Bridging worldviews: Toward a common model of leadership across the health professions.

BACKGROUND: As the pace of health sector transformation accelerates, the importance of leadership continues to grow across all health professions. Advances in a variety of disciplines can inform effective leadership development. However, at present, most health sector leadership competency models do not incorporate these advances and are instead developed using consensus-based methods within specific professions. An interprofessional approach to leadership competencies could help incorporate these advances and support better interdisciplinary leadership development. PURPOSE: This study was pursued to revise and revalidate a widely used health sector leadership competency model and assess its potential for providing greater interoperability across the professions. METHODOLOGY/APPROACH: Using the National Center for Healthcare Leadership's interprofessional competency model Version 2.1 as the starting point, we developed a revised and revalidated model in four phases: (a) we completed a future scan using methods described in Garman et al. [Garman, A. N., Johnson, T. J., & Royer, T. (2011). The future of healthcare: Global trends worth watching. Chicago, IL: Health Administration Press.]; (b) we collected behavioral event interview data from pairs of leaders representing different organizational and performance levels, using methods developed by Boyatzis [Boyatzis, R. E. (1982). The competent manager: A model for effective performance. New York, NY: John Wiley & Sons.]; (c) we conducted a validity study via electronic survey of 145 working managers and calculated content validity ratios using methods described by Lawshe [Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 38(4), 563-575.]; and (d) we used natural language processing to assess the extent to which existing leadership models in the health professions will crosswalk to the new model. FINDINGS: All competencies in the revised model successfully met criteria for validity. The revised model also successfully crosswalked against, on average, 85% of the competencies in the other five health professions leadership models. PRACTICE IMPLICATIONS: Based on the results of this research, we conclude the revised model can provide a "common language" framework in support of interdisciplinary leadership development. The availability of such a model may also assist human resource and development executives in better aligning learning resources with organizational goals.

Hospital cultural competency as a systematic organizational intervention: Key findings from the national center for healthcare leadership diversity demonstration project.

BACKGROUND: Cultural competency or the ongoing capacity of health care systems to provide for high-quality care to diverse patient populations (National Quality Forum, 2008) has been proposed as an organizational strategy to address disparities in quality of care, patient experience, and workforce representation. But far too many health care organizations still do not treat cultural competency as a business imperative and driver of strategy. PURPOSES: The aim of the study was to examine the impact of a systematic, multifaceted, and organizational level cultural competency initiative on hospital performance metrics at the organizational and individual levels. METHODOLOGY/APPROACH: This demonstration project employs a pre-post control group design. Two hospital systems participated in the study. Within each system, two hospitals were selected to serve as the intervention and control hospitals. Executive leadership (C-suite) and all staff at one general medical/surgical nursing unit at the intervention hospitals experienced a systematic, planned cultural competency intervention. Assessments and interventions focused on three organizational level competencies of cultural competency (diversity leadership, strategic human resource management, and patient cultural competency) and three individual level competencies (diversity attitudes, implicit bias, and racial/ethnic identity status). In addition, we evaluated the impact of the intervention on diversity climate and workforce diversity. FINDINGS: Overall performance improvement was greater in each of the two intervention hospitals than in the control hospital within the same health care system. Both intervention hospitals experienced improvements in the organizational level competencies of diversity leadership and strategic human resource management. Similarly, improvements were observed in the individual level competencies for diversity attitudes and implicit bias for Blacks among the intervention hospitals. Furthermore, intervention hospitals outperformed their respective control hospitals with respect to diversity climate. PRACTICE IMPLICATIONS: A focused and systematic approach to organizational change when coupled with interventions that encourage individual growth and development may be an effective approach to building culturally competent health care organizations.

Blueprint for Sustainable Change in Diversity Management and Cultural Competence: Lessons From the National Center for Healthcare Leadership Diversity Demonstration Project.

EXECUTIVE SUMMARY: How can healthcare leaders build a sustainable infrastructure to leverage workforce diversity and deliver culturally and linguistically appropriate care to patients? To answer that question, two health systems participated in the National Center for Healthcare Leadership's diversity leadership demonstration project, November 2008 to December 2013. Each system provided one intervention hospital and one control hospital.The control hospital in each system participated in pre- and postassessments but received no preassessment feedback and no intervention support. Each intervention hospital's C-suite leadership and demonstration project manager worked with a diversity coach provided by the National Center for Healthcare Leadership to design and implement an action plan to improve diversity and cultural competence practices and build a sustainable infrastructure. Plans explored areas of strength and areas for improvement that were identified through preintervention assessments. The assessments focused on five competencies of strategic diversity management and culturally and linguistically appropriate care: diversity leadership, strategic human resource management, organizational climate, diversity climate, and patient cultural competence.This article describes each intervention hospital's success in action plan implementation and reports results of postintervention interviews with leadership to provide a blueprint for sustainable change.

Career inflection points of women who successfully achieved the hospital CEO position.

Women are significantly underrepresented in hospital CEO positions, and this gender disparity has changed little over the past few decades. The purpose of this study was to analyze the career trajectories of successful female healthcare executives to determine factors that generated inflections in their careers. Using qualitative research methodology, we studied the career trajectories of 20 women who successfully ascended into a hospital CEO position. Our findings revealed 25 inflection points related to education and training, experience, career management, family, networking, and mentorship and sponsorship. We found substantial differences in the career inflection points by functional background. Inflections were more pronounced early in the careers of women in healthcare management, while clinical and administrative support executives experienced more inflections later as they took on responsibilities outside of their professional roles. Only two inflections were common among all the executives: completing a graduate degree and obtaining experience as a chief operating officer. More importantly, our findings show that organizational support factors are critical for the career advancement of women. We conclude with recommendations for individuals in an effort to enhance their career trajectories. We also provide recommended activities for organizations to support the careers of women in healthcare leadership.

The role of the chief nurse officer in ensuring patient safety and quality.

Since 1999, dozens of organizations and hundreds of initiatives have emerged to improve the quality and safety of patient care, yet insufficient progress has been made. Attention has turned toward improving senior leadership team effectiveness. The authors describe a national project that examined the role of the senior leadership team in 8 hospitals in promoting quality and safety, with particular focus on the role of the chief nurse officer in this process.

Development of an interprofessional competency model for healthcare leadership.

During the past decade, there has been a growing interest in competency-based performance systems for enhancing both individual and organizational performance in health professions education and the varied healthcare industry sectors. In 2003, the Institute of Medicine's report Health Professions Education: A Bridge to Quality called for a core set of competencies across the professions to ultimately improve the quality of healthcare in the United States. This article reviews the processes and outcomes associated with the development of the Health Leadership Competency Model (HLCM), an evidence-based and behaviorally focused approach for evaluating leadership skills across the professions, including health management, medicine, and nursing, and across career stages. The HLCM was developed from extensive academic research and widespread application outside healthcare. Early development included behavioral event interviewing, psychometric analysis, and cross-industry sector benchmarking. Application to healthcare was supported by additional literature review, practice analysis, expert panel inputs, and pilot-testing surveys. The model addresses three overarching domains subsuming 26 behavioral and technical competencies. Each competency is composed of prescriptive behavioral indicators, or levels, for development and assessment as individuals progress through their careers from entry-level to mid-level and advanced stages of lifelong development. The model supports identification of opportunities for leadership improvement in both academic and practice settings.