1. What Leadership Competencies of Health Administration Graduates Matter Most to Hospital CEOs? Annual Meeting of the Association of University Programs in Health Administration (AUPHA) Kansas City, Missouri June 22, 2016 Dr. John W. Fick, EdD, FACHE Siena Heights University Dr. Lihua Dishman, DBA Dr. Katherine Adler, DHA, FACHE Dr. Letha Williams, PhD, FACHE A.T. Still University

2. Introductions John W. Fick, EdD, FACHE –Professor & Director –Health Care Leadership –Siena Heights University –Southfield, Michigan Lihua Dishman, DBA, MBA –Assistant Professor –Health Administration Program –College of Graduate Health Studies –A.T. Still University Katherine Adler, DHA, FACHE –Acting Dean & Associate Professor –College of Graduate Health Studies –A.T. Still University –Kirksville, Missouri Letha Williams, PhD, FACHE –Program Chair & Associate Professor –HA Program –College of Graduate Health Studies –A.T. Still University 2

3. Siena Heights University Profile Mission - The mission of Siena Heights University, a Catholic University founded and sponsored by the Adrian Dominican Sisters, is to assist people to become more competent, purposeful, and ethical through a teaching and learning environment which respects the dignity of all. Quick Facts: –The main campus is located on 55 acres on a bluff above downtown Adrian, Michigan –Founded as St. Joseph College in 1919 –Renamed Siena Heights College in 1939 –Became coed in 1969 –Renamed Siena Heights University in 1998 –Students from 39 states and 21 countries –One of 18 Dominican Catholic colleges and universities in the U.S. Academic Stats: –Three colleges of study: College of Arts and Sciences, College for Professional Studies, Graduate College –Approximately 100 undergraduate and graduate programs –Approximately 2,700 Students (all campuses) –Approximately 1,200 Undergraduate students (Adrian campus) –12-to-1 Student-to-Faculty Ratio –More than 80 Full-Time Faculty –More than 400 Adjunct Faculty –More than 170 Full-Time Staff 3

4. Siena Heights University 4

5. A.T. Still University (ATSU) Profile Founded in 1892 by Andrew Taylor Still, MD, recognized as the father of osteopathic medicine Originally called American School of Osteopathy Now six schools in two states (one virtual) Kirksville College of Osteopathic Medicine (KCOM) College of Graduate Health Studies (CGHS)* School of Osteopathic Medicine in Arizona (SOMA) Arizona School of Health Sciences (ASHS) Arizona School of Dentistry & Oral Health (ASDOH) Missouri School of Dentistry & Oral Health (MSDOH) 5

6. A.T. Still University: Kirksville, MO Campus 6

7. A.T. Still University: Mesa, AZ Campus 7

8. Session Objectives As a result of attending this session, participants will: 1. learn what leadership competencies of graduates from health administration and healthcare management programs matter most to CEOs of U.S. urban, suburban, and rural hospitals. 2. evaluate whether any courses in their respective program contain learning objectives that are designed to develop these industry-sought leadership competencies of their students. 3. assess whether any of the industry-sought leadership competencies are not currently included in their program/course curricula. 4. analyze how to bridge the gap between leadership competencies sought after by hospital CEOs and related training not currently included in their program/course curricula. 8

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10. Evolution of the Study Started as a sabbatical research project at SHU Statement of the Problem: –The healthcare management practitioner community has indicated that the academic community needs to improve the competency levels of graduates to enter the profession. –While health care leadership competency models exist, there has been little research that has assessed the competency levels of graduates upon entry into the health care management profession. Research Question: –Are students from graduate programs in health care administration prepared with the required competencies to begin a successful career in health care leadership upon entry into the profession? 10

11. Partial Review of the Related Literature Review of the Literature: –Mecklenburg (2001) states that we (educators and practitioners) “must achieve new excellence in graduate education that focuses on the market needs of those buying the product” (Mecklenburg, 2001, p. 8). –Garman and Johnson (2006) presented a summary of seven (7) competency models. –Calhoun et al. (2009) identified four (4) categories of competency based on NCHL competencies: (1) Baseline, (2) Distinguishing, (3) Recommended, and (4) Other Baseline Competencies – Competencies that both the out­standing and typical performers demonstrate in a role or job — during the early career stage –Analytical Thinking –Human Resource Management –Information Seeking –Innovative Thinking –Interpersonal Understanding –Friedman & Frogner (2010) focused on 27 competencies that were based on those adopted at the authors’ CAHME accredited graduate health management program (GWU). The top five competencies that healthcare leaders considered early careerists to be “very competent” included: (1) writing skills (19.7%); (2) presentation skills (19.5%); (3) contemporary healthcare trends and issues (16.0%); (4) information and technology management (14.7%); and (5) financial management (11.4%). –Giles (2016) – The top 10 leadership competencies grouped into five themes 11

12. Giles (2016), HBR 12

13. Study 1 Method Research design & study format –Research design Non-experimental, descriptive research design Mixed method –Study conducted using an Electronic Survey (Survey Monkey ®) Sample – 34 Health care leaders –Board-certified in health care management –Fellow status in the American College of Healthcare Executives (FACHE designation) Sample Selection –Non-probability, purposeful sample Members of the Midwest Health Executives Group & Associates (Board members and general membership) –Institutional Review Board (IRB) Obtained approval from the IRB of Siena Heights University 13

14. Study 1 Method (continued) Characteristics Under Study –Competencies as defined by the NCHL ™ 26 competencies, 3 domains –NCHL ™ Competency categories defined by Calhoun et al. (2009) 26 competencies, 4 categories Instrumentation and Materials –Measurement of 26 Defined NCHL Competencies Five (5) Point Likert Scale –Very Competent (5), Competent (4) –Neutral (3) –Incompetent (2), Very Incompetent (1) Optional open ended question as stated: –If you rated the above question as either "Very Incompetent” or “Incompetent”, please provide your practitioner recommendations on how to improve the curriculum in health care management education to address this perceived competency deficiency. 14

15. Descriptive statistics –Measures of central tendency used to assess competency levels Mean: 3.65 +/- one standard deviation (3.35 – 3.93) Median: 3.57 Mode: 3.57 Range: 3.00 – 4.07 15 Results

16. Study 1 Summary Findings The Good The Bad The Ugly 16

17. Professionalism 5 4.07 Information Technology Mgt.4.07 Self-Confidence4.07 Achievement Orientation 5 4.06 Performance Measurement4.00 Communication4.00 Information Seeking 2 4.00 Collaboration3.93 17

18. Self-Development 1 3.86 Analytical Thinking 3 3.82 Initiative3.79 Financial Skills3.69 Accountability 5 3.57 Relationship Building3.57 Process Mgt. & Org. Design3.57 Organizational Awareness 4 3.57 18

19. Innovative Thinking3.53 Project Management3.43 Team Leadership3.43 Interpersonal Understanding 5 3.43 Impact and Influence3.36 Strategic Orientation3.35 19

20. Talent Development3.29 Change Leadership 5 3.29 Community Orientation3.18 Human Resource Mgt.3.00 20

21. Baseline Competencies (N = 5) – Competencies that both the out­standing and typical performers demonstrate in a role or job — during the early career stage –Analytical Thinking – 3.82 –Human Resource Management – 3.00 –Information Seeking – 4.00 –Innovative Thinking – 3.53 –Interpersonal Understanding – 3.43 21 Results Comparison to Calhoun et al. (2009) Defined Competency Categories

22. Study 2 Purpose Statement 22 To investigate which healthcare leadership competencies are the most important to U.S. hospital Chief Executive Officers (CEOs) who are Fellows of the American College of Healthcare Executives (FACHE). To examine the relationship between overall healthcare leadership competency, as perceived by FACHE credentialed hospital CEOs, and the CEOs’ willingness to hire graduates of online health administration programs.

23. Study 2 Research Questions 23

24. Study 2 Methodology Overview  A mixed-method, cross-sectional, and observational national study  Study period: 2015  Target population: All FACHE credentialed hospital CEOs in the U.S.  Final sample size: 46  Data collection: Both quantitative and qualitative data were collected using a survey instrument  Unit of analyses: U.S. hospital CEOs  Data analyses  Quantitative data: Descriptive and inferential statistical analyses  Qualitative data: Thematic analysis 24

25. Study 2 Data Collection Procedure 25 Developed a survey instrument to collect both quantitative and qualitative data Step 1 Sought ATSU IRB approval and obtained approval Step 2 Emailed the survey to FACHE credentialed C-Suite Executives (CEO, CFO, CMO, CIO, CLC, and other) of U.S. hospitals Step 3 Received 48 responses from CEOs of hospitals across all regions of the U.S. Step 4 Excluded 2 responses that were incomplete Step 5 Obtained the final sample of 46 completed responses from FACHE credentialed hospital CEOs in all regions of the U.S. Step 6 Extracted both quantitative and qualitative data from the 46 complete responses Step 7

26. 26 Study 2 Data Analyses: Sample Hospital CEOs’ Age and Gender Distributions

27. 27 Study 2 Data Analyses: Sample Hospital CEOs’ Distributions of FACHE Years and Position Years

28. 28 Study 2 Data Analyses: Sample Hospital CEOs’ Distributions among Three Hospital Locations and Five Geographic Regions in the United States

29. 29 Study 2 Data Analyses: Sample Hospital CEOs’ Education (Earned a Graduate Degree in Healthcare Management or with a Concentration in Healthcare Management)

30. FACHE Credentialed Hospital CEOs: Demographic Analysis Summary 30 Male: 87% Female: 13% Gender 50 years old or younger: 20% Over 50 years old: 80% Age Earned a graduate degree in HCM or with a concentration in HCM: Yes--83%, NO--17% Education As a FACHE for fewer than 15 years: 53% As a FACHE for 15 years or longer: 47% FACHE Years In current position for 20 or fewer years: 94% In current position for more than 20 years: 6% Position Years Urban hospital CEOs: 15% Suburban hospital CEOs: 26% Rural hospital CEOs: 59% Hospital Location 9% from Northeast, 20% from Southeast, 52% from Midwest, 15% from Southwest, and 4% from West Geographic Region

31. Highlights of Intercorrelations between NCHL Competencies 31 1. Top competencies that were significantly positively correlated with the overall healthcare leadership competency ( r > 0.70): Relationship Building, Communication, Team Leadership, Professionalism, Self Confidence, Impact and Influence, Information Seeking, and Process Management and Organizational Design. 2. Self Development was significantly positively correlated with Interpersonal Understanding, Professionalism, and Community Orientation. 3. Information Seeking was significantly positively correlated with Innovative Thinking, Team Leadership, Performance Measurement, Collaboration, and Relationship Building. 4. Analytical Thinking was significantly positively correlated with Relationship Building, Performance Measurement, and Communication. 5. Organizational Awareness had the greatest statistically significant positive correlation with Talent Development, Communication with Relationship Building, and Financial Skills with Initiative.

32. Study 2 Results Answered Research Question 1 Ranking of Health Administration Graduates’ Healthcare Leadership Competencies from the Perspectives of U.S. Hospital CEOs 32 NCHL CompetenciesTop 15 Competencies Self Development Information Seeking Analytical Thinking Organizational Awareness Accountability Achievement Orientation Change Leadership Interpersonal Understanding Professionalism Communication Strategic Orientation Financial Skills Initiative Performance Measurement Community Orientation HR Management Relationship Building Self Confidence Team Leadership Collaboration Impact and Influence Information Technology Management Innovative Thinking Project Management Process Management and Organizational Design Talent Development

33. Top Five Ranked Competencies Mattered Most to Hospital CEOs 33 Self Development Number 1 Information Seeking Number 2 Analytical Thinking Number 3 Organizational Awareness Number 4 Accountability Achievement Orientation Change Leadership Interpersonal Understanding Professionalism Number 5

34. Hospital CEOs’ Top 5 Ranked Competencies Mapped to NCHL Health Competency Model (Copyright 2004 National Center for Healthcare Leadership ) 34 Transformation Information Seeking Analytical Thinking Achievement Orientation People Self Development Interpersonal Understanding Professionalism Execution Organizational Awareness Accountability Change Leadership

35. Study 2 Results Partially Answered Research Question 2: Indicative Findings from the Linear Regression Analyses 35 The Health administration (HA) graduates’ healthcare leadership competency (HLC) was predictive of male CEOs’ negative decision to hire graduates of online health administration programs (at p<0.001 for the constant and p=0.198 for the IV HLC). The HA graduates’ HLC was the most predictive of female CEOs’ positive decision to hire graduates of online health administration programs (at p=0.970 for the constant and p=0.263 for the IV HLC). The HA graduates’ HLC was predictive of over-55-years-old CEOs’ negative decision to hire graduates of online health administration programs (at p<0.001 for the constant and p=0.108 for the IV HLC). The HA graduates’ HLC was predictive of suburban-hospital CEOs’ negative decision to hire graduates of online health administration programs (at p=0.008 for the constant and p=0.175 for the IV HLC).

36. Program Director Insight General Comments: –All of the NCHL competencies are important, but we wanted to better understand which are most important to those who will hire our graduates. –It makes some sense that those that are most important should also receive considerable emphasis in our programs. –At both Siena Heights and ATSU, we plan to use the results to inform part of our future course development/revisions. MHA Capstone Course Curriculum Committee & Future Course Revisions 36

37. In my other life as a hospital administrator Self Development –When was the last time you were criticized? How did you deal with it? Information Seeking –What is the most difficult decision that you have had to make? How did you arrive at that decision? Analytical Thinking –Describe a very tough problem that a customer presented you with, where the cause was outside the area of your responsibility? What did you do? 37

38. Your Turn! Number 1 Self Development Number 2 Information Seeking Number 3 Analytical Thinking Number 4 Organizational Awareness Number 5 Accountability, Achievement Orientation, Change Leadership, Interpersonal Understanding, Professionalism As a result of attending this session, participants will: 2. evaluate whether any courses in their respective program contain learning objectives that are designed to develop these industry- sought leadership competencies of their students. 3. assess whether any of the industry-sought leadership competencies are not currently included in their program/course curricula. 4. analyze how to bridge the gap between leadership competencies sought after by hospital CEOs and related training not currently included in their program/course curricula. 38

39. Questions 39

40. References Partial List Calhoun, J.G., Wainio, J.A., Sinioris, M.E., Decker, M., Hearld, L.R., & L.E. Brandsen. (2009, Summer). Outcomes-based Health Management Education: Baseline Findings from a National Curriculum Development Demonstration Project. The Journal of Health Administration Education Summer 2009, 179-180 Friedman, L.H. & Frogner, B.K. (2010). Are Our Graduates Being Provided with the Right Competencies?: Findings from an Early Careerist Skills Survey. Journal of Health Administration Education. 27(4), 269-296. Garman, A.N. & Johnson, M. P. (2006, January/February). Leadership Competencies: An Introduction. Journal of Healthcare Management. 51:1. 13-17 Mecklenburg, G. (2001). Career Performance: How Are We Doing? Journal of Healthcare Management, 46(1), 8-13. National Center for Healthcare Leadership [NCHL]. (2006). Competency Integration in Health Management Education: A Resource Series for Program Directors and Faculty, Guidebook 1: Curriculum Mapping, Analysis, and Planning. 40