Healthcare executives and educators think current advanced-degree programs that train future leaders adequately prepare students for a complex, ever-evolving field, a survey by Modern Healthcare reveals.
Despite widespread approval of the general thrust of these programs, a majority of respondents called for greater emphasis in several areas, including compliance, ethics, finance, information technology and medical-staff relations.
The future direction of advanced-degree programs in health services administration is a hot topic in the industry, pushed to the forefront by the National Center for Healthcare Leadership, an organization that wants to transform the way future executives are trained. Its initiative has touched an emotional chord across the industry as educators and administrators alike grapple with a dizzying pace of change that has already prompted dramatic revisions in curriculum and accreditation.
"To use the current phrase, healthcare has undergone a `sea change' in the last decade or so-and we have to adapt our teaching methods, our content and our outcomes to prepare our graduates to address them," said Jeptha Dalston, president and chief executive officer of the Accrediting Commission on Education for Health Services Administration, or ACEHSA.
Dalston's group is collaborating with the NCHL on a wide-ranging plan that would focus graduate programs on a half-dozen "core competencies," providing more real-world experiences to help better train would-be healthcare executives and improving the way healthcare organizations measure the quality of their executives (Jan. 19, p. 6).
Modern Healthcare's informal online survey, conducted Jan. 19 to Feb. 20, tallied more than 1,000 responses. Of those, about 70% of respondents believe that current academic programs adequately prepare students for a career in healthcare. But the survey also sheds light on a growing sentiment that programs should concentrate more on key issues like finance and information technology.
Nearly eight in 10 respondents said more emphasis should be placed on clinical and financial information technology. About 66% said "process improvement" should receive more emphasis. Meanwhile, 64% said relations with medical staff should receive more emphasis, and 62% said finance should be more of a focus, while just 4% said it should be emphasized less.
For today's top executives, issues such as clinical and financial management are among the top responsibilities, outpacing many of the less-technical priorities of yesteryear, said Marie Sinioris, the NCHL's executive vice president and chief operating officer.
The upheaval in health services administration is a response to huge changes that have swept the industry over the last decade-including the emergence of managed care, a technology transformation and a heightened focus on quality spawned by the Institute of Medicine's groundbreaking 1999 report, To Err is Human, according to Dalston.
"The movement to managed care and other forms of financial mechanisms has really changed the specifications for the performance of healthcare executives," he said. Those adjustments, he said, have included a new emphasis on "management sciences," prompting many programs in health services administration to add courses that might have been available only in traditional master's of business administration programs as recently as five years ago.
Along with providing courses in finance, marketing and management, academic programs must prepare future leaders to deal with quality of care, productivity concerns and difficult challenges in human resources-including a nursing shortage as well as ethnic, racial and gender diversity, Dalston said. He said many programs have recognized these changes by beefing up content in financial management, marketing, strategic planning and organizational behavior-all topics that received comparatively short shrift until recently.
Last fall, the ACEHSA, which accredits about 70 postgraduate programs in health administration, changed its criteria to include new attention on two additional subject areas: written and oral communications, and the management of conflict and change, said Robert Hernandez, chairman of the ACEHSA board of commissioners and a professor in the department of health services administration at the University of Alabama at Birmingham.
"One of the things we've heard from the field is, `How do you manage change and conflict?' " Hernandez said. "Those things are rampant. It's one of the ways we can improve what we do."
Many programs, such as the one at the University of Minnesota, have focused more attention in recent years on finances, adding or revamping courses to reflect a need for more business acumen, said Sandra Potthoff, director of the school's program in healthcare administration.
"These days you need a strong, fundamental understanding and skills in really being able to dissect financial statements," she said.
The survey's support for increased emphasis in several key areas, including clinical/financial information technology, also appeared to reinforce a continuing effort by many academics to adapt to changing times, Potthoff said. Even supply chain management, once the province of big manufacturing companies, has been added to the mix as a way to help healthcare executives change with the times (See related story, this page).
At the University of Central Florida in Orlando, administrators have added courses in marketing and service management over the past three years, said Myron Fottler, a professor and executive director of the school's health services administration program. Since 1999 the school's requirement for a master's of health services administration degree has grown from 39 hours to 48 hours as additional courses were added to meet the demands of the market. Fottler's program, like many others, has become increasingly business-oriented as hospitals and healthcare facilities face the disparate demands of cost containment, competition and customer service.
"In fact, it's gotten to the point," Fottler said, "where many organizations say that if they had the choice between an MHA and an MBA with no healthcare background, they'd prefer to hire the person with the business skills they learned in an MBA program, because that's what they need."
While many survey respondents want increased focus on issues such as information technology, finance and compliance, they appeared to pay far less attention to several other key topics in healthcare-racial diversity and capital construction among them. Indeed, while several groups, including the American College of Healthcare Executives, have identified racial diversity as a vital concern, only 25% of the respondents said the issue should receive more emphasis, a result that surprised Dalston.
"I would have thought that there would be a much greater sense of urgency about this," Dalston said. "I would have thought the field would respond and that it would be a priority for 70%, or 80%, or 90%. Maybe that's an indication that we've got to do a much better job."
He said he was less surprised by the lack of interest in a greater emphasis on construction.
The NCHL has outlined 23 recommendations to better define health-management education, assess student learning and develop outcome measures, among other items on its agenda. Last month, the NCHL announced it would seek proposals for up to six university-based pilot projects aimed at identifying "best practices" in curriculum, teaching and assessment. Pilot sites will be selected April 2.
The key survey results, which show that the majority of respondents believe current programs are doing an adequate job, should not be seen as a repudiation of the NCHL's initiative, Hernandez pointed out. "After all there are 30% (of the survey respondents) that didn't agree (that current programs adequately prepare students). We always need to look for improvements."
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