for the service with clear objectives (11). In order to ensure the service goals were aligned with the organisational goals, an important characteristic of the service manager during this process was having a good understanding of the changing healthcare environment and the organisational priorities (11, 12, 13).

Critical to achieving change and success was also his ability to work with staff to collectively determine and communicate the “Why”, “What”, “How”, “Who” and “When” elements of managing change. Regular reinforcement of both the positive and negative implications of the situation as well as setting mutually agreed expectations were also important to achieving change (11). This transformational style of management was also instrumental in gaining confidence and trust of staff in order to manage the workforce culture issues of mistrust, low morale and dissatisfaction largely resultant from historical experiences.

The evidence for efficacy of this style and the associated competencies has been demonstrated by 2 studies reporting that transformational leader behaviour has significant positive impact on employee satisfaction and psychological well-being (14, 15). Additional leader/manager behaviours required and demonstrated by the service manager were those that focused on individualised consideration including; creating close working relationships which encourage mutual respect, empowering and including employees in decision making, creating opportunities for employee development through coaching and mentoring and team building (16).

The benefits of these behaviours are evidenced in other leadership theories including behavioural (consideration behaviours) approach and leader-member exchange theory (11, 14, 17, 18, 19). Followership and early recognition of the relationship dynamics of a team are also key elements to effective management. Working closely with followers and those with team influential ability is useful when change is likely to be difficult or experience high levels of resistance (11).

The use of a collective approach to resolving a problem and delegating the ownership of solution creation to a staff member with high peer influential ability results in achievement of objectives. The ability of the service manager to move appropriately between directive and participatory type management styles was also important in certain situations (11, 19). This was particularly useful for implementing workplace behavioural expectations like punctuality and managing disrespectful behaviours.

A key competency for healthcare manager effectiveness relevant to the management style illustrated above is emotional intelligence (EI) (20). Essentially, this competency recognises the “importance of highly developed interpersonal skills and the ability to get along with others” to be effective at influencing and negotiating (20). The key attributes of a manager with high EI include self-awareness, self regulation, self motivation, social awareness and social skills (20). A summary of the key management competencies relevant to the management style described here is illustrated by the matrix diagram below (Figure 1) (12, 13).

In summary, management styles in healthcare that are based upon the principles of transformational and behavioural leadership and utilise the respective competencies are likely to be more successful. Furthermore, while there are specific skills, behaviours and knowledge that describe the key competency domains, their use in practice is interrelated (see Figure 1) and often context-specific.

References

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2. Mays N. Reorienting the New Zealand healthcare system to meet the challenge of long term conditions in a fiscally constraint environment. Jan 2013 (revised version). Paper prepared for New Zealand Treasury Long-term Fiscal External Panel, November 2012, and Chair of Public Finance, Victoria University of Wellington and New Zealand Treasury conference, Affording our Future, Wellington, 10-11 December. http://www. victoria. ac. nz/sacl/about/cpf/publications/pdfs/Nick-Mays-Revised-Conference-Paper-Jan-2013-website-version. pdf
3.  Ministry of Health. Health Expenditure trends in New Zealand 2000-2010. Aug 2012. http://www. health. govt. nz/publication/health-expenditure-trends-new-zealand-2000-2010
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15. Shewchuk RM, O’Connor S, Fine D. Building an Understanding of the Competencies Needed for Health Administration Practice. Journal of Health Care Management. 2005; 50(1):32-47.

16. Gerstner CR, Day DV. Meta-analytic review of leader-member exchange theory: correlates and construct issues. Journal of Applied Psychology. 1997: 82; 827-844. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. 

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    Phase 2: 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf).

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19. Freshman B, Rubino L. Emotional Intelligence: A core competency for health care administrators. Health Care Manager 2002 20(4): 1- 9. 

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