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dissertation entitled

MANAGING IN HEALTH CARE INSTITUTIONS:
THE ISSUE OF PROFESSIONAL DEVELOPMENT
FOR MANAGERS OF A CHANGING ENVIRONMENT

presented by

Winston Wavell Isaac

has been accepted towards fulfillment
of the requirements for

Doctor of Wdegree 1n _Adul_f_and_Continuing
Education

STWMQ

 

Major professor

Date April 7, 1995

 

MS U i: an Affirmative Action/Equal Opportunity Institution 0-12771

 

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University

 

 

 

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MANAGING IN HEALTH CARE INSTITUTIONS:
THE ISSUE OF PROFESSIONAL DEVELOPMENT
FOR MANAGERS OF A CHANGING ENVIRONMENT

By

Winston Wavell Isaac

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Adult and Continuing Education

1995

 

ABSTRACT

MANAGING IN HEALTH CARE INSTITUTIONS:
THE ISSUE OF PROFESSIONAL DEVELOPMENT
FOR MANAGERS IN A CHANGING ENVIRONMENT

by

Winston Wavell Isaac

Health care organizations have become extremely complex hence health care management
has also taken on a complexity of its own. Health care managers must therefore be very
versatile in management skills while being very knowledgeable in health care issues. One
cannot expect to be fully prepared for a life—time career of health care management by
an academic program alone. Further growth and professional development are demanded
in a highly dynamic environment such as health care.

In this study of health care managers, an attempt was made to provide a foundation for
further discussion on continuing education and professional development needs by
utilizing the perceptions of health care managers. A questionnaire was developed and
distributed to 189 managers. The data provided an indicatitm of the problems and issues
that were present in health care management development. The data also provided the
perception of health care managers on the skills that would be needed for effective
management. The results of the study indicated that the professional development needs
of health care managers were very specific hands-on skills which were not normally part
of an academic curriculum in management. The identified skills were communication,
leadership and results management, in that order. The data showed that the future skills
could be obtained from the pursuit of short, focused course ofi'erings. Health care
managers were very conscientious in the pursuit of continuing education and professional
development activities but not necessarily with a focus. Understanding what practitioners
viewed as desirable skills for the future health care industry would be valuable to the
professional governing body, educational institutions, health care institutions, and also to

 

the managers - present and future.

The focus of the study was managing in health care institutions and specifically, the issue
of professional development for managers in a changing environment. In the 1990’s,
health care organizations were "re-organizing“, 'downsizing", 'rightsizing" and "re-
engineering“processesinanefforttoeopewithdecreasedfundingandatthesametime
satisfy client needs and expectations. All of that activity has caused the health care
environment to be one of constant change. Identification of the issues faced by health
care managers in their pursuit of continuing education and professional development will
help to provide break-throughs in meeting the management needs of the present and
future health care industry.

 

Coryfight by
WINSTON WAVELL ISAAC
1995

 

DEDICATION

I dedicate this dissertation to my late maternal grandmother, Frances Ann Charles, my
late mother, Isa (Charles) Isaac and her three sisters - Mary Charles-George, Catherine
(Charles) Nisbett and Betty Clmrles (deceamd) for their instilling in me, the importance
of a good education; to my children - Bernard and Alison; to my brothers - John,
Alfred, Terry and Lascelles; and also to my cousins - Cromwell Nisbett (deceased), Dr.
Burnell Nisbett, Lorna (Nisbett) Callender and Terry Nisbett.

 

ACKNOWLEDGMENTS

The journey along the Ph.D. highway is sometimes exhilarating, sometimes lonely and
even daunting at times but it is the cheering ofsupporters that helps with the maintenance
of the steadfastness which is required for successful completion and it is for that reason
thatlwouldliketorecognizesomeindividualsandgroups.

Iwouldliketoformallyexpressmysincerethanksandappreciationtoallthose
individuals who instilled in my the value of education and continuing education; those
who nurtured me in many ways; those who facilitated my growth and development; and
finally, those who supported and kept the cheering going until the enjoyable end. Special
recognition is made of:

My dissertation committee - Dr. Steve Weiland (Chair), Dr. Cas Heilman, Dr.
Howard Hickey and Dr. Jim Snoddy for their teaching, guidance and support;

Dr. Roy Giroux and Dr. Howard Hickey for their pioneering spirit;

My children, Bernard and Alison for their understanding when I shared their time
with my computer and for their constant interest in my progress;

Dr. Diana M. Schatz (Michener Institute) for her foresight in initial and
continuing education for the Regulated/Non—regulated Health Professions;

Jo Colby and Verla Ensign for their assistance in manoeuvring the administration
process and additionally, to Jo and her husband Dave for making me feel welcome
in East Lansing;

 

My classmates for their support and encouragement;

Members of the "expert” panel who gave their time so willingly to review the
draft survey instrument and provide feedback;

The ninety-six health care managers who responded to the survey; and

Finally, to all those many friends, relatives and well-wishers who showed a keen
interest in my pursuit of continuing and higher education.

I could not have done it without all the support for which I am extremely grateful.

vii

 

TABLE OF CONTENTS

LIST OF TABLES ..................................... xi
CHAPTER I: INTRODUCTION ........................... 1
Focus of the Study ................................. l
PROBLEM STATEMENT ............................ 5

The Canadian Health Care System ........................ 6

The Canada Health Act .............................. 7
Ontario Health Care Environment ........................ 8

Fiscal Environment ................................. 9
Health Care Trends in Ontario .......................... 9

Issues Facing the Government ......................... 10
Health Goals for Ontario ............................ 1]
PURPOSE OF THE STUDY .......................... 13
SIGNIFICANCE OF THE STUDY ...................... 14
RESEARCH QUESTIONS ........................... 15
ASSUMPTIONS ................................. l6
RELATED LITERATURE ........................... l7
LIMITATIONS .................................. 17
DEFINITION OF TERMS ........................... 19
ORGANIZATION OF THE DISSERTATION ............... 20
SUMMARY .................................... 21
CHAPTER 2: REVIEW OF THE LITERATURE ................ 23
Health Care Organization Change ....................... 24
Health Care Management Change ....................... 25
Federal and Provincial Planning Reports ................... 29
Organizations’ Response to the Changing Environment .......... 33
Program Management .............................. 33
Selected Ontario Examples ........................... 35

Peel Memorial Hospital (Brampton, Ontario) ............... 35
Sunnybrook Health Science Centre ..................... 36

 

West Park Hospital ............................... 36

The Credit Valley Hospital .......................... 37
AMBULATORY SERVICES DEVELOPMENT .............. 38
West Park Hospital ............................... 38
The Credit Valley Hospital .......................... 39
WORK TRANSFORMATION ......................... 39
EVALUATION ...A word to the wise .................... 41
Detractors ..................................... 42
Training ...................................... 42
Changing Nature of Jobs for Managers in Health Care .......... 43
Skill & Knowledge Needs of Health Care Managers ............ 46
Training, Education and Development .................... 47
Mandatory vs Voluntary Continuing Education Pursuit .......... 49
SUMMARY .................................... 50
CHAPTER 3: DESIGN AND METHODOLOGY ................ 52
DESIGN OF STUDY .............................. 52
SAMPLE ...................................... 52
SURVEY DESIGN ................................ 55
PRETEST OF SURVEY ............................. 56
DATA COLLECTION PROCEDURES ................... 57
DATA ANALYSIS ................................ 57
VALIDITY AND RELIABILITY ....................... 58

CHAPTER 4: ANALYSIS AND INTERPRETATION

OF THE DATA ............................... 60
Introduction .................................... 60
Research Questions & Interpretation of Findings .............. 60

Question 1 - Perception of Needs ...................... 60
Question 2 - Barriers ............................. 62
Question 3 - Perceived Benefits ....................... 64
Question 4 - Mandatory vs Voluntary ................... 66
Question 5 - Facilitation Role ........................ 69
Question 6 - Motivators ............................ 71
Question 7 - Reasonable Expectations ................... 73
Question 8 - Future Skills .......................... 75

‘ Question 9 — Skill Development ....................... 77
PROFILE OF RESPONDENTS ........................ 79
SUMMARY .................................... 82

 

CHAPTER 5: FINDINGS, CONCLUSIONS, IMPLICATIONS

a RECOMMENDATIONS ...................... 152
SUMMARY OF FINDINGS .......................... 85
Perception of Nwds .............................. 85
Barriers ..................................... 85
Perceived Benefits ............................... 86
Mandatory vs Voluntary ........................... 87
Facilitation Role ................................ 89
Motivators .................................... 91
Reasonable Expectations ........................... 92
Future Skills .................................. 93
Skill Development ............................... 95
CONCLUSIONS ................................. 96
IMPLICATIONS ................................. 103
Implications for health care organizations ................. 104
Implications for educational and mgmt training institutions ....... 105
Implications for the Health Care Manager ................. 106
Implications for Educational and Development Departments ...... 107
Implications for Senior Management .................... 108
Implications for the College (CCHSE) ................... 109
RECOMMENDATIONS FOR FURTHER STUDY ............ 111
APPENDICES ......................................
APPENDIX A - Letter of Introduction .................... 113
APPENDIX B - Survey Questionnaire .................... 114
APPENDIX C - Map of Southern Ontario ................. 134
BIBLIOGRAPHY .................................. 135
GENERAL REFERENCES ............................ 144

 

LIST OF TABLES

Table 3.1 Questionnaire Record

Table 4.1.0 Response Means for Each Item of Question 1

Table 4.1.1 Valid Responses, Response Means and Standard Deviation - Question 1
Table 4.2.0 Response Means for Each Item of Question 2

Table 4.2.1 Valid Responses, Response Means and Standard Deviation - Question 2
Table 4.3.0 Response Means for Each Item of Question 3

Table 4.3.1 Valid Responses, Response Means and Standard Deviation - Question 3
Table 4.4.0 Response Means for Each Item of Question 4

Table 4.4.1 Valid Responses, Response Means and Standard Deviation - Question 4
Table 4.5.0 Response Means for Each Item of Question 5

Table 4.5.1 Valid Responses, Response Means and Standard Deviation - Question 5
Table 4.6.0 Response Means for Each Item of Question 6

Table 4.6.1 Valid Responses, Response Means and Standard Deviation - Question 6
Table 4.7.0 Response Means for Each Item of Question 7

Table 4.7.1 Valid Responses, Response Means and Standard Deviation - Question 7
Table 4.8.0 Response Means for Each Item of Question 8

Table 4.8.1 Valid Responses, Response Means and Standard Deviation - Question 8

Table 4.9.0 Response Means for Each Item of Question 9

xi

 

Table 4.9.1 Valid Responses, Response Means and Standard Deviation - Question 9
Table 4.10.0 Demographics of Respondents to Survey Questionnaire
Table 4.11.0 Indication of CE & PD Activity, Clinical/Non-Clinical and Direct Reports

 

CHAPTER 1
INTRODUCTION

FOCUS OF THE STUDY

The focus of this study is Management in Health Care Facilities: The Issue of
Professional Development for Managers of a Changing Environment. Before one can
pursue an in-depth discussion on the main topic, one is obliged to set the tone with a
review of the health care environment, providing some historical and current information
on health care in Canada in general and on Ontario in specific. The topic begs for some
discussion about change and it is against that backdrop that the issue of health
management development will be pursued.

Why is there a concern/interest regarding the need for continuing education for health
care managers? The answer might be found in the examination of managerial
appointments and career advancement practices in health care organizations and in Ontario
in particular. The health care environment has a history of promoting from within where
individuals with clinical expertise are promoted to managerial positions and it is not
unusual for those individuals to be lacking in formal management training. In 1989,
Storch reported that 25% of Chief Executive Officers of Canadian health care institutions
(hospitals with over 100 beds) have health occupation credentials as their primary
academic qualification. Individuals working at lower levels in an organization are
performing jobs that likely fulfill needs other than those required for the higher level
positions; they might make poor candidates for promotion. The supervisor/management
positions require balanced achievement and power drives, while the staff subordinates are
generally higher on need for affiliation. (Chusmir, 1986).

One can surmise that there might be a felt responsibility by the organization to provide
the required training as a form of professional development. Without a mandated body

 

2

for overseeing continuing education and professional development for health care
managers, employers cannot be guaranteed that the management staff is current in health
care management knowledge and skills, except in situations where the corporation
supports and facilitates educational opportunities for its management staff.

To put things in perspecn've, Hastings and colleagues in 1981 noted that unlike other
professionally-trained health groups, health administrators are not licensed or registered;
they have not all graduated from accredited training program in health administration;
theydonotnecessarily belongtothesameorany professionalassociation; andthey do
not all use the same title (Hastings et al., 1981). That sentiment was also shared by
Mindell and Barsley in the same year as Hastings (Mindell et al., 1981).

There are a number of important environmental issues which must be kept in mind as one
examinesthecapabilitiesofmanagersinthehealthcareindustry. Theeconomyin
Canada and Ontario is still recovering from the recession and is not likely to experience
a drastic recovery in the near future. The federal government is passing a large
proportionoftheburdenofthecostofhealthcaretotheprovincesthroughreductionin
transfer payments.

More than one-third of Ontario provincial spending is allocated to health care. Hence it
is a primary target for reduction in the tough economy. The provincial government
believes that the health system is terribly under-managed and it is their responsibility to
correctit(Rach1is&Kushner,1989). TheHealthMinisterhasstatedthanbecauseof
thislackofmanagementmorethan30% oftheresourcesspentonhealthiswasted. There
is also the strong belief that far too many patients are institutionalized in Ontario. Many
more people, it is felt should be receiving support in their homes (Statement to the
legislature by the Hon. Ruth Grier, Minister of Health, Ontario, June 6, I994).

Thefocusofhealthcareinthe 1990swillbetoworksmarter. Theprimary challenge
fachghulmcueprovidersmmenendecadecenUesmfindingnewmemmofservice

3

delivery that have lower cost, higher quality and better outcomes. If we are to meet this
challenge, we must monitor and evaluate the pursuit of continuing education and
professional development of the management staff. Not every health care manager will
be able to pursue formal executive development programs, due in part to time constraints
and prohibitive costs, but they should be able to follow other management developmental
activities. Both Queen’s University (Kingston, Ontario, Canada) and the Banff Centre
School of Management (Alberta, Canada) offer a management development program with
a three-week duration at a cost of approximately $10,000. Executive management
programs which offer an academic credential are also very costly. Not all health care
managers need the contentasoffered by thoseprograms, some will need to build on skills
that are not offered in the executive development or formal academic programs.

In Ontario, most clinical staff belong to a regulated health profession and there is an
mandate that the members of the regulated health professions will have a system to ensure
continuing education and/or continued competence (Bill 43, 1991). It seems not
unreasonable to make a similar demand of the management staff. There will be some
logistical problems in that there is no governing body which has been mandated to
monitor health care managers in their continuing education and professional development
pursuits. That should not prevent each health care organization from initiating its own
monitoring process. One can envisage this becoming the norm in an era of Continuous
Quality Improvement and customer focus in the delivery of health care services. An
industry-wide system for monitoring professional development for health care managers
would be preferred. Such processes would help in the preparation for an evolving future
which will demand expertise in the following areas:

Assessment and understanding of the health status of populations;
Organization, financing and delivery of health services from multiple perspectives;
Economic, financial, policy and quantitative analysis;

Values and ethical issues in health administration practice;

Positioning and managing organizations for continued effectiveness;

A

4
Development of leadership potential;
Management of human, capital and information resources; and
Evaluation methods to assess organizational performance, including quality
assessment and assurance (Gelmon et al, 1990).

The Canadian College of Health Service Executives (CCHSE) encourages its members
to continue their professional development by pursuing appropriate activities.
Membership in the college is voluntary hence there is no accountability on the part of the
members to heed the suggestion for professional development. The college offers a
certification process for health executives and that certification involves the challenge of
a comprehensive examination. The successful challenge to the CCHSE examination
offers the designation of Certified Health Executive (C.H.E.) which is becoming an
industry standard. At present there is no mandated maintenance of certification
requirement but a vohmtary reporting of professional development activities; membership
renewal is secured by the payment of an annual fee but that could be changed in the near
future.

Graduation from one of the Accrediting Commission on Education for Health Services
Administration (ACEHSA) accredited programs in Canada, provides prospective
employers with an important quality control mechanism, enabling them to know in
advance that such a graduate has experienced an academic program that meets quality
standards set by the field, and has appropriate preparation for a career in health service
administration. Thatisallthatcanbeassm'edasthereisnomechanismtomonitor
continued learning and development except perhaps on an individual basis and that might
not be a consistent practice by the hiring organizations.

What can/should be done to facilitate, for health care managers, the development and
maintenance of leadership and management skills which are consistent with the needs of
the individual, the organizations, the communities and the province’s interest in high
quality, accessible, and affordable health care in a changing health care industry?

‘

5
Itishopedthatquestionwillbeansweredinthepursuitofthenineareasofinterestas
outlined in the research questions which can be found later in this chapter. The full
sm'veyinstrumentispresentedasAppendixB.

Forty-four percent of business leaders perceive an increase in the value and role of
training, education and development throughout the 1990s (National HRD Executive
Survey, 1991). Business spends more per capita on the training, education and
development of managers and executives than it spends on any other group of employees
(Porter, 1988).

By pursuing continuing education and professional developmental activities, the
competence and knowledge of practising health care professionals, which will be critical
over the next ten (10) years to the success ofthe health care system, will be enhanced
(Carruthers, 1988).

PROBLEM STATEMENT

Health care organizations are very complex and that complexity has been compounded
by a number of issues ranging from external changes to management recruitment and
promotional practices. In order to remain relevant, a leader must be constantly learning
and seeking new ideas, especially where the environment is one of constant change. As
mentioned earlier, the health care sector has a history of promoting individuals into
managerial positions based on technical/clinical skills and technical/clinical competence.
Oneoftheresultsofsuchapracticeistheplateauingofindividualsatthemiddle
magement level without any hope of achieving a senior management position. Another
areaofinterestisthefacta1991surveyfoundthatinoneparticularsegmentofhealth
careinmetropolitanToronto, Ontario, onlyaminmityofmanagersandsupervisbrshad
formal training in health and administration (Williams, 1991). Meanwhile, the new trend
is to employ, at the senior level, individuals who are academically prepared at the
master’s level in a health administration program without any regard to their possession

 

of a clinical background.

For any individual in health care management, the environment is very dynamic and the
need for currency of information is becoming a real demand. Even without the changes
mthehealmcareenvuonment,itcanbeseenthattherearerequirementsfmthe
development of health care managers. Whose role is it to assure that the managers are
current in health care management information and practices? For Rachlis and Kushner
in Second Opinion, 1989, their agreement on inadequate management came in the form
of a statement which identified widespread inefficiencies within the health care system
and which lie at the heart of the problem, “we’re so wasteful that virtually no amount of
money could ever satisfy our system’s proclaimed needs" (p.18).

In what follows are briefs accounts of various aspects of health care in Canada and in
Ontario.

The Canadian Health Care System

The Canadian Health Care system is a government-run insurance plan which uses public
funds to pay for a private system and the public has come to expect unlimited "free"
access to health care services. Patients have free choice of physicians, who in turn are
paid by the provincial plan on a fee-for-service basis. Public hospitals receive most of
their budget directly from the provincial government which in turn receives revenue from
the federal government to partially fund the system. Although national health insurance
is among the most popular government programs, in recent years the declining economy
and increasing health care cost have produced pressure for cost containment.

Canada as a nation was established in 1867 by the British North America (BNA) Act, and
it was that said Act which divided powers between the provincial governments and the
federal government, in Ottawa. The Act assigned all matters of national concern, plus
those activities likely to be costly, to the federal government, which had the broadest tax

7
base. Ottawa was given jurisdiction over such items as railways, canals, coinage and,
in the health fields, quarantine, marine hospitals and health services for native peoples
and the armed forces (Rosenbaum, 1979; Sutherland & Fulton, 1990).

On the other hand, the provinces were given authority for those local concerns which
were, at that time, thought unlikely to be costly - including roads, education and the
Establishment, Maintenance and Management of Asylums, Charities, and Hospitals other
than Marine Hospitals. Health care became a provincial responsibility as it was perceived
to be a natural extension of ’hospitals’. Health care in Canada thus became 10 provincial
health care systems, plus two in the northern territories. Due to economic inequities,
and with some provinces being less able to provide the same level of health care as
others, the federal government became involved in financing health services; this opened
the door for Ottawa to be able to exert an influence on provincial health policy despite
its lack of constitutional authority.

The Canada Health Act

Vayda & Deber reported that in 1983, Canada faced several potential confrontations, one
between the federal and provincial governments and a wcond between the provinces and
their health care providers (Vayda & Deber,1984). At the time, the federal government
was not only refusing to put more money into the system, but was actually proposing to
reduce its contributions to the provinces. At the same time the federal government
favoured the elimination of user charges, or the imposition of penalties for user charges;
either alternative would increase financial liability at the provincial level. This intent was
to discourage a two-tier system which could prove inequitable for the financially
disadvantaged.

It was on December 12, 1983, that the Canada Health Act (Bill G3) was introduced in
the House of Commons and it became law in April 1984. It declared the facilitation of
access to services without undue financial barriers to be an objective of the national health

8
policy thus bringing to five the characteristics of the Principles of Medicare as follows:

0 The service has to be comprehensive i.e. the provinces have to insure all the
services listed in the Act

a The service has to be reasonably accessible to all provincial residents

0 The province has to provide universal coverage

a The coverage has to be portable, meaning that a resident of one province had to

be covered for services received in any other province.

0 The syfiem has to be publicly administered (non-profit) (Rosenbaum & Vance,
1988).

Ontario Health Care Environment

The Canada Health Act (1984) superceeded the Hospital Insurance and Diagnostic
Services Act (1958) and the Medical Care Act (1968) thus paving the way for more
explicit indication of the conditions required for eligibility of maximum payments to the
provinces from the federal government.

In spite of the rapid growth in the provincial economy, the previous provincial
govanmemhadwresmtmhigherpmvincialmxeswbalmcemeprovmciflbudgasince
governmentexpenditures continuedtoexpandatarateinexeessofthegrowthinthe
provincial economy. One of the major components of government expenditures that has
grown more rapidly than others is health expenditures. Over a decade ago these
expenditures accounted for more than twenty-eight percent of government spending; in
1994, those expenditures accormted for more than thirty-three percent (Ball, 1994).

 

Fiscal Environment

Ontario’s economy has more than doubled in size in nominal terms between 1982 and
1989 - the real provincial economy grew at an average annual rate of almost five percent.
While the growth in the well-being of the Ontario economy continued until the second
quarter of 1990, a dramatic decline has taken place since then. For the remainder of the
1990s, few observers anticipate real growth to match that achieved in the second half of
the 1980s.

Health Cost Trends in Ontario

Just as federal health care expenditures have grown so have expenditures in Ontario. The
average rate of growth of nominal health expenditures by the provincial government has
been 12.1 percent between fiscal year 1980/1981 and 1990/1991, while the equivalent
growth rate in real health expenditures and real health expenditures per capita has been
5.5 percent and 4.1 percent, respectively. Consequently, given the rapid rate of growth
of these expenditures, it is not surprising to find that they represent more than one-third
of all government expenditures, and have grown from 4.3 percent of Gross Provincial
Product in 1980/81 to 5.4 percent in 1990/91 (Ontario Ministry of Health, Annual Report
1992-93).

The most dramatic increase in health expenditures has been in the area of physician
services. Expenditures on physician services, after adjusting for inflation, have grown
atan average annual rateofmore than 10 percent. While a portion ofthis increase is due
to population growth and a higher schedule of benefits for physician services, most of the
increase is due to increased utilization (Barer et al., 1988; Rachlis & Kushner, 1989).

The growth in the utilization of physician services has been brought about by an increase
in the supply of physicians and an increase in consumerism. Consumer expectations
regarding favourable outcome of medical intervention has encouraged more people to seek

 

10

medical care. Another reason is that once in the health system patients are now more
aggressive in seeking health care services that match their expectations. This aggressive
search for medical care sometimes results in requests for diagnostic investigations of
minimal utility and in consultations with specialists which may have only a marginal
bearing on health outcomes.

Physicians have considerable discretion over the utilization of health care services by their
patients. As an example, with substantial increases in malpractice premiums, litigation
rates and court awards, the perception of a malpractice “crisis" has created an
environment in which physicians may practice more “defensively”, and consequently,
may recommend more laboratory and radiological procedures for their patients (Coyte and
Dewees, 1991).

The lack of health expenditure control has resulted in a dramatically larger share of health
expenditures in the provincial budget, a substantial increase in the share of the provincial
economy devoted to health.

Issues Facing The Government

The following are some of the issues which have been identified as occupying the agenda
of the provincial government:

a Health expenditures represent the largest single funding envelope within the
provincial government.

a Health expenditures have grown more rapidly than any other area of government
expenditures.

0 The relationship between health expenditures and health outcomes is so tenuous
at best, that considerable room exists to redirect these expenditures to activities

 

11

that are more closely related to a broader view of heath as a resource for daily
living.

0 While some sectors within the field of health have faced some degree of
provincial government restraint, there is a perception that there is room for further
economy in health expenditures, either in regard to Ontario Health Insurance
Payments (OHIP) to physicians or in acute care facility funding.

a A significant need for health managers who can effectively transform the limited

resources for health care services into much needed health outcomes.

0 By configuring Ontario’s health care system towards services that are elements of
the broad view of health as a resource for daily living, the provincial government
has the potential to effect significant improvements in well—being for selective
socio-economic groups and possibly to reduce long term government expenditures.

Health Goals for Ontario

The prospect of declining revenues, increasing expenditures and the increasing deficit
raise doubts about whether the provincial government could afford to finance the health
care system in a manner to which it had become accustomed. Considerable efforts have
been expended on developing health goals for Ontario. These goals have been articulated
in three major provincial government reports (Evans, 1987, Spasoff, 1987, and
Podborski, 1987), and have enjoyed a high level of approval to arch an extent that the
Premier’s Council on Health Strategy has used those goals as the basis for the formulation
of health policy initiatives.

No mention of die Health Goals for Ontario would be complete without a reiteration of
thosegoalsasfirstproposed in l990bythePremier’s CouncilonHealth Strategy inA
Vision for Health: Health Goals for Ontario (p. l), and stated as follows:

 

12
a Shift the emphasis to health promotion and disease prevention

0 Foster strong and supportive families and communities
0 Ensure a safe, high quality physical environment

0 Increase the number of years of good health for the citizens of Ontario by
reducing illness, disability and premature death.

0 Provide accessible, affordable, appropriate health services for all.

The inference here is not that everything has to change. Change may be inevitable in
some situations and that change can add vitality to an organization but on the other hand,
change involving a complete system could be disruptive and non-productive. What could
one say to an organization which changed its management structure twice in as many
years before having any objective evaluation results?

In the 1990’s, health care organizations are "reorganizing", “downsizing", ”rightsizing"
and "re-engineering" jobs in an effort to cope with decreased ftmding and at the same
time satisfy client and customer needs and expectations. These activities have caused the
health care environment to be one of constant change with demands for new management
skills and current lmowledge of health care and related issues. Identification of the issues
faced by health care managers in their pursuit of continuing education and professional
development and documenting their perceptions will help to provide break-throughs in
meefingthemanagememMOfmepresentmdfimnehealmcaremduszmgarding
needed skills and knowledge. Without a clear indication of the needs of the field,
managerswillbeill-equippedtopursue, inameaningfirlway,therequiredskillsand
knowledge.

 

13
PURPOSE OF THE STUDY

The purpose of the study is to identify and describe, factors which may impact on
individual efforts to maintain currency of knowledge and skills while meeting the needs
of the future health care environment. This study will seek to contribute both
theoretically and practically to the study of professional development of health care
managers by documenting the opinions and perceptions of health care managers.

”There are a limited number of national studies of health executives in Canada and the
few that do exist are not well known to the average executive“. (Storch, 1988, p.1).
Even though that sentiment was expressed in 1988, it is still valid. Some of the better
known studies have been commissioned to provide data for manpower planning (McLeish
& Nightingale, 1973); and to provide comprehensive baseline data on the number of
health administrators (Hastings et al., 1981).

Continuing education for health care managers has not been a major topic of inquiry.
One study that had a continuing education focus was reported over a decade ago and that
study was restricted to managers in Long Term Care institutions (Hastings et al, 1981).
In 1991, Williams reported the result of a 1989 survey of the professional characteristics
and education needs of 429 managers and supervisors in long-term care institutions and
community-based service agencies in greater metropolitan Toronto. The data identified
important gaps in the professional training of those administrators and it was identified
thattherewasawidespreadsupponinprincipleandpracticeamongcmrent
administrators in the Toronto region for programs of education which address the
particular challenges of long-term care administration (Williams, 1991).

The purpose of continuing education is to build upon one’s educational and experiential
base for the enhancement of practice, administration, education, or research to the end
of maintaining and improving service to the public. (Ferrell, 1988).

 

14
Lifelong learning is one way to prepare for handling change. Dolan expressed the
opinion that when people do not read, and do not participate in educational programming
or professional association activities, they become insulated. He further stated that
changes march on, whether individuals know about it or not and that is one situation in
which ignorance is not bliss (Dolan, 1993).

SIGNIFICANCE OF THE STUDY

The result of this study would provide invaluable information to individuals, groups and
institutions, viz:

a Health care managers who have a desire to be informed about the current and
projected changes in the environment and also to have access to tools for assessing
their potential for marketability

0 Chief Executive Officers who might wish to obtain a comprehensive picture of
professional development practices of the industry

0 Governmental and other regulatory agencies in setting policy directions for the
pursuit of continuing education and professional development for health care

managers

a Institutions of higher education for program planning and future policy directions
for continuing education for health care managers, and

0 Individuals for their career planning in relationship to health care management and
those with a research curiosity.

Specific agencies with an interest in the results of the findings would be, the health care
industry, institutions of higher education in Ontario, the Canadian College of Health

 

15

Service Executives, the Ontario Hospital Association and the Ministry of Health of
Ontario.

The topic of this study has not been well/extensively research in Ontario, hence additional
data sources will be less well-developed and the research report from this study will make
a significant contribution to the related literature.

Studies of this type cannot be based on “hard" data alone. Stakeholders are an
invaluable source of information on needs, gaps and preferences. Attention was paid to
the qualitative information which was added to the survey responses by individuals. An
effort was made to combine the information gained from these sources with quantitative
data to develop the most complete understanding of the issues. Data collected from the
questionnaires have been analyzed in terms of the study questions and reported in
summary data and narrative information formats.

RESEARCH QUESTIONS
The research questions which this study addressed were:

1. What are the perceptions of health care managers regarding the need for
continuing education and professional development?

2. What opinions are shared by health care managers on the factors (barriers) which
hamper their pmsuit of continuing education activities?

3. What benefits are perceived by health care managers in the pursuit of continuing
education and professional development activities? ‘

4. What are the opinions of health care managers regarding mandatory vs voluntary
pursuit of continuing education and professional development?

16

5. What are the opinions of health care managers regarding who should assume the
role of facilitating their continuing education and professional development?

6. What are the opinions of health care managers as to the factors which would
facilitate/drive their pursuit of conan education and professional development?

7. What are the opinions of health care managers as to what would be a reasonable
expectation in their pursuit of continuing education activities?

8. Whatfumreskillswillberequiredbythemanagersofhealthcareinorderto
function and survive in the face of change?

9. How can the needed skills he developed in the experienced health care manager?

ASSUMPTIONS

It is assumed that a common frame of reference exists for terms and concepts used. It
was further assumed that health care managers will provide the time necessary to state
their opinions and perceptions in an honest manner. Another assumption is that many
individuals, institutions and agencies will be interested in the findings. Last, but not
least, is the assumption that health care managers perceive that continuing education
activities will enhance their personal growth and professional development.

The individuals surveyed are members of the Canadian College of Health Service
Executives and it is assumed that the College will be interested in the views of the
members in the area of professional development in general and specifically opinions on
manthtory versus voluntary participation. That information could also be used by the
College in policy formulation. It was interesting to note that only one fellowship paper
has been presented to the College in the area of continuing education in general and that
was done about a decade ago, in 1985 (Canadian College of Health Service Executives,

 

CCHSE Registry 1993).

RELATED LITERATURE

The review of literature relevant to this study is divided into specific segments to address

the major areas of interest.

Sample literature from related fields e. g. education and management (general) were used
to provide some direction for the study due to the paucity of literature in the specific area
of interest in the Canadian context. A useful source was the American literature in
health management education and reviews of reports on related studies. Canadian studies
on health care management and education, especially in the Ontario context, were
examined for relevance. An historical overview of the Canadian Health Care system has
been provided and the current health care environment of Ontario has also been
examined. The following were the main areas of literature examined:

Training

Changing Nature of Jobs for Managers of Health Care
Skill and Knowledge Needs of Health Care Managers
Training, Education and Development

Mandatory vs Voluntary Continuing Education Pursuits

LIMITATIONS

The current economic climate may influence some of the responses and should be taken
into consideration when interpreting the data. Budget constraints might have had an
effect on organizational financial support for professional development activities for
managers. With the freeze on salaries in health care institutions, it might not be possible
for managers to meet the cost of educational activities.

 

18

There is always a concern for the interpretation of certain terms and it could be different
for individuals based on many factors. The feedback from the panel provided some
assistance in lessening the problem.

The collection of information was dependent on the willingness of individuals to complete
thequestionnaire. Therewasnowayofknowingifthetaskhadbeenassignedtoan
assistant. The questionnaire was designed to be self-administered, hence its validity could
beaffectedbydreclarityofquestionsandthehonestyoftherespondents. Thebiasesof
the investigator may have influenced the construction of the questionnaire and the
interpretation of the qualitative findings. Assessment by other individuals was sought so
astoelinrinateoratleastdecreaseanybiases.

ThefindingsofthisstudycanonlybegeneralizedtohealthcaremanagersinOntarioand
to those who work in hospitals in university cities as outlined earlier. It would have been
ideal to survey everyone but one has to consider practicality of such an undertaking.

The study is limited to health care managers who are employed in hospitals in five
specific university cities in Ontario and who are members of the CCHSE. Such managers
normally occupy relatively senior positions and their opinions may not reflect the views
of all levels of management.

‘The questionnaire was only addressed to a select number of managers. Not every health
care manager in the selected cities or in Ontario was polled for his/her opinions, views
and comments on continuing education and professional development.

MembershipwiththeCCHSEmaymfluenceresponsenteandeventhemnueofthe
responses. The fact that those individuals have chosen to be members of the CCHSE and
to pursue recent continuing development are indications of their interest in matters related
to continuing education and professional development and members would more likely
respond to a survey of this type.

 

19
Health care managers who work in hospitals of the larger university cities in Ontario may
very well have different perceptions, opinions and needs regarding continuing education
and professional development than their counterparts in different work environments and
locations.

DEFINITION OF TERMS

Barrier - an obstacle or circumstance that keeps people or things apart; bars access or
advance.

Continuing Education is typically viewed in terms of formal programs centered around
particular topics and targeted at particular audiences (Gruppen, 1990).

The process by which an individual participates in professional development
activities to prepare for current and future changes in practice.

Education beyond initial professional preparation that is relevant to the type of
patient care delivered in the facility, that provides current knowledge relevant to
the individual’s field of practice, and that is related to findings from quality
assurance activities (CCHFA Accreditation Reference Guide 1991, Ottawa).

Education — systematic and sustained learning activities for the purpose of bringing about
changes in knowledge, attitudes, values or skills (CCHFA, 1994).

Health Care Executive - All those persons with senior management responsibility in the
health care system throughout Canada whose duties involve planning and policy making
(Storch, 1988). '

Management Development - a series of learning experiences that result in planned and
organized training and educational activities; formal or informal (Davidson, 1993).

 

20
Mandatory - an official command or instruction; compulsory.

Mentoring - Trusting relationship between an experienced and novice employee for the
purpose of providing exemplary support, direction, insight, guidance and advice to the
latter with regard to the complexity of their role (CCHFA, 1994).

Motivator - a person or activity that stimulates the interest causing action in a particular
way.

Technical - Information specific to the knowledge base of a particular profession.

Vision - an idealized goal which gives direction to organizational action (Kurz, 1991).

ORGANIZATION OF THE DISSERTATION

Chapter 1 includes an introduction to the topic; a snap-shot of the Canadian and Ontario
health care environments; a statement of the problem, purpose and significance of the
study; a listing of the research questions; definitions of key terms; identification of
assumptions; an outline of the limitations; and the layout of the dissertation.

In Chapter 2, the literature related to the study is explored and analyzed. The chapter
is divided into several sections so as to capture the major areas of interest which form the
study while providing a backdrop against which the health care aavironment could be
understood.

Chapter3providesthedesignand methodologyofthestudyandalsoincludesa
description of the population, survey design, information gathering procedures and data
analysis.

 

21
Chapter 4 contains a presentation and analysis of the findings of the study.

Chapter 5 summarizes the study, presents the conclusions, examines the implications of
the findings and provides suggestions for further research.

SUMMARY

An examination of the health care industry reveals a complex environment with managers
needing new skill and knowledge and a support system for facilitating and supporting the
efforts to that end. In order for health care managers to remain relevant, they must
constantly be learning and seeking new ideas. Due to the number of different routes for
the preparation of health care management preparation and selection, there is no common
body of knowledge nor is there equality in skills.

Although individuals may be promoted based on clinical/technical merit in health care
organizations, chances of acquiring a senior management position by those individuals are
slim to non-existent as those positions are normally filled by individuals who may or may
not have a clinical background but are academically prepared at the master’s level in
health and other administration disciplines. 1f the vision is to enhance the opportunity
forgrowthandpromotionofmiddle managersandothersinthehealthcareindustrythen
each individual must be perceived as having an equal chance and continuing education
may well be necessary to make the vision a reality.

Managers ofhealth administration must be well positioned to take advantage ofthe tough
environment. There are many issues facing health care institutions which must be
addressedwithinthecontextofthechangingenvimnment. Inthisrespecuthereisaneed
for managers to possess a solid understanding of the health care environment, community
needs and the demands of the Ministry of Health’s policy directions and initiatives.
Increased efficiency is required to manage in an environment of decreased resources,
increased needs (doing more with less) and increased complexity.

 

 

22

In an environment with an emphasis on quality care provision and a concern for risk
management, continuous quality improvement and total quality management, one cannot
over-emphasize the need to have individuals of high calibre providing direction for quality
service. Those high calibre individuals must be part of a system which ensures continued
growth and they must be able to acquire current information to enhance their knowledge
while increasing their efficiency.

The literature places a high degree of emphasis on the initial training and education of
health care managers as ifthat were enough for the duration of one’s career. This is in
direct contradiction to the expectation for the clinical and technical staff of health care.
Is the inference that management theory and practices are static while that of the clinical
disciplines have a shorter half-life? No one should be under the illusion of static theory
and practices. Obsolescence does not escape management theory and practices. The very
nature of health care is one of change due to the environmental forces which impact upon
it. The mostly high publicized factor is that of a slumping economy which demands new
skills of the health care manager as organizations seek new ways of doing business.
Anotheraspectofhealthcareisitshighhumanresourceintensity andthataddstothe

dynamic nature of health care management and the environment.

Leaders must be cautious of the expectations of what can reasonably be achieved by
health care managers who pursue continuing education activities. There will be a need
for evaluation of continuing education activities with an emphasis on evaluation of
behaviour change for any indications of the benefits which have been derived. Overall,
thereneedstobeadeterminationofwhatshouldbedonetofacilitate, forbealthcare
managers, the development and maintenance of leadership and management skills which
are consistent with the needs of the individuals, the organizations, the communities and
the province’s interest in high quality, accessible and affordable health care in a changing
health care industry.

Chapter 2 provides a summary and analysis of the literature of interest.

 

CHAPTER 2

RELATED LITERATURE

This study focuses on the perceptions of health care managers regarding continuing
education and professional development as methods of responding to the evolving changes
in health care services in Ontario, Canada.

“A $12-million national forum has been commissioned by the
Liberal government to study ways to revolutionize Canada’s health-
care system." Globe and Mail newspaper, in an article entitled,
National Forum On Health Care Faces Wofold Challenge, on
October 21, 1994.

The above as indicated, was an announcement in one of Canada’s national newspapers
and it provided an indication of further changes to the Canadian Health Care system.
That was not the only indiction of change, worldwide or in health care, as indicated in
the following quotations:

”In a world where the only constant is change, the impact of
technological advances, new governmental regulations and
economic turmoil have all converged to make life within the
organizations complicated, and at time unproductive" (Mezei,
1994, p.19).

"The world is now in a time of profound turmoil. " (Hassen, 1993,
p. 198).

"Given the accelerated pace of change....'. (Senge, 1990b, p.8).

'Thereisnodoubtthatthehealthcaresystemofthefuturewill
look quite differently than it does today." (Carnrthers, 1988, p. 1).

"Even good successful, century-old institutions need to adapt and
evolve to survive in a changing health care environment. " (Block,

23

 

1993, p.16).

“Across Canada right now health care is changing at a pace far more rapid
and far-reaching than the system seems able to withstand. " (Hassen, 1993,
p.6).

In 1989, Rachlis and Kushner in Second Opinion, wrote:

'By now it should be very clear that we can't expect a significant improvement
in Canada’s overall health care status without major social and economic
reforms". (Rachlis and Kushner, 1989, p.218).

Those thoughts and opinions originated from a range of individuals with an interest in
change and in some instances, health care. And those individuals can be categorised as
social policy analysts, health care policy analysts, academic educators, health educators
and health care managers.

Change in the health care context is perceived as the result of events which have been set
in motion by external forces which cause a movement in the direction of health care
delivery. Bridges (1991) described change as an external event i.e. external to the
individual.

Health Care Organizational Change

According to Mechanic (1988), "change is occurring at a dizzying rate for managers of
health care“ (Shortell et al., 1988, p.xiii). The health care manager is caught up in a set
of forces which are demanding that health care institutions function differently to meet
the new’expectations and at the same time, tackle, among other major problems, the
magnitude of the impact of the aging of the population on health expenditures - the
growth of the percentage of the population over sixty-five has been dramatic and an aging
population places greater demands on a health care system.

 

 

25

The changes which are demanded are to some extent intentional in that external policy
directions are indicating that the health care institutions must respond in a different
manner for effective health care delivery. The command has been givaa but the
command is very non-specific. One can use the analogy of being told to get from point
A to point B without being given any assistance in the determination of what method of
transportationtouseorinhowtoreadamap. Thereisanassumptionthatonehasthe
ability to obtain the information which is required for planning and decision-making, but
those activities must be anchored in policy directives.

Health care organizations cannot afford the luxury of becoming unproductive. The
external forces will not allow it - the government will not be hesitant in sending in
inspectors to conduct operational reviews on individual institutions that are not meeting
expectations. Community organizations which offer financial support are not slow in
demanding change when they perceive a lag in progress (Olsen, 1991). On occasion, the
changes come with enlightened leadership within the organization as executives have a
major responsibility to revitalize organizations for a competitive world (Kilmann, 1977;
Zuckerman, 1989).

Health Care Management Change

'l‘hehealthcaremanagermaybeperceivedasaministructurewithinamicrostructure
(the hospital) which is trying to withstand macro forces (economic, political, and
community). The need to change is not a choice for the health care manager but rather
a requirement from the external environment (Hudson, 1993).

The challenge of the health care manager is not to try to control the forces of change but
to prepare for the future which the change brings. Senge in a 1990 paper entitled, "The
Leader ’s New Look : Building Learning Organizations", stated that there was an evolution
of new organintions and with any new organization, there would be a demand for new
leadership roles which in turn would require new leadership skills (Senge, 1990b, p.13.)

 

26

The changes in the health care environment set up other forces of change which occur
within the individual manager. The desired individual responses are those that would
cause health care managers to prepare themselves for functioning at the appropriate level
within their job scope. The situation, then, is a reaction to an external stimulus. It
standstoreasonthatifthehealthcareenvironmentisalwaysinaconmntstateofchange
then one can safely assume that the same conditions exist within the worklife and being
of the health care manager.

Prybil & Warden in a comment on the accelerating pace of change stated that:

Not long ago, the management concepts learned in graduate school and practised
during early work experience could be counted on to maintain their applicability
and utility throughout the course of one’s career. Today, managers find it
necessary on a continuing basis to deal with environmental changes and respond
to expectations that could not have been envisioned in earlier years. (Prybil &
Warden, 1993, p.157)

Their explanation was that modern organizations have become so complex that the
processes involved in their operations are beyond the scope of any individual, including
skillful managers, to comprehend fully.

Crighton (1990), advised that hospital managers must not just be passive administrators
of funds but proactive planners and organizers of services. He also stated that the last
decade had been a difficult period of adjustment in which hospital boards have had to
come to terms with the real implications of management, which had been forgotten in the
open-ended cost-sharing years. He blamed the dilemma on the fact that there were, as
yet, no formal magement development system to further the education process into
policy analysis and development of practical skills for senior managers.

For an insight into the origin of the problem, Shedden 1993, stated that World War II
anditsafiermathduustwhoflynewmanagementmdmganizafionalmsksmthehealm
services upon a diverse groups of health services personnel who had very little training

 

 

27
or background that was relevant to what they had to accomplish (Shedden, 1993).

Dalston & Vail! (1993), upon reflection of the need for management development saw
the whole situation as a desperate attempt for keeping up with the pace of change and the
challenges that are expected. They ftn'ther provided another reflection when they stated
that one of the assumptions that had run through management education development for
decades is that putting an individual through a management training program would make
that person a manager, that somehow there will be a convergence of skills and attitudes.

For Prybil & Warden, they were a bit philosophical in stating that the subject of
magement development had taken on new importance. They also stated that traditional
approaches to the basic preparation and continuing education of managers had fallen short
of what was needed but, "...there are no obvious or simple answers to the question of
what should be done differently". (Prybil & Warden, 1993, p.157).

Loebs (1993), felt that much work needed to be done in identifying the appropriate
content for the continuing education of health care executives. He also showed his
disgust with some attempts at management development when he stated that there was an
unequivocal tendency for many CE programs to respond to the "hot” topics of the
moment which did not serve the needs. He further stated that research on continuing
management education strongly suggested that the needs were specific for different
management levels and different organizations. What Loebs did not say was that there
was no uniformity of management job titles across the industry. It is difficult to make
suggestion about levels when those levels are very organization specific. In the Ontario
healthcaresystem, thejobofaDirectorinoneinstimtioncanprovetobeverydifferent
from that ofa Director in another institution.

Itstandstoreasonthatifthepolicydirectiveshavechanged,andthehealtheare
instimtionsarechangingthewaytheydobusiness,thenoneotherimportantaspectofthe
change paradigm is change for the managers of the health care system. This change

 

28

would include a change in thinking about how managements jobs are performed and how
managers prepare for their jobs.

Change must not be perceived as an over-night process; it does not happen
instantaneously - it is gradual and often painstaking. Health care managers should
understand that as long as the Ministry of Health perceives that benefits will accrue, that
there will be changes in the health care environment. The types of benefits that the
government would be expecting would be decreased costs, increased benefits to clients
with improved care, access and delivery of services.

ltiswiththesepremisesinmindthatthisresearchhassetouttodocumentthe
perceptions of health care managers regarding continuing education and professional
development as activities (suitable processes) for maintaining management skills and
knowledge currency in an evolving health care environment in Ontario, Canada.

It appears that the managers do not have an option - there is no choice but to change
because the health care industry can ill afford, financially or clinically, to entrust the day-
to-day responsibilities of the services to the hands of managers who are not adequately
qualified or who are not properly motivated for the job. Continuing education will not
cure all the ills of health care management but the pursuit of appropriate activities will
at least provide managers with the needed skills while increasing motivation levels.

Regarding future management education needs, Dalston (1993), had observed that looking
into the 19905 and beyond one can see a very dynamic and changing environment in
which graduate education alone quickly becomes inadequate and that more needed to be
done.

In the Canadian College of Health Service Executives News Release of May 1994 re New
Certification Program Helps Health Service Executives Prepare jbr the let Century. Jan
Bartkowiak, Chair of CCHSE Board stated the following:

 

29

The complex challenges of reforming the health care system will place increasing
demands on the knowledge, skills, and abilities of health service executives.

TherapidpaceoforgMzafionalchangehaspromptedanincreasedfocusonhow
organizations learn, or fail to learn, in response to change. In The Fifih Discipline: The
Art and Practice of the Learning Organization, Senge (1990), issued a challenge to
organinfims,bmhmbusinessandmeducafim,wworkmbufld'learMngmgmizafions,
wherepeopleconfinuallyexpandtheircapacitytocreatetherendtstheymdy desire,
where new and expansive patterns of thinking are nurtured, where collective aspiration
is set free, and where people are continually learning how to learn together" (p.3).

'l'hispresentsmdyisdoneagainstaback-dropofchangeas'change'istheoneword
whichapdydescfibestheCmadianhedthcaresystem.Thesystemhasundergone
change, is undergoing change and will continue to undergo change. Finding reasons for
theconMchangemtheCamdianheaimcaresystemisnMadifficuhtaskmneOMy
hasmmviewitshistmyandexaminesomeofthefederalandprovmcialplanning
activities overtheyears. A sample of such activities is presentedfor consideration.

Federal and Provincial Planning Reports

At the national level, a 1969 Task Force on the Costs of Health Services concluded that
mereasedwstscuudonlybedealtwimwreducedsmndudsofcammueasedmxes,
premiumsand/ordeterrentfees,ormoreefficientoperationofthesystem.

In 1972, the Report of the Community Health Centre Projea (Hastings Report)
recommendedmelugescdedevdopmentofwmmumtyhealmcenmbymeprovinces
asweflasremganinfionandmtegrafimofaflhealthservicesandreducfionsmthe
number ofhospital beds.

The Lalonde Report (1974) of the Federal Department of Mitional Health and Welfare

30
stressed the importance ofhealth promotion, lifestyle modification and greater individual
responsibility for health instead of increased provision of medical services.

IheManitoba White Paperon Health in 1972 suggested regionalization ofhealth
savioesmdtheeshbhshmemdwmmumyhedthandsocialservicescennesmmder
toshififromhospitaltoambulatorycareservices.

In Qtebec, the Health section ofthe Report ofthe Conunission ofInquiry on Health and
Social Welfare (the Castonguay Report) 1970, also suggested decentralization, community
cMcsandgreataconmmainpmmtotheorganizafimofhealthcmeservices.

In 1972, inBritishColumbia, the FoulkerReportrecommendedcomplete reorganization
ofthe British Columbiahealthcaresystemwithregionalizafionandrationalizafionbased
mCommufityHealthResmuceandHealthCenfiesmdaMmphasisonhospimluse.

In Ontario, the Report of the Committee on the Healing Arts in 1970; the 1976 Health
Report of the Ontario Economic Council; and the 1974 report of the Health Planning
Task Force (the Mustard Report) all identified increased cost, excessive use of hospital
services and the control and deployment ofmedical and health manpower as key issues,
and included rationalization, regionalization and de-institutionalization among their
remedies.

AfurthercomplicationisthatthereisnonationalhealthcaresysteminCanadabuta
numberofhealthcaresystems. 'l'heFederalgovernmenthasstronginfluenceinwhat
happensintheprovmcialsystemsduemtheuniquefundmgmdpohcymngements
especiallyintheareaofhealth,educationandwelfare. Withtherequirementthatthe
provincial systems meet the five principles of medicare, a change in one province may
influencethesysteminotherprovinces. ItwastheprovinceofSaskatchewanwhich
pimeeredpubficlymnnedheaimcuemmelmJeadingmmembsequemadopfion

31
ofunivasahtymhealthcareacmssmeCamdadmingmelatelmandearIyIWOS
(Hassen,]993).

Steffan (1994), in commenting on the significance of change in health care perceived
hasaeafingmmsmblejobmarkaforhealthservicesmmgasandposdngnewissues
forcareermanagement.

Loebs(l992),providedmataflmenacingmminderfltattheuadifionalmahodof

developing executives primarily by on-the-job experience was no longer adequate:

Themagnitudeandspeedofchangehassomanyrootsintheexternal
environment and the knowledge ofthese changes is so limited by internal
staff, particularly the management development staff, that most

organizationsdonothavethecapacitytoprovidethenecessaryexposure
and learning (Loebs, 1992, p.238).

He goes on to say that continuing management development and education at all levels
willbekeytoanyhealthcareorganizationwhichdesiredtosucceedintheneweraof
change. Loebs provided what he called an explicit assumption and stated that the pace
of change makes formal degree achievement only a component or a building block in
preparation for, and maintaining expertise in, management. The message here seems to
be an attempt of motivating health managers to dispel any thoughts of complacency.

In his 1991 book, “Managing as a Performing Art: New Ideas firr a World of Chaotic
Orange",PeterVaifl,providedagraphicdescfipfionofthehealthcareenvhmmentwhen
hestatedMorgaflnfionswa-emcreasinglyhmcfimmacondifimof'pumanem
whitewater". Vaillcontendsthattherewassuchaconvergenceofimpellingforces
driving organizationsinmultipleandoften contradictory directions,andthu'ewassuch
arapidpaceofchangetakingplaceallabmrtexecutives,thattheywerelessableto
employ conventionally effective techniques of problem solving and managemmt. Most
wihagreethatnewmdhods,techflques,mdapproachesmrequhedmmdumopuam
srrccessfullyinthe'permanentwhitewater'environment. Thereisalsoaneedfornew

32
ways of drinking and operating, along with well-honed instincts, highly developed
peripheralvision,andskillinrepeatedlymakingthedynamicsystemwork. Vaillwas
alsownvincedthfidnrateofchangeimposedmfiehtunalshuchneofmgaflufions
andonexternalrelationshipsislikelytobeunprecedented (Vaill,1991).

mthecomextofdetermmmgresponsesmmenewenvhmman,afundamenmlquesnon
forbealmcareorganizafiomiswhatwmmimmmresmuees(dme,money),mdwhat
emphasisshmudbemadetomamgemaueducafionanddevelopmemeywhatmeans
shouldthecommitmentbefulfilled? Morespecifically,howwillexecutiveslearnto
undashndmenewpuadigm,thenewdaaminantsfmmccess,mdtheimphcafionsfm
very substantial, even global, externalforcesandimperatives?

Loebs (1993), posed some interesting questions:

CanHeaIthCareorganizationsfacilitatedevelopmentofexecutivesinthe
”permanent white water” environment and provide stimuli for lifelong learning
primarilythroughinternalopportunitiesandprogram?

Howcanhealthcareorganizafionspreparebothcturentexecutivesandtheir
successorsforsuccessfitlperformanceinamuchmedemandingfunne?

Willexistingmechanismbesufficientinwhatisarguablyamakeorbreak
environment?

Ifcmrentmeansarenotsufficientornotapproptiate,thenwhatisneeded?
p.138.

Thosequesfimslendmemselvesmformmgthebasisofsevaalexcenentreseamh
projectsasdieycomaindementswhichmofprimecmcernmachanginghulmcam
environment.

33
Organizations’kesponsetotheClnnginanvironment

RachlisandKushnercamebackin l994inStrongMedicineandstated:
Thefirststepinrebufldingourhealthcaresystemistochangethenuesthat
governhowitisorganizedandfinanced...Asthemles change, sowilltheroles
ofthe various playersinthesystem...new rules, new rolesandsomenewtools -
aflueneededtomakeCanada’shedthcaresysternthebestintheworldmachhs
and Kushner, 1994, p.252).

Cmfimedhrdgetpressmesueexpectedmawelaatechmgeswiminthehomimlsecwr

overthenext20r3years. Senior managerswillhavetograpplewithdownsizing

programs, restructuring betweeninstimfionswithinacommtmityandreformingtheway

inwhichhospitalsaremanagedandoperated.

Someofthemherpresnneswhichm'efacedbyhospimlsmlmg-termcaremfmm, total
systemreconfigmafim,flnincnmenmlhnegrafimofhedthandsodalmices,me
realities of consumerism, community empowerment, community-based sector expansion,
systems thinking, governance, the changing roles of health professionals, the challenge
of managing change, and public policy options of federal and provincial governments.

Somehealthcuemsfimfionsuerespondingmmechangingenvhmmentwithchanges
to management structures e.g. Program Management; delivery methods; delivery foci.
SomeOntarioexamplesareprewntedlaterinthischapter.

Program Management

hmel980s,hospimlsbegmmdevelopprMEt-hnemmagementasawayofcmnolhng
costandrespondingtotherapidlyclmnginghealthcareenvironment. Product-line
mmgementmemsredesigningthemfimflsnucmresomamtumsuvices)
canbecoordinatedandmanagedassepar'atebusineasentitiesmynn, 1991). Product-line
mamgemmtlnsbeenusedinbusinessforovaSOyearsasamamgementsnategym
controlcost(Anderson, 1985; Yano-Fong, 1988). Thereisanassumptionthatcostscan

34
bemmagedmmeefiecnvelywhenmehospimlproduaisdividedmsmaflaenfifiesmd
unhofityfmdedsimmaldngisdecmtahzedmmelevelwhaemesaviceisdefivaed.
Anaherasmmpfimismatfimelydedsionscanbemadebythosewhoueclosestwme
productandhavethemostknowledgeabouttheproductmird, 1988).

Msfimfingmoduct-hnemanagemanohenmvolvesareorgamndmofthesnucnuemd
philosophy of management. Product-line magement requires a decentralized
orgammfimalsu'ucmreramermanthehiaarchical,btueaucmficsnucnuemathas
traditionallyexistedinhospitals(Flynn, 1991).

Intheircontinuingpursuitofquality, effectivenessandefficiency, Canadian hospitalsare
adopting Program Management, or clinical unit management - a modified form of
ProgramManagement-asorganizationalmodels. ProgramManagementissimilartoand
maverylargeextent,thesameastductLineManagemembutappearstohethe
preferredterminCanadianhospitals. Thereareseveralmodelstochoosefrombutthe
onewhichseemstobehighlyfavouredintheGreaterTorontoareaistheonewhich
decenmhzesmenadiuonflchmwsnucnnesandshifmresponsibihtywprogram
managers. Withinthatstructure,allclinicalstaffworkingwithintheprogramare
accountabletotheprogrammanager.

Eachpmgramhasamamgementteamthatisresponsiblefmmanagingaflprogram
resorncestoensurethatanestablishedlevelofserviceismintainedforpatientsandthat
thereisproperutilintionandadherencetobudgetsMilson, 1993).

Program Management represents a significant cultural change for those involved and

perhapsespeciallysoformedicalstafi‘. ‘I‘hesuccessofProgramManagementisbased
upontheabifltyofthehospitaltoidenfifyandbfingtogetherthefightplayas. Program
Management also offers employees greater autonomy and empowers staff to collectively
mkedecisions. Staffaremoredirectlyinvolved,inboththeprovisionofserviceand
intheplanningandimplementationofservices. Asstaffassumenewrolesatthe

35
planningandcommitteelevel,theyshouldreceive additional orientation, training, support
mdmcomagemencasprofessionfleducafimofiendoesnmadm'ersmeseueasMflmn,
1993). Training should not stop at the staff level but should also include management
pasonneltoenablekeyindividualstofuncfioneffecfivelyinthehnewmles. Oneeffect
ofProgramManagementisthechangingofrelationshipsandroles. Thathasbeenone
ofthedifficultieswheninitiatedwithallthesameplayersformanold(matrix)system.
ltisdifficultfortheplayerstoletgoandassumenewroles. Thisneedsahighdegree
of preparationand awell orchestrated implementation process.

Selected Ontario Examples

ItseemsappropfiateMsomespecificOnmioexamplesbepresentedatmisfimem
demonstatewhatacfionshavebeentakentocopewiththenewdemandsofhealth
provision. Avarietyofinstitntions havebeenpresentedasexamples.

Peel Memorial Hospital (Brampton, Ontario)

BruceHarber, PresidentandChiefExecutiveOfficerofPeelMemorialHospitalin
Brampton, Ontariowrotethefollowinginthehospital’sAnnualReportforfiscal
1993/1994:

ltisanticipatedthatthefirtureroleofacutecarehospitalswithinthehealthcare
systemtobequitedifferentthaniscmrentlythecase. Massiverefonnofthe
systemisunderwayandithasbeenaconstantchallengetocontinuetoprovide

arangeofsa'vicesrequiredbyacommunity. ltisequallyaschallengingto
infmmandeducatemepubhcoftheappropfiateuseofheahhcaresavicesand

toshapetheexpectationsofwhatcanrealisticallybeprnvided.

Peel Memorial Hospital adopted Program Management on April 1, 1988 with six
programsandwasthefirsthospitalinOntariotoreachthatleveloffimctioningwithin
thencwstructme(Harba&Goodwin, 1989). ltistheperceptionofthePresidentofthe
hospimlthatthesnucnnalbarfiastoinnovafionhavebeenremovedandthatthe

36
organization is far more dynamic (Thomas, 1990).

Sunnybrook Health Science Centre (North York, Ontario)

Afeahn'ereportinathe TorontoStarNewspapernotedthatSunnybrook Health Science
Centrewas 're-engineeringitsorganizationtoputcustomersfirst; focusingonpatient
care" (Toronto Star, September 5, 1993, Section 61)

TheChiefExecufiveOfficerwasreportedtohavesaidthattheemployeeswillbegiven
mmeresponsibfliflesanddecisimmldngmthmityandthmmuewiHbeareducfionm
thenumberofcategoriesofworkers.IntheopinionoftheChiefExecutiveOfficerofthe
facflity,mechmgeswfl1requhesumgludashipmdmeacquisiflmofasophisficawd
informationsystem.

'I'heActingChiefofService-Nursing,IaneDeIacywasreportedassayingthatthere
wfllbeaneedwspendhrgeammmtsofmoneymstaffmimngmteachpeoplemeskifls
neededtomakethenewsystemwork. Thereisanimplicitinchtsionofmanagersaspart
ofthestafftowhomtrainingwillbeprovided. Ifmanagersareexchrded,thenthe
systemisdoomedmfaihnesincenotmmyhedthcuemanagershaveexpefiencedan
envhonmentomegramMamgemunmdmuchoftheguidanceissdnmthenial-and-
errorstages.

West Park Hospital
InApril 1992, Tornnto’sWestParkHospital, a406—bedcontinuingcareand
rehabilitation facility, joined a growing number of Canadian hospitals that
implemented Program Management. By restructm'ing management and the
delivery of services, hospitals hope to improve accountability and effectiveness,
andbettermanagetheircosts(Monaghanetal., 1992, p..33)

ltisthebeliefoftheauthors,whoincidentallywerethePresidentandtonice—
Presidents, thatprogram-specific planningandmamgement, guidedbyacorporate vision

37
andstrategy,hadstrengthmedWeuPukHospiml’sabflitymrespondmcmrentmd
futurehealthcarechallenges,andtodesignanddeliverservicestomeettheneedsofits
various communities (Monagbanetal., 1992, p.37).

TheCreditValleyHoapital

In a feature entitled, The credit Valley Hospital: A Health Facility Success Story. Special
Supplementto TheGlobeandMail Newspaper, November 23, 1992, the366-bed facility
whichwasopenedonNovemberS, l985joinedtheranksofthoseCanadianhospitals
withProgramManagementasanorganiaational structure. Thefacilitywasreferredto
nMgamodern,dynamic,wmmmhyhospimlprovidingleadashipmmedehvayof
primary, secondary,mdternaryhealthcaresavicestothepeopleofMississaugaand
surrormdingregion.

DeanSane,PresidentdehiefExecufiveOfiicuofmefadhty,hadbeenqumedas
saying, “One ofthe major progressive steps achieved atthe Hospital has been the
inu'oductionofProgrammeManagement' (p5). Hewasfurtherquotedassayingthat
Programme Management was one of the hallmarks of The Credit Valley Hospital’s
efficient and effective functioning. Introduced in 1989 on a trial basis, Programme

ManagementwasexpandedfromfourtotenprogramrnesinSeptember, 1991.

ThePresidentofthehospimlflsostatedthatmergrammeMmgementteamswae
givenmecompleterespmsibihtyandmmmityfmmeopaafimofmeirpmgrammes;
thatteamworkwastheessenceofProgrammeManagementwitheachPhysician Director,
meNmsingDireamandmeAdnumsnafiveDhectmeachbfingingaumquesaofskills
andabilitiestotheeffectivefunctioningoftheteam.

TheCrethafleyHospimlphcestheemphasismcoflabmafimandcoopaafimbaween

programmesanddepmunengandevenmwghngrammeManagementaddedan
addifimflekmentofcompkxhywdnhospimlsuucnnemdmnagementsystemsdtwas

38
felt that the benefits significantly outweighed the costs.

AMBULATORY SERVICES DEVELOPMENT

HealthCueorgaflzafims,whfleimmfingnewmamgementsnuchnesmconnolcosts,
nealsochangingthemethodsofservicedehverymdAmbuhtoryCmismeofthe
methodsgainingprominenceinhealthcareservices.

TheinitiativesoftheMinisuyofl-lealthsupportthedevelopmentofanambulatorymode
ofdeliveryofhealthcareservices. Totakesomespecificexamples,thearronicCare
Role Study (1993) and the Partnerships in Long-Tenn Care (1993), documents released
bytheOnmfiogovanmeanmmotedthedevelopmentofambulatorycareservice
delivery modes. 'l‘heyrecommendedthemigrationoftraditional inpatientcaredelivery
mmbulatoryseningsmdafinmaredefimdmofcMccareresmncesmampon
rehabilitation and reactivation. In particular, they recommended the provision of
ambulatory care and community based supportive living arrangements with the dual goals
ofeimerrelnbflinflngpasonsbackmtheircommumwmofmaimmmgchentsmtheh
homesinthecommunity.

WestPark Hospital

Inthesummerofl993,WestPukHospimlconductedmambulmmyservicesneeds
mtbidenfifycMneedsandwphnforresnncnningmdefiva-ambruamrycam
andservices. Ambulatorycaredevelopmentwouldexpandtheabilityofthehospitalto
meetmespechlmedsofmecflentswhomphysiuflympsychologicaflychaflenged,
andwhorequirearangeofinwrdisciplinaryservices. Developingmoreambulatory
wrviceswmfldalsoemblemefadhtymmpponchentswhoueminmecommnmty
whflemppmfingthehospiml’squestforueafingoppmmmfiesforpasmalniumphfm
individuals(CmndMRepononAmbulamryCareServices,WestParkHospital
Library, 1993).

39
The Credit Valley Hospital

AmajmpmtofthefimnephnmngwithmmeMedicdStafiOrganiufionatTheCredit
VaneyHospinlcmnesumndwnhtlmarymservicestmueasingmovement
awayfromlengthyinpatientstays. Initiativesat'l'heCreditValleyHospitalinchrded,
SurgicalShortStayUnit; TransitionalLevelofCare; RegionalGeriatricsIaboratory;
andRegimflRenflSavices(GlobeandMaflNewspapa,SpeciflSupplemthovember
23,1992).

WORK TRANSFORMATION

WorkTrwrtfomnfionisacuefuflymhesuatedapproachwhrgescalemmfional
change, focusingoninnovative approachestotheway workisdone. lthasredefinedthe
waypeopleconductworkandacceptaccountabilityforresults. Itisafocusedefiortto
improve quality, streamline processes and reduce costs. (Hay Consulting, 1993).

Work Transformation initiatives provide major strategic changes in the delivery of quality
Meme,theredesignofjobsmdworkproceeses,andmedevelopmemthigh-
performing interdisciplinary teams. Work transformation offers the possibility of
improved effectiveness of care for patients, improved work life for individuals throughmrt
the organization, and improved efficiencies in complex work system.

Inl993,dteHayConsulfingGroupwunedthatWorkTmnsformafionmustnotbe
per-ceivedasaneventbtnrama'asmongoingprocessthatsnppmtsconfinuws
improvemensandproactivechangeintheorganintion’sculnne. ltwasdesignedto
complementandsupportqualityimprovementinitiatives. Worktramformationwas
designedmmkeawmprehensiveviewofhowwmkwasbeingcmductedmdmreassess
thedynamicsofmeetingtheneedsofcustomersflnnughorhtheorganizafion.

Worknmsfmmafim,alsoknownasre-engineuing,requiresfummemanshuflhngof

40
positions, a shifting of players, and the creative application of new titles. Although it
appearstobeaboutprocess,worktransformation, whichisgrowinginpopularityisin
reahtyapeopleinifiafivethatfoursesmmehumnsideofhealmcaremostonmd
Vestal, 1994). ‘I‘helong-rangegoalshouldbeastable, financiallysormdorganiutionin
whichqualhy-bothintamsofemployeeworkhfeandpafiemcue-confinuesmgrow
regardlessofthechangesinthefield.

Theprocessofworkumsformafimfitswimmehealthcuemdusnyneedsseeingmat
theprovisionofhealthcareisaverydymmicundertaking. Creatingandmotivating
employeestobemoreflexible,toacceptnewresponsibility,andtoparticipateinthe
worknansformafionproceascanbedifficuhwhhmnsnongleadershipfiomthetop
(BostonandVestal, 1994).

Transforming a health care organintion requires both tangible and intangible investments.
Theeostofmchaprojed,hchdingdireflexpendinnesfmpmjeawpponmdmdima
costsassocifledwififieehgsmfimpmficmmmeprocess,mustbebahncedagamt
thedesiredresults. Ashealthcareissuchahumanresomceindustry,removing
mdividuflsfornm-pafientcareacfivifiesnnngesuhmlesscmemwiflrequinme
replacementofthefreed—upindividuals. ThisisespeciallytrueinaProgram
Mamgememmucnneswhaecatainhealthcareprofessionalsmemployedmsmafl
numbers. Insuchsimations,anydecreaseinstaffatanyparticulartimecouldbe
significanteffectsonpatientcare.

ChangesmorgamnfionalstrucnneasmProgramMamgemenLnewservicedehvery
modelsasinAmmdatmycmeandWorannsformafionorreengineaingrequimthat
aumvolvedmdasmndthegmlsmdobjecfivesofmeeffmtmdthattheleadashipbe
atahighlevel. ltisnotstnficienttochangewithoutprovidingtheedncationaland
trainingsupportrequiredtninformalltheplayers. ltmustnotbeassumedthatthe'old'
playersareconversantwiththerulesofthe'new" games. Aconcertedeffortmustbe
madetoclarifytherules,rolesandpmvidedirectionandsupport.

41
EVALUATION ..... A word to the Wise

In Managing Transition: Making the Most of Change, Bridges (1991) advised that
«Madmslmuldcarefirflysmdytheimpactofproposedclnngesandpmmplace
edmafionalprogramstohelppeopleaccommodatefeehngsoflossofidenfify, control,
meaning,belongingandoptimismforthefuune. Followingnewdirectionsforhealth
cuedehvayiscommendablebutdtereneedstobemevaluafionplmaspmtofthe
differentchangeproceasestopmvideobjectiveassersmentsovertime.

Organizationsexpectingimmediatemcceaswillbedisappointed; thetransformationof
morgadnfion,inchrdingitsinfiastucnne,culnneandmwardsystem,mkesfime. The
mccessandprogressofchangeprojects, whethertheyarecostreductions, improved
mstomasafisfacfimmenhmcedemployeerehfims,mbenmeamredduwghsusmined
resultsoveralongertime,ratherthanatonepointintime.

Mainminingmommdenthusiasmdufingthefimehmkesfiomdesignmrendtscan
be difficult in today’s "results-oriented" environment. It is pow’ble for organizations to
meetmatchaflengebyidenfifymgupfinm,mecrhaiamatwiflbemeamreddunughmn
thepmjectanddesignhgasystemformonitmingandcommumgfingprogress.

Thedevelopmemwduseofmeannesofouqnnmdoutcomemhealmcareareessenfial
forachievinghealthserviceobjectives. Ifdeliberaterationingistobeastrategyforcost
cmflhmengthencuflracksmustbeeffeaedmthetypesofcuewhichhavemelowest
expectedvalue. Expectedvalueisdefinedasmeprobabilityofimprovingtheclinical
uncomennufipliedbythevalueplacedonthatolncomemanenaman&Taylor, 1990).

Ontheotherlnnd,hisneceasary,aswen,towarnagainsttoomuchrelianceon
quantification. Frequent measm'ingcandistortorganintional efforts because,asarule,
someaspectsofoutputaremoremeasmablethanothers. Excessivemeasurementtends
toencmnageovaproducfionofhighlymeaanableitemsandneglectoftheless

42

mamblehhhigflynecessaryonesnsismeusemsomeaspectsofflnprovisionof
healthcare.

Detractors

ltmustbeasmmedmatnmevayonewasenthusiasucabmtthechmgesmkingphcem
healthcareascanbeseenfmmtheexpreasedfeelingofCr-ighton. Inl990,hestated
diatthesphntaingofdieadmmisuafivegrwpmwawholemgeofmbsecfionsraises
anumberofquestionsaboutbormdariesandorganizational design.

mmemficleabmnStmybrookHealdeenceCenne,therepatastatedmatamanager
atthecenuecautionedthatwhileitwasfinefortopadminisnatorstosmdy management
methodsthuworkweumbminess,meyneedmremembermatahospimlisamedical
centre,notaproductionline.

Towudsmecloseofl994,malocdtelevisimstafim,me0nmfioheahhcaresystem
wasthetopicfmthemghflypresenmflmandacommenmmfehmattheOnmiohealth
systemwasbeingdismmdedrathathanbeingrefinedinmferencemtheMimwyof
Health’s effortsathealthcarereform inOntario (CFMT - November 17, 1994 - Dick
Smyth).

Training

Inmeecmonuchtaanne,educafimmdnainingmexaminedmtumsofhuman-capiml
theory. Inmderformindividualmundemkeerhrcafionanduaining,dterehastobe
somereturnfortheinvestrnentoftimeandmoneywhichisbeingused. Themoney
mvesunuuisdhect,mdnformofmchexpensesasnufion,fees,mdbooks,andthe
mvesunentismdhecnmtamsofmeemningswhichmfmgmewhilethepasonism
school (Meltz, 1982).

43

Thefadthflemployerimqestsuelugelyeconomiccamotbeovasmtedashhasa
bearingonpolicyformulationandmctice. Trainingisassumedtobebeneficialtoa
companyinenlnncingthegoalsoftheorganintion(Gutekl988). Whatthatperception
ispopularwiththeorganinfion,managerswhobtnldthenmanagememuaining
objecfiveswithmatphflosophy,wfllglinWLbothfimncialmdotherwise. Denora
(l979),agreedwfidnecommicbasisfmhahhgmdfinmamtedmmbusinessmust
nesteducafimasminvesunem,mdhkemyom«investman,thevalueofeducafion
willbeassessedintermsofitsrennn.

Companiesaresearchingforapaybackonmoneyinvestedinuaining. 'Thequestionof
whetheremployeesneedmm'euaininginevimblycomesdowntofimeandmoney. Will
thefimeandmoneyyoumvestmdayinuainingberepaid-withhuaest-inthenext
week,momh,yemmdecade?'wasmequenimaskedbyfiassen(Hassen,l992p.53).
ByinvestingintheHunnnResource,employersarerealizingthatitisoneofthemost
dependablewaystosolvepmblemsmdukeadvanmgeoftheopporumifiesasthey
present themselves. Employers and employees are now beginning to realize that the
ecmomyismuansifionandasmhmhmforemwafionmdnainmgmustcmsiderskills
thumableflexibflhymdadapmbihtyasweuaswecificjobmlnedskiusmmeafunue
demands(Goffee&Scase, 1992; Senge, 1990a).

ChangingNatureoflobsforManagersofHealthCare

Mamgerialjobsueclnngingandwiflcontinuetochangeevenmoresooverflre
immediate-fume. A1991 surveyeonductedbyTheAmericanSocietyforTrainingand
Developmentmdicatedmn38pacentofexecufivesstatedmmmejobofmemamger
hasclnngedtoagreatorverygreatextentovertheprecedingtwoyearswhilenpercent
predicted thatthe manager’s job will change over the following two years. (National
HRD Executive Survey, 1991; Horton, 1991; Senge, 1990a).

Thefollowingprovidesanindicationofreportedchangesinthejobofthemanager:

44

managing more with less; customer focus; working with Total Quality Methods
increased management of work teams; increased cross-functional work; managing an
increasingly diverse workforce; increased management processes; and
global/international management responsibilities (Horton & Reid, 1991; Noble, 1990;
Senge, 1990; Taylor, 1989).

IfhedmwefacihfiesmmmeamechaflengeofmainmiMngqmfityandaccessibihty
ofsavicesmmepresentecommicmvhmmennsignificammangeswiflberequhedm
mewaymwhichhealthcaremmagasfuncfimsothattheywfllbepreparedmmeathe
needsoffiewmmmitynndprnvidecfiahcahaedsaviceshawflefiecfivemanner.

m1993,Gfieslnberwrotethatfuhueheahhcaremamgaswiflrequiremuchsnmger
skinsmmmgingprofaammauydivaseworkgrmpmdthatdiemcessfiflmmagerof
thefuun'ewillalsobeauansformationalleaderie. leada'swithsufficientvisionto
mficipatedemandsmthehmgarunfimsandwimleadershipqualinesmchmgetheir

Grieshaber 1993, sets the tone with the following comment:

Therapidlychanginghealth-caresystemwillrequiremanagersand
leaders, as well as caregivers, with new sets of skills. Health-care
institutions ofthe 21st century will require managers with different
skills from those at work today. By definition, management
practicewillstillrequirethatresom'cesbeacquiredandused
efficiently to achieve organizational goals. However, the types of
resom'cesandtheorganizationalstrucnnethemselveswillbe
changedinmchawaythatthemixofskillsrequiredoftheir
managers will change (Grieshaber, 1993, p.25).

Thechmacterisficsofmeemerginghealthcareorgminfionhavebeenstatedas
decenualizafion;anemphasisoncafingmtherthancming;andbycoordimfionof
activitiesandresom'ces. Gfieshaberwasconvincedthatthemanagerofthefunn'ewill
besodiffmfiomthemeofmepresentmatifhwerepossiblewcmstructmatfuune

45
managerandplacehimintoday’senvh'onmenthewmddbelessthanasuccess.

Ufuhnehalficaremmagaswiflbemanagingaprofessimaflydivasewmkgrwp,mey
wiflneedtospeakthelanguageofcliniciansandbecomfortablewithmedical
terminology. Themanagerwillneedtobeconfidentintheabilitytoevaluateclinical
resmn'ceneedsonanequalfootingwithclinicians.

Thesuccessfirlmanagerofthefuunealsowinbeauansformationalleader. Themore
healthcuemovesiMflrecommufltthemerespmsivehmustbewmeneedsofthe
comthy.Thehdustywfllneedleadaswifisufficientvisimwanficipatedemmds
mtheirorganizafionsmdwithleadershipquafifiesmchmgeflreirorganimfions. They
wiflalsoneedmposseasmecapacitymdedwimtheuncamintymdcmstamchmgeof
organintionallife.

In an exploratory quantitative research project involving health care managers, LLoyd
(1994), identified features perceived to be essential for effective health care management.
In particular, “key figure“ attributes were described as charisma, commitment and drive -
all of which received high ratings. Leadership competencies are perceived, not
unreasonably, as having significant implications for managerial success. For Lloyd, the
importantpointtoconsiderwasthatthedefinitionofleadershipisheavily influencedby
thehneaucnficculhuewhichpavadestheheaflcaresystemmdwithhwhichthe
majority of survey rewondents operate (Lloyd, 1994).

I.oebs(l993), believedthatMewasachallengeformanagement development of health
wemamgasasheperceivedsupuiorexecufivepafmmancemmemasrequhing
adeepenmderstandingofthesocial, political, economicandtechnologicalforceswhich
areshapingandwillcontinuetoshapetheiroperatingenvironment. ’

46
SkillandKnowledgeNeedsofHealthCareManagers

Leadmhtheprivatesedmmceivemmeformalhainhgmanthencmmterpartsmthe
public sector(Natiomll-IRDExecutive Survey, 1991). Bypursuingcontinuing education
mdpmfeafimaldevdopmenmlacfivifies,mewmpamceandknowledgeofpracfising
healmcm'eprofeasimflswfllbeaiflcflovathenenten(10)yeusmmemessofthe
healthcare system (Carruthers, 1988).

Kamjian(1993),reportedmastudywhichwasconcernedwithfimnedhecfiomm
hedthmmagemeMasexpressedmta'msofskillsandknowledgerequhedmfidfilme
managementroleofthefuture, Findingsfromthesmdyshowedthatformaleducation-
ennylevelandconfinning-wasgenuaflyindicatedtobetheprefaredsomceof
competencefmprepmingleadashhealthcaremmageMmdMsomecompetendes
wereacquiredfinmmulfiplesmucesincludingmmtmsandon—thejobexpaience
(Kazanjian,1993).

Project TEAMS (1980) and Schaaf (1991) have suggested the following as areas of
development for health care managers: management skills re self-awareness, time
managemmt, problem-solving and decision making, accounting and budgeting;
communications, public relations; recruiting and hiring re labour laws, evaluation of
employees and motivation; delegation, personnel management, conflict resolution, stress
management, risk management; and management theory, planning, program evaluation,
change process management, technological management.

Training of Senior Public Health Administrators: Report of a WHO Working Group
(1978), mentioned contimring education for senior public health administrators in the
decision-making and managerial policy areas. Eubanks (1991), reported that although
82% ofChiefExecufiveOfficmsrepmtedthatmeireducafimhadadeqnatelyprepared
themfmfliehmlesasChiefExecufiveOflicustthomecitedweaknessesmmearea
of communication skills.

47

Basedintheforegoing,itcanbeseenthattheneedsformanagementdevelopmentare
manymddiversemdtheremayneverbemagreementastowlntmmemneeds.
Davidson (1993), focused his study on the goals of management development and
descfibedavmidyoftechfiquesfiatshouldbecmsidaedbyheaflcmeexewfivesm
meefingthehpasmalmmagememdevelopmentneedsasweuasmemgminfion-wide
needsoftheirinstitutions. Hefoundthatashealthcareexecutivesmovedtln'ougha
resoucnuingofmehealthdefivaysystem,thehabflhymfomsmservicemthe
communitywasoftenhamperedbytheneedtoensrneinstimfiomlsmvival. He
cmchdedthfimmgaialobsolescenceraisedimpquuesfimsabmnmepfiofityof
management development intoday’shospital environment.

Training, Education and Development

Mamgememmghasbeenreceivingimreasinganenfionoverthepastdecade. A
shrdybyloo(1992),repmteddmthHeaMCareorMufionsonly36%Mtedhavhg
formaleducationpoliciesandproceduresformanagementtraining. Henotedthatonthe
posifiveside,mmyhealmcaremganinfionswereevolvmgmwardsammearficuhted
andcomprehensiveapproachtomanagementtraining. Hefurthernotedthatthe
conshahtofhmhedfundsfortainingwasfiequenflycitedasahinchancetogoal
aminmentGm, 1992). Overall,bothhealthcareandotherCanadianorganizations
recognisedmeimpmunceofmmagementuamingfmachievingmgmiufimalgoalsmd
theyaresu'ivingtoimprovesuchn-ainingmazemk&Clarny, 1991).

Hunt (1990), statedthatthe exponential increase intbe costofmanagement development
wiflleadtomuchfighterconoolsmquahtyandeffecfivenessofthedevelopment
process.‘Evenmmrghmerefaencewasonefiommdusuy,maeismreasonwhthifl
notapplyinthehealthcaremanagementfield. Careerdevelopment,likeother
development functions, is a very complex process. Progress in one’s career is
mdoubwdlysfimulatedmdquafifiedbymemteracfiveefiectsofmtanalmdexwrnal
forces. (Argyris, 1991; Schaaf, 1991; Baldwin, 1990). Simply put, the individual must

48

bemotivatedinordertoreceiveanybenefitfi'omadevelopmentalprogram. Thesource
ofthemotivationcouldbepersonalorjobrelated.

deel(1979),masmdyspecificmmenmlhealmadmimsnamreportedmatmeyhad
continuing educationneedsintheareasof managementandrecords; problem resolution;
projection of needs; education of the public; outreach; and Philosophy.

ThedanfiomWflliams’smdyofl991revealedthatmmanycasetheeducaflonal‘
credenfialsoftherespondentswaemfiddsnotdirecflyrelatedmtheprovisimm
managementofhealthorhumanservices ..... lessthanone-fifihofthesm'veyrespondents
reportedthatmeywerenainedmhealmcareorbusinessz.1hatled
Wflliamsmconchrdematiftheunveyrenfltsmggenedimpmmntgapsmeducauon,
meyflsomdicmedasubmfialdegreeofMdividualmdmsfimfionalsmponme
educationinthefield(Williams, 1991). Theinferencehereseemstobethatanyattempts
nimprovmgthegapswinpmvidebenefitsmtheindividualandmmemganizafion.

On the matter of professiomtl development for health care managers, Aylor (1993),
expressedtheopinionthatitwasquiteapparentthflmgraduateprogramofmy
generation couldpreparepractitioners for a future containingas much uncertainty and
volatilityashealthcareadminisuation. Hefeltthatboththeadministrator’sinterestand
the demands placed up them by their professional life inevitably change over time and
that muchmoreisrequired ofprofessional educationtoenablehealthcareexecutivesto
be effective throughout their careers as obsolescence was an ever-present danger.

Knowles(l980),believedthatifhumanneedswereaddressed,theadultlearnerwillbe
ablemchmbsimulmneouslyupMaslow’shimhyofueedsaswmkwmpaendeswa-e
being developed. Davidson (1993), believed that the most essential purpose. of
professional developmentwastohelptheorganizationmeetitsmissionandobjectives,
mdthattheptnposewasbestmetwhenmanagementdevelopmemwfivifieswaefied
directlytotheorganization’sneedtogrow, renew, changeandmeetwithnew

49
environmental challenges and opportunities.

Mandatory vs Voluntary Continuing Education Pursuits

Many US states have initiated mandatory continuing education for re-licensure for
muses. CannonandWatersfehthatmandatedcontinuingeducafionshouldservedual
purposes: retainingacrurentandinformedbodywhile,atthesametime,promoting
professionalism? (Cannon&Waters, 1993). AsfarasUrbano was concerned, "Required
leunhg'hasevoNedasamahodofcombafingthemreatofobsolescencemampidly
clunging musing profession (Urbano et al., 1988).

InasmdydonebyO’Connorofnmsesasreportedby Urbanoetal. (1988), itwas
conchrdedthatnmsespmficipatedmmndatedconfinumgeducaumfmreasommhted
topmfessimalcmrencymdabflhymsewemmkind,mmanmerelythepresencem
threat of legislation (Urbano et al., 1988). In Urbano’s own study, she found that nurses
whoparficipatedmmmdatmypmfessimalconfinumgeducauondemmsuamdmesame
pattern of motivational orientations as those who voluntarily participated in educational
activities - motivated primarily by cognitive interest and a desire for professional
advancement and competency (Urbano et al., 1988). In 1992, Thruston stated that the
rapid development of technology and expansion of knowledge have made necessary a

frequentupdateofskills.

Urbanosaidthattherewereotherbenefitstoamandatedsystem. Itbadbeensuggested
thmmemandatmquuhememhadgenaatedahrgenumberofaltanateoppommiues
forparticipationinprofessional continuingeducation(Urbanoetal., 1988). Thosemay
haverendtedhalngemyofpmfessiomflymlevavaaflableemrcafimflofiefings
fromwhichnmsescouldchoosethanwouldexistiftherewerenomandatory
requirements.

50
SUMMARY

ForVain,hisimpressimofmeenvhmmemhasbempresentedasa’whhewatawmld’
whichmakecanyingmnofthebasicdutiesoftheexecufivetobeavaydemandingin
termofenergyandtime. Heremindedusthatthoseindividualshaveanothersetof
responsibilitiesanditistotheirfamilies. 'Allofusareconstamlytorninn'yingtokeep
somesembhmeofbalanceinmnhfe-offufliflmgmnstewudshipresponsibififiesm
mnmgamnfimflwmldandfidfilhngmnresponsibflifiesmmufamihesandmourselves
inthepersonalworld. Wearecaughtwithinadilemma' (p.202). He viewed continuing
managememdevelopmentasacompoundingofthedilemma. Heoffered,asasolution,
matbothmemdividualmdmeorganizafionshmudmkethepomtofviewmmmmng
mgemandevdwmemmnmwmethingwbedonemnsideoftheworkenvhmment
mmtsideofworkdufieshrtasmimegralpanofmemandthefime,theexpecmuons,
andflieenvhmmenh'whmeconfinuaflyupdafingmuselvesandreuewingmuselvesm
termsofknowledgeandskillispartofom'basicexpectations.’ (p.202).

Thereisasuongrecogrufionthatthemanychmgesinthehealthcaremdusuyare
causing concerns and that has prompted one health care executive to provide some
encomagementasfollows:

Clnngeofthismagninrdeisnevereasy. Butashardasitmaybe,
it’s going to be gratifying. Patients and their families are goingto
be better served, and employees will face a diversity of challenge
thatwillmaketheirjobsmoreinterestingmoston&Vestal, 1994).

Davidson(1993), alsoprovidedsomeencmuagementwhenhestatedthatnowwasthe
toughesttimeinthehistoryofAmericanHealthCaredeliverytobeahospitalexecutive
duetotheradical change whichwastaking placeacrosstheentirehealthdelivery system.
Forhim,itwasapaceofchangeneverbeforeexperiencedbyhealthcareexecufivesand
becauseofmm,hewassympameficwhedthcmeleadasespedfllyifmeywerefeehng
disorientedanduncertainofthe future.

51

Asamauerofsurvival,healthcaremamgersneedtobeknowledgeablemorderm
successfuflycopewhhtheincreasingnumbersofmn-nadifionalworkersmthe
workplaceaswellastomaintainacompetitiveeconomicposition. Futurehealthcare
mmgaswiflrequhemuchsflongerskfllsinmanagingaprofeesiomflydivasework
grmrp(Grieshaber, 1993). WithmanagementstrucnnessuchasProgramManagement,
unhteamsarecomposedofmdivimnlsh'ommmyheahhcaredisciphnesmdwmudnm
bereporfingmamanagemanpersonofthesamedisciphneasisnormaflymecasein
differentmamgementstrucnn'es.

Asorganintionsrestructureandre-engineer forincreasedefficiencyandeffectiveness,
mganinfimalpressmewiucausemmentmamgusmreevaluatemenownleadership
skills. Managerswfllneedassismnceinmainminingthenrequiredknowledgeandskiu
levelmdthatassisflncecanbeWinmnyformstusthavethempmofafl
meplayerssothattheneedsofallweremet. Thosewhocanfindwaystoimprovetheir
skiflswiflsrnvivemdmeywihbeseekingguidancemdassistancefiomesmbhshed
educational instimtionswhichwillbeforcedtorespondwithprogramstostimulate
imaginationandmeettheneedsofthestakeholders.

Chapter3,whichfollows,providesadescriptionofthedesignandmethodologyofthe
studyandalsoincludesadescriptionofthepopulation, anveydesign, information

CHAPTER3

DESIGN AND METHODOLOGY

Theimentofthesurdywasmdocumenttheopmionsandpercepfionsofhealmcare
mamgasmspecificaspectsofcmfinmngeducafimmddetaminehowmosepercepfions
mdopiflonsaffectflrepracficeofprusuingcmfinuhgeducafionmdprofessional
developmtactivitiesinthefieldofhealthcaremanagement.

Thischapter providesdetailedinformationontheresearchmethodology which wasused
bytheresearcherinthecollectionofdata.

DESIGN OF STUDY

A survey research methodology wasusedtocollect data. Therationale for using survey
researchmachievethepruposeofthesutdywasmmmeresearcherdidnotseekm
explain relationships, to test hypotheses, or to make predictions. Instead, the intent was
topresemmeperceptionsandopinionsofhealthcaremanagersonsomespecificsaspects
of continuing education and professional development. The plan was to obtain the
perceptionsandopinions of healthcare managers regarding perceptions of needs, barriers,
perceived benefits, mandatory vs vohmtary practise of continuing education, facilitation
role, motivators, reasonable expectations, skills for the future health care manager, and
suggestions for skill development in the experienced manager. The questions were
providedinmoredetailinChapterlonpage 15,andacopyofthequestionnairewas
providedasAppendix B.

SAMPLE

Thesamplewastakenfromapoolofapproximately900healthcaremanagerswhowere
employed by hospitals in major university cities in Ontario, Canada. Managers in major

52

53

university cities will probably have different access concerns regarding suitable
educational opportunities. There are five Ontario cities (Toronto, London, Hamilton,
Kingston and Ottawa) with large universities which offer a medical program and also
post-graduatedegreesmhealthadminisuafimmd/mbusmessadmhusuafimmdlm
public administration (M.H.A., M.H.Sc., M.B.A., & M.P.A.). Appendix C is a map
ofsouthernOnmfioandthecifiesmenfionedinthesmdycanbelocatedthereon. The
individuals were selected from The Members Directory 1993-94 of the Canadian College
of Health Service Executives (CCHSE). The directory provided full mailing addresses -
homeorbusinessasselectedbythemember. HealthCaremanagerstendtobemembers
of the College which offers several membership categories. An attempt was made to
havethesamplereflectthepopulationregarding maleandfemaleproportionbutno
attemptwasmadetobalancethesamplesizeforeachofthefivecities. Lemieux-Charles
(1994) and Storch (1988) found that the ratio of females to males in health care
managemem was about 3:2. The sample size was one hundred and eighty-nine
individuals comprising of ninety males and ninety-nine females. The sample was
randomly selected. Distribution for the five cities was as follows:

Hamilton - 8 males and 13 females, totalling 21;

Kingston - 10 males and 5 females, totalling 15;

London - 14 males and 11 females, totalling 25;

Ottawa - 17 males and 15 females, totalling 32; and

Toronto and vicinity - 41 males and 55 females, totalling 96.

A total of nine surveys were returned as undeliverable making the effective survey sample
one hundred and eighty. Please refer to Table 3.1 on the following page for more
details.

namesake—LL. 2L. 3 commence.— oLmES 05 .Le 3&3 Lg nonsmgm o

thupuoaoemumufizuz

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

co No X” on L me mm a L. N am L too co mLSoh

we mm 2 on em on L. m N 3 mm L». OPZOKOH

N L o o L n 3 L. L L L c mm m L L. L <3<E

N L a v nu L L vL c c 6 mm L L 3 2820..—

LL v L. m L m L: c o a mL m L: ZOFmOZLvL

ML a v on NL LL L L e LN m L w ZOH1L=>L<LL
.L. n— 2 .L. n— 2 "L .Lt “L E ADLUL

25:3— 0533 monofiLoD LuoLoZLouaD Leon axotsw couscou—

 

 

 

 

 

n—MOUQM gzzopmmba . n.n 03-h.

 

55
SURVEY DESIGN

Thepfimarymethodforcouecungdamfiommehealmcaremanagersmcludedinthe
samplewasaquestionnairesurvey. Acopyofthefullquestionnairecanbefoundin
AppendixB.

The self-administered questionnaire was divided into eleven sections to facilitate easy
completion,dataprocessingandamlysis. Eachsectionwasthensub—dividedwithitems
rangingfromeighttoseventeen. Thefirstninesectionsofthequestionnairesolicited
opinionsonthestatementsofinterestwhilethelasttwosectionsweredesignedtocollect
demographictypeinformation. Therating scalewas constantthroughouttheninesections
whereopinionsweresolicited. Alikertscale,withvaluesfromlt05,wasuti1izedfor
expression of level of agreement/disagreement: 1 = Disagree Strongly; 2 = Disagree;
3 = Neutral; 4=Agree; and5 =AyuS®ngly.Thelengthofthequestionnaire
allowedforcompletioninlS-zominutes. Spacewasprovidedattheendofthefirst
ninesectionsforparticipantstoaddcomments.

Thereseamherdecidedmconsuuaannveyquesfimnaimafiermuchsearchingfman
appropfiateinstrnmem.1heinvesfigatmdidnmfeelthatmyofthecommerciany
available or published instruments would have solicited the information needed, especially
asthissurdywasnotareplicationofapreviouswork. Mucheffortwasputintoa
lhaahueseuchmdthengleanhgfiompublishedarficlesmemmmmueasofmtaen,
especiallymoseareaswhichwaegivenmuchanenfionmmemferencedhteraune. It
istheopmionofmemvesfigatormmmemsuument,ascmSchted,wasmebenmolfm
thetopicunderinvestigation.

EvayeflonwmmadewcmmuammmumthWaspleasingtotheeyesoasm
encwrageparficipafion.1hehymnwasdoneinapainsmkingmmavoidsmall
printsandclutter. Toassisttheprocess,theratingscalewasrepeatedatthetopofeach
page. The researcher avoided words and phrases which might prove offensive and which

56

werenotconsideredpoliticallycorrect,inaneffortnottooffmdanyone. Oneindividual
statedsomcobjectiontothefactthatademographicitem10.7requestedinformationon
culmralbackgrumd.

mtheleua'oflnmfion(AppendixA),pardcipantswaeassuedofamnymitymd
confidenfiahtyandwaeukednmmidenflfythemselvesmmequesfiomairebtnthey
wemmvitedtomakeeonmctwimmeresearcherifmeywishedmpmvideaddifimal
informationorbecontactedforodierrelatedreasons. Theyweretomaketherequest
aherthanmtheauveymsuuman.Atelephonecmmctnumbaandhomeaddr-esswere
providedontheletterofintroductionandonpagelofthequestionnaire.

PRETEST 0F SURVEY

Themeymstrumentwasreviewedbyaselectedpanelofexpcrtswnsisfingof
psychologists who specialize in measurement and evaluation, and health care managers
andeducatols. Fifieenindividualswereinvolvedatthisstage. 'I‘hereviewerswereasked
mevaluatethemveymsuumemmmhfionmundersmndabflityofmsuucfionsandthe
clmitymdcompletenessoffiequesfions.TheMcaremmaguslmdtheaddifimfl
taskofcompletingthequesfionnaireasweflaspmvidefeedbackonclafityand
undermdabilityofthequestions. Basedontheresponsesandcommentsofthe
reviewerschangesweremadetothedmftquestionnaire. Thefeedbackfromtheexpert
panel was very helpful in providing suggestions for clarity and some very necessary
changesormodificafionswa'emademmemsuumentbefmeitwassentommthefinal
form. Theresponsesfiomthehealthcaremanagaswereanalysedforrefiahifltyofthe

items which composed each question.

57
DATA COLLECTION PROCEDURES

'I‘hesm'veywasaddressedtoonehundredandeighty-nine (189)healthcaremanagers
whowereemployedby hospitalsinfive Ontariocitieswherethereare large universities
chhofiaedprogramsmmedicmeandpost-graduamdeyeesmManmeusiness
and/orpublicadministration. Graduatesfromthoseprogramsareknowntobeemployed
ashealflicmemnagas.1heresearcha,beingacerfifiedmembaofmeCanadian
CollegeofHealthServiceExecutiveshadaccesstoapoolofabout900individualsfi'om
which to obtain the randomly selected individuals.

ThequesfionnairewassentmnmearlyFallofl994withmeintemofcapmdngthe
auenfionofpmenfialrespmdentsmcemeyhadseuledbackmtomehworkroufimafier
thesummerandbefmebecomingmoinvolvedintheholidaybreakinDecember. Data
were collected over a four-week period.

Therespmdentswereaskedmreuunmecomplaedquesfiomahemmeresearchermme
envelope which was provided with the survey instrument and were instructed to keep their
responses anonymous. No one wished to provide additional information by way of
pmalmviewsbutthecommemwfionsoftheinmmentwa‘eusedandsome
individualscommentedthattheyfoundthesurvey interestingandwouldbeexpectingto
seetheoutcomes ofthe study.

DATA ANALYSIS

Descriptive statistics were used toanalyze responses to the survey questions. Comments
andadditional informationprovided wereanalyzedforcontentandsummarizedaspart
ofthereport. Thedemographic informationwasusedfordiscriminantanalysisuSing
AN OVA (Analysis of Variance). Investigation was made into the inter-relatiomhips of
the demographic variables and the attitufinal scales.

58
Descripfivemflysiswasobtfinedfmuchmmmuchsecfimofmequesuonmhe.
For enchatfimdinalscale,amflabflhymalysiswaspaformedmmdermdeterminethe
Cronback’sCoefficientAlplm(inter-nalconsistencyofthe scale). Thisprovidedsome
assmanceflNeachitemmthesedewasmeasmingwhattheenfirescaleprupmtedm
measure. Witbareliablescale,thereisaasurancethattherewasnoanalysisof

extraneousmaterial.

Afactoranalysiswasalsodonemeachscalemobminadetaminafimofwhahaeach
scale measuredonlyonedimensron Thefactorscoreofeachscalewasusedasa
dependentvariable forfm'therdiscriminantanalysis. Usingfactorscoresasdependent
variables allowed for the use of discriminant analyses such as ANOVA and MANOVA
(Multivariate ANOVA) and multiple regression to determine group differences e.g.

gender difference, education, experience, age, culture, etc. The questionnaire provided
foraminimumofl36datapoints.

The data collection and analysis from the study was extensive and required extensive data
management and statistical analysis. The MINITAB Statistical Soflmre package was used
for most of the analysis of the data. MINITAB is a highly fimctional, relatively easy-to-
usestatisticalsoftwarepackagethatprovidesawiderangeofbasicandadvanceddata

analysis capabilities. The MINITAB Statistical Software provides a system for organizing

andanalyzingdata, andreportingresultsinstatistical analysis.

Thestudywill providedatawhich couldbeappliedindecision—makingandplanning for
continuing education for health care managers.

VALIDITY AND RELIABILITY

EnsuingvalidityofthesmveyinshuMwasveryimportamtothissmdy. Theintent
ofeachquesfionshmddmeanthesameMgstoanrespondentsandthatresponses

59
correspondtowhmtheyaresupposedtomeasmeordeterminemestandxhan, 1986).
In this study, an attempt to assure 'face' validity was made through the expert panel.
Each memberofthepanelwasaskedtocommentontheclarityofinstmctions,the

understoodengmmtentofeachquesfionmdalsomwherencymdcompleteness
ofthe surveyasawhole.

Refiabifiryismedegreeofcmsistencymatmemsuumentdemmsuatesmest&m,
1986). It is the extent to which individuals in comparable positions and situations will
respond in similar ways. In this type of survey design, good questions are reliable
providedthatthereiseonsistency inresponseincomparable situations. Inorderwords,
respondentswillprovidemesamemswerifmequesfionmhewereadmmisteredat
different intervals of time or in different situations. Providing consistent wording and the

use of easily understood terms will go a long way in maintaining reliability. That was

another area where the expert panel provided some valuable assistance.

Initial return was very encouraging with a receipt of a number of completed
questionnaires on a daily basis within a week of mail-out. Some strategically placed
telephone calls resulted in about 8 responses after the initial flow was stemmed. The

final return of usable responses was 96 of 180 assumed delivered i.e. 53.3 96. (Nine
questionnaires were returned undelivered).

Ascanbeimaginedwithastudyofthistype,thereportconsistsoftabularpresentation

ofthematerialwithexplanatorytextandispresentedinmoredetailinChapter4which
follows.

CHAPTER 4

ANALYSIS AND INTERPRETATION OF THE DATA

Introduction

This chapter reports the data collected from ninety-six health care managers in five major
Ontario cities. The focus ofthe study was Management in Health Facilities: The Issue
of Skill Development for Managers of a Changing Environment and the purpose was to
identify anddescribefactorswhich may impactonindividual effortstomaintaincurrency
of knowledge and skills while meeting the needs of the future health care environment.

Research Questions & Interpretation of Findings

The following nine research questions were identified because they represented the areas

of interest of health care managers and researchers in the areas of continuing education
and professional development:

Question 1 -Whatweretheperceptionsofhealthcaremanagersregardingtheneed for
continuing education and professional development?

The managers agreed that continuing education and professional development should be
a requirement for all health care managers. Senior Managers and CEOs were provided
assub-groupsofmanagersbutyettherewasastrongindicationthattheyshouldbepart
of the group of managers for which continuing education was a requirement. Advantages
ofcontinuing education for health care managers were indicated for individuals who had
been away from formal academic education for greater than three to five years, so that
theywouldbekeptcurrentinmanagementissues. Itwasalsoagreedthatmanagers
without formal academic credentials in health care management or in general management
had a need which could be met via professional development.

60

61
Amkingofmedamshowingresponsemeanfmeachitemofthequesfionregarding
perception of need revealed that item 1.10 (4.604) produced the highest level of
agreement followed by items 1.9 and 1.1. The item receiving the lowest level of
agreement was item 1.7 with a mean score of 3.316 which was jun above the neutral
ratingof3 (Table4.l.0). Theoverallresponsemeanforthequestionwas3517andthe
numberofvalidcaseswas90. Themanagers showedsomeambivalenceinresponding
toitem1.7whichstatedmatconfinumgeducadonshwldbenlatedmexpefiencelevel.

TABLE 4.1.0 - Response Mean For Each Item OfQuestion l.
PERCEPTION OF NEEDS

Continuing Education for health care managers

 

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noun-quantum“.-

 

 

 

 

Ian-gents
“mill-IV. 2Jill!“ S-NIIIIII: “A": LUIS-Ii:

62
Table 4.1.1 - Valid Responses, Response Means and‘Standard Deviation - Question 1

vum name - an.
r 2 s 4 s
m 1.0 2.: 3.1 an cu m 0.153

1.305)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

libs”:
kWh-fly; this; Lu; O-A'ue: S-A'Uhfly

QuesfionZ-Whatopinionsweresharedbyhealthcaremanagersonthefactors (barriers)
which hampered their ptu'suit of continuing education activities?

Therespondentsofthesmdywereabletoprovideahigh level ofagreementonwhich
factors negatively impacted on their attempts at continuing education activities. The top
choices are presented in Table 4.2.0 which is a record of the Response Mean for each of
theten itemsonuestionZ. Thepopularchoiees forbarrierswereitems2.5 -costof
courses, conferences and related activities (3.989); 2.1 —job wont load (3.965); and 2.7
personal responsibilities related to home life (3.667) were the top three barriers chosen
from the list of ten provided. The lowest scoring item was 2.8 - managers perceiving
continuing education to be of low personal value (2.663). The other item scoring less
than 3 wasitem2.6-theperceptionthatcontirmingeducationisnotvahredby
employers. TheoverallresponsemeanforQuenion2was3307andthenumberofValid
cases was92. Ambivalencewasshownbythemanagerswhenchoosingitemssuchas
inadequatecomseoffuings,dismncefiomhome,melowprobabihtyofmcreased
financial reward for their'efforts at professional development and whether continuing

63
educationwasnotperceivedasanexpectationbyemployers.

ltispossiblethatmanagerswerenotsurewhetherornotcourseswereavailableorthey
hadnotdonemoughinvestigating. Somewritteneommentshadindicatedashortageof
appropriatecomseoppormnities. Underlyingtheambivaleneeisaneedformanagersto
project a positive image of themselves regarding their willingness to pursue developmental
opporhmifles.1hemspmdentsmigmwhavewishedmgivememdieafionthatsome
healthcareorganizationdonotvalueprofessionaldevelopment, eveniftheyfeltthatway
basedonthelackofsupportinsomespecificsituations.

TABLE 4.2.0 - Response Mean For Each Item OfQuestion 2

 

 

 

 

 

 

 

 

 

 

 

 

 

BARRIERS
Continuing Education activities by health care managers are negatively irrmacted
by
2.1 pm 3.“
a: won-um am
2.3 hall-I. 3.3“
2.4 “ah-uh 3.319
2.3 mdmmdlfld“ 3.”
1.6 umuu—qmaumnw 2.719
2.? "manual... 3.“?
2.3 “Me-mmmbdhp‘fl m
2.9 humans-ammonia.) an:
2.10 “unuhMIIWHW 3.32
luau:

bum-m; z-M L“; 445.; MAI-"y

64
Table 4.2.1 -Valid Responses, ResponseMeansandStandardDeviation-QrestionZ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“Bab:
l-Dbumy. z-m 34”: 4-A'us; LAC.”

Question3-Whatbenefitswereperceivedby healthcaremanagersinthepursuitof
continuing education and professional development activities?

The choices for perceived benefits were made from seventeen items. The top five were
items 3.3 - increased opportunities for net-working (4.253); 3.1 - currency of
information (4.232); 3.4 - increased self-esteem (4.021); 3.12 - increased job knowledge
(3.979); and 3.7 - improved management skill (3.884). The lowest ranked item was 3.2
- increased promotability anternal) (3.305). No item received less than a neutral score
(Table 4.3.0). The overall response mean for the question was 3.750 and the number of

valid cases was 94.

mmisquesfim,maewaeomytwoitemsmwhichtherespondentsreactedwithsome
neuhalhymdecidingmevalueofmcreasedpmmmflitywhhtheirmgminfionand
mcreased' performance apprarsal' rating. Increased opportunities" for mternal’ promotion

65
mightnotbeperceivedasapossibilityduetothedecreasingnumberofmanagementjobs
duetodownsizingofhealthcareorganizations. Asfarasincreasedperformanceratings
go, thepereeption here was that in situations where performanceappraisalswere regularly
done, the managers have been rewarded for job tasks rather than developmental activities.
A mix of both would be valuable in providing some encouragement for the pursuit of
professional development. Until employers demonstrate that management development
isvalues, therewillalwaysbealevelofdoubtonthepartofthe managers.

TABLE 4.3.0 - Response Mean For Each Item Of Question 3

PERCENED BENEFITS

Continuing education for health care managers provides for . ..

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.11 hump m an
3.13 wean-anagram 3.119
3.14 rum-u M an am I
3.15 W unsun- 3.1m '
3.16 was” 3.45: i
an hymn-haunt any 3.611

fir m

I'M-"y; Luna; 34rd; Hun; s-ma—uy

66
Table 4.3.1- Valid Responses, Response Means and Standard Deviation - Question 3

MI— vumam-n-ua Inn-sl— hum
clut-
: 3

3.103) 1.1 3.1

37.9

1.4

13.?

NJ

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13.2

 

mm;
l-Dbnamy; z-m 34¢“; 4-A'aa; S-mm

Question 4 - What were the opinions of health care managers regarding mandatory vs
vohmtary pursuit of continuing education and professional development?

Managers were more explicit in the written comments in stating their negative opinions
of regulations which mandated continuing education. In the numerical rating of the
available choices from the items of the question, the highest rated items of the twelve
were 4.5 - I regularly pursue continuing education and professional development activities
(4.344); 4.3 - I do not need a mandatory continuing education program to motivate me
to pursue continuing education activities (4.115); and 4.12 - Continuing education for
health care managers is a critical factor in the We success of the organization (4.000).

67

Thelowestmmditemwas4.9-Salaryincreasejbrheahhcannmnagersshouldbe
basedon thepursuitofaccredited continuing education (2.740). Therewas no other
scorebelowtheneutralrating. TheoverallresponsemeanforQuestion4was3.545and
thenumberofvalidcaseswas94.

Fourofthetwelveitemswerescoredintheneutralrange. Itwouldappearthathealth
earennnaguswaenmcomfomblemmppmdngdrepmsuhoffmmaloraccredited
programsofcontinuingeducation. Theyindieatedsomediificultywithendorsingthe
befiefmatammdatmyprogramofconfimungedueafimwmddbebeneficialmmehown
development. Thestatementmathealtheareorganimtion withmandatedcontinuing
educafimrequhementswmfldbeassuedawmpefifiveedgecausedsomeuneasmessfm
managers. Ingeneral,manymanagersdonotperceivehealthcareasacompetitive
environment,nordotheywishittobeso. Theresponsewouldbeverydifferentifa
differentwordwaschosentoreflectthehealthcaresysteminanon-competitivemanner.
Hedmcammmaguspmfermprojeatheirorganizafionsasbeingprogressiveand
evaluate how well they are meeting the needs of clients and the community.
Organimtions would not be competing for clients but be striving to compete for survival
inthefaceofscareresources. 'I'hevaluesofhealthcaremanagerswillneedtochange
toadoptsomelevelofcompetitionevenifitisnotexpressedassuch.

68
TABLE 4.4.0 - Response Mean For Each Item OfQuestion 4

MANDATORY vs VOLUNTARY

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“a

 

 

 

 

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an”:
t-D-Iamy; 2.0”“; 341d; 445's; hm”:

69
Table 4.4.1 -Valid Responses, ResponseMeansandStandardDeviation-Question4

0‘..- VAqu-l-e. ml. "0m
CN‘
1 2 3

4.1 m 3.1 13.0 3..

4.2 (Q 3.1 3.2 3.4

43 on 1.1 10.4 4;
4.4 on 1.1 21.0 3.4
4.300 0 4.3 1.1
4.000 1.1 3.2 21.3
4.193) 3.4 :11 13.4
4.193) 1.1 . as
4.000 12.3 33.3
4.1099 0.3 . 313 33.3
4.11 m 1.0 . 30.3 43.0

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Inhabit-Is:
bun-my: Louis; 34!“: 04"; s-A'Iawy

QuestionS-Whatweretheopinionsofhealthcaremanagersastowho shouldassume
the role of facilitating their continuing education and professional development?

From the choices provided, health care managers were fairly confident in their choices
of responses. For facilitation, the primary role was assigned to employers for facilitating
continuing education activities for health care managers (item 5.1 with a response mean
of4.4(I)). Nextwasitem5.6whichstatedthateachhealthmremanagershada
responsibility to facilitate his/her own continuing education activities (4.295); The third
level was formd in item 5.8 which stated that educational institutions shouldjhcilitate
continuing education activitiesjbr health care managers (4.289). The lowest rated item
was 5.5, which stated that employers should firdlitate continuing education aaivitiesby
giving bonuses to participants (2.253). The only item which received a neutral rating
was 5.2 which stated that employers should facilitate continuing education activities for

health care managers by oflEring FULL financial support (2.926) (Table 4.5.0).

70

Healthcaremanagersshowedalevelofdiscomfortwiththeideaoffullfinancialsupport
foranacfivityfiomwhichpersonalbenefitsworfldaccruefortheparficipants. The
concernswasgreaterifhwasperceivedthatfinmcialsuppmtwmddprovidean
mappmpfiatemcenfivefmhealthcaremamgerintheirptusmtofpmfessional
development. Therewasalsoarecognitionthatintimesoffinancialreshaints,support
forprofessional developmentwaslikelytodecreaseconsiderably. Theoverallresponse

meanforquestionSwas3.736andthenumberofvalidcaseswas83.

TABLE 4.5.0 - Response Mean For Each Item Of Question 5

FACILITATION ROLE

 

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3.1 ‘
3.2 mmmammmuumwn H
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3.4 ammmmmwumrwmn
“a 3,93 ;
3.3 WHWMMWhWWDW I
2:33

3.6 manna-mummmmm I
activates 4193 i
3.1 mmmumflmmaymm :
Mic”! 4.021 ‘

3.3 wmwmafiqwmhum

”I

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l-hmy; 24”.; 344“; O-A'Ia; S-mm

4.2”

71
Table 4.5.1 - Valid Responses, Response Means and Standard Deviation - Question 5

 

 

 

 

 

 

 

 

 

 

 

 

m _ VAIJD am - PU“ - h ”I Duh!-
& N 3&-
1 2 3 4 3
3.1 (93) 0 0 1.1 37.9 41.1 4.4” 0.314
3.2 (93) 7.4 34.7 24.2 ”.3 8.4 2.9” 1.113
3.3 (93) 0 11.6 12.6 33.8 ”.0 3.842 0.879
3.4 (93') 0 9.3 18.9 44.2 27.4 3.83 0.916
3.3 (93) 18.9 44.2 29.3 7.4 0 2.233 0.8”
3.6 (93) 1.1 1.1 6.3 ”.3 41.1 4.293 0.727
3.7 (93) 2.1 3.2 12.6 34.7 21.4 4.021 0.830
3.8 (83) 0 0 7.2 36.6 5.1 4.289 0.393
I“ It:

bunny; LM 3d”: hm 34"”,

Question6-Whatweretheopinionsofhealthcaremanagersastothefactorswhich
would facilitate or drive their pursuit of continuing education and professional
development?

Top rated motivators among the choice of thirteen were items 6.4 - ifierlt my skills
would be enhanced (4.219); 6.8 - ifJ felt the need to increase my marketability (3.938);
and 6.1 - ifi.programs were accessible (3.734). The lowest rated items from the group
of 13 were, 6.13 - iferlt secure in my position (3.147) and 6.7 - if..Ifelt insecure

about my fitture with my present employer (Table 4.6.0).

Therewerenoscoresbelowtheneutral rankingbuttherewerethreeitemswhich were
ratedatthatlevel. Themanagersdidnotwishtoappearoverlyconfidentinassuming
lifetimeemploymentofcm'rentpositions. Atthesametime,meydidwishtoexpose
mehmsecufifiesmgardingjobsecmitymrmdicatemmywaythmmeyweredependent
onorganintional policiestomotivatethemtoincrcasetheirknowledge. Theoverall
responsemeanforQuestion6was3.611andthenumberofvalidcaseswas90.

72
TABLE 4.6.0 - Response Mean For Each Item Of Question 6

MOTIVATORS

I WOUID WCREASE MY PARHCIPA ”ON IN CONTINUING EDUCA HON IF. . .

 

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gnu-mammal”

 

 

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lflhuetuuthI-yp—m

 

[uh-040mm)“,

 

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Waikiki-shah

 

 

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Table 4.6.1 - Valid Responses, Response Means and Standard Deviation - Question 6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

73

Question7-Whatweretheopinionsofhealthcaremanagersastowhatwouldbea
reasonable expectation of their pursuit of continuing education activities?

'Howmuchiseumrgh?'wouldbeaquesfiontoanficipateinmydiscussiouwhich
preceded any policy wring to plan for professional development. There were ten items
formingthechoicesforreasouableexpectations. Thehighestrateditemswere7.2-
Health care managers should be required to attend at least one professionally related
activity per year (4.234); 7.7 - Health care managers should be allowed to set their own
continuing education goals (3.915); and 7.8 - Secondment to another organization should
be considered an appropriate educational activity for health care managers (3.863). The
low scoring items were 7.4 - Health care managers should be required to publish at least
one article in a profissional journal every year (2.389); and 7.9 - Health care managers
should be expected to follow educational activities specific to a clinical discipline (2.642).

Therewaedueeotherlowscmingitemsandtheywereallmlatedtoreseamhand
publication (Items 7.3, 7.5 and 7.6) (Table 4.7.0). Fifty percent of the responses were
ratedintheueutralzoue. Thisshowsahighlevelofindecisiouamongtherespondeuts.
Managersdemonstratedaneedtoprojectawillingneastodecideoulevelsofactivitybut
thereweredifficultiesindecidingouthoselevels. Theneutralresponsetothe
expecmhonmatheahhcaremamgaspmsumgacfiviueswhichwerespecificinmmre
mfleasomeumesolvedcmflictfmmanagaswithachmwbackgrmmd.1haeappems
tobeash'ongallegiancewiththecliuicaluainiugforthosemanagerswhowereso
trained. Forindividualsdirectrepmtswaemostlychmwmerecouldbeadeshembe
currentinmattersrelatiugtothediscipliue. Individualswithacliuicalbackgroundand
who belong to a regulatory college, might have a requirement to prune professional
developmentactivitieswhicharedisciplinespecific. Theoverallrespousemeanfor
Questiou7was3.243andtheuumberofvalidcaseswas86. ’

74
TABLE 4.7.0 - Response Mean For Each Item OfQuestion 7

REASONABLE EXPECTATIONS

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1..

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33-3.

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Ids-em

 

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Oaths.

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Table 4.7.1 - Valid Responses, Response Means and Standard Deviation - Question 7

 

 

 

 

 

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75
Quesfion8-Whatfuuneskiflswfllbemquiredbythemamgasofhealthcaminmder
to function and survive in the face of change?

Thereqrmsemeansofmeelevenitemsshowedmatthemanagasagreedmdagreed
sumglywithaflthesuggesfionsforfuuneskillsofthehealthcareenvuonnwm. For
fuhneskills,niueoftheitems(outof11)wereratedabovea4(agreetoagreestrougly)
withthetopthreebeing 8.2- Communication (4.802); 8.1 -Leadership (4.677); and
8.7 -Results Management (4.563). The lowestranked itemswere 8.9 - Compliance to
Standards(3.990) and8.10 -Teaching/Instructional (3.969) andtheywerebothcloseto
a4rating(Table4.8.0). 'I‘heoverallrespousemeanforthequestionwas4.426andthis
indicated a high level of managers’ confidence in their knowledge of what was expected
tomanageinthehealthcareindustry. Perhaps,therewasanindicationfmmmanagers
whatskillstheywouldbepreparedtodevelopforthemselvesaudmggesttoother
individualswithaninterestinhealthcaremanagement. Theskillschosenwouldbe
transferable to other types of management situations thus adding flexibility for managers
whomightwishtoaddtotheirmarketability.

There was an awareness that preparation for teaching and providing instructions could be
time-consuming. Therewere indicatiousthroughouttherespousesandthecommeutsthat
timewasascarecommodityinhealthcaremauagement. Healthcaremanagerswould
mwmgmcmwaMMcMgmlemmdividualswhopoesessedmereqturedskiflmd
training. Theuumberofvalidcaseswas94.

76
TABLE 4.8.0 - Response Mean For Each Item Of Question 8

FUTURESKILLS

In order to survive in the face of change. health care managers will require the
following skills . . .

 

 

 

 

 

 

 

 

 

 

 

 

 

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Table 4.8.1 - Valid Responses, Response Means and Standard Deviation - Question 8

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

77

Questiou9-Howcantheskillsneededbythehealthcaremanagerinthefuuue
organizationbedevelopedintheexperiencedhealthcaremanager?

Theskiflsrequiredforthefirunewaeideufifiediutheprevioussecflonanddus section
provided the favorued methods for developing those skills. Fourteen suggestions were
providedasthebasisfortheresponsesforsldlldevelopment. Thetoprateditemsofthe
14 were 9.10 - Attending workshops with a specific fircus (4.263); 9.11 - Attending short
courses - 1-4 days duration (4.221); 9.1 - Self-directed individualized programming; 9.3
— Pursuit of current health administration programs (4.000) and; 9.5 - 0n the job
training WITH a mentor (4.000). There were two low scoring items viz. 9.13 -
Attending residential programs. - 6 weeks or more (3.500); and 9.2 - Formal
undergraduate courses (3.526) (Table 4.9.0). These responses reflect the preferences of
health care managers to ptrrsue developmental activities that would not take them away
from work and personal responsibilities for extended periods of time. Formal
uudergraduateprogramswmddbenmbenecessaryfmthemajontyofbealthcare
managersduetotheprevalenceofgraduatedegreeholders. Fromthecommeuts, itwas
mdicatedmatmdm‘gr'aduatepmgr'amsdonmwessmilymeatbeprofessimal
development needs of practising health care unnagers. Flexibility and focus were the
desired characteristics of professional development programs for health care managers.

Item 9.6 was the only one which achieved a neutral rating viz. on the job training
WITHOUTa mentor (2.755) (Table 4.9.0). There were some individuals who perceived
that it was possible to development professionally through job related activities but that
greater benefits could be derived from structured mentorship arrangements. The benefits
tomemashipmeevidentinhealthcareorganizafiouswhmetherearesuucuned
mentorship arrangements for students from academic programs. The opportunity needs
tobemadeavailabletothemanagersaswell. TheoverallresponsemeanforQuestion
9 was 3.823 and the number ofvalid cases was 91.

78
TABLE 4.9.0 - Response Mean For Each Item OfQuestion 9

SKILL DEVELOPMENT

Methods for further developing skills of experienced health care managers for the
future organization are as follows:

9.13

9.14

 

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79
Table 4.9.1 - Valid Responses, Response Means and Standard Deviation - Question 9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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PROFILE OF RESPONDEN TS

Table 4.10.0 providesasummary of responsestothedemographic itemsasrequestedin
SectionlOofthequestionuaire. Thatinformatiouhasbeenutilizedtocompileaprofile
ofthe individuals who participatedinthestudy. Therewere 36.5% malesand63.5%
femalesrespondingmmesuveyandmeyrepmtedthmmeavaagedmespentmhealth
carewas 12.9yearswithaminimumof1yearaudamaximumof30years. Asforthe
Highest Level of Education Attained, the category showed that 3.2% of individuals
reportedCommuuityCollegeastheireducatioulevelwhile19.1%possessedatleastone
Bachelor’ Degree. 9.6%reportedhavingptn'suedsomegraduatelevel education while
thelargestcategorywasintheMaster’sDegreecategoryat66%. Therewere2.1% of
respmdunswimmDegr-ees.1‘womdividualsdidnmprevidemfmmafimmme
highestlevelofeducatiouattained.

80
Twenty-eiflpercent(28%)of¢eresponden8waeefia€hiefExxufiveOfficasm
one level below. The next level down had 44.1% with level 3 down having 23.7%.
Therewere4.3%ofindividualsatlevel4. 'I‘herewasuoindicationfrom3individuals
oftheirlevelwithintbeirorganintiou. 27.7% oftherespoudeutswerewithinthe30—39
agegroupcategorywhichwassimilarinsizetomeSO-59agegrmpwhichhad28.7%.
Themajority (42.6%) formedthe40-49agegroup. Twoiudividualsdidnotrespondto
therequestfor age classification.

Sixty-four percent (64%) of respondents reported having being trained in a clinical
discipline while thirty-eightpercent (36%) showed a non-clinical background. There
wae7individualswhodidnmwspmdmmecategoryomefessimalBackground. The
meanTimeiuHealthCarewas19.5yearswithaminimumof1yeartoamaximumof
40yeats. Therewere2.2% ofthesamplewhohadlessthanoneyearwiththeircurrent
employer. TotalnumberofindividualswifiLessTlnnFom'YearsOfServicewas
19.6%. Between4and15 years ofservicetherewere 66.3% ofthemdividualsand
14.1% inthegreaterthanlSyearscategory. Fouriudividualsdidnotrespondtothe
requestfmmemformafithesecfimmonmmlBackgroundrevealedthatthebulk
(92.5%)oftherespondentswereWhite/Caucasian. Threeiudividualsdidnotrespondto
thequestiou.

As far as income was concerned, the largest category was the 360,001-370,000 salary
group with 22.5%, followed by the 370,001-380,000 group with 21.3% and the
3100,0001 plus group with 20.2%. At the lower end, the 340,001-350,000 and $50,001-
360,0(XJgroupscombinedtoform 19.1%. Sevenindividualsdidnotprovideinformation
to this question.

rm 4.18.0- morn..-

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5 N - 39 (27.7%) 12 80.001 - fl.” (13.3%)
0 0 - 49 (42.6%) 1 ”.01 - 370.” (22.3%)
TI 30 - 39 (28.7%) 19 370.1Dl - 300.000 (21.3%)

1 Q d or. (1.1%) 12 300.1111 - 030.000 (13.3%)

2 140m 3 330,001 - $100,000 (3.4%)
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82
SUMMARY

Apresentationandanalysisofthedataappearedinthischapter. Thesummarywas
wmprisedoffimreseuchquesfiomwfichsofichedflnpacepfionsandopmimofm
care mamgers regarding continuing education and professional development for
magementskilldevelopmentandmaintenance. SectionlOofthequestionnaire
provided demographic infornntion (Table 4.10.0),whileSection 11 provided information
which gave some indication ofcontinuing leaming activity, span ofcontrol and groups
(clinical/non-clinical) to which leadership was provided (Table 4.11.0).

ltwaslearnedthmfocuswasimpmnmmskifldevdopmentfmhealthcaremamgasmd
thatfacilitationwaspossiblebyattendingshortcmnseswhichhadinputfromthetarget
audience. Targetedskiflsforhealthcat'emanagemetnshmtldbecomnunicationasthe
toppriority. Development shmfldappealtopersonalenhancements suchasmarketability
andpromombifitymdmmmeacfivityshmeefacihmtedbymeemployasandshould
include on-site offerings, mentoring and arrangements for secondments. Personal
enhancementsshmddnotbemterpretedasbeingofnobenefitmtheorgmmn. On
thecmflary,theorgaflufionshndsmbenefitwithmcreasedmmaleofmanagersand
having managers with increased capabilities.

The activities of management development should also provide currency of health care
managementinformation. 'I'herewasnoexpectationthatsalaryincreaseswwldbea
nahnalocmmencefoflowhgupmskiflenhmcemembmitomddbeanindirectbenefit
withincreasedoppormnities. Managerswereveryawm'eofcostresu‘aintsbutme
messagewasthatcreafivewayscouldbefwndmsponsorconfinuingeducafimand

professimaldevelopmentfmhealthcuemmagasmmechangingindusuywithout
addingtothefinancialburdenoftheorganization.

Professional development was not perceived as a 'nice-to-have" but as a necessity based
ontheneedsofadynamichealthcareindusu'y. ltwasalsoacknowledgedthatsuch

83

valueslndtobeembodiedbytheBoardofGovernorsoftbehealthcareinsfimfionsand
alsobytheseniormanagers.

The overwhelming message was that the pursuit of continuing education and professional
developmemmvifieswasarequnemanfmeveryhealthcmmanagerwhowishedm
phyanwtsmndingmlemmedymmicandcomplexhealthcm'eenvirmmembmwould
notbemandatedbyaregulatoryexternalbody. Employerexpectationforhealthcare
management professiornl development was the preferred route. Given the inevitability
ofchmgesinhealthcaremdtbenecessityofmakingthemostofthemvesunentm
human capital, effortsatmaximisingeachmanager’s contributionwillpaybigdividends
tothehiringorganintionandtotlwhealthcareindusu'yasawhole.

Thenextchapterprovidesmoredetaileddiscussionofthefindings, conclusions,
implications and recommendations for future research.

CHAPTER 3
FINDINGS, CONCLUSIONS, IMPLICATIONS AND

RECOMMENDATIONS

Themanagersofhealmcareinsfimfionsworkinanenvironmemmatisconstanfly
undergoing change. The external environment has caused the health care industry to
evaluate its service delivery and redirect its focus to areas such as community care and
patient-centered care. The industry cannot be expected to provide new ways of serving
its clients without undergoing some change itself. Some of those changes have resulted
in management restructuring for cost effective service delivery models. For health care
managers to function effectively in the changed environment, they must possess the skills
which are demanded by the new organization and the new external environment. For
some managers, this would require a new commitment to professional development but
forthemajority,therequirementmightbeashifiinfocustorecognizethevalueofnon-
traditional methods of professional development.

Thepurposeofthestudywastoidentifyanddescribefactorswhichmayimpacton
individual efforts to maintain currency of knowledge and skills while meeting the needs
of the future health care environment. To facilitate the task, a questionnaire was
developed and mailed to 196 health care managers in five Ontario cities. The source of
the population and sample was the Members Directory 1993 - 94 of the Canadian College
of Health Service Executives. It is the opinions of ninety-six respondents (53.3% of
delivered questionnaires) which formed the result of this study. Nine questions were
developed in order to address the main question which was stated as follows: What
can/should be done to facilitate, for health care managers, the development and
mahtemnceofleadashipandmmgementskiflswhichuecmsistentwfihmeneedsof
the individual, the organization, the communities and the province’s interest in. high
quality accessible, and affordable health care in a changing health care industry? The

84

85

responseshavepr'ovidedsomemswusmddh'ecfionforasauingflrathealmcare
managerswillbeequippedtomanageinthefirtme. Excerptsfromwrittencommentsare
interspersedwiththenarrative.

SUMMARY OF FINDINGS

PerceptionofNeeds-TheresponsestoQuestion l showedthathealthcaremanagers
were in favour of continuing education and professional development regardless of their
level of responsibility within the organization. There was a strong agreement that senior
managers could also benefit from the pursuit of professional development activities. Most
itemsonthequestionreceivedahighrating. 'l‘heresponsesalsoindicatedastrong
commitmentto, andsupportfor,continuingeducationactivitiesforallhealthcare
managers.

Thefindingsshouldnotbesurprisingtoanyonewhoisawareofthedemandsofthe
changing health care industry. The new situation demands new skills and different
management practices which will only be possible with a new perspective and different
values.

Barriers-Thetopbarrierintheptu'suitofprofessional developmentbyhealthcare
managers was identified as cost of courses. conferences and related activities. That
sentimentwassupportedbyindividualsindicatinginitem6.ll thattheywouldbe
mofivatedmincreasepmficipafionifacfivifieswaeofferedattheirworksite. This
indicatedaneedmkeepcostincheckwhfleincreasingaccessibifitymleuning
opporhmities.

Jobmrkloadwasperceivedasanotherbarrier. Onerespondentarticrrlatedhisconcer'ns
inthefollowing:
'“I'hehardestthingisgettingthetimetodoadditionalformal
education(graduatelevel). WorktakesupéOhomsaweek,and

86

with a family which I don’t want to suffer, it doesn’t leave much
time for formal education“.

Senge l990,hadsmtedthatindividmlscamotbeexpectedtolearnwhentheyhaveso
littletimetothinkandreflect. Itwouldappearthathavingactivitiesonthejobpremises
wmrldassistindecreasingthatbarrieraswell. Thesamegoesforpersonal
responsibilitiesathomewhichwasalsonamedasoneofthetopbarriers. Theinference
beingthatitwouldbeeasiertoparticipatedm'ingworkhoms. Loebsl992,warnedthat
thespeedofchangehassomanyrootsinmeextemalenvironmemandthatthe
knowledge of those changes were so limited by internal staff, particularly the management
developmemmff,matmostorganiufimsdidnmlnvemecapacitympmvidethe
necessaryexposm'eandleaming. Seniorexecutivescouldnotberelieduponfor
assumingtheinstructionalroleastheywereperceivedtobetooengmssedincopingwith
theissuesatlnndandwithmultipledemandsofconstiments.

Ifthm'earegoingmbeoppmmmfiesfmlem'nmgmthejob,someonehasmassumethe
respmsibifitymenmmthmmelemningexpmiencewfllbebeneficialmmemdividual
managerandalsototheorganization.

PerceivedBenefits- Healthcaremanagersintheirresponsesdisplayedanagreementfor
increased opportmtities for networking as a benefit to be received from professional
development activities along with being aurent in health care injbrrrtation. Other
benefits perceived were positive ejects on self-esteem. job knowledge and management
skills. Overall, all seventeen items were perceived as favourable outcomes when pursuing
professional development and continuing education activities.

maconsnndychangingheahhcareenvh'mmunmemustbecmcanedwithmeabihty
ofhedmcaremamgusmmeetmcfunuereqmrementsofthemdusnyintermsofskius
and currency of knowledge. There was an indication that health care managers remain
inthefieldforlongperiodsoftimeandifthatisso,therewasafurthuassumptionthat

87

skillsmainwnanceandknowledgeamencywmfldbecommmbeaddressed,evenif
themmagerdidndremainwiththesameemployerbmdidcmfinuewworkwithinme
mdum'thaemumbesystemsofamponfmindividudswhosemleshavechangedm
mclnnging.1helengthoffimethatparficipantsofflresmdywu‘emhealthcam
managementrangedfromlyeutoBOyearswithameanoleByears. Forthetimein
healthcarethatrangedfmm1yearto40yearswithameanof19.5years.Therewere
sevaalmdividuflswhohadbeenemployedbytheucmrentorgminfimforovafifieen
years. Healthcareorganizafionsshmfldnotbeconcernedabomlossofamamgerwhose
professiomldevdopmemhadreceivedfinamialassismme.Mmeofleannm,ifthe
mdividualleavesmemgminfim,medesnnafimwiflmostfikelybeanmherhealmcare
Wmhencefihehainhgisnmhsthnredeployedwimmthehealthcmmdusny.

Mandatmymvolunrypmnitofprofessionaldevelopment-Ananalysisofthe
responsesmtheimresaumundingmandatoryvsvomcmfinumgeducafimfm
healthcuemamgasmdicatedflntindivichtalswa'enotstmporfiveofmandated
professionaldevelopmem,especiallywhenadmmiswredbyanextanalbody. They
comededthatcmfinuingeducafimacfivhywasaaificalfactmmmefuuuesuccessof
healthcmmMnfionsbtnthmhealthcm'emgamnnmsshmddhavefomalpolicies
regarding expectations for managers to pursue professional development. Even though
therespondents were pursuing continuing education activitiesonaregular basis,they
werenotpreparedtosupportthenotion ofmandatedprofessional development. In
compafingmiswithmydirecfivefmconmflancemnecanmawfiommanalogythatwas
mademgudingaproposalfmmemgisnafimofanfireumsownedbypfivatecidzens.
Onemediacommenmwasheardmmnnrkthmmelegishfimwaspmducingasystem
wherethelawabidingelementsofsocietywerebeingaskedtopaythepenaltyforthe
actsofthecriminals.

Regardingcomprflsmyconfinuingeducafion,mosehealthcaremmgerswhoare
mofivawdmconfinuedpmfessimaldevelopmmtwinbeafiectedifammdepohcy
wereputinplace. Even ifcturentindividualpracticeshavebeeneffective, theywould

88
havetobemodifiedtomeetthepolicydirectives. Mandatorycontinuingeducationhas
always provedtobecontroversial, especially atthe initiation phase. Thefollowing four
quotesprovideaflavmuofthemmmentsfiomhealthcuemamgersmthesmdymmeir
opposition to any proposed system of mandated professional development:

“Personally, mandatory activities are too constraining -
expectationsleadpeopleintofollowingthenormifnotitcanbe
dealtwiththroughtheappraisalprocess'.

“Continuing education is critical, nnndatory training while
beneficialcanbelimiting,ifpeoplestoptakingotherprogramsto
focusonlyonaccreditedones; canbetoobureaucratic'.

'Mandatoryprogramsdisempowertheindividualanddonot
motivatethoseaheadyaversetoformaleducation'.

'Isuppm'tanenvironmentwheremanagersaremotivatedtopmsue
continuing education, rather than being ’forced’ to do so“.

Theisweofmmdatmypmfessimalcmfimhgeducafimhasgeneratedcmsidemble
debate among health professionals, educators and legislators. Conca'ns have been
expressedoncostaswasnmedbyoneofmeChiefExecufiveOfiicasmmestudywhen
hestated:

'Myconcernaboutnnndatoryaccreditedformaleducationisthat
asanemployer,Iwmldberequiredtoassistinthefundingofthe
continuing education. Many organizations do not have the fiscal
resmucestoprovidetheappropriatefunding".

Balancethecommentabovewiththatprovidedbyanon-CmeffixecufiveOfficer:

“In the Regulated (Health) Professions Act- (health) professionals

aremaderesponsiblefortheirowncontinuingcompetence. Some
healthcareinstiurtionsmaythenbackawayfromfinancial

involvement".
Thefitaauuehascnedcmcernsabmuthcimpactmdefi'ectsonleamarecepfivhy. It
hasbeensmtedmatmmdatmycmfinuingeducafimdoesnmwcessarflyensmeeim
utilization of knowledge or increased competence. Proponmts of mandatory continuing

89
educationhavestatedthatitmightbetheonlymethodofensmingparticipationbythe
majorityofpracfifimersinthefieldasthosemostinneedwmddbeleasthkelyto

Themoregenamswfitershavegmeasfarasmstatethatmsimafionswhaethaeis
low professional development activity,thatthefault mightnotnecessarilylie withthe
non-participafivemanagerbrnthatthesimafionmightbeforcedduetolackof
accesfibifity,aasociatedcosts,fimeflmiflonsandconsfiaintsandfinafly, institutional
andpersonalconstraints.

mmoughrespondentsofmesmdysnmglymppmtedmeneedfmmguhrprofessional
development, they did notwa that such activity should befinancially rewarded. The

results did suggest however, support for a system of accormtability in that although health
care managers will pursue professional development on their own accord, that it should
still be an expectation of them. From the 11.8. nursing literature, it would appear that
afteryearsofresistingthemandatedsystems, nmseshavecometoappreciatetheneed
for regular continuing education and professional development. With the changes in the
environment and the demands being placed upon the health care sector for services, the
choice will soon be gone forhealth care managers...continue to develop yourself or
else!... will be the new directive.

Facilitation Role - The facilitation role has been assigned to individuals, institutions such
as employers, educational institutions and professional bodies. In this study the prime
responsibilityhasbeengiventoemployers, buttherewasnoexpectationforfullfinancial
support, although ”it would be nice“ as one respondent remarked.

"Employers should try to support continuing education by
providing in-house programs with in-house resources to what ever
extent possible”.

The facilitation by the employer could be in the form of agreeing to be part of a

90

secondmentprocess. 'I‘hemessagehastobecommunicatedtotheemployersthatthere
wasanexpectationforthemtosharesomeoftheresponsibilitytofacilitateprofessional
development. In an age of budget restraints and cost cutting, employers would be less
inclined to be budgeting for professional development of managers as a significant
financialoutlay.

'Continuing Education by in-house Training and Development is
also becoming difficult due to government cuts/budget cuts, little
left for staff/ management training and development” .

lfmehealmcmemmgapa’ceivedtheemployaasholdingmeprimerespmsibflity for
facifihfingconfinrfingeducafimthenmecanassumematifmatexpecmfimfafledwbe
satisfied, it can have a negative impacton professional development pursuits by health
caremanagers. Atthesametime,healthcaremanagersexpecttobeconsultedonthe
planning of continuing eduction opportrmities - areasonable request which will encourage
buy-in.

ltmustnotbeassumedthattheonlyresponsibilityfortheemployerintheroleof
facilitationwasthatoffinancier. Otherroles archascareerplanningwouldbeuseful
whaemdividmlsmassistednnthassessmmtofabififies,mtaesm,cmeaneedsmd
goals; organization’s assessment of employee’s abilities and potential; communication
ofcareeroptionsopportrmities; andcareercounsellingtosetrealisticgoalsandplanfor
theirattainment. (Lemieux—Charles, 1994). Thehealthcareindusnyishighlylabour
intensive and as such, each organization should lnve a human capital development plan
whichclearlymndatesstrategiesmdmcficsfmthedevelopmemofmamgas,whom
mrnwilldevelopthestaff.

Therespmdentsmthissmdyalsoassignedahrgepanofmeresponmbflitytothe
employee.

"Employees must buy-in to the need for updating of continuing
educationandbypayingpartofcoststheyaremorelikelytoget
valuemnofcontinuingeducation'.

91

The individual manager has a responsibility to improve and develop his or her knowledge
andskill,hencealldevelopmentbeginswithhimorher.

Tbemformafionfiomtheopinionsonfacflitafionmleshmndbeofinterestalsoto
educafionalmsfimfionsmuspmvidingthemwithaperspecfivemwhoshmddmkethe
leadandfromwhominputshouldbereceived.

Motivator: - Personal enhancers dominated the choices of motivators and they included
skill enhancement, marketability and promotion possibilities. There appeared to be a
genuineinterestinimprovingone’sabilitytodothejob. Theheavyweightingtoward
personalenhancememdmmagasshmddnmbenegafivelympruedbmwouldbe
perceived as a willingness to provide greater value to the employer by being more

Accessibility of programs including on-site activities would increase participation but that
would have to be balanced against work and home life responsibilities. The following
two comments identify a plea from managers to the organintion to assist their motivation
to pursue professional development activities.
“What is needed is time, release of W of day-to-day
functionsandifpossiblefinancialsrqportforeducationfor
managers and especially staff" .

“Organizations need to provide for continuing education
opportunities (time/money)".

ConfinuingdecreasesmtbenumberofhealmcaremamgememMfimsmOnmfiocmud
verywellbethesignaltomanagersthatthedaysofhealthcarebeingahavenweregone.
Managersarethusfmeedtocompeteforposifionseiflrerwithinmeirpresent
organizationsorwithinanotherorganization. Havingcurrentknowledgeandrequired
skiflsvduaddvaluemthehedthcaremmga'whoisforcedinwmecompefifivejob

92

market. Recently, healthcaremanagementappointmentshavebeenaccompaniedby
WMclearlyspefledmutermmanmchuseswhichmeasierwadmmisterman

drepreviwssystemofappoinnnemswhichwaehuu'pretedashfefimeposifims.

ReasonableExpecufiona-Mamgasmmesmdyshowedaprefaencefmarequuement
whavehedthcaremamgasanmdulustonepmfsuomflyremedacfivityperyear.
'I'hechoicescouldbewiderangingaslongastherewas 'demonstratedimprovedon-the—
job results (outcome measures) for the educational investment made”.

"Activities related to a clinical discipline, management, education
or research are all appropriate fields”.

'lthrnk' education,inanyformwithanykindofcontent(within
reasonl),isabroadeningandchallengingexperiencewhenmet
withareceptrv'emmd' . Iftheindividualisnotmotivated
themselves (sic),noamountof ”requirement'willhaveanyimpact
onthem".
There was strong agreement that secondment to another organization should be considered
anappropfiateeducafionalordevelopmentalacfivityforhealthwemamgers. Thisis
adeparmrefiomtheviewflratonlycrediteducanonalcmuseswereofvaluein
professional development. In the past, individuals ptnsing credit courses enjoyed stronger
approvalandfinancialsupportthanthosetakingnon-creditcomses.

At the management level, regardless of clinical backgrotmd clinical professional
developmmtslnddndbethefocusMratherthatitshmddbemnagemaumhted.
Mamgementmhtedacfivifiesshaddnmbemtapmedascmdncmusesbutratheras
activitiesthatwouldenhancetherole. Therewasonecommentwhichdidnotseemto
Wmmormmrmgmmgmmmmmmm
intheparadigmofcreditcomseswhenshestated:

”If the licensed professionals are having difficulty in establishing
these kinds of standards, CME contact hours, publishing volumes,
etc,ldon’tknowhowwecanapply suchstandardsorcriteriato
something as generic as management”.

93

LiflesrmpmtwasoffaedforemyingMacfivifiesofresearchandpubficafim.Itwould
appearthatwasdueinpmmflrebehefthatanmcaremmagershaveme
skilhandknowbdgerequhedfmmemsks.1woChiefExemrnveOfficemprofidedme
followingcomments:
”Why publish? There is too much nonsense/rubbish, garbage
beingpublishedasitisatpresent!"

'Thereistoomuchcrappublishedalready-Fewmanagershave
theappropriatetrainingtodogoodresearch'.

Developers of continuing education programs should be aware that research and
publication skills and knowledge could be lucrative areas for program development.
TherewasalsoasnmghinthhiefExecufiveOfficmsthatthereneedsmbeafocus
onthoseaspectsofdevelopmentformanagers. Thereappearedtobeamisconception
that publication had to be the result of exhaustive research activities of a quantitative
nature. Publicationcanbethesharingofideas. Withmoresharingofideasviathe
literature, more joint ventures could be undertaken as articles could be used to identify
individualsor organization oflike mindedness, while providing increase opportunities for
knowledge acquisition.

Future Skills - Respondents provided an extremely high level of agreement with the
skfllswhichwereidenfifiedasbeingneededformefimuehealthcareindusuy.
Commnicationskillwasthetopmteditemamongtheelevenchoicesoffered. Roberts
l993,statedthatagoodleaderwassomeonewhocommum«tedofienandopenly. Thae
isnodmrbtthflthehedthcarehdustydemandsahighlevelofwmmMcafionskflls
fiomitsleadathneedsmdividualswhocmprovidemfmmafimmiGmnsduwntsand
atthesametimereceiveinformationfromthem. Inanaaofclientservicefocus,the
manager mustbeperceivedasanindividualwithwhomtheclientcancommunicate.
Healthcaremanagersarealsoexpectedmbeablemcommunicatemeplansofthe
organizations to other stakeholders such as funding agencies, especially on matters of

94
servicedeliverytomeettheguidelinesassetbythoseagenciesandalsotoeffectively
demmsuatehowtheproposedphmfitwfihtheovaallhedthdefivaystrategyofme
province. OperatingPlansforhealthcarefacilitiesmustnotonlybeproperly
documentedbmmeleadasofthemsfimfimsmustbeabletouficuhtesrmhphnsmthe
respecfiveDisniaHeaMCmmcflwhichwiflmakemeappropfiaterecommendafionsm
theMinistryofHealth. anntario,theMinisn'yofI-Iealthhasexpectationsofahigher
levelofcooperationbetweenhealthcarefacilitiesandmecommunity. Thatdirective
requireseffectivecommunicationinvariousmodes.

Widrthechangestakingplaceinheslthcarem‘ganintions,themanagersmustbeableto
commMcatemdpresentthechmgeswithhmestymdmtegritymotonlymtheuown
staffbutalsotootherinterestedpmfieswhomaybeverycfificalmmesmvival ofthe
organization.

Thenexthighlyratedskillwasthatofleadership. Thehealthcaremanagersmustbe
abletodevelopavisionfortheorganintionandfacilitatetheachievementofthatvision.
Nmmlywiflleadasneedmmficipatethefunuebutmeywiflberequiredwmficipate
variouspossibilitiesandbepreparedforthem. Thehealthcaremanagermustunderstand
themterdependenceofpofifical,technicalmdculmralaspectsoforgammon decision-
making(Grieshaber, 1993). Onerespondenttothequestionnairereferredtothemanager
withtheappropriateskillsasa'superperson'. Inherestimation,thatiswhatwouldbe
neededmefiecnvelymmgemehealmcaremganizafionofmefimne-awperperson.

Roberts l993,pomlatedthatafiertheyear2000,thedefinifionofhealthwiubegreafly
expanded. Henceinseekingeducafionalopporhmifiesforhealthcuemanagerthefocus
shmddbeplacedonaressoffunueneedsthatmnotnadifionallyapmofhealth
managementcurricula. Thisstudyidentifiedsomeareasoffimn'eskills,asperceivedby
health care managers. Overall, the study respondents demonstrated an overwhelming
agreementonthetopratedskillsneededforhealthcaremanagers.

95
Skill Development- ltwasfittingandveryappropriatethatQuestionSldealtwithskill
development. Having had an indication of the needs, perceived benefits and facilitation
role, itwasimportantthathealthcaremanagers hadanopportunity toprovide suggestions
for methods and activities which would facilitate skill enhancement.

Preference was stated for attending workshops with a speaficfirats. short courses of I -
4 days duration and opportrmities for on-the-job development with the assistance of a
mentor, with the manager having had input into planning the program or activity. The
shortduration focusedworkshoprequestsupporttheconstantneedfornewinformation
inachanginghealthcareenvironment. Italsofitswiththeperceptionofbeingover
burdenedwithjobtasks. Beingawayfromthejobforshortperiodsnotonlyallowsthe
managertoconcentrateonthefocusofthedevelopmental activity, butitalsolessensthe
anxiety level of a large build-up of job tasks. The 1991 study by Williams of Long-Term
CueAMsnatmsinOntafio,showedthattherespondentsprefenedmodesof
education program delivery that were short, intensive seminars and which were offered
as night classes.

In this present study, the top rated items indicated that at the senior levels ofhealth care
management there was a necessity or preference for having developmental activities that
werefocusedasopposedtobeinggeneral. Generalinthiscontextreferstomaterial
whichisnormallytaughtinundergraduatecom‘ses. Therequestappearstobefor
information about new work processes; new methods of service delivery; new
organizational structrnes, e.g. Program Management; new directives from the Ministry
of Health; and the results/recommendations of various Ministry of Health Task Forces
and Commissions of Inquiry.

Overall, the respondents to the survey were very pontive toward skills development and
therewasash‘ongindicationthatmanywouldliketoseesomeformofsupportfromthe
orgminfimbm,atthesamefimetheywereverycogmsamoffimndalresnaintsfaced
byhealthcareorganizations.

96

'Unwillingness ofemployers to grant education leave ofabsence
with pay due to tight budgets”.

“Difficult to find funds for continuing education when budget reductions
aresobad, staffbeinglaidoff'.

Moneywasnotalwaystheissue. Aswaspointedoutinthecommentwhichfollows,
policyissuesandorganizationalvaluesplayapart.

'AkeyissueinourorganizationisBoard’s(ofGovernors)
expectation about Continuing Education. If it is perceived as
’nicety’ and not a ’requirement’, thm’e will be little commitment.
Expectations concerning the amount, type, and financial support
for Continuing Education has In been formalized as part of the
Board/Hospital Policy. This is a cm weakness in achieving
support for Continuing Education. If there was Board mandate, it
would facilitate Senior, Middle Management in moving toward this
goal”-

Therewasaconcer'nexpressedbyoneindividualwhich statedthatskilldevelopmentwas
perceivedinsomecircles, 'asan ’extra’ whentimepermits".

II

“My opinion (totally unsubstantiated), is that the organizational
culmremustfostertheanimde-itcannotbeforeed'.

CONCLUSIONS

Management development needs of all health care managers must be
addressed.

Theneedsoftheindusuychangewithnewinifiativesandnewpoficydirectives
henceaco-ordimtedapproachwfllbemmesupporfiveofmamgusintheirquest
for decreasing their deficiencies. Addressing management development needs will
provide greater efficiency in managing the changing health care industry.

97

Henlthcaremanagementjobtitlesshouldbestandardizedacrossthehealth
managementfield.

TTusacfionwinlessentheconfusionbetweminstimtionsandpmvideabener
mderstandingforthepubflcandaspuinghealthcaremanagersinparficular.

Developacertificationprocessforeschhenlthenremanagementposition.

Thisacfionwiflprovideconcretempstobetakenasoneaspirestoaparticular
healthcarennnagementposition. Itwilltakethegueasworkoutofpreparation.

PerformanceAppraisalsystemsforhenlthenremanagessshouldemphasize
development.

Thiswinassisthealthcm'emanagastophntheirownpmfessimaldevelopmem
btnmepu'fmmmceappraisalsmustbedoneonaregular(atleastamual)basis.

Organizeasystemtoallowacademicfacultytospendtimeinhenlthcare
organizationafortheirownprofessional development.

Thiswfllfacflitatemebufldingofarelafimshipwhichwmrldprovideinpmmto
theinitialandcontinuingeducationofbealthcarennnagers. Itwouldalso
provide partnerships for management development and other collaborative
endeavours.

for management personnel to be more actively involved in program

delivery.

Thiswillassistinthefm'therdevelopmentofmanagerswhileproviding

#10

98
opportrmitiestoslnreinformation. Strengthsofbothsidescouldbeharnessedto
improve management development oppornmities.

Providehealthcaremanagerswithmortnnitiesforthedevelopmentof
researchandpnblicationskills.

Thiswfllfacflitatethesharingofhealmmamgementinfmmanmonawidelevel.
Highqualityresearchandpublicstionwilladdtothescholarly literature.

Developsyatemwidesnpportformanagerstopnrsnemanagement
professionaldevelopmentactivitiesandopportnnitiestontilizethenew
knowledgeandskills.

Thebusyhealtheareenvuonmernwasanidentifiedbarrierfortheptusuitof
professional activities hence any support for employers would be welcomed and
thatsupportdoesnothavetobepurelyfinancial. Itcouldcomeintheformof
timerelease forattendanceateducational opportrmities.

Develop and support strong education and profssssonal development
services within each facility.

Asnongintanalsavicewmddbeabletoidenfifycoflecnvemdindividualneeds
andpositivelyrespondtotheminatimelymanner.

Eachhenlthcarefncflitymustfacilitateneedsassessmentservicesforits
mgementstaff.

Notevaymanagerhastheskiflforneedsasseesmenthencemavaflableservice
willfacilitatefuun'emanagementdevelopment. Itwillalsofillthosegapswhere
theseniormanagementstaffmembasareumbletopmvidetheserviceaspanof

99

performanceappraisal-wherethatisaregularoccmrence. Partofthis
facilitationistheinclusionofpersonalyowthactivities.

Ill Managementdevelopmentmnstbeconsideredanorganizationalexpectation
ofits managers.

Theorganizationmusthavepoliciestosupportmanagementprofessional
developmentandrecognizeitsvaluetotheorganization. Thiswillsendastrong
positivemessagetothemanagerswhoinnn'nwillbemoremotivatedtoptusue
profsssronaldevelopment.

#12 Managers must be encouraged to develop lifelong learning skills.

Thiswinaflowthemanagerstoplanmeirowndevelopmentandwillassistthem
inthedevelopmentofanappreciationforfm'therlearning. Relianceonthe
educationandprofessionaldevelopmentstaffmaybelessened.

Thissmdyansweredsomeofmequesnmsregudingwhmmnswmldbeneededfmme
firnuehealmcuemdusnyandbywhatmethodsthoseskillscouldbedeveloped.
Respmdentswereva'ycmfidentmtheirresponsestuesfims8&9whichdeahvdth
thosetopics. TherewasnoambivalencemanifestedintheresponsestoQuestion8and
onlyforoneoutoffom'teenitemsforQuestion9. However,thestudyalsoraised
quesfionsmgardingmemppmtespedaflyfinancialmdfimerelusewhichcouldbe
expectedfi'omemployingorganizstions. Itwouldappearthatsupportisavailablebut
mmeofienmannmisbasedmjoblevelwidunthemgammmwhichmayequatewith
budgetconn'olautonomyoftheindividual.

Thethree items, comnumication, leadershipand results management, which have been
fmmdtobethefimneskinneedsofhealthememmagaswmndformmebasisofsmmd
educationalprogrammingforin-houseofferings. Whenofferedin-house,therewillbe

100
opportunitiesforevaluation,follow-upandreinforcement. Therehastobeacommitment
fiomhoerafionnotonlytoprovideoppormnidesbrnalso,mprovidequafity
opportumtres" whichwillbefacrhtated" bycompetentandqualrfied' mdrvrduals' " .

Thedammdicatedthatdthoughheslthcuemamgasmmyhaveavuietyofacadenuc
bukgromdsandMflrerewaeanumbuoflevelswflhmmagemeaneskiHsdenred
inmesemdividualsshmddbemesameregmdlessoftheirscademicprepmafimmd
positionwiththeorganintion. Thispositionisdestinedtogeneratesomehested
discussimduemwhathasbeenpaceivedaslevelsofimpormncemdmofthe
differenthealthcaremanagementjobs. Ifinternalpromotionorevenexternaloneswere
toconfinueasavenuesofupwardmobifity,menthe'lowerlevel'mmagamustbe
afi'ordedtheoppornmitymdevdoptherequirednnmgementskiflswhflesnnmthe
'lower'levelposition. Havingthenecessaryskillwilllikelydecresseanyconcerns
abadopporhmifiesformtanalpmmofimmdwmldgivelowu'levelmmagasaposinve
feelingaboutopenandfaircompetition.

Theargumentthatdevelopmentshouldbe strictlyrelatedtolevelofmanagementposition
isbecomingweakinanagewhenhenlthcaremanagersaresskedtoassumemme
significantroles. Continuedperpemationofthatideswillhelptokeepmanagers
compmunenmhzedandwmndnmwvideoppmuminesfordevdopmentandmusofier
theopporumitytoprogressbeyondtheirdesignatedcompartment. Developmentshould
bebasedonindividualneedsandnotonjobclam‘ficationneeds.

Thefmegohgshowsthateverymehasamlemmanagementdevelopmentmdthatfor
theendeavmutobesuccessfid,mleswiflneedmchmgemddifi‘erentoppormnifies
providedforallthekeyplayers. Healthcaremanagersneedtochangetheirperception
ofmepmsuitofprofessimaldevdopmanmrenfizethatnwasmimpmmmpmtofthen
growthandthatitwasanexpecmtion. Noone’scareeradvancementshouldbe
detu'mmedbyluckandchanceasmoreofienflnnnot,hrckwiflfavmnaparficular
group. Toooflen,thebasisforselectiontohigherleveljobsinhealthcareseemstohave

101
mquanfifiablecfitaiaexceptfmmoseexisnngmthemmdsofthedecision-makem.
Suchasystemisfiddledwithabusemditwasmsmpfisethatthemwasonedommated
racialgroupinthisstudy. ltwasformdinanotherstudy,Storchl989,thatalthough
womenmadeup60%ofhealthcaremanagers,tlntthenumberofwomenintheposition
ofChiefExecutive Officer/Presidentwaslow(16.7%)andmoreoftenthannot,the
womenhadsuperioracademicqualificstiom. Thesystemneedstobereflectiveofequity
andfairness. Itwasnolongaacceptabletorejectanappficantwithombeingabletostate
aplausiblereasonortoplantherestrucnu'ingofanorganintionsothathighlyqualified
andmpablemmagaswaedispbcedwhflehssquafifiedmdlesseapablemdividuals
wereretainedduetokimhipwiththeseniormanagers.

Itissafetosaythattheexcellenceofhealthcarefacilitiesistheexcellenceofthe
managers. It is that group which holds the decision-making power. Health care
msfimfionsmustpossessanytheabifitymammMpquafitymamgersandmamgers
withpotentialbuttheymustalsobeabletoretainthosecmrentlyemployed. Thisisof
pmamouminmormncemhealmcmeinsnmfionsconcernedwimmaopmgmdmainmm
quality service. Thatvisioncouldbeoperationalizedbyinstinrtingpolicies whichwill
foster growthanddevelopmentofmanagers. Intheidealworld, healthcaremanagers
wouldbeequippedtofacilitatetheirowngrowthanddevelopmentMonemust
rememberthatthehesltheareenvimnmentwasnotanidealworld. Theresultofthis
snrdyudflassistmmkingmeseamhfmideahsmeasiaasmesnugglebyhealmcare
magersforreadinessconfinuesasmeyamemptmfacemefimuemamgementmles.

Therewaesomeneutralresponsestosomeitemsofthequestions. Thoseneutral
responsessuggestedthmmaewassomeambivalencemmepanoftherespmdents. The
areaswithahighneutralresponseshouldformotherstudies. Itispossiblethatthe
responsesweremfluemedbymelevelofmerespondenSthinmemganimfimmdmat
NewmavebeenanwuflizingacfionbetweentherespmsesfmSem«Mamgers
andthoseofthe lower levels.

102
Thefindingsofthisstudyhaveproposedsomeinterestingquestions.

Whetherthehealthcareenvironmenthaschangedtomodifymepa'cepfionsof
Wcuennmgasregm'dingtheskillsneededorwaethosepereepfionsalways
present. Inotherwmds,wasthisnewinformation? Ihardlythinkso. Arepeat
studywillhelptoprovidesomeclarifieation.

Researchandpublication forhealthearemamgerswerenotpositively received.
Thiswasnotasrnpriseseeingthatonlyoneaccreditedgraduateprogramin
HealthAdmidsuafion(Canadian)hasbeendeemedsnonginofferingresemchas
partofitsaeademicprogram. Themessageappearedtobethatresearchwasnot
importantinhealthcaremanagement.

hdividualswhohavesn'mgmmgementskiflsandcmremhealmcueknowledgewfll
dowellinmanagingthehealthcareorgflmfionsandmightbeaffordedsomelevelof
jobsecurity,ane1usivecommodityinthesedaysofrestrucmring. Itwasconsideredto
beemsivebecausemsomemes,theselecfionofhealthcuemamgasappearedm
bebasedonkinshipasopposedtoabilityandknowledge—especiallywhenthe
orgaflnfionwasshieldedbyemploymemmtsandhavetheabihtytoprovide
severance payments which meet the minimum requirements of the Employment Standards
Act. Withdocumentedevidenceofpossessingmddisplaymgthereqrnredskifls,me
processforretendmmdselecdmwmddbemademmenanspmuuandopentoscmfiny
andtherewillbemoreaccormtability. Havingtherightpersonintherightmanagement
podtionwouldgoalongwayinimprovinghealthcaremanagement.

103
IMPLICATIONS

Whatdomepresemfindingssuggestformehealmcmeindusnymgmdingmmagement
development? Thefindingsshowedthattherewasaneedforthedevelopmentof
mamgementskiflswhichwmddimprovepuformancefmaflhealthcaremanagers.
Professimaldevelopmentofhealmcuemmgemcannotbedmemisohflmbecause,
inherentinthehealthcareindusuyaresomemamgemausnucnues,valuesmd
procedueswhichdemandexaminafimmdchmge.1herequnedchmgewiflmngefiom
radicalmmodaatechangeifmyanemptsatmamgememdevelopmemvetobenuly
successful and have far-reaching desirable effects.

Oneveryobvimrsspecificacfimwinbemaddressmemmagememdevelopmentneeds
ofmosemamgaswhodonmwssessmemeorencalknowledgeofmmagememandhave
notexperiencedformalacademicmanagementeducation. Bridgingthegapwillincrease
melikelihoodofhavingawell-informedandcreativemanagementstaff. Butwhysingle
outthosemanagers? Notonlyaremeylackingintherequiredmanagementacademic
education,theyarealsothemostlikelygroupnottohavewelldevelopedneeds
assessmentskills. Itwouldnotbermusualtofindthatsomeofthoseindividualswill
haveaspuafiomforfmthajobpmmodon.1hosememesamemdividualswhosejobs
waddbemjeopardywithfinancialcm-backs,withmumymgm'dfortheirlengmof
servicewiththeorganization. Careerredirectionwouldalsopresentsomedifficultiesfor
thatgrwpduemmtensityofthecompefinonfiomothasvdthdredesuedacademic
preparation.

Theindicafionsarethatheahhcaremamguswhohavepmsuedaformalaeademic
programhmmagemmtshouldndnemrflycmfinuemmmaesdemicmgramsper
se. Theemphasisshouldbeplacedonskilldevelopmentandonthoseaspectsin
pmficulmwhichhavebeenmdiatedmmennveyfindings.1hetMeempnemsselected
byrespondentsasskillsneededbyfuhnehealthcuemmgas,men«nmmaflypmtof

104
Implications for health care organizations

Position level definitions/classifications will make it easier to compare like job across
organizationswithinthehealthcareindustry. Prewntly,eachorganizafionisatliberty
mnameitmamgementposifionswithmnanymwghtoftheeffectontherestofthe
industry. Moreoftenthannot,onemganizationwiflmakechangestojobfiflesandtheir
actionmaybefollowedbyothers. Havingcommontitleswhichareequivalentacrossthe
heaMcmehdushywiflalsomakeresearchfindhgsmoreMngfinwhenmmagemem
jobs title play a significant part.

Orgmunfimsneedmm-evfluatemehvaluesmgmdingmeimpomnceoftheeducanon
andprofessionaldevelopmentdepartment. Greaterimportancehastobeplacedonthe
serviceswhicharebeingofferedorshouldbeoffered. ltmustbeperceivedasanintegral
paflofflremganizafionmdndasmaresofbudgetreservesoflratmthedifficult
financialtimes,thatwouldbetheservicetodisband. Onthecontraryindifficulttimes,
mfimesofmgminfionflresnucuningmddowmsizing,meeducafimalmdprofessionfl
developmentdepmtmentshmndbegivenanenhancedmleespedallyinprepafing
sm'viving managers for expanded and/ornewroles.

Educafimservicesvdflfinhedmcaremsfimnmsshmndbekeptcennalizedmmeageof
Program Management to avoid fragmentation and compartmentalization of professional
developmentforhealthcaremanagers. Withacenn'alizedservice,therewillbegreater
flexibilityinmeetingneeds,bothtngentandnon-tugent,inadmelymanner. The
philosophyofProgramMmagemntmdicaesMeachpr-ogrambesefl-mffidem. That
migmmasirablefmdireaservicedefivayhnmeremesomefacetsofmemmnm
matshotddmmaincorpmatemdeducafimalanddevelopmenmlsavicesshmddbea
corporateservice.

Usingthefindingsofmennveywiuprovidefmmorefocusedin-hmrsepmgmmmmg
insteadofthepotporufithatappearstobecommoninmanyinstitutions. Professional

105

developmunmustbeumquemthem’ganizafimandtheindividualanditmustnmbe
viewedasanextensionofacsdemicmanagementeducation. Atthessmetime,noone
shuddassumethataflmamgerswiflreceivethesamelevelofbenefitorachieve
comparablelevelsofproficiency.

Healthcuemgammonswiflflsoneedmreevaluatehowmeynmpmtpmfessional
developmentformanagers. 'Neighbom-gazing'hasgottostop. Theneedsofone
organizationarenotnecessarilythoseoftheother. Anyeffortatmanagement
developmentmustbebasedonmeidenfifiedneedsofthemagersofaparficular
organization. Onceneedshavebeenidentifiedtherewasnoharmincollaboratingwith
neighbmnhgmsnmnons.1herecommendafimwasforstming,inacennaldambase
(intanal),thedocumentedneedsof&eorgafinfimsfmmanagemundevelopment. That
mformafimcmddmenbeshuedwithmexmrnalcenualdambasee.g.CCHSE,andthe
collectiveinformationcouldthenbethebasisfortheplamingofmanagemem
developmuuprograntswhichwouldbeofimaestmmanyhealthcueinsumfions. The
srmrceoftheinformafimfortheiManaldatabasewmfldberegularperformance
appraisalswithanemphasisoncareerdevelopment. Toooften,theemphasiswasplaced
mpastachievementswhichweremostlynormfljobresponsibififiesmdndenough
emphasisonmedevelopmenmlaspects,whichshmddbetheprimefocusofagood
performanceappraisalsystem.

Implications for educational and management training institutions

Usinghealmcmeadminisuationasanmketingploywouldneedtoclnnge. Theremight
beaneedfminaeasingmenumbaofmifialmanagemmtprogramsbutthaeshmddbe
noneedtomarketnnnagemunprogramsasmeefingmeneedsofaspecificgrwp. There
ismuchtobegainedfiommeuuaacfimofmdividualsfiomavnietyofbackgmunds.
Itsddsdepthmdvfluemmenawm'kingexpaimeespecianyfmmeexpaiencedhulm
caremanager. Onecombinedmanagementeducationprogrammingperacademic
institution would probably be more cost-effective and stronger. Basic management

106

namingcmddbeperceivedasthefmmdafionforacmeerinhealthcaremamgemau.
Wuhpropadhecfimmdmenuuingfihenainedmanaguscmfldbeasfistedmacquning
competenciesinspecificareasofhealthcaremanagement.

pumashipsnthermancompentionfa'professiomldevelopmemmdconfinuing
educationofi'erings. Thereneedstobeahigherlevelofco—operationbetweenacademic
faudtymdquaflfiedhealthcaremmagasinthedeflvayofmmagememdevelopmenml
programs. Utilizingtheresmuoeofmanagementstaffinmachingmleswiflenhancethe
theoreticalofferings. Academicfscultywillbewelladvisedtospendtimeinmehealth
careenvironMaspmtofmeirownprofessionaldevelopmemformeirmlein
deliveringinitialandprofessionaldevelopmentprograms. Academicfacultyinthehealth
emeenvironmentwiflhaveansddedoppmnmityforassessingtheinstrucfional
capabififiesofmosehedmmamgaswhohaveanhnerestmprewnfingprogramsinme
academicenvironment. Theincreasedinteractionwillalsoprovidesomeparmershipsfor
researchandpublication. Thiswillnotonlyaddtotherelevantliteramrebutitwillalso
assisthealthcmemmagasmdevelopingtheuresearchandpublieafionskins. Efforts
ueresearchandpublicafionwmddevenmaflyaddtothescholarlyliteranue.

Implications for the Health Care Manager

HMcaremanagasneedmbeskinedandknowIedgeablemmeprinciplesofaduh
educationsincemuchofthejobisinvolvedwiththedevelopmerdofothers. Inany
syaemofmmgemundevdopmmagusshmddbepmofmepoolofinsnuctms.
Propapreparafionudflmakehmmmeefiecfivehfichhgoppmuminesmthefomal
academicenvironment. Academicexecutivedevelopmentprogramsexpectparticipants
mmme-mmmmnmmmmwmmminm
presentations. Pooriydevelopedornon—existentpresentationskiflswilldeuactfiomone’s
opporumityforgrowthofselfandassistinginthegrowthofothers.

107
Therewiflbemimreasedmlehgflherhgmformafimoncmrenthedthcareissuesand
beingpartofthedisseminationtesm. Externally,therewillbeaneedforinteractingwith
memediaespeciaflywhenmueisadesirembufldasnmgrdanonshipsomatmemedia
wiflbemppmfivempresenfingmformafimonmeinsfimdonorprogmmsinaposidve
manner. CommMfieshavealsoraisedmeirexpectanmsAuetoahigherlevelofawue,
aboruwhatwascommtmieatedwhenplansarebeingnndetochangeservices.

ImplieationsforEducationandDevelopmentDepartments

Itiswithtaudoubtmmmaednddbeasuengmenedmkwnhmcreasedrespmsibifity
foreducationandprofessionaldevelopmentmrvices. Acrucialingredienttosuccess
wouldbelnvingtheappropriatestaff-staffthatarehighlyuainedandare
knowledgeable,notmlymmemamdflofhnaeubutdsomaduhedrwafimpfinciples.
Edrmafionanddevdopmemmfimustnmbeselectedbasedonstatedmtaestalme. The
individualsmustbetrainedforthetaskathand. Developmentalservicesmustseek
matucfimflassinmcemnsideofmenmrowsphaeofimimmediamstafiandunlizeme
skillsofothers,betheymanagersortmiversityfaculty.

Moreevaluationhastobedoneregardingcnnnedprograms. ltisnotappropriateto
rauchaseprogramswitheatchyddesandofferingmemtomemanagaswithmnany
notionofwhetherornottheyaremeennganyone’sneeds-betheycorporateor
individual. Thesimmoniscompmmdedwhentheprognmsaredeliveredbymdividuals
whomenotnainedatmeappropfiatelevelandhavehnleornoappredanonfmme
interestorjobroleofthecustomer/clientele. Whenconsultantsareutilized,theymust
flsobecuefirflyselectedmdndseleaedbasedmmempicsaspubfishedmapromofim
brochure. Bothcsnnedprogramsandconsultantserviceshavearoletoplayin
magementeduafimandmeymustmomybecost-effecfivebmflreyshouldalsobe
appropriateinmeetingidentifiedneeds.

Managementeducafionanddevelopmentjobsmustbepaoeivedasfuflfimemhsas

108
opposedtosomethingwhichisassignedhasedonavailability. Thetrainingstaffmustbe
awareofavarietyofeducationsrmrcesandtechnologies. Theymustalsobeableto
efimimvaednofionsofidedmgememdevelopmartprogramsmdfocusm
theindividualandthesimation. Thiswouldrequirethatinputbereceivedfrommose
individualsforwhomtheprogramsareplanned. Asisthecaseformanagers,education
mdprofessionfldevelopmentstaffmustbemnremmhealmcueissresmdbepudy
respmsiblefordisseminafingmnmformafimmdbenleastablemdemonsuateme
relevanceoftheinformation.

Udlizeofierquafifiedandknowledgesblestafifiommueasofmemsnmon. Some
organizafionalsuucuuemightnotfostamhamlafionshipduemmecompefifive
environmentwhichmightresultfromaparticularstrucnue. Forpurposesofeducation
andprofessimaldevelopmengmebmfiasmustbemmovedsomatmsmmonalskills
ofaflcmddbeufihzedmwlnteverextaupossiblefmdebenefitofmeorgamunon.

ImplicationsforSeniorManagement

Seniormanagerscannolongerbethekeeperandsoledissemmmmofhealthcare
information. Thiswouldrequiresomeshiftinthinkingformanyseniormanagers
becauseitcouldprovemreatemngfmmosewniormmagaswhosemlwmigmappear
modifiedinanegativeway. Insuchsituations,onecsnnotmleoutthedisplayof
negafivebehavimusonthepmtoftheseniornmnagerswhichcmldundemfinean
mhawiseefi'ecfivemmgememdevelopmanprogram,espechnywhaecostappmval
fortheprogramoraspectsoftheprogramlieswiththeseniormanager.

Thesystemwinmquuematanseniormmagemanpasomelbeufinedpresentasand
haveaworkingknowledgeofadulteducationprinciples. Emphasisonthedevelopment
ofindividualswillrequiresomeveryspecificknowledgeandskill. Seniormanagersare
knownmdehveraspectsofm-hwsenaimngandflnoMyqualificafimfmmatspecific
mle,msomesimafions,ismehposifimwiminfl|eWon,mdnGnecemfilyfiom

109
a knowledge base or skill level.

Thedanandmyexpaienceinmefieldofhealthcaremanagementsuggestthatthe
administrative head ofthe department ofeducation and professional development should
beanemberofSeniorMmagement-nmrepmnngmaVicePresidem,especiaflyifmm
VPhasneithertheknowledgenormemestregardingmauersofeducafionand
professionaldevelopment. Therehastobeahighlevelofautonomyenjoyedbythe
managerofeducationalservices. Suchanarrangementwillwndtheappropriatemessage
totherestofmeorgmizanonregu'dingmecomnuunentoftheorganizafionto
developmentalopportlmities.

Provideoppmumifiesfmmmagasformeirskifldevdopmemeortheufilinfionof
thoseskills. Theutilintionofthoseskiflscantaketheformofnewjobresponsibilities
orbymerelyincorporatingthemintorhilyactivities. ltisreasonabletoassumethatonce
newskinshavebeenacquued,mdivimrflswmndwekomeoppmominesfmuseofmose
skillssoMexpafisecmfldbebufltmdmainminedespecidlywhaemeskiusfmmpm
ofthejob requirements.

Oppmhmifiesfmmedsassessmentofhdfimremmagmscouldbemguhrlyprovided
aspanofmemguhrperfmmmceappraisalsystemntherthanmasystemwhichmigm
beperceived as diagnostic in which case, co-operation couldbethreatened. Withthe
performance appraisal system, one’s “weaknesses" would be identified in a mutually
safisfyingmamerwimafamiharboss,mthmmmenvhonmemwithadiagnosfician
whomightnotbeassensifivetotheneedsofmemamgersandwmddnotmgendera
non-judgementalsituationleadingtoacceptanceandco—operation.

Implications for the College (CCHSE)

Generateeffortsforbreakingdowntheartificialbarrierswhich havebeencreatedbetween
generalmanagementandhealthcaremanagementn'aining. Theremightbeaneedto

110

identifywhatrequirementsmustbemettomanageinhealthcare. Referencehereisto
jobrequirementsandnotnecessarilyCoflegerequirementsformembership. Adding
cerfificafionforthedifferemlevelsofmmagementwiflbeausefiflmdmeaningfid
contribution to health care management. The College could be assigned the responsibility
ofcertificationofthedifferentlevelsormanagers. Withacleardelineationofthe
differemwgementjobsandmeurequiredwmpaencies,maeshmddbemcmfirsim
moundingwhataddifimalskifldevelopmaumiglubereqrnredtoqualifyfora
managementpositioninhealthcare. Knowingtherequirementsfordifferentposition
levelswillalsoprovidesomestructm'eformanagementdevelopment. Notonlywillthere
becleuerexpecmfimsofmwmbenmmmerewinalsobecleardnecfionfmmose
aspiringtoaparticular management job.

The regulatory college should be the focus and source of professional development
activityforhealthcaremanagers. Bymaintainingtheexternaldatabaseofcareer
developmentneedsofheflthcammnagasasidenfifiedatpafmmanceappraisfl,me
Collegecanofferprogramswhichwillmeettheneedsoftheindusn'y. Suchcentral
programming shouldnotnecessarilymeancennaldeliverymnlesscennaldeliverydoes
notmeanacentralvenue. Cenn'alprogramminganddeliverywouldbepossiblebased
ontechnological capabilities of me mdrvrdualsandorgamzanons e.g.distanceeducation
viainteractive computerhook—up. Such systems of program deliverywillimprove access
especially if the interactive system provides for individual pacing of requirements
compledonandinaworkenvuonmentwheremereissnongsupportofthehifing

TheCoflegeshmddfosterintm‘dependencemdcooperafionbetweeneducafional
institutions, health care organizations, theprofessional body (College) and the managers.
Sharingthedatabaseinformationwillfacilitateco—operation. Theresultsofthatco—
operafionwiflenhancethedevelopmentaloppmomifiesforhealmcaremamgasin

various locations.

l l l
RECOMMENDATIONS FOR FURTHER STUDY

The following are some suggestions for consideration:

0 Repeatastudyofthistypeatlensteverythreeyearstoidentifytheneeded
akillsforadynamiccomplexhealthcareenvironment.

Suchanacfivitywiflprovidevaluableinformationforconfinuedmanagement
development.

a Repeatthisstndyusingmanagessfiomanon-healthcareenvironmentasthe
populationofinmrestandcornparetheresultswiththoseofthisstudy.

Idonotmficipatemydiffaencesbtutherendtswmddassistmconvincingsome
individualsthattheacademicpreparationformanagementinhealthcare
organizationsisthesameasthatrequiredformanaginginotherfields.

O Conductastudytoidentifythehealthcareorganizationswhichare
supportiveofmanagementdevelopmentandevaluatetheirsuccessas
determinedbycnstomerandmanager satisfaction levels.

lanticipatedratthempporfiveorganizafionswiflbeperceivedasefi'ecfive
organizations meeting the needs of their communities while having managers who
enjoy a high level of job satisfaction.

0 Replicate this study targeting lower level managers and compare their
perceptionsandopinionswiththoseoftherespondentsofthissmdyf

Thisrecommendafionshorddbecarfiedotubyindividualorganizafionssothat
specificorganizationalneedscouldbeaddressed. Ifdoneasslargerstudythen

112

itshouldbeplannedsothatindividualrendtscwldbeseparatedoutsoasto
alloweachorganizationtoknowitsspecificresultsandthusbeabletoreacttothe
findings.

Although health care managers have a variety of academic backgrounds, and that the
skiflsdesiredshorddbethesameregardlessoftheiracademicpreparafion, identified
needsexistedforneedsassessment, forprovidingdirectionforskilldevelopment, andfor
on-going support for the pmsuit of profsssronal development for managers.

Thefocusofthesmdywasmanaginginhealflrcareinsfimdonsandspecificafly,theissue
of professional development for managers in a changing environment. In the 1990’s,
health care organizations are ”re-organizing“, ”downsizing", 'rightsizing" and ”re-
engineaing'jobsmmeffonmcopewhhdeaeasedfundingmdmthesamefimesafisfy
clientandcustomerneedsandexpectations. Thoseactivitieshavecausedthehealthcare
envuonmentmbemeofcmstantchangewim&mandemdifierentmmagementskins
andctnrentknowledgeofhealthcareandrelatedissues. Identificationoftheissuesfaced
by health care managers in their pursuit of continuing education and professional
development and documenting their perceptions will help to provide break-throughs in
meefingmemamgementneedsofmepresemeummhealthcaremdrmregarding
needed skills and knowledge. Without a clear identification of the needs of the field,
managerswillbeill-equippedtopursue, inameaningful way, theacquisitionofrequired
skills and knowledge.

APPENDICES

APPENDIX A
Letter of Introduction
8 Morton Way, Brampton, Ontario, MY 2R7

Dear Colleague

qufimmhehmbwnMvemuxuamlmmflcfimeQMonsand
perceptionofhealthcaremanagersonthetopicofContinuingEducationand
Professional Development.

ThereismdoubtthflMheaMcmeenvummemisconsmMychangingmdsomehealth
caremamgmsmigmuwondefinghowtheycanmainmmtheskimrequuedformeefing
the future needs of the industry. Continuing education and professional development
couldverywellbetheroutetomaintainingctnrency. Itismyexpectationthatsomevery
revealing answers would be provided through my research.

Thereareelevensectionstothequestionnaire. Marenowrongorrightansrvers,
onlyopinionsandperceptions. Thesummarydatawillbeusedinadissertationreport
for my Ph.D. degree. Your answers are completely confidential and anonymous.
Donotputyournameanywhereonthequestionnairebutintheeventthatyou
wouldflketobecontactedforprovidingmoreinformafionortobeinterviewed
pleaseindicatesepnrately.
Themfingscflethoughomismesamebmisrepeatedmsevmalqrotsmfacflimteeasy
completion. Completion ofthe questionnaire shouldnottakeyou morethan 15 -20
minutes. PleaserenunintheenvelopeprovidedbyOctober31/1994.

Ifyouhaveanyquestionspleasefeelfreetocontactmeat(905)4511778oratthe
addressstatedatthetopofthispage.

Thank you for your kind co-operation.

Yours sincerely

Winston‘W. Isaac, M.A., M.P.A., C.H.E.

113

APPENDIX B

CONTINUING EDUCATION QUESTIONNAIRE

Winston W. Isaac, M.A., M.P.A., C.I-I.E.
8 Morton Way, Brampton, Ontario
L6Y 2R”! (Phone (905) 451 1778)

114

115

CONTINUING EDUCATION QUESTIONNAIRE

 

 

Using the rating scale provided, please indicate your level of agreernent/disagreement with the following
statements:

1. PERCEPTION OF NEEDS:

Wmfidua’mfa'w meme...

 

1.1 should bearequnementforallhealthcaremanagers

 

1.2 would keep health care managers current in
management issues

 

1.3 would be advantageous to individuals who have been
away from formal education for greater than 3 years

 

1.4 would be advantageous to individuals who have been
away from formal education for greater than 5 years

 

1.5 should be mandatory for managers who do not pom
formal academic credentials in health ears
management

 

1.6 should be related to specific levels of job responsibility

 

1.7 should be related to experience level

 

1.8 should be a mutual understanding between manager
and supervisor

1.9 should be required for Chief Executive Officers

 

 

1.10 should be required for Senior Management
y f

 

 

 

 

 

 

 

 

 

116

CONTINUING EDUCATION QUESTIONNAIRE

 

 

Using the rating scale provided please indicate your level of agreement/disagreement with the following
statements:

2. BARRIERS:

Mammanmfilbyw T new." :Mby...

 

    

job workload

 

2.2 inadequate course offerings

 

2.3 distance from home

 

2.4 distance from work

 

2.5 cost of coursss, 00an and related activities

 

2.6 the perception that continuing education is not valued
by employers

 

2.7 personal responsibilities related to home life

 

2.8 managers perceiving continuing education to be of low
personal value

2.9 the low probability of increased financial reward (pay
raises)

 

 

2.10 continuing education not being perceived as an
expectation by employers

 

 

 

 

 

 

 

 

 

liq

CONTINUING EDUCATION QUESTIONNAIRE

 

 

 

2.11 OTHER (Please add sumtions)

 

 

 

 

 

 

118

CONTINUING EDUCATION QUESTIONNAIRE

 

 

 

Using the rating scale provided, please indicate your level of amt/disagreement with the following
statements:

3. PERCEIVED BENEFITS:

WWIG'W mmmvflsfa’...

 

3.1 currency of information

 

3.2 increased promotability (internal)

 

3.3 increased opportunities for net-working

 

3.4 increased self-esteem

 

3.5 increased marketability (external)

 

3.6 increased political know-how

 

3.7 improved management skills

 

3.8 increased morale

 

3.9 increased level of job satisfaction

 

3.10 increased performance appraisal rating

 

3.1 1 increased productivity

 

3.12 increased job knowledge
3.13 increased decision-making ability

 

 

3.14 improved communication skills

 

3.15 increased motivation

 

 

 

 

 

 

 

 

 

3.16 increased efficiency

 

119

CONTINUING EDUCATION QUESTIONNAIRE

 

 

 

3.17 improved organizational ability

 

3.18 OTHER (Please add)

 

 

 

 

 

 

120

CONTINUING EDUCATION QUESTIONNAIRE

 

 

Using the rating scale provided, please indicate your level of agreement/disagreement with the following
statements:

4.

 

4.1

MANDATORY vs VOLUNTARY:

Health caremanagersshould berequired to pursue a
formal or an accredited program of continuing education

 

4.2

A mandatory program of continuing education for health
care managers would be beneficial to my own
development

 

4.3

I do not need a mandatory continuing education
program to motivate me to pursue continuing education
activities

 

4.4

A mandatory continuing education program will not
make any difference in my pursuit of continuing
education activities

 

4.5

I regularly pursue continuing education and professional
development activities

 

4.6

Accredited continuing education should be an
expectation of health care managers

 

4.7

Allhenlthcaremanagersshould beexpected to report
their continuing education activities to a governing body
on an annual basis

 

4.8

Accredited continuing education should be an
expectation for health care managers in my organization

 

4.9

 

 

Salary increases for health care managers should be
based on the pursuit of accredited continuing education

 

 

 

 

 

 

 

121

CONTINUING EDUCATION QUESTIONNAIRE

 

 

4.10 Health care organizations which mandate continuing
education for managers will be assured a competitive
edge

 

4.11 Health care organizations should have formal policies
regarding expectations for managers to pursue
continuing education

 

4.12 Continuing education for health care managers is a
critical factor in the future success of the organization

 

4.13 OTHER COMMENTS:

 

 

 

 

 

 

 

 

 

122

CONTINUING EDUCATION QUESTIONNAIRE

 

 

Using the rating scale provided, please indicate your level of agreement/disagreement with the following
statements:

5. FACILITATION ROLE:

   

5.1 Employers should facilitate continuing education
activities for health care managers

 

5.2 Employers should facilitate continuing education
activities for health care managers by offering FULL
financial support

 

5.3 Employers should facilitate continuing education
activities for health care managers by offering
PARTIAL financial support

 

5.4 Employers should facilitate continuing education
activities by providing PAID TIME for attendance

 

5.5 Employers should facilitate continuing education
activities by giving bonuses to participants

 

5.6 Each health care manager has a responsibility for
facilitating his/her own continuing education activities

 

5.7 The professional body should facilitate continuing
education activities by providing appropriate
opportunities for managers

5.8 Educational institutions should facilitate continuing
education activities for health care managers

 

 

 

 

 

 

 

 

 

 

123

CONTINUING EDUCATION QUESTIONNAIRE

 

 

 

5.9 OTHER (Please list other ideas):

 

 

 

 

 

 

CONTINUING EDUCATION QUESTIONNAIRE

 

 

Using the rating scale provided, please indicate your level of agreement/disagreement with the following
statements:

6. MOTIVATORS:

I WOULDME‘SEMYPARWATTONDVWUHVGWUONHL

 

6.1 programs were accessible

 

6.2 my employer provided FULL financial support

 

6.3 my -ployer provided PARTIAL financial support

 

6.4 I felt my skills would be enhanced

 

6.5 I felt that my salary would be increased

 

6.6 I felt that my chances for promotion would be enhanced

 

6.7 I felt m about my future with my present employer

 

6.8 I felt the need to increase my marketability

 

6.9 I felt that I could increase my chances for secondment

 

6.10 there were formal organizational policies in support of the
activity

 

6.11 educational activities were done on site

 

6.12 I could share my knowledge with colleagues

 

 

 

 

 

 

 

 

 

6.13 I felt mm in my position

 

125

CONTINUING EDUCATION QUESTIONNAIRE

 

 

 

6.14 OTHERS (Please add)

 

 

 

 

 

 

126

CONTINUING EDUCATION QUESTIONNAIRE

 

 

Using the rating scale provided, please indicate your level of agreement/disagreement with the following
statements:

7. REASONABLE EXPECTATIONS:

 
   

7.1 Health care managers should be required to take at least
one credit course per year.

 

7.2 Health care managers should be required to attend at least
one profccaonally related activity per year.

 

7.3 Health care managers should be required to pursue
research activities on the job.

 

7.4 Health care managers should be required to publish at least
one article in a professional journal every year.

 

7.5 Health care managers should be required to publish at least
one article in a professional journal every 3 years.

 

7.6 Health care managers should be required to publish at least
one article in a professional journal every 5 years.

 

7.7 Health care managers should be allowed to set their own
continuing education goals.

 

7.8 Secondment to another organization should be considered
an appropriate educational activity for health care
managers.

7.9 Health care managers should be expected to follow
educational activities specific to a clinical discipline.

 

 

7.10 Health care managers should be expected to follow
educational activities related to management.

 

 

 

 

 

 

 

 

 

127

CONTINUING EDUCATION QUESTIONNAIRE

 

OTHER (Please add)

 

 

 

 

 

 

 

 

 

 

 

128

CONTINUING EDUCATION QUESTIONNAIRE

 

 

Using the rating scale provided, please indicate your level of agreement/disagreement with the following
statements:

8. FUTURE SKILLS:

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Leadership

Communication

Lifelong Learning
Consumer/Community Relations
Health Environment Awareness
Conceptual

Results Management

Resource Management

Compliance to Standards
Teaching/Instructional

Stress management

 

129

CONTINUING EDUCATION QUESTIONNAIRE

 

 

 

8.12 OTHER (Please add)

 

 

 

 

 

 

 

 

 

130

CONTINUING EDUCATION QUESTIONNAIRE

 

 

Using the rating scale provided, please indicate your level of agreement/disagreement with the following
statements:

9. SKILL DEVELOPMENT:

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Self-directed individualized programming

 

9.2 Formal undergraduate courses

 

9.3 Pursuit of current health administration programs e.g.
MHA. MHSc

 

9.4 Pursuit of current management programs, e.g. MBA,
MPA, CMA

 

9.5 On the job training WITH a mentor

 

9.6 On the job training WITHOUT a mentor

 

9.7 Paid educational leave

 

9.8 Secondment to another organization
9.9 Reading professional journals

 

 

9.10 Attending workshops with a specific focus

 

9.11 Attending short courses (1-4 days duration)

 

9.12 Attending intensive courses (1-3 weeks duration)

 

9.13 Attending residential programs (6 weeks or more)

 

 

 

 

 

 

 

 

 

9.14 Presenting at conferences

 

131

CONTINUING EDUCATION QUESTIONNAIRE

 

 

 

9.15 OTHER (Please add)

 

 

 

 

 

 

132

CONTINUING EDUCATION QUESTIONNAIRE

 

10. DEMOGRAPHICS:

 

  
 

   

_ Some Post Secondary _ 6 months to 1 year

__ Community College _ 1 to 2 years

_ Bachelor’s Degree __ 2 to 4 years

_ Some Graduate Work _ 4 to 6 years

__ Master’s Degree _ 6 to 10 years

_ Doctoral Degree __ 10 to 15 years
more than 15 years

OTHER

  
 

 

 

 

 

 

   

Levels between your position & Chief
Executive Officer
0

     

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2
3

  

  

$40.1!” - $50,(X)0
$50,001 - 560,1!)0
S60,m1 - $70,000
$70,001 - $80,000
$80,“)! - $901110
$90.1!” - $100,000
$100,001 plus

 
    
 
   
   
 

 

 

 

 

133

CONTINUING EDUCATION QUESTIONNAIRE

 

11.0 OTHER

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Credit Courses taken

Non-credit courses taken (external)

Workplace courseslserninars taken (non-credit)
Conferences attended

Presentations made at Conferences

Guest presentations made at colleges or universities
Courses delivered at colleges or universities
Publications (___ Author or _ co-author)
Formal mentoring/preceptor occasions

OTHER: Please add

 

 

 

 

11.2 “Mmmmfiym

Clinical or _ Non-Clinical

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