Healthcare facility planning: A systemic literature review

The current issue and full text archive of this journal is available on Emerald Insight at: www.emeraldinsight.com/1751-1879.htm Management and leadership competence in hospitals: a systematic literature review Vuokko Pihlainen Management and leadership competence 95 Central Finland Health Care District, Jyväskylä, Finland Tuula Kivinen Department of Health and Social Management, C

ORDER A PALGIARISM FREE PAPER NOW

entral Finland Health Care District, Leppävesi, Finland, and Received 6 November 2014 Revised 23 March 2015 9 June 2015 Accepted 24 August 2015 Johanna Lammintakanen Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland Abstract Purpose – The purpose of this study is to describe the characteristics of management and leadership competence of health-care leaders and managers, especially in the hospital environment. Health-care leaders and managers in this study were both nursing and physician managers. Competence was assessed by evaluating the knowledge, skills, attitudes and abilities that enable management and leadership tasks. Design/methodology/approach – A systematic literature review was performed to find articles that identify and describe the characteristics of management and leadership competence. Searches of electronic databases were conducted using set criteria for article selection. Altogether, 13 papers underwent an inductive content analysis. Findings – The characteristics of management and leadership competence were categorized into the following groups: health-care-context-related, operational and general. Research limitations/implications – One limitation of the study is that only 13 articles were found in the literature regarding the characteristics of management and leadership competence. However, the search terms were relevant, and the search process was endorsed by an information specialist. The study findings imply the need to shift away from the individual approach to leadership and management competence. Management and leadership need to be assessed more frequently from a holistic perspective, and not merely on the basis of position in the organizational hierarchy or of profession in health care. Originality/value – The authors’ evaluation of the characteristics of management and leadership competence without a concentrated profession-based approach is original. Keywords Health care, Health leadership competencies, Leadership, Hospitals, Management, Literature review Paper type Literature review Introduction The requirements for, and contents of, health-care management and leadership competence are constantly changing due to several contemporary and future challenges. Examples of factors promoting the need for competence development in management and leadership include: transition and reform in the delivery of services by health-care Leadership in Health Services Vol. 29 No. 1, 2016 pp. 95-110 © Emerald Group Publishing Limited 1751-1879 DOI 10.1108/LHS-11-2014-0072 LHS 29,1 96 organizations, increasing demands for performance improvement and performance profile comparisons, changed expectations of patients and, in the European Union, the issues of health-care integration and cross-border care (Wismar et al., 2011; Busari, 2012; Tchouaket et al., 2012). Additionally, the expectations of a new generation of employees differ from older generations’ expectations, and therefore, the future workforce requires a novel managerial approach (Stanley, 2010; Piper, 2012; Coulter and Faulkner, 2014). The aim of this study is to describe the characteristics of management and leadership competence in health-care leaders and managers, especially in a hospital setting, from a holistic perspective. Health-care leaders and managers included both nursing and physician managers. Therefore, this paper focuses on a competence-based approach of managers and leaders instead of merely the profession-centered viewpoint, even though the profession-centered approach is dominant in previous studies. Management and leadership competence in this study signifies knowledge, skills, abilities and attitudes that are necessary for managerial levels and tasks in hospitals or clinical settings. The definition of competence has become complex, and scientists have not yet arrived at a general consensus. Various definitions of competence have formed in several disciplines, and in health care, the definitions have arisen from a professional perspective. Furthermore, one approach to competence in the literature is context dependent, and related definitions of competence include personal capabilities to use and link knowledge, skills and attitudes to develop performance in a particular context (Laibhen-Parkes, 2014). Usually, to be deemed competent, a person must demonstrate a master set of skills; however, scholars have not reached an agreement on this definition (Thistlethtwaite et al., 2014). Knowledge and skills are overtly and indisputably stated as inherent components, while abilities and other attributes are merely implied. In sum, attitudes, abilities, values, judgment and personal or character attributes are considered characteristics of competence. Additionally, two divergent conceptions about the utilized components of competence by a competent person were found. One conception focuses on selected, individual components of competence in a specific situation. The second describes a synergistic combination of the components in a given situation (Fernandez et al., 2012). One definition of competence concentrates on the interaction between the person working and abilities actually applied while at work, but this varies because of the possibilities and limitations of the work environment (Ruohotie, 2006). The recent need for management and leadership competence in health care and the appeal of management and leadership as a career choice are contemporary challenges (Ackerly et al., 2011; Enterkin et al., 2013; Yoder-Wise, 2014). Attempts to develop health-care managers and leaders have been described as inadequate and contradictory (McCallin and Frankson, 2010; Ackerly et al., 2011; Townsend et al., 2012). Management and leadership exceed the scope of the physician’s role especially; thus, management and leadership competence proves to be deficient (Dickinson et al., 2013; Kuhlmann and von Knorring, 2014). In recent decades, studies have demonstrated numerous approaches to and theories of management and leadership involving personal characteristics, behaviors, styles, models, theories and functions. At present, process-based management with the lean approach and competence-based management are emphasized (Hasna, 2014; Tevameri, 2014). Supportiveness and functionality in the work environment of health-care professionals can be achieved by effective clinical leadership, but as a conception, it has no clear definition (Mannix et al., 2013). Typically, management and leadership roles in health care are profession-based; physicians and nurses receive a different education, and they learn unique models of leadership and management. Additionally, studies of management in hospitals or clinical settings across the globe produce critical results, demonstrating inadequate management and leadership competence, which have been under discussion worldwide (Pillay, 2008; McCallin and Frankson, 2010; Ackerly et al., 2011; Townsend et al., 2012). Deeply institutionalized organizational routines, professionalism and growing specialization within the boundaries of clinical departments are absolutely strong cultural features in hospitals that affect management and managerial work (Fältholm and Jansson, 2008). As a solution, organizational management and leadership trainee programs and clinical supportive supervision have been implemented to promote the management and leadership role. In challenging professions, managerial work requires indispensable management skills. Also, clinical expertise needs to be strengthened by management and leadership competence (McCallin and Frankson, 2010). Conflictingly, the competence-based approach to leadership and management has not been unconditionally accepted. Formal programs to develop management and leadership competence have not been as remarkably influential as informal approaches used, for instance, by mentors and coaches (Pillay, 2008; McCallin and Frankson, 2010; Straus et al., 2013). Competence-based leadership development programs for clinicians have been established in Europe, the USA and Canada (Jahrami et al., 2008; Ackerly et al., 2011; Berkenbosch et al., 2013b), as exemplified by the Medical Leadership Competency Framework (MLCF) and the Royal Australasian Medical Management Framework. In sum, literature about the characteristics of management and leadership competence in health care is surprisingly limited. So far, systematic reviews that combine the views of professional groups in this field are scarce. In this paper, our approach to management and leadership competence, in light of a modern organizational theory, is to explore and discuss them from a holistic perspective. Methods We used systematic literature review to identify studies that described diverse types of management and leadership competence in health care, particularly those carried out in hospitals, during a certain time period. Data collection included searching and selecting articles from relevant electronic databases, as comprehensively outlined by Fink (2005). An information specialist was consulted about search terms and the process. After careful consideration and some initial searches, the following electronic databases were selected: Cinahl, PubMed, Cochrane, Scopus, Web of Science and Finnish Medic. The search period spanned a decade (2003-2013) because during this period, literature regarding the competence-based approach to management and leadership increased dramatically. The past decade provided opportunities to compare the studies and explore noticeable trends and trajectories regarding management and leadership competence. The search limits included reviews or research articles in English and Finnish with titles related to the study topic. After evaluating studies with relevant titles and abstracts (if they were previously available), the search outcome decreased from 1,451 to 253 papers. The studies remaining, which comprised empirical research, theoretical models of the characteristics of competence or literature reviews, described diverse characteristics of management and leadership competence in hospitals or clinical Management and leadership competence 97 LHS 29,1 settings (see inclusion criteria in Figure 1). A more detailed examination of the abstracts and full texts of these papers revealed those that offered a diverse range of descriptions of knowledge, competence or skills needed in management. Criteria were set to exclude editorials, evaluations or descriptions of management and leadership competence education or developed models and papers with constricted perspectives of 98 Databases: CINAHL (307) PubMed (303) Cochrane (22) Scopus (502) Web of Science (249) Medic (68) Search terms: Leadership*, manage*, competence*, skill*, hospital, hospital administration 1,451 Limits: Period 2003-2013 Research article or Literature Review in Finnish or in English Abstract available Inclusion criterion that title and abstract pertain to research question or topic 253 Inclusion criteria: Based on abstract or on full text, Research or literature review, Several characteristics of management competence or leadership skills are described, Article is available Exclusion criteria: Editorial article Describes a certain characteristic of management competence or leadership skill Describes an education framework or an education model or Evaluates an education model 74 Figure 1. Process of data collection After excluding duplicates and carefully reading articles, 13 papers were included in the systematic literature review Databases in final search outcomes: Cinahl (6), PubMed (2), Scopus (2), Medic (1) and Web of Science (2) management competence. Because our focus was on the characteristics of management and leadership competence and how to describe and identify them, studies concerning models or evaluations were excluded if they lacked descriptions of diverse characteristics of management and leadership competence. Replicating the search in each electronic database using combined search terms produced the same outcomes. Figure 1 describes the search process used, along with inclusion and exclusion criteria, and the outcomes after each stage. The number of search outcomes was curtailed from 74 to 13 after thoroughly reading the papers in full and eliminating duplicates. However, surprisingly, the fewer outcomes were appraised carefully and the selected papers, from PubMed (two), Cinahl (six), Scopus (two), Web of Science (two) and Medic (one), met the criteria precisely. Later examination of the selected studies identified mainly surveys, four of which were executed with the Delphi method, and one study design was a structured interview. After the search process, the findings were accepted as focused and precise content for the aim of this paper, with accompanying discussion. The papers included are presented in chronological order in Table I. The material was subjected to inductive content analysis to assess the data on the diverse characteristics of management and leadership competence, especially in a hospital context. During the first stage, competence and skills, identified as characteristics from the studies, were classified into concepts using words that described the data (Elo and Kyngäs, 2008). Many words and even short phrases, such as “using financial information”, were used, and several similarities were found during analysis. These words and clauses were organized into synonymous groups and, then, further analyzed and regrouped into 13 separate sub-categories. Finally, the sub-categories were assigned to three major categories relating to the characteristics of management and leadership competence. Findings In this study, three main categories of leadership and management competence emerged: health-care context-related, operational and general. Each category consisted of sub-categories of related sections. Health-care context-related management and leadership competence The health- care context-related competence category was broken down into four sub-categories: social, organizational, business and financial competence. Social competence included knowledge and understanding of the laws, roles and different functions of the political, social and legislative systems. The level of a manager or leader in the organization, characterized by varying degrees of rigor and scope, determined whether any of these systems formed part of managerial operations. Social competence was observed mainly in European studies (Hennessy and Hicks, 2003; O=Neil et al., 2008; Berkenbosch et al., 2013a). Additionally, Sinkkonen and Taskinen (2003) showed that the health services quality and cost efficiency approach to investigating health policy and health-care development proved a topical challenge in Finland. Organizational competence and related skills are more obviously related to management and leadership. This sub-category included managers’ organizational tasks and work content. In the studies analyzed, competence was represented as knowledge and understanding of organizational functions, relationships and Management and leadership competence 99 To identify charge nurse competencies To identify the most relevant characteristics considered necessary for working as a Chief Nurse to inform and systematize recruitment To obtain perceptions of the roles, competencies and educational foundation required from nurses in mid-level and senior nursing management roles To identify and figure out management competencies needed at different management levels for developing nursing management and management education To explore the contemporary nurse manager role and to gain perspective on the critical leadership skills and competencies required to build a nursing leadership model To ensure that assets are used in the most effective manner and required skills and expectations to lead are used 1. Conelly et al. (2003) USA 2. Hennessy and Hicks (2003) UK 3. Kleinman (2003) USA To characterize the profile of nurse managers at accredited hospitals, identify strategies used to select these professionals and compare the opinions of nurse managers and those hierarchically above them relative to the competencies of these nurse managers as viewed by their superiors To assess the level of and the differences in managerial competencies, to determine the best predictors of managerial competencies for NAS To compare nursing leaders and employees’ perceptions of leadership style, personality characteristics and managerial competencies and to determine the associations between these factors 8. Furukawa and Cunha (2011) Brazil 10. Lorber and Savič (2011) Slovenia 9. Kang et al. (2012) Taiwan To forecast relevant competencies and important skills, knowledge and abilities for Navy Nurse Executives in the next five to ten years 7. Palarca et al. (2008) USA 6. O=Neil et al. (2008) USA 5. Sherman et al. (2007) USA Structured questionnaire survey n ⫽ 509 Cross-sectional survey, self-administered questionnaire n ⫽ 330 Two types of data: A telephone survey n ⫽ 27; A paper survey n ⫽ 54 Delphi ⫺ 2 iterations: An electronic questionnaire n ⫽ 38 Questionnaire via email n ⫽ 93 Questionnaire n ⫽ 24 (13 ⫹ 11) A structured face-to-face interview n ⫽ 120 Interviews Delphi n ⫽ 42 Delphi Round 1 n ⫽ 330 Round 2 n ⫽ 180 Survey questionnaire n ⫽ 35 n ⫽ 93 Survey n ⫽ 604 (continued) Head Nurses, supervisors, Deputy Directors, Directors of Nursing in 16 acute hospitals Employees in Nursing, Nursing Leaders Nurse Managers, Directors Senior Navy Nurses holding the rank of Captain 0-6 Chief nursing leaders in three broad settings: Hospitals (n ⫽ 20), Education (n ⫽ 16), Public health (n ⫽ 18) Nurse Managers Nurse Managers in Primary and Secondary Health Care Nurse Managers, Nurse Executives 15 key experts in each of 22 European countries Charge Nurses, Head Nurses, Staff Nurses, Supervisory personnel Design and respondent pool 100 4. Sinkkonen and Taskinen (2003) Finland Aim Table I. Summary of previous studies of management competence Authors LHS 29,1 To identify and empirically investigate the dimensions of leadership in medical education and health-care professions To investigate how medical specialists perceive the managerial competencies of medical residents and their need for management education To begin to explore the knowledge, skills and abilities needed in the emerging practice settings of health-care management 11. Citaku et al. (2012) Australia, Canada, Germany, Switzerland, UK and USA 12. Berkenbosch et al. (2013a) Netherlands 13. Hazelbaker (2013) USA Aim Authors Directed surveys, Delphi n⫽8 Questionnaire via email survey n ⫽ 129 Questionnaire via email survey n ⫽ 229 Athletic Trainers working as Hospital or Health care Managers Educators, Physicians, Nurses, Other health professionals with academic positions Medical specialists Design and respondent pool Management and leadership competence 101 Table I. LHS 29,1 102 decision-making systems (Connelly et al., 2003; Kleinman, 2003; Sinkkonen and Taskinen, 2003; Hazelbaker, 2013). Business competence, a notable sub-category, included knowledge, understanding and practice of business skills in clinical and cultural contexts as well as different types of processes, such as changes, services, development, resources and planning (Kang et al., 2012; Hazelbaker, 2013). Some studies demonstrated an awareness of health care as a business or industry, and in a wider context than finance, including development of services and resources, productivity and effectiveness (O=Neil et al., 2008; Berkenbosch et al., 2013a). Financial competence included knowledge and understanding of, and skills related to, financial, marketing and budgeting issues and the ability to manage them successfully; these components emerged from several studies (Connelly et al., 2003; Kleinman, 2003; Sinkkonen and Taskinen, 2003; Sherman et al., 2007; O=Neil et al., 2008; Palarca et al., 2008). Financial competence was considered essential for nurse managers’ work (Sherman et al., 2007). Operational management and leadership competence The second category, operational competence, encompassed the following subcategories: process, operation, clinical and development competence. Process competence comprised items such as improvements in quality and service processes and management of and focus on patients (Connelly et al., 2003; O=Neil et al., 2008; Furukawa and Cunha, 2011, Lorber and Savič 2011; Berkenbosch et al., 2013a). Operation competence included the ability to manage a ward using clinical skills (Berkenbosch et al., 2013a). The importance of thoroughly knowing and understanding operations and available resources, executive tasks and abilities to delegate were constituent attributes of this sub-category (Furukawa and Cunha, 2011; Lorber and Saviè, 2011). Leadership skills (Hennessy and Hicks, 2003; Furukawa and Cunha, 2011; Kang et al., 2012; Berkenbosch et al., 2013a; Hazelbaker, 2013) and operational management abilities, such as resource allocation (Berkenbosch et al., 2013a), were also included in this sub-category. Clinical competence included the knowledge and skills of professional and clinical operations issues and professional credibility (Connelly et al., 2003; Hennessy and Hicks, 2003; Sherman et al., 2007), specialists’ requirements and current medical knowledge (Berkenbosch et al. 2013a). Professional ethics and learning from mistakes and failures were also included (Sherman et al., 2007; Berkenbosch et al., 2013a). Development competence encompassed staff development and improvement abilities in work. It involved the ability to obtain and use information (Connelly et al., 2003; Sinkkonen and Taskinen, 2003; Palarca et al., 2008; Furukawa and Cunha, 2011; Citaku et al., 2012). A proactive approach to unit, clinical and organizational changes and impacts was also included (Sherman et al., 2007; O=Neil et al., 2008; Palarca et al., 2008). General management and leadership competence The third category, general management and leadership competence, was common to all the health-care professionals, and included the following sub-categories: time management, interpersonal skills, strategic mindset, thinking and application skills and human resource management. Time management involved scheduling ability and skills in managing both time and tasks (Sinkkonen and Taskinen, 2003; O=Neil et al., 2008; Kang et al., 2012; Hazelbaker, 2013). Interpersonal skills were strongly linked to management and leadership, and included communication and the building and maintenance of interpersonal relationships. These were described mainly as management and leadership competence in all studies, but descriptions varied and consisted of elements such as: teamwork skills, decency, integrity, inter-personal skills, relationship building, relating to people and development of collaborative relationships within the organization. In nine papers, communication skills were described with diverse attributes like: communication, conformation to the flow of information, networking, written and oral fluency and clarity and active listening to and facilitation of discussion (Connelly et al., 2003; Hennessy and Hicks, 2003; Sinkkonen and Taskinen, 2003; Sherman et al., 2007; Palarca et al., 2008; Furukawa and Cunha, 2011; Lorber and Saviè, 2011; Citaku et al., 2012; Kang et al., 2012). Additionally, O=Neil et al. (2008) listed communication skills in conjunction with strategy, vision and mission. Strategic mindset entailed notable competence in strategic thinking, strategic process and vision and strategy development. The word “strategic” was combined with “thinking”, “planning”, “task management”, “view”, “goals”, “vision” and “mission”, and in a few papers, neither “strategy” nor “strategic” were observed (Sinkkonen and Taskinen, 2003; Connelly et al., 2003; Kang et al., 2012; Berkenbosch et al., 2013a; Hazelbaker, 2013). The strategic mindset sub-category also highlighted the level at which the manager operated, which varied from motivating staff to accomplishing the mission and strategic planning. Analytical thinking, achievement orientation and ability to communicate strategy, vision and mission were all included in the strategic mindset sub-category (Hennessy and Hicks, 2003; Kleinman, 2003; Sherman et al., 2007; O=Neil et al., 2008; Palarca et al., 2008; Furukawa and Cunha, 2011; Lorber and Savič, 2011; Citaku et al., 2012). Thinking and application competence contained abilities to think critically, prioritize, multi-task and use information in decision-making and problem-solving. Abilities to receive and present constructive feedback and skills in conflict resolution were also described in studies, and were sub-categorized in the general competence of management and leadership category. Personal development skills, such as self-awareness, strategic focus, upheld integrity and personal mastery, were also mentioned in papers (Hennessy and Hicks, 2003; Sinkkonen and Taskinen, 2003; Sherman et al., 2007; O=Neil et al., 2008; Citaku et al., 2012; Kang et al., 2012; Hazelbaker, 2013). Human resource management (HRM) involved the development and management of human resources and mastery of personnel. HRM was usually described as one of the main aspects of management and leadership competence, and was most often demonstrated in nursing management studies (Sinkkonen and Taskinen, 2003; Kleinman, 2003; Sherman et al., 2007; Palarca et al., 2008; Lorber and Savič, 2011; Kang et al., 2012). Discussion The objective of this study was to describe the characteristics of management and leadership competence as seen in health-care leaders and managers, especially in hospital environments. The approach included contemplation of the perspectives of several health-care professions as well as health management science. For this study, competence included knowledge, skills, attitudes and abilities that enable management and leadership tasks. The literature review was limited to the years 2003-2013 when competence-based research approaches became more frequent in management and Management and leadership competence 103 LHS 29,1 104 leadership contexts. This period provided opportunities to compare the studies and to explore noticeable trends and trajectories for management and leadership competence in health care. We used inductive content analysis to gather data from 13 papers that were selected using systematic literature review. Based on our findings, competence could be broken down into three main categories: health-care context-related, operational and general competence. Knowledge was the most frequently described characteristic, but skill, ability and attitudes were also depicted, albeit not as clearly. Managerial roles requiring health-care context-related competence comprised social, organizational and financial dimensions. Health-care reforms have been implemented in several countries. Because of the restructuring of public services, many European countries have adopted market-like mechanisms and managerial models and techniques from the private sector. This new managerialism, which enhances innovation, creativity, competencies and staff participation in strategic issues, has made knowledge of rules or bureaucratic procedures less relevant (Byrkjeflot and Jespersen, 2014). Additionally, contemporary integration objectives (Wismar et al., 2011) and trends to reorganize hospitals as process-based structures are challenging the traditional course of action (Tevameri, 2014). In sum, managerial roles and the development of management and leadership competence have been under discussion in many countries with divergent health-care systems and funding. Within the category of operational competence, process, operation, clinical and development competence proved important for the managerial role, based on analysis of different functions described in the selected literature. However, a common unsatisfactory experience of new nurse managers has been an appointment to the management role without possession of adequate skills (Townsend et al., 2012). Similar to this, the majority of medical residents in The Netherlands, Denmark, Canada and Australia needed training to develop management competence (Berkenbosch et al., 2013b). According to one nursing science study, systematically observed strategies for enhancing nursing management and leadership competence are lacking (Kleinman, 2004). Seven years later, as Kantanen et al. (2011) have shown, the situation remains unchanged. However, the challenges proved similar when both medical and nursing studies were observed. For example, managerial positions and roles were described quite differently from clinical roles, and the need for knowledge, skills and attitudes was identified (Ackerly et al., 2011; Townsend et al., 2012). General management and leadership competence, which comprised time management, inter-personal skills, strategic mindset, thinking and application skills and human resource management, was notable and common to all the studies. Findings about industry-specific, technical and general types of competencies also fell into this category (Aitken and von Treuer, 2014). Because tasks and responsibilities vary by level within the organization, the need for and application of competence also vary for different managers (McGurk, 2010). At all organizational levels, managers require leadership skills to motivate employees and inform them of objectives. Development programs pertaining to managerial levels and organizational strategy are shown to increase the impact of management and leadership (McGurk, 2010). Perspectives on leadership and management education and development in the most recent studies analyzed centered on profession-based and individual approaches (Furukawa and Cunha, 2011; Lorber and Savič, 2011; Citaku et al., 2012; Kang et al., 2012; Berkenbosch et al., 2013a; Hazelbaker, 2013). Boundaries between professions have been a strong cultural feature primarily found in hospitals and clinical settings (Fältholm and Jansson, 2008). Additionally, boundaries were observed between medical specialties in Sweden during the implementation of process orientation. One visible effect of boundaries is that it has been more difficult to change professional cultures than to transform management structures (Ackroyd et al., 2007). As a signal of changing convention, hospital reforms in Norway have increasingly aimed to create stronger management positions with less professional influence, and the managerial role has become more of the focus (Nordstrand Berg, 2014). Evidently, the tradition of the medical profession has not involved support for physicians related to management and leadership competence (Clark and Armit, 2008). Physicians value their professional work more so than management, but the perceptions of management as a temporary appointment or a career trap decreased after hospital reform in Norway (Nordstrand Berg, 2014). The trajectory of the competence-based approach to management and leadership has become noticeable. Our findings from the period we examined demonstrate that in the beginning, the objective of published studies was to identify the characteristics of management and leadership competence, characteristics and different roles needed in nursing managerial positions (Connelly et al., 2003; Hennessy and Hicks, 2003; Sinkkonen and Taskinen, 2003; Kleinman, 2003). Although the study perspectives varied, the objective was common to them all. In Finland, particularly, the managerial involvement of the physician and his or her need for training in managerial skills were apparent (Kumpusalo et al., 2003). In studies published during 2007 and 2008, the aim was to improve the identified characteristics of management and leadership competence by education and training, and to construct a leadership model (Sherman et al., 2007). Moreover, these studies sought to forecast relevant characteristics of management and leadership competence and important skills, knowledge and abilities (Palarca et al., 2008); additionally, the interest in improving management and leadership competence widened, especially in medicine. With the exception of systematized management and leadership education and training, measurement and evaluation of competence also occurred in the research field (Jennings et al., 2007; Calhoun, 2008; Ackerly et al., 2011). Management research extended to health sciences (Citaku et al., 2012; Hazelbaker, 2013), and particularly in medicine, the need for management education has been recognized (Ackerly et al., 2011; Berkenbosch et al., 2013a). Nowadays, the development of management and leadership competence by formal education is prevalent. However, according to Mintzberg (2004), manager development occurs abundantly through experience and practice, which denotes learning by performing managerial work. The successful managerial role requires change in mindset and attitudes toward skill and knowledge advancement by informal modes. In line with this, informal learning is achieved collectively, with mentors, peers or coaches, and is a method for building the organizational capacity and managerial strategies of an organization (McGurk, 2010) or promoting interactive and problem-based didactics (Taylor et al., 2008). Development, support and training provided to leadership and management roles confirm physicians’ abilities to perform managerial work (Dickinson et al., 2013; Straus et al., 2013). In response to a need in the USA and other countries, developed models were published that aimed to concurrently improve the abilities of Management and leadership competence 105 LHS 29,1 106 health-care leaders and managers at different levels while they work (Batcheller, 2011) or to include studies as pathways to clinical management and leadership (Ackerly et al., 2011). Systematic production of the best organized leaders and managers is necessary for the future of health care, and requires a plan for achievement (Yoder-Wise, 2014). From organizational and strategic perspectives, the more important question is management and its systematic processes and flexibility, not which profession holds the management position. Several factors restrict holistic approaches to developing management and leadership competence in health care. Instead of representing managerial work as a task list or profession-based question, a shared strategic mindset in management and leadership at all organizational levels enables managers and leaders to observe management and leadership in health management science from a holistic perspective. Developing a framework for learning in which managers and leaders can work in the organization with adequate support and opportunities to reflect and to evaluate success in their role is a globally shared challenge for health care in the future. Recently, Straus et al. (2013) studied the impact of leadership training programs for medical centers; they found modest effects and identified the need for rigorous evaluation of these programs. Essential points to consider include unifying the individual and organizational approaches to developing leadership and management competence, and improving managerial effectiveness in line with the strategies of the organization. The study design and the methods were carried out rigorously, but the majority of all papers described diverse characteristics of required competence in nurse managers and leaders, reflecting the fact that a larger body of research on management and leadership exists for nursing than for medicine. From the physician managers’ and leaders’ perspective, the required characteristics of management and leadership competence are similar, but a few papers were found that corroborated this perspective, suggesting a need for further study. Conclusions As implied above, the individual approach to leadership and management competence, as well as to organizational and strategic styles, requires an integrated, unified perspective of management that was deficient in the studies analyzed. Furthermore, the majority of the analyzed studies described diverse characteristics of required competence in nurse managers and leaders. Nevertheless, the management and leadership competence required from physician managers are similar, but studies integrating both nursing and physician managers’ perspectives were not found, suggesting a need for further studies from a health management sciences approach. Therefore, developing a framework for learning in which managers and leaders can work in the organization, with adequate support and opportunities to reflect and evaluate success in their role, is a globally shared challenge for health care in the future. The framework must include common, non-professional-based elements of management and leadership competence to promote a shared understanding of management and leadership throughout the organization. In sum, the development of management and leadership competence will strategically and systematically improve general organizational performance and essential managerial functions, and will produce new, motivated, potential managers and leaders. The characteristics of leadership and management competence required for the future comprise a captivating direction and challenge for further study using novel research methods. Multi-professional groups of experts in the health-care field that would serve as subjects of study might offer more information and varied perspectives on the required characteristics of management and leadership competence methods for developing them in the future. Management and leadership competence References Ackerly, D.C., Sangvai, D.G., Udayakumar, K., Shah, B.R., Kahlman, N.S., Cho, A.H., Schulman, K.A., Fulkerson, W.J. and Dzau, V.J. (2011), “Training the next generation of physician-executives: an innovative residency pathway in management and leadership”, Academic Medicine, Vol. 86 No. 5, pp. 575-579. Ackroyd, S., Kirkpatrick, I. and Walker, R.M. (2007), “Public management reform in the UK and its consequences for professional organization: a comparative analysis”, Public Administration, Vol. 85 No. 1, pp. 9-26. Aitken, K. and von Treuer, K. (2014), “Organizational and leadership competencies for successful service integration”, Leadership in Health Services, Vol. 27 No. 2, pp. 150-180. Batcheller, J. (2011), “On-boarding and enculturation of new chief nurse officers”, Journal of Nursing Administration, Vol. 41 No. 5, pp. 235-239. Berkenbosch, L., Bax, M., Scherpbier, A., Heyligers, I., Muijtjens, A.M.M. and Busari, J.O. (2013a), “How Dutch medical specialists perceive the competencies and training needs of medical residents in healthcare management”, Medical Teacher, Vol. 35 No. 4, pp. 1090-1102. Berkenbosch, L., Schoenmaker, S.G., Ahern, S., Søjnæs, C., Snell, L., Scherpbier, A.J.J.A. and Busari, J.O. (2013b), “Medical residents‘ perceptions of their competencies and training needs in health care management: an international comparison”, BMC Medical Education, Vol. 13 No. 25, pp. 1-12, available at: www.biomedcentral.com/1472-6920/13/25 (accessed 6 September 2014). Busari, J.O. (2012), “Management and leadership development in healthcare and the challenges facing physician managers in clinical practice”, The International Journal of Clinical Leadership, Vol. 17 No. 4, pp. 211-216. Byrkjeflot, H. and Jespersen, P.K. (2014), “Three conceptualizations of hybrid management in hospitals”, International Journal of Public Sector Management, Vol. 27 No. 5, available at: www.emeraldinsight.com/journals.htm?articleid⫽17111937&WT.mc_id⫽ journaltocalerts (accessed 6 June 2014). Calhoun, J.G. (2008), “Development of an interprofessional competency model for healthcare leadership”, Journal of Healthcare Management, Vol. 53 No. 6, pp. 375-389. Citaku, F., Violato, C., Beran, T., Donnon, T., Hecker, K. and Cawthorpe, D. (2012), “Leadership competencies for medical education and healthcare professions: population based study”, BMJopen, available at: http://bmjopen.bmj.com/content/2/2/e000812.full.pdf⫹html?sid⫽ 9708ef34-d3a6-455a-a758-c0229ca04671 (accessed 25 January 2014). Clark, J. and Armit, K. (2008), “Attainment of competency in management and leadership, no longer an optional extra for doctors”, Clinical Governance: An international Journal, Vol. 13 No. 1, pp. 35-42. Connelly, L.M., Yoder, L.H. and Miner-Williams, D. (2003), “A qualitative study of charge nurse competencies”, Medsurg Nursing, Vol. 12 No. 5, pp. 298-306. Coulter, J.S. and Faulkner, D.C. (2014), “The multigeneral workforce”, Professional Case Management, Vol. 19 No. 1, pp. 46-51. 107 LHS 29,1 108 Dickinson, H., Ham, C., Snelling, I. and Spurgeon, P. (2013), “Medical leadership arrangements in English healthcare organizations: findings from a national survey and case studies of NHS trusts” Health Services Management, Vol. 26 No. 4, pp. 119-125. Elo, S. and Kyngäs, H. (2008), “The qualitative content analysis process”, Journal of Advanced Nursing, Vol. 62 No. 1, pp. 107-115. Enterkin, J., Robb, E. and McLaren, S. (2013), “Clinical leadership for high-quality care: developing future ward leaders”, Journal of Nursing Management, Vol. 21 No. 2, pp. 206-216. Fältholm, Y. and Jansson, A. (2008), “The implementation of process orientation at a Swedish hospital”, International Journal of Health Planning and Management, Vol. 23 No. 3, pp. 219-233. Fernandez, N., Dory, V., Ste-Marie, L.G., Chaput, M., Charlin, B. and Boucher, A. (2012), “Varying conceptions of competence: an analysis of how health sciences educators define competence”, Medical Education, Vol. 46 No. 4, pp. 357-365. Fink, A. (2005), Conducting Research Literature Reviews from the Internet to Paper, Sage Publications, Thousand Oaks. Furukawa, P. and Cunha, I.C.K.O. (2011), “Profile and competencies of nurse managers at accredited hospitals”, The Revista Latino-Americana de Enfermagem, Vol. 19 No. 1, pp. 106-114. Hasna, H. (2014), “Not just for cars: lean methodology”, Nursing Management, Vol. 45 No. 3, pp. 39-43. Hazelbaker, C.B. (2013), “Perceived skills and abilities required by athletic trainers in hospital and clinical management positions: a Delphi study”, Journal of Athletic Training, Vol. 48 No. 1, pp. 87-91. Hennessy, D. and Hicks, C. (2003), “The ideal attributes of chief nurses in Europe: a Delphi study”, Journal of Advanced Nursing, Vol. 43 No. 5, pp. 441-448. Jahrami, H., Marnoch, G. and Gray, A.M. (2008), “Leadership competencies in the context of health services”, Health Services Management Research, Vol. 21 No. 2, pp. 117-130. Jennings, B.M., Scalzi, C.C., Rodgers, III, J.D. and Keane, A. (2007), “Differentiating nursing leadership and management competencies”, Nursing Outlook, Vol. 55 No. 4, pp. 169-175. Kang, C.M., Chiu, H.T., Hu, Y.C., Chen, H.L., Lee, P.H. and Chang, W.Y. (2012), “Comparisons of self-ratings on managerial competencies, research capability, time management, executive power, workload and work stress among nurse administrators”, Journal of Nursing Management, Vol. 20 No. 7, pp. 938-947. Kantanen, K., Suominen, T., Salin, S. and Åstedt-Kurki, P. (2011), “Review of the management and leadership skills of nursing”, Hoitotiede, Vol. 23 No. 3, pp. 185-196. Kleinman, C.S. (2003), “Leadership roles, competencies, and education”, Journal of Nursing Administration, Vol. 33 No. 9, pp. 451-455. Kleinman, C.S. (2004), “Leadership and retention: research needed”, Journal of Nursing Administration, Vol. 34 No. 3, pp. 111-113. Kuhlmann, E. and von Knorring, M. (2014), “Management and medicine: why we need a new approach to the relationship”, Journal of Health Services Research and Policy, Vol. 19 No. 3, pp. 189-191. Kumpusalo, E., Virjo, I., Mattila, K. and Halila, H. (2003), “Managerial skills of principal physicians assessed by their colleagues: a lesson from Finland”, Journal of Health Organization and Management, Vol. 17 No. 6, pp. 457-462. Laibhen-Parkes, N. (2014), “Evidence-based practice competence: a concept analysis”, International Journal of Nursing Knowledge, Vol. 25 No. 3, pp. 173-182. Lorber, M. and Savič, B.S. (2011), “Perceptions of managerial competencies, style and characteristics among professionals in nursing”, Croatian Medical Journal, Vol. 52 No. 2, pp. 198-204. McCallin, A.M. and Frankson, C. (2010), “The role of the charge nurse manager: a descriptive exploratory study”, Journal of Nursing Management, Vol. 18 No. 3, pp. 319-325. McGurk, P. (2010), “Outcomes of management and leadership development”, Journal of Management Development, Vol. 29 No. 5, pp. 457-470. Mannix, J., Wilkes, L. and Daly, J. (2013), “Attributes of clinical leadership in contemporary nursing: an integrative review”, Contemporary Nurse, Vol. 45 No. 1, pp. 10-21. Mintzberg, H. (2004), “Managers not MBAs”, A Hard Look at the Soft Practice of Managing and Management Development, Berrett-Koehler Publishers, Inc, San Francisco. Nordstrand Berg, L. (2014), “Management in hospitals – a career track and a career trap: a comparison of physicians and nurses in Norway”, International Journal of Public Sector Management, Vol. 27 No. 5, available at: www.emeraldinsight.com/journals.htm? articleid⫽17111905&WT.mc_id⫽journaltocalerts (accessed 6 June 2014). O=Neil, E., Morjikian, R., Cherner, D., Hirschkorn, C. and West, T. (2008), “Developing nursing leaders”, The Journal of Nursing Administration, Vol. 38 No. 4, pp. 178-183. Palarca, C., Johnson, S., Mangelsdorff, A.D. and Finstuen, K. (2008), “Building from within: identifying leadership competencies for future navy nurse executives”, Nursing Administration Quarterly, Vol. 32 No. 3, pp. 216-225. Pillay, R. (2008), “The skills gap in hospital management in the South African public health sector”, Journal of Public Health Management Practice, Vol. 14 No. 5, pp. E8-E14. Piper, L.E. (2012), “Generation Y in healthcare: leading Millenials in an era of reform”, Frontiers of Health Services Management, Vol. 29 No. 1, pp. 16-28. Ruohotie, P. (2006), “Key qualifications in work and education”, in Maclean, R. (Ed.), Communication and Learning in the Multicultural World, University of Tampere and OKKA foundation, Saarijärven Offset Oy, Saarijärvi, pp. 153-159. Sherman, R.O., Bishop, M., Eggenberger, T. and Karden, R. (2007), “Development of a leadership competency model”, Journal of Nursing Administration, Vol. 37 No. 2, pp. 85-94. Sinkkonen, S. and Taskinen, H. (2003), “Leadership and management competencies of nurse leaders”, Ylihoitajalehti, Vol. 31 No. 8, pp. 4-20. Stanley, D. (2010), “Multigenerational workforce issues and their implications for leadership in nursing”, Journal of Nursing Management, Vol. 18 No. 7, pp. 846-852. Straus, S., Soobiah, C. and Levinson, W. (2013), “The impact of leadership training programs on physicians in academic medical centers: a systematic review” Academic Medicine, Vol. 88 No. 5, pp. 710-723. Taylor, C.A., Taylor, J.C. and Stoller, J.K. (2008), “Exploring leadership competencies in established and aspiring physician leaders: an interview-based study”, Journal of General Internal Medicine, Vol. 23 No. 6, pp. 748-754. Tchouaket, É.N., Lamarche, P.A., Goulet, L. and Contandriopoulos, A.P. (2012), “Health care system performance of 27 OECD countries”, The International Journal of Health Planning and Management, Vol. 27 No. 2, pp. 104-129. Tevameri, T. (2014), “Matriisirakenteen omaksuminen sairaalaorganisaatioissa – rakenteeseen päätyminen, organisaatiosuunnittelu ja toimintalogiikan hyväksyminen”, Turku School of Economics, Sarja/Series A-3:2014, available at: http://urn.fi/URN:ISBN:978-952-249-347-7 (accessed 23 April 2014). Management and leadership competence 109 LHS 29,1 110 Thistlethtwaite, J., Forman, D., Matthews, L.R., Rogers, G.D., Sketekee, C. and Yassinen, T. (2014), “Competencies and frameworks in interprofessional education: a comparative analysis”, Academic Medicine, Vol. 89 No. 6, pp. 869-874. Townsend, K., Wilkinson, A., Bamber, G. and Allan, C. (2012), “Accidental, unprepared, and unsupported: clinical nurses becoming managers”, International Journal of Human Resource Management, Vol. 23 No. 1, pp. 204-220. Wismar, M., Palm, W., Figueras, J., Ernst, K. and van Ginneken, E. (2011), “Health care in the European Union: mapping and analyzing practices and policies”, Observatory studies series, European Observatory on Health Systems and Policies, available at: www.euro.who. int/__data/assets/pdf_file/0004/135994/e94875.pdf (accessed 2 June 2014). Yoder-Wise, P.S. (2014), “The future of leadership”, Journal of Nursing Administration, Vol. 44 No. 6, pp. 318-320. For instructions on how to order reprints of this article, please visit our website: www.emeraldgrouppublishing.com/licensing/reprints.htm Or contact us for further details: permissions@emeraldinsight.com
Purchase answer to see full attachment