MANAGEMENT COMPETENCE IN HOSPITALS: A SYSTEMATIC REVIEW OF THE LITERATURE

MANAGEMENT COMPETENCE IN HOSPITALS: A SYSTEMATIC REVIEW OF THE LITERATURE Mr. Aidan Walsh, Professor Peter Hines and Professor Denis Harrington.  This paper presents findings of a review of the literature examining... [ view full abstract ]

MANAGEMENT COMPETENCE IN HOSPITALS: A SYSTEMATIC REVIEW OF THE LITERATURE

Mr. Aidan Walsh, Professor Peter Hines and Professor Denis Harrington.

This paper presents findings of a review of the literature examining managerial competence in healthcare management, with a specific focus on hospital environments, and is part of a larger research study that seeks to explore the managerial competencies required to manage lean improvement activities within an Irish Healthcare context. The motivation for this research lies in the current debate around the need for greater efficiencies, improved patient care, and reduced waiting times in the provision of healthcare services. The global healthcare sector is characterised by challenging trends including escalating costs, increased incidence of chronic illnesses, aging populations, and greater urbanisation, all leading to higher rates of many blood-born, infectious, and pollution-related illnesses (Elton and O’Riordan, 2016; Atallah et al., 2012).

The Irish healthcare system faces challenges similar to those previously outlined, including significantly reduced budgets; long waiting lists; capacity deficits; an ageing population; and a significant growth in the incidence of chronic illness (Department of Health, 2018; Department of Health, 2017a; Department of Health, 2017b). In response to these challenges the Irish Department of Health developed a “Healthy Ireland” strategy (Department of Health, 2013) that specifies operational principles for the reform of the health service between the years 2013-2025. Core operational principles such as ‘better use of people and resources’, ‘better systems for healthcare’ and ‘better use of evidence’ underpin a drive to secure the efficient use of resources (including human resources) and the elimination of waste and drive continuous performance improvement and co-ordination across different providers (Department of Health, 2017a).

Van de Walle and Hammerschmid (2011) describe an emergence of new ways of thinking about the role and nature of government that lead to a series of reforms that would become known as New Public Management that involved the implementation of management ideas from the business and private sector into public services; many of which sought to pursue efficiency, value and cost reduction (Hood, 1991; Hood and Dixon, 2015). This was evident in adoption of continuous improvement approaches such as quality management (Rosenhoover and Kuhn, 1996; Matei and Lazar, 2011), lean (Spear, 2005; Radnor et al., 2006; Radnor, 2010; Emiliani, 2004; Bateman et al., 2014), six sigma (Fryer et al., 2007; Chiarini, 2013), and lean six sigma (Lokerbol et al., 2012; Antony et al., 2016; Cole, 2011) in the public sector. However evidence suggests that the adoption of continuous improvement process strategies in the public sector may not just be a simple application of what has been tried in the private sector (Radnor and O'Mahoney, 2013; Brown et al, 2003) and that the public sector which is based more on values, and has ethical and professional concepts to consider, may present many more complex challenges (Diefenbach, 2009).

In healthcare, competency based assessment and development are established practices for professional development in the administration of medicine and treatment by physicians and nurses. Previous research studies (Shewchuk et al., 2005; Calhoun et al., 2008; Garman and Scribner, 2011; Clarke et al., 2004; Riley et al., 2012) have also explored the use of competencies in healthcare management education and practice. Stefl (2008) comments on work undertaken by the Healthcare Leadership Alliance (HLA) on identifying competencies for senior leadership. This paper will critically review previous studies focusing on the development of managerial competencies in healthcare in order to identify those competencies that have been identified as being key to successful healthcare management.

A systematic approach was applied in developing this literature review to identify studies that described diverse types of management and leadership competence in healthcare. A protocol for the systematic review (Ryan et al., 2007) detailing search terms (managerial, competency, healthcare, hospital, knowledge, skills, ability, behaviour and lean), inclusion and exclusion criteria with a focus on: organisational setting, organisational level and organisational role) was developed. Data collection included searching and selecting articles from relevant electronic databases such as PubMed, Cochrane, Web of Science and Science Direct; including other online databases available via the multi-search function provided by the library at Waterford Institute of Technology.

This paper will contribute to theory and practice by identifying, through a systematic review of prior literature, characteristics of management competence of healthcare leaders and managers in hospital settings. Competence is assessed by identifying the knowledge, skills, attitudes and abilities that enable management tasks.  

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