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Leadership competencies in healthcare administration graduate degree programs: an evaluative study

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Leadership competencies in healthcare administration graduate degree programs: an evaluative study

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Content Running head: LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 1

LEADERSHIP COMPETENCIES IN HEALTHCARE ADMINISTRATION GRADUATE
DEGREE PROGRAMS: AN EVALUATIVE STUDY

by

Shawishi Haynes

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December 2018

Copyright 2018 Shawishi Haynes
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 2

DEDICATION
I would like to dedicate this dissertation to my loving family, my husband (Calvin), my
children (Pooh, Rmanii and Maleke), my granddaughter (Peyton), my mother (Garlina), all my
sisters but particularly (Kicheko and Anya). My family has always been very supportive of my
journey. My children have never known a time in their life where mom was not in school. To
my granddaughter Peyton who I could not always play with when she wanted me to because
Nana was working. My family has always supported me in this journey. My husband has been
amazing through this journey. Without his support I could not have accomplished this goal. I
love you Calvin.
In memory of my late sister Anya, I thank you for your love and encouragement. You
taught me the meaning of enjoying your life to the fullest and being happy and cheerful no
matter what. You held me up so high on a pedestal when at times I know I did not deserve it. I
thank you, love you and miss you dearly. I know that it is because of you looking down on me
and pushing me to press forward that gave me the energy to stay up late nights working on this
document.
Finally, I thank God for giving me the desire, the drive and passion that enable me to
engage in this self-fulfilling journey. I ask that you continue to inspire and lead me to utilize the
knowledge gained through this process to enhance the lives of my family, friends and all of
those around me.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 3

ACKNOWLEDGEMENTS
Completing a doctoral degree is no small effort. To be successful in this endeavor
requires a tremendous amount of support from your colleagues, professors, committee, friends,
family work, and family. In addition to these groups, I would like to express my appreciation to
the USC Rossier School of Education Program that provided that provided the platform which
resulted in an academically rigorous, collaborative and engaging environment to discuss
difficult topics such as education, diversity, healthcare, innovation, accountability and research.
Thank you to my dissertation committee: Helena Seli, PhD., Darline Robles, PhD. and
Francis Kellar, EdD, your time, advice and encouragement, including challenging me to go
deeper with my research. Dr. Seli, you were amazing as a Dissertation Chair. You offered
guidance and counsel. You were patient with me and very accessible. Dr. Guadalupe Garcia,
my editor I would like to thank you for your willingness to quickly review my work at a
moment’s notice.
A special word of thank you to my classmates… You were a great cohort. I will cherish
the friendships and bonds made with you that challenged my thinking and supported me through
rough patches. Our study group was awesome with Dr. Wise leading the group.
To my colleague and friend Dr. Kathleen Wiggins who kept me going with her daily
phone calls of encouragement.
Finally, my aspiration to complete this journey would not have been possible without the
love and support of my husband Calvin and my children Pooh, Rmanii, Maleke, my
granddaughter Peyton and my mother Garlina. You all have been my greatest support system
and a blessing. Thank you, thank you, thank you!
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 4

TABLE OF CONTENTS
Dedication 2
Acknowledgements 3
List of Tables 5
List of Figures 7
Abstract 8
Introduction to Problem of Practice 9
Field Context and Mission 11
Importance of Addressing the Problem 12
Field Performance Goal 12
Stakeholder Group of Focus and Stakeholder Goal 14
Purpose of the Project and Questions 15
Methodological Approach 16
Review of the Literature 17
Historical Perspective of Healthcare Competencies 17
Generational Leadership Groups 20
Issues Emanating from Poor Healthcare Administrators and Leadership 24
Disparities between Current Skills and Leadership Priorities 27
Studies on the Efficacy of Leadership Competencies in Healthcare Administration 28
Challenges When Leadership Competencies Are Not Developed in College 30
Program Directors’ Knowledge, Motivation and Organizational Influences 31
Interactive Conceptual Framework 41
Data Collection and Instrumentation 44
Results and Findings 49
Analytic Procedures 50
Research Question 1 (Stakeholder Knowledge and Motivation) 59
Research Question 2 (Interaction between Knowledge, Motivation and Organizational
Influences) 77
Additional Findings: Participant Solution Recommendations 87
Recommendations for Practice 93
Conclusion 99
References 101
Appendix A: Participating Stakeholders with Sampling Criteria for Interview, Survey and
Observation 122
Appendix B: Protocols 126
Appendix C: Credibility and Trustworthiness 137
Appendix D: Validity and Reliability 138
Appendix E: Ethics 139
Appendix F: Integrated Implementation and Evaluation Plan 143
Appendix G: Miscellaneous 160

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 5

LIST OF TABLES
Table 1: Field Mission, Global Goal and Stakeholder Performance Goals 14
Table 2: Summary of Assumed KMO Influences on Program Directors Understanding of
How to Effectively Incorporate Leadership Competencies into their Graduate Degree
Program Curriculum 39
Table 3: The KMO Subscales Items 53
Table 4: Demographic Data 56
Table 5: Knowledge of the Healthcare Administration Competencies and Career Readiness 61
Table 6: Descriptive Summary of the Program Directors’ Responses to Knowledge
Influences 63
Table 7: Summary of Themes for Leadership Competencies and Career Readiness for
Healthcare Professionals that Emerged from the Telephone Interviews 68
Table 8: Summary of Themes for Knowledge Influences that Emerged from the Interviews 72
Table 9: Motivation to Engage in and Facilitate Programs and Courses Curriculum
Improvement 73
Table 10: Descriptive Summary of the Program Directors’ Responses to Motivational
Influences 75
Table 11: Summary of Themes for Motivational Influences that Emerged from the Telephone
Interviews 76
Table 12: Organizational Influence to Engage in and Facilitate Programs and Courses
Curriculum Improvement 80
Table 13: Descriptive Summary of the Program Directors’ Responses to Organizational
Influences 81
Table 14: Summary of Organizational Influences Themes that Emerged from the Telephone
Interviews 83
Table 15: An Interaction of the Knowledge, Motivation, and Organizational Influences 84
Table 16: Summary of Improvement Areas 88
Table 17: Summary of Documentation Review from University Websites 91
Table 18: Summary of Knowledge Influences and Recommendations 94
Table 19: Summary of Motivational Influences and Recommendations 96
Table 20: Summary of Organizational Influences and Recommendations 98
Table 21: Outcomes, Metrics, and Methods for External and Internal Outcomes 145
Table 22: Critical Behaviors, Metrics, Methods, and Timing for Evaluation 147
Table 23: Required Drivers to Support Critical Behaviors 149
Table 24: Evaluation of the Components of Learning for the Program. 154
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 6

Table 25: Components to Measure Reactions to the Program. 155
Table 26: Key Performance Indicator Report 158

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 7

LIST OF FIGURES
Figure 1. Conceptual framework: Interaction among the organization, the stakeholder group,
and the organization’s goal. 42
Figure 2. Visual representation of sequential explanatory mix methods research methodology
for study. 46
Figure 3. Type of graduate degree in healthcare administration offered. 55
Figure 4. Period that the program director has been accountable. 58
Figure 5. Number of leadership courses required to graduate. 59
Figure 6. Graph of Program Directors’ Knowledge of HLA and NCHL competency models. 65
Figure 7. Mindmap of leadership competencies identified by program directors from the
telephone interviews. 67
Figure 8. A graphical overview of the program directors self-identified priorities 79
Figure 9. A graphical overview of the knowledge, motivation, and organizational influences. 85

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 8

ABSTRACT
This field evaluative study focused on program directors’ knowledge, motivation and
organizational influences related to integrating the Healthcare Leadership Alliance and National
Center for Healthcare Leadership Competencies into their degree programs such that students
would develop experiential leadership competencies. Graduate programs in healthcare
administration have an opportunity to develop these competencies by providing their students
with opportunities for experiential knowledge and skills throughout their degree program. The
study employed a mixed methods sequential explanatory research design with a Qualtrics
survey conducted first, followed by telephone interviews and document analysis. The results of
the study identified that program directors were motivated to incorporate leadership
competencies but several of the participants lacked the specific knowledge regarding the
identified competencies. There was no universal set of leadership competencies that all directors
expected of students prior to graduation and minimal time was spent on curriculum related
activities due to other competing priorities in their roles as program directors. Furthermore, the
results also revealed several organizational influences such as teaching load, publishing
requirements and administrative tasks kept the program directors from focusing on student
career and work-path readiness. The outcome of this study resulted in recommendations for
training of program directors on how to make changes in their curriculum to align with industry
requirements and for the academic institutions to re-evaluate the program directors’
expectations and priorities to enable them to focus on tasks that will better inform needed
curricular changes. Future research in this area should be focused on how to better assess how
leadership competencies are manifested in the work setting by recent graduates.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 9

Introduction to Problem of Practice
Broom, Turner, and Brichto (2016) note that, when evaluating how well healthcare
administration graduate programs fulfill their role in management development based on
assessment of competencies, the results reveal there is much work ahead for directors of these
programs. Broom et al. (2016) further indicate that, based on the Commission on Accreditation
of Healthcare Management Education (CAHME) accreditation data from 2007 to 2015, over
70% of all healthcare management programs had adverse criterion-related findings on their
ability to assess their students and graduates’ attainment of competencies. Major problems
identified were (a) not measuring competency attainment within courses; (b) not measuring
competency attainment across courses; (c) significant reliance on student self-assessments; and
(d) failure to use assessment data for overall program improvement (Broom et al., 2016, p. 1).
Patients are regularly harmed while receiving care and services (James, 2013; Kalra,
Kalra, & Baniak, 2013). It is estimated that between 44,000 and 98,000 lives are lost annually
due to preventable human errors during healthcare delivery (Kalra et al., 2013; Makary &
Daniel, 2016). These errors are largely related to deficits in people and processes (World Health
Organization, 2014). Deficits in the healthcare workforce, such as challenges in handling
emerging complications, insufficient communication and teamwork skills, and failure to adopt
evidence-based approaches in service delivery are among the leading causes of errors (Epps &
Levin, 2015; Singer & Vogus, 2013). The World Health Organization (2018) estimated that, of
the 421 million annual hospitalizations, approximately 42.7 million have adverse events.
Furthermore, the United States spends in excess of $41 billion due to costs associated with
medication errors. Five percent of adults in the United States experience a diagnostic error and
up to 50% of the primary care visits have administrative errors (World Health Organization,
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 10

2018, pp. 1-4). Thus, the current healthcare leaders are having challenges with identifying
suitable solutions to address the complexities that they face with implementing the types of
programs that will improve quality, reduce cost, and streamline operations (Teel, 2018). One of
the contributing factors is an administrator of a healthcare organization’s ability to manage
personnel, processes, resources, projects and budgets that can affect care delivery and cost.
Thus, healthcare workforce career readiness has far reaching implications on healthcare quality.
Increasingly, healthcare employees require a core set of knowledge, skills, and abilities
to be successful (Finkelman, 2015; Ford, 2009). Healthcare administration graduate programs
play a critical role in providing students the knowledge, skills, and competencies required to
obtain gainful employment in the field (Calhoun, Vincent, Calhoun & Brandsen, 2008; Hirschy,
Bremer, & Castellano, 2011; Kwok, 2005). The National Association of Colleges and
Employers (NACE, 2017) outlined key competencies for career readiness as
critical thinking/problem solving, oral/written communications, teamwork/collaboration,
digital technology, leadership, professionalism/work ethic, career management and
global/intercultural fluency. Leadership is defined as the ability to leverage the strengths
of others to achieve common goals and use interpersonal skills to coach and develop
others with the ability to evaluate and manage their emotions and those of others; use
empathetic skills to guide and motivate; and organize, prioritize, and delegate work.
(para. 5)
This study focused on leadership competencies taught within healthcare administration graduate
degree programs.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 11

Field Context and Mission
The field of healthcare administration is a dynamic, complex, and unique field that
primarily has four key entities: payers, providers, patients, and vendors (Gilmartin, & D’Aunno,
2008; Huppertz, Strosberg, Burns & Chaudhri, 2014; Shi & Singh, 2010). Payers include
employers, individual consumers, and the government. Providers consists of hospitals and care
providers. Patients are the consumers of healthcare services. The fourth entity are the vendors
within the industry that support the provision of various services to these entities. These entities
have interconnected systems and processes (Langabeer & Helton, 2015). As healthcare costs
continue to rise in the United States, representing roughly 18% of the national gross domestic
product (Centers for Medicare & Medicaid Services, 2017), people managing healthcare
organizations have a responsibility to develop efficiencies that will control or reduce
unnecessary costs.
According to Langabeer and Helton (2015), “there is an increased focus on how
healthcare organizations are being managed and a heightened awareness of the effect that
efficient and successful management of the health care organization can provide” (p. xxi).
Healthcare organizational leaders require leadership competencies to navigate this industry and
the bureaucracies they will face. For the purpose of this research healthcare organizational
leaders are people that manage healthcare organizations and or departments or business units at
all levels to include supervisors, managers, and directors and above. Furthermore,
administrators of healthcare organizations must be able to influence these four key power
groups to engender the necessary support to make wide-scale changes in their organizations
(Porter, Haberling & Hohman, 2016).

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 12

Importance of Addressing the Problem
It is important to address the problem of career and work path readiness among
graduates of healthcare administration programs due to the implications for the industry as
whole. Healthcare management requires a core set of skills that current graduates lack (Stefl &
Bontempo, 2008), and there are a number of consequences associated with poor leadership.
These include lack of quality in delivery of care, rising costs, failures in change management
and process improvements, and the need for intensive human capital (Budden, Zhong, Moulton,
& Cimiotti, 2013; Griffith, 2007; Makary & Daniel, 2016; Popescu, 2015). These negative
consequences ultimately speak to a lack of efficiency and thoroughness in the management of
healthcare systems (Dekker, 2014; Raban & Westbrook, 2014; Starmer et al., 2013). Healthcare
administration program graduates who lack required competencies have a negative impact on
the entire healthcare industry, including spending and patient outcomes. Therefore, this field
evaluation study presented herein is important based on evidence that the current workforce
lacks the skills to manage large integrated healthcare delivery systems (Epps & Levin, 2015;
Singer & Vogus, 2013). Ensuring that healthcare administration graduate students acquire the
knowledge, skills, and abilities during their degree program is important because these students
will be responsible for leading complex healthcare systems into the future (Hartman & Crow,
2002).
Field Performance Goal
Table 1 identifies the global and current performance goal that underpins the rationale
for this research. The mission of the healthcare industry is to provide safe care to patients. To
work toward this goal, it is imperative that healthcare organizations’ leaders advance their
knowledge and leadership capabilities. Thus, the more granular mission is to improve the
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 13

quality of healthcare administration graduates which will, in turn, facilitate improvements in the
management of healthcare organizations thereby improving clinical outcomes, patient
satisfaction, patient safety, financial performance of healthcare organizations and a reduction in
both administrative and clinical errors.
The National Center for Healthcare Leadership’s (NCHL, 2017) competency model
“promotes the standards of leadership excellence that are necessary to achieve organizational
performance envisioned by the Institute of Medicine” (p. 3). In addition, the objective of
Healthcare Leadership Alliance (HLA) is to ensure that managers in healthcare have the skills
required to be effective in healthcare administration. By incorporating the work of the
aforementioned organizations into graduate degree programs’ curricula, students should be
career ready upon graduation. These efforts will, in turn, facilitate improvements in the
management of healthcare organizations, thereby improving clinical outcomes as well as
outcomes related to patient satisfaction and safety, financial performance and a reduction in
both administrative and clinical errors.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 14

Table 1
Field Mission, Global Goal and Stakeholder Performance Goals
The Field of Healthcare Administration Mission
To improve quality and patient outcomes and to do so in a fiscally responsible manner by
having leaders that have the requisite knowledge, skills and abilities to successfully lead
complex healthcare organizations.
The Field of Healthcare Administration Global Performance Goal
By 2023, 85% of organizations, business units and or departments managed by recent
healthcare administration graduate students will realize improvements in their key performance
indicators (KPIs) such as cost, quality, patient experience and employee engagement.
Healthcare Employers’ Goal

Healthcare Administration
Program Directors’ Goal
Healthcare
Administration Faculty
Goal
By August 2019, 100% of
healthcare employers will
inform degree-granting
institutions of the required
leadership competencies
needed to be successful in
their specific work
environment.

By August 2020, 100% of
program directors will
integrate the HLA
Competencies and the NCHL
competency models into their
degree program curriculum
that using experiential learning
methods.
By August 2021, 100% of
healthcare administration
faculty will implement
applied and experiential
learning opportunities and
field projects into their
course curriculum to enable
students to demonstrate the
development of leadership
competencies throughout
their degree program.

Stakeholder Group of Focus and Stakeholder Goal
Graduate degree programs in healthcare administration play a critical role in preparing
students for gainful employment in the healthcare industry (Hirschy et al., 2011; Kwok, 2005).
Thus, it is important to identify the concerns presented in the literature regarding the career
readiness of graduates of these academic programs (Carnevale, Jayasundera, & Hanson, 2012;
Mangelsdorff, 2014). Although a complete analysis would involve all stakeholder groups, for
practical purposes, the healthcare administration programs’ directors were the sole focus of this
study. The focus on these stakeholders was informed by concerns that the students they
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 15

graduate are not prepared for the leadership demands of an administrative career (Irby, Cooke,
& O’Brien, 2010; Mangelsdorff, 2014). In a recent study by Messum et al. (2017), both
managers and students reported skills gaps in critical areas consistent with competencies
required to lead organizations. Some of these competencies identified in the “critical analysis
sub-scale” included priority setting, planning, ability to analyze the environment, conceptual,
creative, strategic and independent thinking” (p. 11). These stakeholders are important because
they are considered the foundation of their educational programs. Specifically, this study
evaluated whether or how they integrated the HLA competencies and/or the NCHL competency
model into their programs as measured by a review of core course requirements and
deliverables. The goal for the stakeholder group of focus is that, by May 2021, 100% of
program directors will integrate the HLA competencies and the NCHL competency model into
their programs such that students are able to develop their leadership competencies while in
graduate school.
Purpose of the Project and Questions
The purpose of this study was to evaluate the degree to which healthcare administration
programs meet the global goal of graduating students who have experiential knowledge and
skills as measured by the HLA and NCHL competency model. The study’s overall framework
was based on the work of Clark and Estes (2008). The evaluative study, presented in the
executive dissertation format, focused on knowledge and skill, motivation and organizational
influences related to achieving the global goal through meeting stakeholder performance goals.
The data analysis focused on healthcare administration graduate degree program
directors’ knowledge, motivation and organizational influences related to integrating the health
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 16

administration leadership competencies into their programs such that students would develop
experiential leadership competencies. Three research questions guided this study:
1. What is the healthcare program directors’ knowledge and motivation related to
integrating the leadership component of the HLA competencies and the NCHL
competency model into their degree program?
2. What is the interaction between field culture and context and healthcare program
directors’ knowledge and motivation?
3. What is the recommended knowledge and skills, motivation, and organizational
solutions?
Methodological Approach
This study used a mixed-methods approach. Creswell (2014) noted that the mixed-
methods research design integrates both qualitative and quantitative data in a single research
study. The intent for using this method is that it allows for a small sample to yield an extensive
amount of data (Creswell, 2014). From a historical perspective, using multiple methods was
first introduced in the research process in 1959 by Cabell and Fiske. Sieber was the first
researcher to combine survey and interview data while the method of triangulation was first
raised by Jick in 1979 (Creswell & Clark, 2007) which is similar to the research design used in
this study. This information demonstrates a long history of mixed-methods research designs in
social science research. This method was employed because a single method is often not
adequate in answering the aforementioned research questions. Moreover, this method allowed
me to identify the degree to which the qualitative data captured from the document artifacts
aligned with information that is captured from the quantitative survey data.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 17

Review of the Literature
This section provides an historical overview of studies on the development of leadership
competencies. It also examines literature on the core competencies for healthcare administration
and explores the issues emanating from ill-prepared healthcare administrators and leadership. In
addition, it examines the knowledge, motivation and organizational influences of healthcare
administration graduate degree program directors. Lastly, it examines the disparities between
current skills and leadership priorities before exploring potential solutions to the problem of
leadership competencies not developed in college.
Historical Perspective of Healthcare Competencies
Healthcare competencies refer to an employee’s knowledge to carry out the core
functions of their job (Fukada, 2018; MacPhee, 2014). Failure to attain these competencies can
contribute to poor workforce management, a decline in efficient utilization of resources, and
patient safety issues (Thompson, 2012; Popescu, 2015). To understand the necessary leadership
competencies for the future generation of leaders in healthcare organizations, it is important to
examine healthcare administration from a historical perspective.
Evolution of competency-based curricula in healthcare educational programs. The
concept of competency-based curricula is well documented in management literature and dates
to the early 1980s (Dominguez, Garcia, & LaFrance, 2013). However, it was not until the early
2000s that health management programs and associated professional organizations introduced a
comprehensive set of competencies in the profession (Boyd et al., 2018; Dominguez et al.,
2013). The Institute of Medicine called for a common set of competencies in 2003, initiating a
shift in the manner scholars conceptualized education, assessment theory and practice.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 18

The introduction of the NCHL framework in 2004 signaled the start of a rapid evolution
of the structure and understanding of health administration education in general. The
Accreditation Council for Graduate Medical Education established six general competency
requirements for all residency programs: patient care, medical knowledge, practice-based
learning and improvement, interpersonal and communication skills, professionalism, and
systems-based practice (Weggemans, Van Dijk, Van Dooijeweert, Veenendaal, & Ten Cate,
2017). The United States is not alone in the design and implementation of competency-based
curricula. Similar models have been implemented in Canada, the United Kingdom, and many
other countries (Takahashi, Waddell, Kennedy, & Hodges, 2011).
Today, healthcare management educational programs incorporate a competency-based
approach to improve students’ preparedness for modern workplace challenges (Jones, Jorissen,
& Bewley, 2016). Whereas the faculty is charged with preparing the students for the workplace,
Jones et al. (2016) noted that little research has explored their perceptions of using a
competency-based curriculum and how it influences students’ preparedness and employer
expectations of program graduates. Therefore, the current study bridges this gap by examining
the KMO influences from the academic program directors’ perspective.
Graduate programs development periods. Haddock, McLean, and Chapman (2002)
examined the lifespan of the healthcare management career and identified separate development
periods. The development of the field of healthcare management dates back to 1900 when the
first formal healthcare administration education program was established in health economics at
Columbia Teachers College in New York (Haddock et al., 2002). The first healthcare
administration degree program was that of Marquette University, Wisconsin, and the first
graduates were two religious women who graduated in 1927 (Haddock et al., 2002).
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 19

Over the years, the number of academic programs targeting healthcare management has
grown, and they are organized to continue to enhance the quality of healthcare administration
education. Some of the most notable improvements in the area started in 1948 when various
graduate programs in the field of healthcare joined together to form the Association for
University Programs in Health Administration (AUPHA; Arndt, 2010). The year 1968 marked
another milestone in the field, as the Accrediting Commission on Graduate Education for
Hospital Administration was incorporated as an accrediting agency for graduate programs in
healthcare administration (Haddock et al., 2002; Linnander, Mantopoulos, Allen, Nembhard, &
Bradley, 2017). Although the industry continues to grow and there has been a proliferation of
healthcare management graduate degree programs, a host of programs are not accredited by the
CAHME and, therefore, have not met the requirements of an accredited program (ACHE,
2015).
Despite the rich history of the healthcare administration field, it was not until the last 5
decades that the industry experienced significant growth (Fuchs, 2012). It was during that
period that hospitals became large and complex organizations, technological advancements
occurred at rapid rates, healthcare financing moved from self-pay to a complicated system of
third-party reimbursements, and the role of government in the delivery of healthcare
significantly increased (Fuchs, 2012; Haddock et al., 2002). In the wake of the changes,
healthcare administrators still retained their traditional roles of managing the financial aspects
of healthcare facilities with a focus on increasing efficiency and financial stability and were
responsible for providing basic social services to the most vulnerable people as well as
maintaining the moral and social order in healthcare organizations. Subsequently, healthcare
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 20

administration has emerged as a busy and growing field (Bureau of Labor Statistics, 2010) that
has come a long way.
Generational Leadership Groups
Existing literature explains the history of healthcare administration programs from the
1960s to the present day and identifies different generational groups engaged in the workforce
(Stanley, 2010). Three generational groups have been identified in the labor market, namely
veterans (who are now retired), Baby Boomers, Generation X and Generation Y, each with a
unique set of values, perspectives on authority, attitudes towards work, expectations of leaders,
work environment and communication style (Brčić & Mihelič, 2015; Gursoy, Maier, & Chi,
2008; Stanley, 2010). Identification of different generations of healthcare leaders implies each
would be characterized by unique traits, skills, and leadership styles. As the industry has shifted,
so have the types of leadership skills and competencies required to manage large complex
healthcare organizations.
Core competencies for healthcare administration and management. Healthcare
leadership today is required to master management talent sophisticated enough to match the
ever-increasing complexity of the healthcare environment (Stefl & Bontempo, 2008). According
to Stefl and Bontempo (2008), healthcare administrators are expected to demonstrate
measurable outcomes and effectiveness while practicing evidence-based management. Existing
graduate-level academic programs have focused on the attainment of competencies related to
the healthcare workplace effectiveness, and the paradigm shift to evidence-based management
has resulted in numerous efforts to define and refine the competencies most relevant to the
healthcare field (Stefl & Bontempo, 2008). Moreover, the healthcare environment has
increasingly become complex, resulting in the need for leaders to master equally sophisticated
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 21

management talent (Brčić & Mihelič, 2015). The leadership competencies encompassing the
domains related to employee knowledge, motivations and behaviors required in various
leadership positions are usually reflected through competency models (Hughes, 2018). Some of
the most popular leadership models used in healthcare are the NCHL and the HLA competency
models. The Center for Creative Leadership has also developed a model focused on
competencies that are required for leaders managing healthcare organizations as well
(Browning, Torain, & Patterson, 2011). Studies on the design of healthcare administration
degree program curriculum often discuss the integration of a competency to develop students’
leadership competencies (Dearinger, 2011; Patterson et al., 2016).
The NCHL is represented by three domains: the transformation domain, the execution
domain and the people domain. The three domains are comprised of eight technical skills, such
as financial skills, and 18 behavioral competencies. The transformation domain consists of the
achievement orientation, analytical thinking, community orientation, financial skills,
information seeking, innovative thinking and strategic orientation competencies, while the
execution domain consists of accountability, change leadership, collaboration, communication
skills, impact and influence, information technology management, initiative, organizational
awareness, performance measurement, organizational design, and project management
(Krawczyk-Sołtys, 2017). The people domain consists of human resources, interpersonal
understanding, professionalism, relationship building, self-confidence, self-development, talent
development and team development (Krawczyk-Sołtys, 2017).
According to the HLA, healthcare administrators are expected to demonstrate
measurable outcomes, effectiveness, and evidence-based management. The HLA advanced five
competency domains that are universal to all practicing healthcare administrators:
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 22

communication and relationship management, professionalism, leadership, business skills and
knowledge, and the knowledge of the healthcare systems (Krawczyk-Sołtys, 2017; Stefl &
Bontempo, 2008). While the five skills are important, this study focused on leadership skills and
competencies. However, it should be noted that communication is a by-product of leadership
(Men, 2014), and one cannot be considered to be a good leader when effective leadership skills
are absent (Barrett, 2006, p. 197).
Effective communication skills. Communication and relationship management is one
of the core HLA competency domains and is defined as the ability to communicate clearly and
concisely with both internal and external stakeholders to establish and maintain relationships as
well as facilitate constructive interactions with both individuals and groups (Krawczyk-Sołtys,
2017; Stefl & Bontempo, 2008). It is a core requirement for healthcare professionals who must
identify and relate with all colleagues to promote cohesiveness and continuous delivery of
services (Stringer, 2014). Hess (2013) noted that healthcare administrators require problem-
solving skills along with creative and innovative thinking to address problems emerging in their
field. In addition, they require practical communication skills to help in conflict resolution
(Hess, 2013).
In the face of the changing generational groups of the workforce, ensuring a competitive
healthcare workforce would benefit from the preparation of the future workforce for the unique
challenges and opportunities presented by the global economy (Austin, 2011). Austin (2011)
reported a trend in career training that focused majorly on helping students acquire marketable
skills and emphasized the need for American students to acquire a “global mindset” coupled
with an understanding of how the emerging labor dynamics work. The complex labor mix
presents an opportunity for graduate schools to transcend the traditional forms of delivering
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 23

content by preparing their students for the world where both technical skills and soft skills, such
as communication skills, are imperative (Austin, 2011, p. 3). Scholars in this area have noted
that business school students often came to the workplace with great theoretical knowledge
about business, but significantly lacked people skills (Robles, 2012).
Clearly, there exists a gap in the provision of additional training for students in areas
such as learning the industry language. Given that modern employers only hire trustworthy
employees with whom they are comfortable, it has become increasingly important for career
educators and program directors to ensure that students are ready for the global marketplace.
Institutions of higher learning should graduate students who are perceived to be part of the
workplace culture. Therefore, communication competence serves to establish a clear
understanding of work procedures and associated information.
Leadership skills. On the other hand, leadership skills represent the ability to inspire
individual and organizational excellence, create and achieve a shared vision, and manage
change in an organization to achieve strategic objectives as well as enhance performance
(Krawczyk-Sołtys, 2017; Stefl & Bontempo, 2008). Leadership competencies are central to
healthcare executives’ performance. Therefore, the domain anchors the HLA model, and the
four other competencies draw from the leadership area as well as feed and inform leadership
(Krawczyk-Sołtys, 2017; Stefl & Bontempo, 2008). Existing literature emphasizes the need for
administrative personnel to possess sound leadership skills in order to manage junior staff
members (Chassin & Loeb, 2013).
According to Patterson et al. (2016), healthcare leaders today know about change and
the need to adapt as individuals and as the whole organization. However, the authors also
emphasize that leadership skills, which are most important in today’s uncertain and complex
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 24

healthcare workplace, are not apparent. The researchers argue that, due to changing
demographics leading to ongoing change in the sector, cost pressures, and legal as well as
ethical considerations, it has become increasingly difficult to know whether organizations have
the leadership talent required to set the direction, create vision alignment and gain commitment
among the various stakeholders in their mission to ensure quality and safe patient care
(Patterson et al., 2016).
Since leadership competencies are the foundation for all other preparedness
requirements and for successful career development (Daly, Hill, & Jackson, 2015; Hess, 2013;
Sonnino, 2016), institutions of higher learning must develop capacity needed to adapt and
succeed in the future (Patterson et al., 2016). Therefore, administrators must remain abreast of
technological issues to capture changes in their practice. In addition, they require competence in
work ethics and professionalism, which are vital in upholding standards and regulations. The
management personnel should also have the teamwork skills necessary to promote collaboration
among various teams (Weaver, Dy, & Rosen, 2014). Finally, as suggested by Hernandez,
O’Connor and Meese, 2018, it is important to understand which specific competencies will
facilitate improvements in clinical outcomes and operational performance for the healthcare
organization.

Issues Emanating from Poor Healthcare Administrators and Leadership
As stated above, effective leadership is a crucial component of modern healthcare
systems. Its functions range from improving organizational effectiveness to enhancing
operational efficiency (Ghiasipour, Mosadeghrad, Arab, & Jaafaripooyan, 2017). Various
studies have examined the issues emanating from poor healthcare leadership in relation to the
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 25

career readiness of graduate students in health administration programs. Some of the issues
emerging from the literature are low-quality service delivery (Nzinga, Mbaabu, & English,
2013; Lee, Khong, & Ghista, 2006), interdepartmental conflicts (Chatterjee, Suy, Yen, &
Chhay, 2017), and misuse of resources (Hess, 2013).
Low-quality service delivery. Current conversations on leadership skills involve
debates on healthcare leaders’ current needs. One of the emerging themes includes whether the
leaders understand how to improve the quality of care (Baker, 2003; Nzinga et al., 2013). As
emphasized in this study, healthcare leadership competencies provide the pillar for preparedness
and career development (Hess, 2013; Sonnino, 2016). However, inefficient leadership within
academic institutions means students graduate with low levels of preparedness, which implies
that healthcare services delivery is of low quality. Ultimately, poor administration has numerous
effects on the healthcare system. According to literature, quality of service delivery issues are
often attributed to the managers’ not developing operational improvement in nonclinical areas
which directly influence services (Lee et al., 2006; Nzinga et al., 2013).
Notably, poor management can also lead to deviations from organizational goals, per the
standards of operation, to self-focused activities (Dalton & John, 2016). According to Smith
(2015), most cases of misuse of organizational funds by both management and primary
caregivers result from the administrator’s inability and inadequate leadership competencies.
Smith further emphasized the importance of complying with regulatory goals while providing
care to patients, arguing that this is feasible only if there is sufficient career preparedness among
administrators. In other cases, poor healthcare management is the result of ineffective
coordination of activities. As a result, the operating conditions can be deemed unbearable for
some practitioners and ultimately lead to non-performance. Consequently, lack of uniformity
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 26

will result in a deviation from pre-determined organizational goals (Beal, Nye, Marraccini, &
Biro, 2014).
Inter-departmental conflicts. Interdepartmental communication in the healthcare
setting is a vital component to the provision of safe and quality patient care (Blouin, 2011;
Mothiba, Dolamo, & Lekhuleni, 2008). This is mainly due to the importance of communication
to the delivery of patient care and to the improvement of organizational processes.
Interdepartmental conflict, which is a factor of poor communication, often leads to adverse
events or patient harm. Mastery of managerial competencies influences administrators’ success
through their application of technical, administrative and rational knowledge (Amestoy et al.,
2014). Changes in the healthcare model have also been cited as a cause of interdepartmental
conflicts. These notwithstanding, the administrator needs to be adequately prepared to assume
the role of a leader, represent the fundamental condition for achieving transformation in the
workplace, and reconcile organizational objectives with team priorities (Amestoy et al., 2014).
Inefficient preparedness among administrators may yield interdepartmental conflicts and staff
relationship issues that cause delays in care delivery. As such, balancing opinions and
relationships helps practitioners, and all other ancillary and administrative staff, understand one
another and collaborate in care services (Chatterjee et al., 2017).
Misuse of resources. The two main objectives of any healthcare delivery system are to
enable patients to receive services when they need them and to deliver services that meet pre-
established standards in a cost-effective manner. However, overuse and misuse of services
present problems that affect both quality and cost of care, thus hindering an organization’s
capacity to achieve its primary objectives (Burns, Dyer, & Bailit, 2014). Given that financial
management, change management, and personnel relationships depend on a manager’s
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 27

leadership competencies (Daly et al., 2015; Hess, 2013; Sonnino, 2016), unqualified and
incompetent leaders tend to misuse organizational resources (Hess, 2013), leading to an intra-
organizational rivalry for positions of power and authority. Administrators with developed
leadership qualities can have a positive influence among their subordinates and colleagues with
minimal conflict (Hess, 2013).
Disparities between Current Skills and Leadership Priorities
The disparities between healthcare administrators’ current skills and leadership priorities
provide the leadership gap this study sought to address. The information presents significant
insights that organizations require to develop meaningful leader development strategies as well
as build the capacity of leaders in various key positions (Patterson et al., 2016).
Leadership competence priorities. Different healthcare organizations and leadership
experts develop competency models to guide the evaluation of leadership skills, plan leadership
development, and manage the talent pipeline (Patterson et al., 2016). Various studies seeking a
deeper understanding of the competencies required by healthcare leadership teams have
explored the views of the people working in the sector, such as middle to senior managers. One
such study was conducted by Patterson et al. (2016) and involved healthcare managers who
completed the Center for Creative Leadership’s benchmark assessments as well as the leaders’
supervisors, peers and direct reports who rated the managers’ leadership behaviors. The study
was based on 155 behavioral descriptor items, and the respondents were asked to rate the
importance of 16 leadership skills within their organizations (Patterson et al., 2016). The results
indicated that the leadership competencies rated most important by the respondents were
leading employees, resourcefulness, straightforwardness and composure, change management,
and participative management, while those ranked least important were confronting employees,
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 28

compassion, sensitivity, putting people at ease, knowledge that differences matter, and career
management (Patterson et al., 2016).
Other studies exploring leadership competencies have established the need to focus
more on soft skills such as communication skills (Austin, 2011; Chen, 2018; Dearinger, 2011;
Madden, 2015). Dearinger (2011) explored the competencies considered most relevant to
successful job completion for academic medical center department administrators. About 300
leadership competencies in the five HLA domains were listed. The results also concluded that
clinical department administrators relied heavily on soft skills, which are not as easily measured
as technical industry skills. The researchers suggested putting more emphasis on the social
competencies (Dearinger, 2011; Madden, 2015).
Effectiveness. Different studies have also emphasized assessing leaders’ effectiveness
rather than their specific skills. For instance, Patterson et al. (2016) involved the aspect of
effectiveness whereby the respondents would rate the leader’s effectiveness in executing each of
the 21 competencies. In so doing, the researchers sought to examine leadership skill and
derailment factors. Results showed that healthcare leaders were more likely to be effective in
acknowledging differences matter, putting people at ease, and being a quick study. However,
they were least likely to be adaptive to change and meet business objectives.
Studies on the Efficacy of Leadership Competencies in Healthcare Administration
Having explored the knowledge gap in the healthcare industry, it is important to explore
the efficacy of leadership competencies in ensuring healthcare administration programs meet the
global needs for graduating students who have experiential knowledge and skills as measured
by the HLA and NCLH models. Various studies have indicated an increase in the acceptance
and desirability of formal training in leadership for healthcare leaders (Day et al., 2014;
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 29

McAlearney & Butler, 2008; Sonnino, 2016). According to Sonnino (2016), there is a need to
formally teach leadership competencies despite natural leadership instincts. The taught
competencies are regarded as the differentiating competencies that respond to the needs of
specific cohorts of individuals.
In recent years, the issue of developing effective leaders and leadership behaviors has
taken center stage among healthcare organizations (Day et al., 2014). McAlearney and Butler
(2008) used data from three qualitative studies on leadership development in healthcare to
determine opportunities to employ leadership development programs to improve quality and
efficiency (McAlearney & Butler, 2008). Using data collected from 200 health systems
managers and executives, academic experts, consultants, individuals representing associations
and vendors of leadership programs, the study showed that leadership development programs
provided four opportunities for healthcare quality and efficiency improvement: increasing the
caliber of the workforce, enhancing efficiency in the education and development activities of
the organization, reducing turnover and associated expenses, and training the attention of the
organization on its strategic priorities (McAlearney & Butler, 2008). Furthermore, Sonnino
(2016) reports that leadership competencies significantly contribute to the increasing number of
individuals taking leadership positions. As the number of healthcare leadership programs
increase for postgraduate residents and fellows, a pipeline of practitioners with formal
leadership training is created (Sonnino, 2016). This supports an organization’s succession
planning and contributes towards a sustained organizational success for the healthcare system as
a whole.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 30

Challenges When Leadership Competencies Are Not Developed in College
It should be noted that reliance on the leadership training program is not risk-proof to
either individual or institution. One of the main challenges lies in the fact that the programs
address different leadership competencies and provide students with personal tools they need to
move healthcare forward (Sonnino, 2016). This implies that leadership programs often do not
include key components which are covered by more comprehensive curricula. As such, relying
on such programs alone may not adequately prepare individuals for a leadership role, and
healthcare companies often cannot afford to put all resources into generalized leadership
development programs with the hope that students will achieve the right outcomes (Patterson et
al., 2016). This calls for measures to address the problem of leadership competencies that are
not developed in college.
The literature suggests five methods for developing leadership competencies not
developed in school: mentoring, coaching, action learning, networking, and experiential
learning (Chen, 2018). Mentoring programs help potential leaders to grow and improve to
become a better version of themselves with the help of another. Coaching, on the other hand, is
aimed at enhancing the performance of an individual in a specific area of leadership. According
to Chen (2018), coaching is usually goal-oriented and short. Action learning is based on the
concept that leadership knowledge, attitudes, and skills can be developed outside college
through joint solutions to problems in the workplace, while networking involves building of
interdependent, mutually beneficial relationships that can help one develop the much-needed
leadership competencies. Finally, experiential learning takes many forms, such as taking
entirely new assignments or part-time roles in ongoing clinical work to different organizations
to learn from the different experience. Overall, a combination of leadership competencies and
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 31

technical expertise is vital to meet a population’s healthcare needs. However, as this review has
revealed, the leadership skills considered most important in today’s uncertain and complex
healthcare environment are not apparent. Therefore, this study sought to fill this gap by
addressing program directors’ knowledge and motivation related to integrating the leadership
component of the HLA competencies and the NCHL competency model into their degree
programs, the interaction between field culture and context and program directors’ knowledge
and motivation, and the recommended knowledge and skills, motivation, and organizational
solutions.
The following section discusses the specific influences on program directors’ knowledge
and motivation coupled with identified organizational influences affecting their ability to
develop curriculum that will ensure graduates are career ready from a leadership perspective
when they graduate. Finally, a study conducted by Munz (2017) examined the problem that the
“healthcare industry has no clear evidence of the academic competencies that influence the
attainment of organizational success” (p. 14) which resulted in recommendations for future
research in two main areas (1) identification of requisite competencies that influence success or
failure of academic educational programs for organizations and (2) quantitative initiatives that
measure the utility of leadership competency and infusing them in the healthcare delivery
system which further provides validation for the importance of this study.
Program Directors’ Knowledge, Motivation and Organizational Influences
In this section the KMO influences will be presented in connection to the stakeholder
group of focus for this study which are the Program Directors for healthcare administration
graduate degree programs. Clark and Estes’ (2008) gap analysis framework was applied to
answer the research questions for this study. Based on Clark and Estes’ gap analysis framework,
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 32

individuals need goal-related knowledge and motivation as well as organizational support to be
successful. The following sections present the KMO influences required for the program
directors to achieve their goal.
Knowledge influences. There are four main knowledge types: factual, conceptual,
procedural, and metacognitive (Anderson et al., 2001; Rueda, 2011; Star & Stylianides, 2013).
The basic tenet of factual knowledge is that there is an understanding of the facts (Rueda, 2011).
In relation to this study, the program directors would have industry-specific knowledge such as
terminology, details of processes, or be familiar with these to effectively function and solve
problems in their capacity. Thus, factual knowledge refers to the basic elements that an
individual must acquire to understand a certain discipline (Star & Stylianides, 2013). According
to Rueda (2011), “conceptual knowledge refers to knowledge of various theories, models, or
structures pertinent to a particular area” (p. 28). The program directors’ knowledge is indicative
of their ability to integrate field-specific leadership competencies into the curriculum.
Furthermore, this knowledge will also determine whether these stakeholders create curriculum
in a way that will promote the development of these competencies.
This study determined what knowledge program directors had related to the previously
mentioned leadership competencies required to be successful in their work setting. Procedural
knowledge refers to various methods of inquiry and the ability to carry out an action or how to
do something (Krathwohl, 2002; Rueda, 2011; Star & Stylianides, 2013). Lastly, metacognitive
knowledge is the knowledge of one’s own thinking process (Anderson et al., 2001). Rueda
(2011) indicated that “metacognitive knowledge is the type of knowledge that allows one to
know when and why to do something” (p. 28). Relative to this study, understanding the program
directors’ metacognitive knowledge provided insight into their strategic behavior and why they
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 33

have or have not integrated the competencies into their programs. Table 2 summarizes the
assumed knowledge, motivation and organizational influences on program directors’
understanding of how to effectively incorporate leadership competencies into their graduate
degree program curriculum.
Motivation influences. Motivation is a significant factor to the attainment of any goal
and it is highly idiosyncratic and multifaceted (Belenky & Nokes, 2015; Martin & Guéguen,
2015). This means that motivation can occur in different forms for different people. Motivation
is not restricted to individuals; organizations also need motivation to meet their goals. One can
argue that no goal can be completed without some degree of motivation. This is because lack of
motivation translates to lack of willpower and this will almost always result in failure.
Motivation is necessary to start, maintain and complete a task which is what is needed to meet
various goals (Burton, 2012).
Self-efficacy. Motivation for program directors can be influenced by factors such as the
belief in the ability of the institutions to influence the performance of those managing healthcare
organizations or business units. Program directors need to be confident in their ability to
produce quality healthcare leaders. Self-efficacy refers to the belief in one’s abilities in certain
scenarios to complete particular tasks (Gao et al., 2011; Zhang et al., 2015). The program
directors also need to realize that failure to provide the requisite knowledge and skills for
healthcare administration students affects the quality of service delivery and other key
performance indicators (KPIs) within healthcare organizations. This is consistent with the
attribution theory that explains how human beings attach meaning to other people’s behavior or
their own behavior. In this regard, Scwarzer (2014) discusses the theory of self-efficacy in
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 34

relation to thought control of action which suggests issues with personal agency and
ones’ belief in the accuracy or utility of information provided to inform program
curricula.
Creating the belief among program directors that they can provide the necessary
scaffolding such that students develop the required knowledge and skills is essential.
Furthermore, the program directors must believe and understand that this requires a
collection of efforts not only from themselves but the academic institution as well.
Deans and academic leaders must provide resources and clear priorities for program
directors to achieve their goals. A person with high self-efficacy is likelier to be
confident of handling a particular task than an individual with low self-efficacy.
Additionally, the self-efficacy levels affect other activities such as choice of activity,
level of effort, emotional reaction and persistence (Hassankhani et al., 2015). The
confidence that the program directors have in their ability to develop a curriculum that
enable students to develop experiential knowledge is critical to improve organizational
performance of healthcare organizations that employ these graduates. Thus, the program
directors then know that whatever action they take to improve the curriculum will
ultimately provide public goodwill because these actions are tied to improving the
quality of healthcare through effective leadership.
Attribution. Harvey and Martinko (2009) discussed the concept of attribution of
causality, which, in the sense of this analysis, would suggest that there is a cause for healthcare
organizations to have ill-prepared leaders or those internal to organizations that would prefer
not to promote to leadership positions. The educational institutions and program directors
should be motivated by the negative effects that a lack of adequate preparation has on patients
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 35

and the healthcare industry. The desire to correct the mistakes of the past and ensure that
healthcare sector workers are well suited to take on management and leadership roles within the
institutors should be the main goal of the program directors.
Organizational influences. The following section reviews literature focusing on
organizational related influences that are crucial to the achievement of the program directors’
goal. The goal is to ensure that a 100% of all program directors will integrate the HLA
competencies and the NCHL competency models into their degree program curriculum using
experiential learning methods by the year 2020. For the purpose of this study the academic
institutions will serve as the organization. The study evaluated multiple universities healthcare
administration degree programs to determine the extent to which these programs have
incorporated the Healthcare Leadership Alliance Competencies into their curriculum, core
courses and assignments. This study focused on the cultural influences driving change in
institutions of higher education with particular emphasis on the cultural models and settings and
how they impact career readiness from the perspective of graduates having the experiential
knowledge and skills prior to graduation.
The healthcare environment is competitive which requires healthcare administrators
with sophisticated knowledge and skills of the sector (Kieft, de Brouwer, Francke, & Delnoij,
2014; Wainright, York & Woodward, 2012). Institutions of higher education must have
infrastructure and change management processes in place to collaborate with the healthcare
industry to inform programmatic content. The influences impacting both industries; healthcare
and higher education relate primarily to the regulatory landscape and how these organizations
work together to improve the healthcare system and the overall health status of the population
(Elwood, 2011). Kirch (2011) notes that colleges and universities have a responsibility to
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 36

educate the healthcare workforce to meet the ever-changing needs of the 21
st
century which
suggests that this is not occurring today. Thus, what are the industry influences that prohibit
higher education from preparing the healthcare workforce? The assumptions that underlie the
core issues and influences around the program directors’ goals related to curriculum
improvement is centered on when changes in the healthcare industry occur and how the
organization responds to those changes to support career and work path readiness.
Cultural models. Cultural models within an organization represent nonphysical things
such beliefs, norms and values that are recognized by how employees within the organization
engage with each other and conduct themselves (Hirabayashi, 2017, Rueda, 2011, & Gallimore
& Goldenberg, 2001). Gallimore & Goldberg (2011) further elaborates on this concept
suggesting that cultural models within higher education are used to characterize the business
practices, academic settings, and individuals such as faculty and program leadership. The
aforementioned are expressed through the cultural practices such as competency, behavior,
rules, regulations, policies and procedures (Rueda, 2011, & Gallimore & Goldenberg, 2001). On
the other hand, cultural settings represent the tangible items such as those things that are visible
such as behavior, performance and so on. Rueda (2011) notes this to be the “who what, when,
where, why and how” (p. 57) in the organizations. Thus, who in the organization is responsible
for the program content, what infrastructure is in place to update course materials and the like,
when is the information updated, where does the new or revised content derive from, why is
content and books outdated or misaligned to establish industry specific competencies and how
are the issues and challenges within the content resolved represent the cultural settings to
understand relative to the stakeholder performance goal.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 37

The two cultural models this study examined include (1) whether the program directors
experience challenges with updating and implementing new curriculum due to the processes
defined by the University and (2) does the school prioritize and hold program director
accountable for the integration of NCHL and the HLA Competencies into their programs’
curricula via aligned assignments and class activities that will facilitate the development of
leadership competencies. The cultural settings that the researcher explored included
understanding if program directors are burdened with other job-specific responsibilities, causing
a lack of focus on aligning program curriculum with changes in the healthcare industry.
Additionally, the researcher explored the extent to which the program directors have the
infrastructure and resources within the school to know what the competencies are and how to
integrate new industry competencies into the curriculum.
Accountability structures within the institutions of higher education drives the desire for
program directors to facilitate changes even when they are “off cycle” from the established
procedures and timelines which is another cultural model that influence action. Moreover,
competency is a state of knowing or ability to perform. In order to build knowledge capacity
there should be some evaluation of competency of program directors to reach the industry goal
(Sanghi, 2016, pg. 26) which represents the cultural models associated with procedures for
talent management.
Culture is not something that one can touch but rather an invisible phenomenon within
the subconscious of an organization (Clark & Estes, 2008; Rueda, 2011; & Schein, 2010).
Higher education espouses to six change theories which include biological, teleological,
political, life cycle, social cognition and cultural (Kezar & Eckel, 2002). When evaluating the
organizational influences impacting performance it is important to understand the implications
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 38

of these domains. Clark and Estes (2008) discuss the importance of having efficient and
effective work structures such as policies, procedures and processes to facilitate an
organizations’ ability to meet various performance goals. While there are core competencies
established at the industry level, higher education institutions have not fully embraced and
integrated these competencies through purposeful and value-added learning (Schmitt, et al,
2011) to improve performance of healthcare organizations. Furthermore, Clark and Estes
(2008) suggests that in order for an organization to recognize and make the requisite changes to
improve performance there must be an understanding of how its standard operating procedures,
practices, vision, resources and beliefs impact goal attainment.
Cultural settings. There are two cultural settings that influence the cultural models
previously discussed which may serve to explain the factors causing challenges within the
organization to develop a robust curriculum aligned to recognized industry standard
competencies. These cultural settings include the fact that program directors are burdened with
other job specific responsibilities causing a lack of focus on the healthcare administration
program curriculum and aligning to the multitude of changes in the healthcare industry. The
concern that program directors do not have the infrastructure and resources within the school to
know how to integrate new industry competencies into the curriculum is the second cultural
setting that can explain the deficits in the program content. This second cultural setting
influence is derived from the lack of institutional guidance and or explicit expectations centered
on program requirements and expected performance measures. Schneider et al., (1996), notes
that in order to abolish or at minimum positively improve the cultural models and settings
organizational leaders must recognize what the stakeholders need in order to be successful and
facilitate the attainment of the performance goals.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 39

Table 2 is a description of the knowledge, motivation and organizational influences that
are relevant to Program Directors and their ability to develop healthcare administration program
curriculum. The objective is for graduates to have the opportunity develop experiential
knowledge and skills during their degree program with an emphasis on the students’ leadership
competencies. The intent of the table is to categorize the influences that have a direct impact on
the program director’s ability to achieve the aforementioned goal.
Table 2

Summary of Assumed KMO Influences on Program Directors Understanding of How to
Effectively Incorporate Leadership Competencies into their Graduate Degree Program
Curriculum

Knowledge Influences
Declarative (Conceptual)
Program Directors need knowledge of the HLA
Competencies and the NCHL competency model.
(Anderson et al, 2001;
Bradley, et al, 2008; Rueda,
2011 & Star & Stylianides,
2013; Stefl & Bontempo,
2008)
Metacognitive
Program directors need to be willing to self-assess
their own knowledge, skills and abilities in relation to
the development of leadership competencies in the
degree program.
(Anderson et al, 2001; Rueda,
2011)
Knowledge Influences
Procedural
Program Directors need knowledge to develop the
type of curriculum, courses, and assignments that
will facilitate the development of experiential
leadership competencies for healthcare.
(Huppertz et al., 2014;
Krathwohl, 2002; Kumar,
2006; Ozdemir & Stebbins,
2015; Rueda, 2011; Star &
Stylianides, 2013)
Motivational Influences
Self-Efficacy:
Program directors must believe they have the ability
to effectively educate students about the leadership
competencies and provide the ability to develop
experiential knowledge and skills during the learning
process.
(Bandura, 1994; Pajares,
2009)
Attribution:
The program directors need to acknowledge that they
play a significant role in the problem of quality of
(Anderman & Anderman,
2009)
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 40

healthcare and that they can do something about it by
better preparing students.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 41

Table 2, continued
Organizational Influences
Cultural Model Influence 1:
Program Directors experience challenges with
updating and implementing new curriculum due to
the processes defined by the University.
(O’Connor, 2011)
Cultural Model Influence 2:
The school should prioritize and hold program
director accountable for the integration of NCHL and
the HLA Competencies into their programs’ curricula
via aligned assignments and class activities that will
facilitate the development of leadership
competencies.
(Clement et al., 2010; Getha-
Taylor et al., 2013; Stefl &
Bontempo, 2008)
Cultural Setting Influence 1:
Program Directors are burdened with other job-
specific responsibilities, causing a lack of focus on
program curriculum and aligning with the multitude
of changes in the healthcare industry.
(O’Connor, 2011; Rissi, &
Gelmon, 2014)
Cultural Setting Influence 2:
Program Directors must have the infrastructure and
resources within the school to know what the
competencies are and how to integrate new industry
competencies into the curriculum.
(Getha-Taylor et al., 2013;
Huppertz et al., 2014;
O’Connor, 2011).

Interactive Conceptual Framework
The conceptual framework is derived from a review of the relevant literature. The
purpose of this conceptual framework is to provide a visual of the association between the field
goal cultural models and settings and the knowledge and motivational influences that affect
stakeholder performance. There are influences on the stakeholder group related to knowledge,
motivation, and organizational contexts. Thus, the conceptual framework is the theoretical
foundation that supports the study, questions, design, methodology and analysis (Maxwell,
2013; Merriam & Tisdell, 2016). Furthermore, the conceptual framework illustrates how the
field of healthcare administration and the program directors are connected and interact to
facilitate achievement of the performance goal.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 42

Figure 1. Conceptual framework: Interaction among the organization, the stakeholder group,
and the organization’s goal.
Figure 1 provides an image of the conceptual framework for the study, underscoring the
interaction among the field, the stakeholder group, and the healthcare field’s goal and
promotion of key concepts. The stakeholder of focus is the employee group within the
university that is accountable for implementing and overseeing the quality of healthcare
administration degree programs and is represented in the model within the green circle as the
program directors. The stakeholders’ knowledge is indicative of their ability to integrate field-
specific leadership competencies into the curriculum. Furthermore, this knowledge will also
determine whether these stakeholders develop the curriculum in a way that will promote the
development of these competencies. Clark and Estes (2008) discussed the importance of
knowledge delivery, noting that, if the delivery is chaotic, the mental connections associated
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 43

with the acquisition of knowledge will equally be chaotic. This circle represents the stakeholder
and the knowledge and motivation influences that affect their ability to achieve goals.
The larger blue circle represents the healthcare industry as a whole and the cultural
models and settings within it that affect achievement of program learning goals and
performance. The nesting of the circles represents the direction of influences between the
industry goal and the program directors. This nesting further suggests that cultural models and
settings within academic institutions have a direct impact on program directors’ knowledge and
motivation to persist toward goal achievement. To elaborate, there are four main knowledge
types: factual, procedural, conceptual and meta-cognitive (Anderson et al., 2001; Star &
Stylianides, 2013). Factual knowledge refers to the basic elements a student must acquire to
understand a discipline (Star & Stylianides, 2013). Procedural knowledge deals with how to do
something, or the criteria for using skills, methods of inquiry, algorithms, and techniques (Star
& Stylianides, 2013). Conceptual knowledge deals with the relationships among basic elements
and how the relationships allow these elements to function as a unit while metacognitive
knowledge is the knowledge of cognition (Anderson et al., 2001). Finally, the yellow square
represents the industry goal. The stakeholder and field goal are to ensure that all healthcare
administration graduates have experiential knowledge by the year 2020.
There are influences on the dynamics and interactions between the healthcare industry
and the stakeholder group. The smaller internal circle relates to factors close to the stakeholder
of focus. The larger circle represents general organizational factors that influence the
stakeholders both directly and indirectly. This model depicts factors associated with achieving
the field of healthcare goal. In addition, there are both positive and negative influences between
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 44

the various entities that can cause changes in knowledge and motivation based on organizational
contexts. This phenomenon is represented in the smaller nested green circle in Figure 1.
While the conceptual, procedural and metacognitive knowledge domains can support
this analysis (Mayer, 2011; Rueda, 2011), this analysis focused on the declarative,
metacognitive, and procedural knowledge domains. These knowledge domains address how
program directors self-assess their ability to lead a quality healthcare administration degree
program and the extent to which they have the procedural knowledge to change the content
based on the fluidity of the healthcare industry (Baker, 2006; Krathwohl, 2002). In addition to
the knowledge domains, the nested green circle reflects the motivational factors of self-efficacy
and attribution that influence the administrators’ desire to persist and work toward the industry
goal. The final piece of the conceptual framework consists of the organizational factors that
influence goal achievement, such as various cultural models and setting dynamics that are
apparent in academic institutions. Thus, the conceptual framework in Figure 1 and discussed
throughout this document provides foundation for this study. Moreover, the illustration provides
a display of the connections between variables in the study.
Data Collection and Instrumentation
According to Maxwell (2013), qualitative data serve to validate the information
identified from quantitative data. Thus, this study employed a sequential explanatory mixed-
methods design to answer the research questions. These types of data collection methods are
used when quantitative data is collected and analyzed followed by qualitative data collection
and analysis which concludes with an interpretation of all sets of data analysis (Creswell, 2014;
Terrell, 2012). Figure 2 provides an image of the methodology for the study, revealing both
components of the quantitative and qualitative data elements. Based on recommendations by
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 45

Creswell (2014), data were analyzed separately to determine how the analysis via the different
methods aligns. Creswell posited that the working assumption is that data collected from each
source will yield different but meaningful data to inform the answers to the research questions.
The data were gathered from the school’s website. Competency statements, curriculum
content and course catalog materials were organized by type. The material was evaluated to
identify which, if any, reflected leadership competencies. From the catalogue, the researcher
identified the number of courses specific to leadership that were required for degree completion.
The evaluation determined whether the class was considered a core or an elective course. The
researcher also identified courses that had leadership-related course objectives wherein
leadership was not mentioned in the title of the course. The intention was to evaluate curriculum
and syllabi if available. However, upon collection of the data, the syllabi were not available for
the school sample used. This caused an inability to gain insight as to the types of assignments or
deliverables that were required to aid in developing leadership competencies. The data gathered
through document review provided information related to the integration of leadership
competencies into the program from the survey. Both the qualitative and quantitative data were
used for comparison and triangulation purposes once the independent analysis of each data set
was complete. Upon completion of the document review and surveys, telephone interviews
were conducted with a select group of program directors who agreed to be interviewed. The
telephone interviews provided additional insights related to their knowledge, motivation and
organizational influences that could not be gleaned from the other data sets. Figure 2 provides a
visual representation of the data collection methods and processes to answer the research
questions.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 46

Figure 2. Visual representation of sequential explanatory mix methods research methodology
for study.

Quantitative data were collected through online surveys sent to program directors to
understand the knowledge, motivation, and organizational influences associated with
incorporating core competencies into their graduate degree programs. Additionally, this portion
of the research enabled me to determine if the respondents use these competencies to develop or
inform their programs’ curricula.
According to Terrell (2012), the rationale for conducting mixed-methods evaluation
research is that it allows for quantitative survey data to be compared with qualitative
information obtained from the telephone interviews and the review of program documents
found online. Furthermore, qualitative data were used to validate information obtained from the
survey and it enabled a richer understanding of how leadership competencies were incorporated
into the curriculum if at all. This approach allowed for corroboration and a comprehensive
account of the facts, which allowed for richer information capture (Creswell, 2014; Merriam &
Tisdell, 2016).
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 47

Surveys. The survey was administered through Qualtrics and consisted of 24 questions.
The questions were a mixture of closed-ended Likert-type items, open-ended and ordering type
questions. The survey asked respondents to answer questions related to their perceptions of
organizational culture and their level of knowledge and motivation regarding the integration of
the HLA Competencies or the NCHL competency model into their degree program curriculum
to foster experiential learning. The impetus of ensuring experiential learning in healthcare
administration programs is based on the expectations of employers (Ewell, 2008). Surveys were
chosen as a data gathering methodology as they are a cost-effective and efficient way of
gathering data (Fink, 2012). The surveys were emailed to the program director at all 130
schools in the AUPHA membership directory.
The survey was subjected to a validation process for face and content validity. In the
validation process, copies of the questionnaire and research questions were distributed to one
program director via email to ensure the adequacy and appropriateness of the survey instrument.
Once the survey was validated, pilot testing was completed using two program directors who
were not participants in the actual study. The pilot test included the same IRB-approved survey
that was used for the actual research. Furthermore, evaluative questions were asked to identify
the program directors’ perceptions regarding the length, difficulty and overall satisfaction with
taking the survey and if the survey items would yield enough substantive information to address
the intent of the survey. The pilot identified how the pilot respondents reacted to the survey in
terms of item clarity to determine if more survey questions were needed in certain areas and
whether there were items on the survey they would prefer not to answer. Once the pilot test was
completed, the survey was administered directly to the sample population. The survey stayed
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 48

open for three months. Reminders were sent every 14 days and sometimes more often if there
were minimal respondents that week to capture the highest response rate possible.
Documents and artifacts. Bowen (2009) noted that document analysis involves a
systematic review and evaluation of documents in paper and electronic form. He further
mentioned that review of institutional documents has been a consistent process in qualitative
research for several years. The qualitative research component of this study was an examination
of the schools’ healthcare administration program documentation such as curriculum content,
through a perusal of program websites, catalogues, and syllabi. The documents were reviewed
against the HLA and the NCHL competency model. Ten program websites were perused to
locate the program curriculum, catalogue, and additional information to inform how the
university incorporated competencies into its program. The documents were reviewed to
identify courses related to leadership and required for degree completion. The collection of
artifacts from the program websites and telephone interviews represented the qualitative data
and the survey was the quantitative data which were compared and interpreted to answer the
research questions. Material available online such as curriculum information, program
catalogues and other material related to the curriculum was obtained primarily through online
searches of the programs’ websites because this information was freely available. Bowen (2009)
noted that “document analysis is the form of qualitative research in which documents are
interpreted by the researcher to give voice and meaning around the topics being assessed” (pp.
27-28). All of the aforementioned documents were coded which allowed themes to emerge
which further informed the study recommended solutions.
Telephone Interviews. The telephone interviews enabled the researcher to generate
knowledge that could not have been produced through other data collection means.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 49

Furthermore, they allowed the researcher to gain additional information that can often
complement quantitative data collected through surveys and documentation review. Brinkmann
(2014) noted that, in social science research, qualitative interviews are generally semi-
structured. In this type of interview, the researcher uses an interview protocol or guide with
questions that are developed to answer the research questions, however, based on responses
from the interviewee additional follow-up questions may be asked. Patton (2002) and Creswell
(2014) discussed the importance of an interview protocol. Thus, an interview protocol was used
to facilitate consistency with the interview questions and process.
This type of semi-structured interview offers the flexibility needed to inform analysis
and resulting narrative. Finally, interviews are a genuine way of gaining additional insights into
the perspectives of the study group (Maxwell, 2013). There were 10 program directors
interviewed from different universities. The interviewees were selected based on their stating
their agreement to be interviewed on the survey. The agreement to be interviewed question on
the survey yielded 24 program directors who were amenable to participating in this phase of the
data collection. Of those, 10 were randomly selected to be interviewed. The average interview
length was 30 minutes. Creswell (2014) recommends the employment of handwritten notes to
complement any electronic devices for capturing interview transcripts. Thus, the telephone
interviews were documented on the interview protocol worksheet and voice recorded as well.
Permission to record the telephone interviews was completed at the time of scheduling and via a
separate email.
Results and Findings
The purpose of the present study was to evaluate the extent to which program directors
integrate the development of the HLA Competencies and the NCHL competency models into
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 50

their degree program curriculum and as a result, the extent to which healthcare administration
programs are able to graduate students who have experiential knowledge and skills prior to
graduation. The first phase of data analysis examined survey-based quantitative data such as
the participants’ demographic information and the participants’ knowledge, motivation and
organizational influences related to integrating leadership component of the HLA competencies
and the healthcare leadership competencies model into their degree programs. Quantitative data
collected through Qualtrics were entered into IBM’s Statistical Package for Social Sciences
Version 21, and descriptive statistics addressing the research questions were obtained. The
second phase of the analysis utilized qualitative data to address the research questions. The data
from telephone interviews conducted in the follow-up to the quantitative data were transcribed
and thorough analysis conducted to reveal emerging themes and patterns (Creswell, 2014).
There are three research questions guiding this study. This section will answer research
questions one and two. The third research question will be answered in the recommended
solutions section of this study. The specific research questions are as follows:
1. What are the healthcare program directors’ knowledge and motivation related to integrating
the leadership component of the Healthcare Leadership Alliance Competencies and the
Healthcare Leadership Competency Model into their degree program?
2. What is the interaction between field culture and context and healthcare program directors’
knowledge and motivation?
3. What are the recommended knowledge and skills, motivation, and organizational solutions?
Analytic Procedures
The quantitative data were cleaned and assigned numeric values in preparation for
analysis. The analysis was conducted in two stages. First, descriptive analysis using frequencies,
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 51

percentages, means, and standard deviations was conducted to identify trends and distributions.
The KMO responses comprised of Likert-type data whereby the various response items were
combined to give a quantitative measure of the knowledge, motivation, and organizational
culture and context related to integrating the leadership component of the HLA competencies
and the Healthcare Leadership Competency Model into the degree programs. According to
Boone and Boone (2012), when analyzing Likert-type data responses similar to those collected
in the present study, the researcher is often interested with the composite score representing the
KMO variables. The descriptive analytic procedures proposed by Boone and Boone (2012)
include the mean to give a measure of central tendency and the standard deviation to show
variability.
On the other hand, the telephone interview qualitative data were transcribed and
organized for textual analysis. An interview matrix was developed in an excel spreadsheet
wherein all interview questions were organized horizontally and the interviewee responses were
situated vertically on the matrix. The interviewees were listed at the top of each row with the
actual names of the respondents masked. Each respondent was represented on the interview
matrix as a number (interview 1, 2 and so on). This process enabled the researcher to readily
review each interview question and corresponding responses from all participants in the same
row. This facilitated the identification of themes for each interview question. The data and
notes were read to identify qualitative themes before coding and assigning of labels. The
thematic analysis offers a useful qualitative approach to help researchers to capture the
meanings within the data as well as organize and interpret qualitative data to create a narrative
understanding that brings together the commonalities and differences in the participants (Crowe,
Inder, & Porter, 2015). Qualitative research findings were presented in a narrative form
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 52

indicating the themes emerging from the data. Rich descriptions were utilized to support the
themes and patterns as well as the interpretations of how leadership competencies were reflected
on the school’s website and embedded in the program’s curriculum.
Reliability of the scales. The internal consistency of the three KMO subscales was
tested in order to enhance the accuracy of their assessment and evaluations. This is a
fundamental element in the evaluation of a measurement instrument. The knowledge subscale
consisted of eight items measuring the program directors’ knowledge of the healthcare
administration competencies and career readiness from the survey data. The subscale exhibited
an acceptable internal consistency (Cronbach’s alpha, α = 0.73). The motivation subscale
consisted of five items (α = 0.74), and the organizational impact subscale consisted of eight
items (α = 0.83). The measures of internal consistency of the KMO subscales are crucial in
understanding whether the items in the knowledge, motivation and organizational influences
subscales all reliably measure of the same latent variable.
The eight items on the knowledge subscale were combined into one variable, which was
an average of the eight variables. Similarly, the five items on the motivation subscale were
combined into one motivation variable, and the eight items on the organizational subscale
combined into a single item (see Table 3).

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 53

Table 3
The KMO Subscales Items
Knowledge Influences subscale items
 I am aware of the National Center for Healthcare Leadership Competency Model.
 I am aware of the HLA competencies.
 The leadership courses in the curriculum are designed to develop the students’
leadership skills.
 I am aware of the NACE definition of career readiness.
 In my program, graduates will be career ready based on the NACE definition by the
time they graduate.
 I know how to evaluate the effectiveness of the curriculum at my school.
 I can identify the tools that are used to identify the core competencies required of an
MHA/MSHA program curriculum.
 I can describe the process used to align course requirements to core competencies
required of healthcare administrators.
Motivational influences subscale items
 Engaging with professional associations is important for me in the conduct of my job
duties
 I would feel personally responsible if students say they do not feel career ready.
 I am comfortable with my role in curriculum development.
 I feel responsible for student learning outcomes in my program.
 My role as a program director has a direct impact on a students’ preparedness to enter
the workforce.
Organizational influences subscale items
 My job gives me the autonomy to develop the curriculum the way I see fit.
 The organization provides me with the tools and resources needed to do my job.
 The amount of work expected of me is reasonable.
My organization is willing to prioritize content related to healthcare leadership over other
course content.
 My job gives me the opportunity to stay abreast of changes in the healthcare industry.
 I have adequate opportunities for training to improve my skills in curriculum
development.
 I am empowered to make updates to the curriculum.
 My college/university has established relationships with professional associations in
healthcare administration.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 54

The section to follow will begin with a review of the demographic data for the
stakeholder group of focus and their program. Research questions one and two will be
discussed beginning with the survey data followed by the interview data for each KMO
influence. The document analysis data will be the final set of data presented.
Demographic data. A total of 130 program directors from both public and private
universities in the United States were invited to take part in the quantitative survey. However,
only 44 completed the survey, representing a response rate of 33.85%. The data revealed that
56.8% of the respondents were from public universities while 43.2% were drawn from private
universities. The composition of the university representation was highest for the South region
(34.1%), followed by the Northeast (22.7%), Midwest (20.5%) and the West (15.9%). Forty-
three percent of the universities represented in the present study offered Master’s in healthcare
administration (MHA), while 27.3% of the program directors came from universities offering a
master of science in healthcare administration (MSHA). In addition, 7% of the respondents
indicated that their institutions offered a master’s in business administration (MBA) program,
4.5% offered a master’s in public administration in health (MPA), while 2.3% offered a
master’s in public health (MPH) program. Figure 3 gives a graphical illustration of the types of
graduate degree healthcare programs represented in the study.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 55

Figure 3. Type of graduate degree in healthcare administration offered.

A vast majority of the programs allowed more flexibility in terms of distance
education. For instance, 72 % of the respondents indicated that their universities deliver
programs via distance education, while 25.0% answered in the negative. Table 4
summarizes the characteristics of the participants of the present study. There are a number
of different degrees offered for graduate studies in healthcare administration. An individual
can obtain a graduate degree in healthcare administration by pursuing one of the following
degrees: (1) Masters of Science in Healthcare Administration, (2) Masters of Science in
Public Administration with an emphasis or concentration in health administration, (3)
Masters in Healthcare Administration, (4) Masters in Business Administration with an
emphasis in healthcare management, and (5) Masters of Public Health with a concentration
in healthcare administration (Accrediting Commission on Education for Health Services
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 56

Administration, n.d.). These programs reside in different schools at the university such as
the Schools of Business, Public Administration, Public Health, Health Sciences or Health
Professions (CAHME, 2016). Although these programs are managed in a school outside of
Health Professions or Health Sciences, the concentration or emphasis is healthcare
administration. Thus, this data is important to distinguish between the learning modality
(online as opposed to on ground) and also the type of degree offered (MSHA, MPA, MHA,
MBA and MPH) as well.
Table 4
Demographic Data
Demographic
Question
Characteristic Frequency Percentage
What type of
graduate degree(s) in
Healthcare
Administration does
your college offer
Master of Science in
Healthcare
Administration
(MSHA)
12 27.27
Master of Public
Administration in
Health (MPA)
2 4.55
Master’s in
Healthcare
Administration
(MHA)
19 43.18
Master of Business
Administration in
Healthcare (MBA)
3 6.82
Master’s in Public
Health (MPH)
1 2.27
Others 7 15.91
In what part of the
U.S. is your
University located?
Midwest 9 20.45
Northeast 10 22.72
South 15 34.09
West 7 15.91
Other 3 6.82
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 57

Table 4, continued
Demographic
Question
Characteristic Frequency Percentage
The University that
employs you is:

Public University 25 56.82
Private University 19 43.18
How long have you
been accountable for
the healthcare
administration
graduate degree
program?

Less than a year 5 11.36
1 to 2 years 7 15.91
3 to 5 years 17 38.64
6 to 9 years 5 11.36
10 to 15 years 6 13.64
15 to 20 years 4 9.09
Number of leadership
coursesrequired to
graduate
0 4 9.52
1 15 35.71
2 14 33.33
3 3 7.14
4 2 4.76
6 1 2.38
10 3 7.14
Organization
providing
accreditation and/or
certification for
programs
Higher Learning
Commission
2 4.65
CAHME
Accreditation
30 69.77
AUPHA Certification 2 4.65
CEPH Accreditation 1 2.33
Others 8 18.60

The quantitative analysis also considered the overall composition of program
administration, which indicated that the participants of the survey fell within a wide range of
demographic characteristics. The data examination revealed the number of years the participants
had been accountable for the healthcare administration graduate degree program. As shown in
Table 3, about 66 % of the respondents had held the position for fewer than five years, while
34.09% of the respondents had held the accountability position for between six and 20 years.
The demographics indicated that the participants were relatively new to leadership roles with
their institutions. Figure 4 gives a graphical illustration of the number of years the program
directors had been accountable for their programs prior to the study.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 58

Figure 4. Period that the program director has been accountable.

The number of leadership courses required to graduate from various institutions
represented in the present study varied from zero to 10 courses (Figure 4). However, a majority
of institutions (78.56%) required fewer than three courses to graduate, while only 21.42%
required three or more. In addition, CAHME provided accreditation for a majority of the
programs (69.77%). Figure 5 provides a graphical illustration of the number of leadership
courses required to graduate in the various programs represented in the study.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 59

Figure 5. Number of leadership courses required to graduate.
Research Question 1 (Stakeholder Knowledge and Motivation)
Knowledge results and findings. The researcher wanted to understand the healthcare
program directors’ knowledge and motivation related to integrating the leadership component of
the HLA competencies and the NCHL competency model into their degree program curriculum.
To answer this question, quantitative data from the surveys was used. The first analysis
considered the survey responses from questions where the respondents were asked to indicate
the extent to which they agreed with various statements related to their knowledge of the
healthcare administration competencies, career readiness requirements, and evaluation of
program curriculum, tools used for identification of competencies and the processes used to
align course requirements to core competencies. The questions covered three knowledge
influences: conceptual (declarative), procedural and metacognitive.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 60

Survey data. Likert-type responses ranging from 1 (Strongly disagree) to 5 (Strongly
agree) were collected. Questions exploring conceptual knowledge influence identified the
respondent’s knowledge of the NCHL competency model, and the HLA competencies. As
shown in Table 4, the directors’ awareness of the NCHL competency model had the highest
knowledge influence score (M = 4.61, SD = 0.78). Ninety-three percent of the program directors
agreed (agreed or strongly agreed) that they were aware of the NCHL, compared to 2.3% who
disagreed (disagreed or strongly disagreed). On the other hand, 58.1% of the program directors
agreed that they were aware of the HLA competencies compared to 9.3% who disagreed.
Moreover, conceptual knowledge identified by the program directors when responding to the
survey regarding their awareness of the NACE definition of career readiness was low as
depicted by the mean score of 2.63 (SD = 1.31). The respondents who indicated awareness of
the NACE definition of career readiness was 25.6%, while those who were not aware was
double the amount at 51.2%.
For the procedural knowledge influences, 95.1% of the respondents indicated that they
could describe the process used to align course requirements to core competencies.
Additionally, 92.9% of the respondents indicated that they could recognize the tools that are
used to identify core competencies required for program curriculum (M = 4.48, SD = 0.71). In
addition, respondents reported a high degree of ability to describe the process used to align
course requirements to core competencies required of healthcare administrators (M = 4.54, SD =
0.60). The proportion of program directors who agreed with the statement that the leadership
courses in the curriculum were designed to develop the students’ leadership skills were 91%,
while none disagreed. The procedural knowledge influence questions explored the program
directors’ knowledge to develop the type of curriculum, courses, and assignments that facilitate
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 61

the integration of leadership competencies into healthcare leadership programs. The individual
scores for the three questions were high, ranging from 4.45 (SD = 0.74) to 4.54 (SD = 0.60). The
proportion of program directors who agreed with the statements was over 90%, while those who
disagreed were below 3%. The mean score for the category was 4.45 with a standard deviation
of 0.58. Table 5 provides identifies each competency illustrations along with the percent of
agreement versus disagreement, mean scores and standard deviations.
Table 5
Knowledge of the Healthcare Administration Competencies and Career Readiness
Competency Illustrations Mean
Score
Standard
Deviation
Agree
n (%)
Disagree
n (%)
I am aware of the National Center for Healthcare
Leadership Competency Model.
4.61 0.78 41(93.2) 1(2.3)
I am aware of the HLA competencies.
3.65 1.38 25(58.1) 4(9.3)
The leadership courses in the curriculum are
designed to develop the students’ leadership
skills.
4.36 0.65 40(91) 0(0)
I am aware of the NACE definition of career
readiness.
2.63 1.31 11(25.6) 22(51.2)
In my program, graduates will be career ready
based on the NACE definition by the time they
graduate.
2.93 1.13 10(24.4) 11(26.8)
I know how to evaluate the effectiveness of the
curriculum at my school.
4.45 0.74 38(90.5) 1(2.3)
I can identify the tools that are used to identify
the core competencies required of an
MHA/MSHA program curriculum.
4.48 0.71 39(92.9) 3(.07)
I can describe the process used to align course
requirements to core competencies required of
healthcare administrators.
4.54 0.60 39(95.1) 0(0)
(1=strongly disagree to 5=strongly agree)
Based on the self-report, the program directors had a high degree of knowledge about
the NCHL competency model (M = 4.61, SD = .78), the design of the leadership courses in the
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 62

curriculum to develop the students’ leadership skills (M = 4.36, SD = .65), evaluation of the
effectiveness of the curriculum at their schools (M = 4.45, SD = .74), identification of the tools
used to identify the core competencies required of a MHA/MSHA program curriculum (M =
4.48, SD = .71), and the description of the process used to align course requirements to core
competencies required of healthcare administrators (M = 4.54, SD = .60). It also emerged that
the program directors had less knowledge about the NACE definition of career readiness (M =
2.63, SD = 1.31), and graduate career readiness based on the NACE definition (M = 2.93, SD =
.1.13). Overall, the knowledge influences were favourable since the majority of the respondents
did not disagree or strongly disagree.
Further, the knowledge influences were considered in terms of the respondent’s tenure
in their role as program director, number of leadership courses offered in a program, as well as
whether the programs were offered in a private or public institution. Interesting trends emerged
from the knowledge data. The proportion of participants who were aware of the NCHL model
was 93.2% while those who were not aware were 2.3% (see Table 5). Similar trends were noted
for statements that the leadership courses in the curriculum were designed to develop the
students’ leadership skills, the program directors knew how to evaluate the effectiveness of the
curriculum at their school, the program directors would identify the tools used to identify the
core competencies required of a MHA/MSHA program curriculum, and that the program
directors would describe the process used to align course requirements to core competencies
required of healthcare administrators (see Table 6). However, knowledge gaps were identified
in the areas of awareness of the HLA model and the NACE definition of career readiness. HLA
awareness was lowest for program directors serving in private institutions (68.4% disagreed),
while awareness of the NACE definition of career readiness was lowest for program directors
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 63

from private institutions (52.6% disagreed), directors who have been accountable for more than
five years (64.3%), and for programs requiring fewer than five leadership courses to graduate
(54% disagreed). Table 6 offers a summary of directors’ perceptions of knowledge influences
related to the integration of leadership competencies into their programs.
Table 6
Descriptive Summary of the Program Directors’ Responses to Knowledge Influences

Knowledge Influences
Public vs. Private Tenure of
accountability
Number of
Leadership
Courses
Overall

n(%) Public
n(%)
Private
n(%)
<5years
n(%)
>5years
n(%)
<5
n(%)
5 to 10
n(%)
I am aware of the
National Center for
Healthcare
Leadership
Competency Model.
Agree 24 (96) 17(89.5) 28(96.6) 13(92.9) 36(97.3) 3(75) 41(93.2)
Disagree 0(0) 1(5.2) 0(0) 1(7.1) 1(2.7) 0(0) 1(2.3)
I am aware of The
Healthcare
Leadership Alliance
competencies.
Agree 12(48) 3(15.8) 17(58.6) 7(50) 22(59.5) 3(75) 25(58.1)
Disagree 7(28) 13(68.4) 5(17.2) 5(35.7) 9(24.3) 1(25) 4(9.3)
The leadership
courses in the
curriculum are
designed to
develop the
students’
leadership skills.
Agree 24(96) 18(94.7) 28(96.6) 12(95.7) 35(94.5) 4(100) 40(91)
Disagree 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0)
I am aware of the
NACE definition
of career readiness.
Agree 5(20) 6(31.6) 9(31) 2(14.3) 8(21.6) 1(25) 11(25.6)
Disagree 12(48) 10(52.6) 13(44.8) 9(64.3) 20(54) 2(50) 22(51.2)
In my program,
graduates will be
career ready based
on the NACE
definition by the
time they graduate.
Agree 3(12) 7(36.8) 8(27.6) 2(14.3) 8(21.6) 1(25) 10(24.4)
Disagree 5(20) 6(31.6) 7(24.1) 4(28.6) 10(27) 1(25) 11(26.8)
I know how to
evaluate the
effectiveness of the
curriculum at my
school.
Agree 22(88) 16(84.2) 25(86.2) 13(92.9) 32(86.5) 3(75) 38(90.5)
Disagree 0(0) 1(5.2) 0(0) 1(7.1) 1(2.7) 0(0) 1(2.4)

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 64

Table 6, continued

Knowledge Influences
Public vs. Private Tenure of
accountability
Number of
Leadership
Courses
Overall

n(%) Public
n(%)
Private
n(%)
<5years
n(%)
>5years
n(%)
<5
n(%)
5 to 10
n(%)
I can identify the
tools that are used to
identify the core
competencies
required of an
MHA/MSHA
program curriculum.
Agree 23(92) 16(84.2) 26(89.7) 13(92.9) 33(89.2) 4(100) 39(92.9)
Disagree 0(0) 1(5.2) 0(0) 1(7.1) 1(2.7) 0(0) 1(2.4)
I can describe the
process used to align
course requirements
to core competencies
required of healthcare
administrators.
Agree 21(84) 18(94.7) 25(86.2) 14(100) 33(89.2) 4(100) 39(95.1)
Disagree 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0)

Interview data. To further address the first research question using qualitative data, the
researcher fortified the data with analysis of the interview transcripts as related to the program
objectives and the knowledge, motivation, and organizational influences. The interview
explored the program directors’ conceptual knowledge by asking questions on their
understanding of the HLA and NCHL competencies along with information related to their
thoughts on leadership competencies and how leadership readiness is defined in the context of a
healthcare administration professional. The telephone interviews revealed that generally, the
participants were not familiar with the HLA competencies. When asked to give their thoughts
on the HLA competencies, one respondent said “not familiar.” Another respondent said, “I
haven't worked closely with them. I'm familiar with them, but we haven't specifically utilized
that as part of our process.” The sentiments were echoed by yet another respondent who said,
“The Alliance for Healthcare Leadership Competencies. Was that something, hopefully I didn't
say that I knew what that was. I'll have to look it up right now. I'm not familiar with that group.”
Overall, 50% of the interview participants indicated that that they were familiar with the NCHL
competencies while only 20% had knowledge of the HLA competencies. Thirty percent (3) of
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 65

the respondents noted that they either use the NCHL competency model or a modified version.
None of the program directors interviewed used the HLA competencies (See Figure 6). In
review of the survey data as compared to the interview data for the same questions related to
awareness of each of the competency models NCHL and HLA respectively 93% of the survey
respondents were aware of the NCHL competencies while a much smaller percentage at 58.1%
acknowledged awareness of the HLA competencies. Thus, the two data sets are aligned on
knowledge of the NCHL and HLA competency models.

Figure 6. Graph of Program Directors’ Knowledge of HLA and NCHL competency models.

With regard to the NCHL, a majority of the respondents confirmed having used the
model and described their experience. For instance, one respondent noted that they currently use
a modification of the 2.0 NCHL model, and they have used that model for several years. The
respondent spoke of the new 3.0 version of the NHCL model and their role in testing with
alumni and their advisory board. Thus, the NCHL model emerged as the preferred model
among the program directors interviewed. One respondent said, “That’s the one actually that we
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 66

have adopted our model to” while another stated, “I like them, I think they are kind of
interesting. Even though CAHME the accrediting body will not say this, the NCHL
competencies are probably the preferred model of the accrediting body.” When asked what
comes to mind when they think of leadership competencies, there was a wide range of
responses. One respondent indicated the ability to manage self, others and the organization. The
respondent mentioned that leadership competencies play a crucial role in helping one deal with
the ambiguities as well as sort of resolving conflicts around resource allocation. Another
program director asserted that leadership competencies were among the model they use in their
program. While it can be broken down into several facets such as achievement, orientation,
initiatives and health competence, the respondent emphasized that it involves influence, or an
individual’s ability to influence others. Some of the core competencies required included
emotional intelligence, interpersonal communication among others. According to the
respondent, leadership competencies lay more emphasis on influence and emotional
intelligence. Finally, a third respondent had a slightly different perspective on leadership
competence in the context of a healthcare professional indicating that
leadership competencies in a healthcare professional is about having technical
knowledge, analytical capability, the ability to step back and look at the big picture and
understand how a myriad of stakeholders interact. He quoted Peter Drucker who said the
hospital is the most complex organization every devised by man, and, if you consider the
entire health system, it's mindbogglingly complex, highly regulated. So, the ability to
change, the ability to understand change, the ability to look at things critically and that,
again, going back to that emotional intelligence and critical thinking. I think those are
what make a successful leader in any industry, but certainly in healthcare”.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 67

Figure 6 is a mindmap of program director responses during the interview process
revealing that all of them had a different perspective on the skills and abilities that represent
leadership competencies. A study conducted by Forbes in 2012 identified several of these
competencies as skills that employers are looking for such as problem solving, critical thinking
and decision making (Casserly, 2012). While there were some common elements across all
program director responses such as critical thinking, knowledge of the healthcare industry,
interpersonal skills and problem solving, there was also a wide array of differences when
discussing leadership competencies.

Figure 7. Mindmap of leadership competencies identified by program directors from the
telephone interviews.

While some of the respondents felt that leadership competencies and how they would
define leadership in the context of a healthcare administration professional would yield similar
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 68

responses to the identified leadership competencies, one program director succinctly stated, “Do
the staff and patients think you are doing the right thing for the right reason?” Further to this
point, another director noted that “people are not going follow, unless they understand your
thought processes.” Another respondent posited that leadership is not really different than the
automotive industry or any other industry, noting that all industries has its own unique sort of
knowledge requirements, but, with respect to the U.S. healthcare system,
by and large, being ready for a career is understanding the context of that industry,
understanding who the major players are, what competition looks like, what strategy
looks like, how to analyze the match between the environment and the organization
that's working in, the culture of that environment and their strategy.
Table 7

Summary of Themes for Leadership Competencies and Career Readiness for Healthcare
Professionals that Emerged from the Telephone Interviews

Question Theme Description
When you think of
leadership
competencies, what
comes to mind?
Leading the
organization
Understanding and
navigating the
organization
Influencing others
Managing change
Setting the vision and
strategy
Analytical thinking
Ethics and integrity
Leading self Ability to manage self
Self-awareness/ Ability to
stand alone
Flexibility/adaptability
Leading others Ability to manage others
To enable other people
Emotional intelligence
Diversity and inclusion
Interpersonal
communication
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 69

Table 7 provides a categorization of responses when the researcher inquired program
directors about their overall thoughts and reflections on leadership competencies during the
interview. The respondents gave responses surrounding three major themes: leading the
organization, leading self, and leading others. On leading the organization, a variety of
subthemes emerged, which included the understanding of the organization, influencing others,
managing change, setting the vision and strategy for the organization, thinking analytically and
maintaining high standards of ethics and integrity. Leadership competencies also encompassed a
person’s ability to manage self, self-awareness, and adaptability. One respondent argued that the
essential elements of leadership competencies for her were the ability to stand alone, ethical
attributes, flexibility, and a strong philosophy around diversity and inclusion. Another
respondent indicated that when she thinks about leadership competencies what comes to mind is
the ability to manage others and yourself. There is the necessity to be authentic and to
recognize that your job is to enable other people, whether it’s the people that you work
for, the people that work for you. Leadership is about dealing with ambiguity and sort
of resolving conflicts around resource allocation, if there was some sort of a recipe for
how to do things then you wouldn’t really need people with that extra quality.
Leading others was characterized by the interpersonal communication competencies,
ability to manage others, understanding that leadership is mainly about enabling others and
having high emotional intelligence. According to one of the respondents, leadership
competencies heavily rely on the soft skills and emotional intelligence.
When asked how to define leadership readiness in the context of a healthcare
administration professional, the program directors emphasized the significance of healthcare
leadership competencies in ensuring that a healthcare professional is career ready. For instance,
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 70

“one program director said that in addition to having the basic knowledge about the healthcare
industry, an individual needs the competencies such as teamwork to function in the healthcare
interdisciplinary team.” Another respondent highlighted the “importance of understanding the
context of the industry, the major stakeholders, competition and business strategy.” According
to the respondent, “the understanding would help them analyze the match between the
environmental culture and the strategy employed.” Another respondent said “I think that it's
having the basic knowledge about the healthcare industry and also having the ability to work in
it professionally.” Similarly, it was noted by another respondent that when she thinks about how
she would define leadership in the context of a healthcare professional there is the need to be
“flexible, your ability to adapt, your ability to be a lifelong learner ... Be open to transformation
leadership, those kinds of things.”
With regard to the directors’ metacognitive knowledge, the program directors were
generally willing to assess own knowledge, skills, and abilities in relation to the development of
leadership competencies in their programs. For instance, when asked what comes to their mind
when they think of healthcare career readiness, the directors provided a wide range of
perspectives into their understanding of the issue. To some, healthcare career readiness is linked
to professionalism in the sense that graduate students build on the professional skills to promote
career readiness. Others associated it with adaptability, lifelong learning, and awareness and
ability to transform. Another respondent said,
I think, first of all, adaptability is incredibly important. I think lifelong learning is
important, and awareness and the ability to transform not only as an individual, but in
terms of leadership that the student provides in a management capacity relative to the
changes necessary ongoing in healthcare.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 71

A majority of the respondents acknowledged the curriculum in their institutions was
implemented by the individual faculty teams in collaboration with the program director. These
teams are knowledgeable and able to make the necessary changes to the content, course
readings, assignments, and evaluations. For instance, the program directors said that the
individual faculty members were responsible for implementing the course content and
determining the various assignments required for the courses along with the method(s) for
assessing student learning such as projects, tests, etc. During the telephone interviews when
asked how the curriculum is implemented one respondent said, “My oversight with the faculty
that implements the curriculum.” Another said,” I am responsible as a collective team to
implement the curriculum once it’s developed.” Finally, another indicated that “the ultimate
accountability for implementing the curriculum lies with me and my faculty.” The program
directors have a responsibility to ensure that the course objectives and requirements tied to the
competencies in the curriculum. They are also responsible for the assessment of programmatic
learning outcomes. This demonstrated that the program directors shared the responsibilities
with the faculty implementing the curriculum (see Table 8).

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 72

Table 8
Summary of Themes for Knowledge Influences that Emerged from the Interviews
Knowledge influence
Question Themes Frequency
What are your thoughts
on the Healthcare
Leadership Alliance
competencies
Not familiar 7
What are your thoughts
on the NCHL
competencies?
Not familiar with NCHL 1
Use NCHL 6
When you think of
"healthcare career
readiness” what comes
to mind?
Technical and soft skills 1
Knowledge base 1
Professionalism skills 1
Competency models 1
Adaptability, lifelong learning and
awareness
Flexibility
1
Empathy 1
How is your curriculum
implemented?
Implemented by the faculty and program
director
6

Motivation results and findings. The program directors’ motivation influences were
explored under the self-efficacy motivational influence and the influence of attributions. Under
self-efficacy, the researcher sought to determine the program directors’ beliefs regarding their
ability to effectively educate students about leadership competencies as well as provide the
ability to develop experiential knowledge and skills during the learning process. Under
attributions, the researcher sought to determine if the respondents’ felt that their role as program
directors have a direct impact on students’ career readiness. In addition, the researcher wanted
to understand if the program directors’ felt they had any personal responsibility regarding the
level of career readiness felt by their program graduates.
Survey data. The survey data was analyzed to determine the program directors’
motivation influences under the self-efficacy motivational influence and the influence of
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 73

attributions. The program directors indicated a high degree of confidence for their role in
curriculum development (M = 4.41, SD = 0.76). A similar trend was also noted under the
attribution motivational influences whereby the directors indicated a significant amount of
personal responsibility for student learning outcomes in their programs (M = 4.51, SD = 0.70),
feeling of personal responsibility if students say they do not feel career ready (M = 4.48, SD =
0.73) as well as the feeling that their role as program directors had a direct impact on their
students’ preparedness to enter the workplace (M = 4.55, SD = 0.59). Table 9 presents a
descriptive summary of the directors’ motivation to engage in and facilitate their programs and
course curriculum improvements.
Table 9
Motivation to Engage in and Facilitate Programs and Courses Curriculum Improvement
Competency Illustrations Mean
Score
Standard
Deviation
Agree
n (%)
Disagree
n (%)
Engaging with professional associations is
important for me in the conduct of my job duties.
4.48 0.66 40(90.9) 0(0)
I would feel personally responsible if students
say they do not feel career ready.
4.48 0.73 40(90.9) 1(2.3)
I am comfortable with my role in curriculum
development.
4.41 0.76 39(88.6) 1(2.3)
I feel responsible for student learning outcomes
in my program.
4.51 0.70 40(90.9) 1(2.3)
My role as a program director has a direct impact
on a students’ preparedness to enter the
workforce.
4.55 0.59 42(95.5) 0(0)
(1=strongly disagree to 5=strongly agree)
Based on self-reported data, the program directors had a high degree of motivation about
the importance of professional associations engagements (M = 4.48, SD = .66), feeling
personally responsible if students did not feel career ready (M = 4.48, SD = .73), feeling
comfortable with one’s role in curriculum development (M = 4.41, SD = .76), feeling
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 74

responsible for the student’s learning outcomes (M = 4.51, SD = .70), and the direct impact of
the director’s role on the students’ preparedness to enter the workforce (M = 4.55, SD = .59).
Since the means for all motivation items were above 4, it was clear that the motivational
influences were favorable.
Further, the motivational influences were considered in terms of the program directors’
employment tenure in their job, number of leadership courses offered in a program, as well as
whether the programs were offered in a private or public institution. About 4% of the program
directors in the public sector, 3.4% of program directors with tenure accountability of fewer
than five years, and 2.6% of program directors whose programs had fewer than five leadership
courses indicated that they would not feel personally responsible if students said that they were
not career ready (see Table 10). In addition, 5.2% of the program directors in the private sector,
3.4% of program directors with tenure accountability greater than five years, and 2.6% of
program directors whose programs had fewer than five leadership courses indicated that they
were not comfortable with their role in the curriculum development, and did not feel personally
responsible for student learning outcomes in their programs (see Table 10). Table 10 offers a
summary of directors’ perceptions on motivational influences related to the integration of
leadership competencies into their programs.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 75

Table 10
Descriptive Summary of the Program Directors’ Responses to Motivational Influences

Motivational Influences
Public vs.
Private
Tenure of
accountability
Number of
Leadership
Courses
Overall

n(%) Public
n(%)
Private
n(%)
<5years
n(%)
>5years
n(%)
<5
n(%)
5 to 10
n(%)
Engaging with
professional
associations is
important for me in the
conduct of my job
duties
Agree 23(92) 17(89.5) 26(89.7) 14(93.3) 34(89.5) 4(100) 40(90.9)
Disagree 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0)
I would feel personally
responsible if students
say they do not feel
career ready.
Agree 23(92) 17(98.5) 26(89.7) 14(93.3) 35(92.1) 4(100) 40(90.9)
Disagree 1(4) 0(0) 1(3.4) 0(0) 1(2.6) 0(0) 1(2.3)
I am comfortable with
my role in curriculum
development.
Agree 23(92) 16(84.2) 28(96.6) 11(73.3) 34(89.5) 3(75) 39(88.6)
Disagree 0(0) 1(5.2) 0(0) 1(6.7) 1(2.6) 0(0) 1(2.3)
I feel responsible for
student learning
outcomes in my
program.
Agree 22(88) 18(94.7) 26(89.7) 13(86.7) 36(94.7) 4(100) 40(90.9)
Disagree 0(0) 1(5.2) 0(0) 1(6.7) 1(2.6) 0(0) 1(2.3)
My role as a program
director has a direct
impact on a students’
preparedness to enter
the workforce.
Agree 24(96) 18(94.7) 27(93.1) 15(100) 36(94.7) 4(100) 42(95.5)
Disagree 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0)

Interview data. The program directors’ motivational influences were also examined
using the interview transcripts. With regard to attribution, the directors acknowledged that they
play an important role in student career path readiness. The researcher asked the respondents
how they would describe their roles in student career work path readiness. There were a variety
of different responses. One respondent indicated “we have professional development workshops
and we have a requirement that our students complete a certain number of hours of professional
development.” Another said “my role is to meet with the students as they are willing and
available.” Another respondent provided a more detailed response indicating that “for me I
think job one is to ensure the integrity of the program and so just making sure that the program
itself is rigorous.” Finally, another said “I have a lot of contact with students talking about their
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 76

preparation for the workplace. And typically, that starts even when students are applying to the
program.”
Different roles were acknowledged, among them, ensuring the integrity of the program,
mentoring and advising the students to help them meet their career objectives, ensuring that the
curriculum supports the students’ readiness and general supervision of the program. Supporting
the graduate students to be career ready was the dominant theme emerging from the interview
transcript analysis. As one director said, their role involves a lot of contact with the students and
giving them advice on their preparation for the workplace. Similar sentiments were echoed by
another director who said that they take a vested interest in everybody who graduates from their
program, helping them to get where they want to be. While there was no mention of the
association between the roles of the program directors and the problems in healthcare, it was
clear that the program directors understood and acknowledged the role they play in improving
the quality of healthcare. These included mentoring their students as well as ensuring program
integrity. The summary of the program directors’ motivational influences is given in Table 11.
Table 11
Summary of Themes for Motivational Influences that Emerged from the Telephone Interviews
Motivation influence
Question Themes Frequency
How do you maintain
your own knowledge of
the types of leadership
skills that are required
in the practice of
healthcare
administration?
Interactions with program stakeholders 4
Attending conferences and networking
meetings
4
Reading leadership books, journals and
periodicals
4
Advanced programs such as a second
master’s degree
1
How would you describe
your role in student
career/work path
readiness?
Coaching and mentoring 5
Ensuring program integrity 3
Counseling 3
Personal development workshops 1

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 77

Research Question 2 (Interaction between Knowledge, Motivation and Organizational
Influences)
The second research question two sought to examine the interaction between field
culture and context and healthcare program directors’ knowledge and motivation. Results
revealed some gaps in knowledge and processes in the conceptual and procedural knowledge
domains. The framework illustrated the interaction between the healthcare organization and the
program directors to facilitate the achievement of the objective of career readiness of the
healthcare administration graduate students. It was hypothesized that cultural models and
settings within the educational institutions have a direct impact on the program directors’
knowledge and motivation to persist towards goal achievement.
Organizational results and findings. Answering the second research question involved
a comparison of the knowledge, motivation, and organizational influences related to the
integration of leadership competencies in graduate healthcare leadership programs.
Survey data. Having explored the knowledge and motivational influences of program
directors, this section explores the program directors’ organizational influences in relation to the
integration of the leadership competencies into their degree programs. Using the survey data
collected from the survey, the mean scores for each question on the organizational influences
were calculated (see Table 12). The organizational influences examined included the program
directors’ level of autonomy to perform their duties, the infrastructure, tools provided by the
institution, the amount of work expected of the director and the organizations’ willingness to
prioritize healthcare leadership content, whether the organizational environment provided an
opportunity to stay abreast to changes in the healthcare, training opportunities, empowerment,
and people skills. Opportunities to stay abreast with changes in the industry and relationships
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 78

with professional associations scored highest with means of 4.27 (SD = .85) and 4.23 (SD =
1.06). On the other hand, the lowest scoring organizational influence had a mean score of 3.23,
with a standard deviation of 0.97 which is related to the organization providing the program
director with tools and resources to do their job.
Table 12 summarizes the survey data in relation to the organization’s impact on the
directors’ ability to perform duties. Furthermore, when the program directors were asked on the
survey to prioritize their tasks from one to ten with (1) being the highest priority based on a
predetermined list of tasks, 38% indicated that activities related to the curriculum and the
program would be their first priority followed by accreditation program review with 22%
indicated this as a first priority and 27% identifying this task as their second priority. Of note is
that 2.3% of the respondents indicated that assessment activities were their first priority
although 20.5% listed this task as their second and third priorities. Figure 8 identifies the
program directors self-identified priorities which they noted differ from those placed on them
by their organizations.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 79

Figure 8. A graphical overview of the program directors self-identified priorities

From the self-report, the program directors indicated a high degree of agreement that the
organization gives them an opportunity to stay abreast of changes in the healthcare industry, and
that they are empowered to make updates in the to the curriculum the way they see fit. The
directors indicated less agreement that work expectations were reasonable, and that the
organization prioritizes content related to healthcare leadership over other course content (see
Table 12).

13.6%
6.8%
38.6%
6.8%
22.7%
2.3%
0.0%
2.3%
2.3%
4.6%
2.3%
20.5%
15.9%
0.0%
27.3%
20.5%
4.6%
2.3%
4.6%
2.3%
6.8%
6.8%
25.0%
11.4%
15.9%
20.5%
2.3%
6.8%
4.6%
0.0%
Budgeting
Coordinating teaching assignments
Curriculum review/changes and other activities to
maintain a high quality academic program
Recruitment of faculty
Accreditation program review coordination
Assessment activities
Maintaining current course syllabi for the program
Holding program meetings
Maintaining program records
Other responsibilities not listed
Program Director Self-Identified Priorities
Priority 3 Priority 2 Priority 1
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 80

Table 12

Organizational Influence to Engage in and Facilitate Programs and Courses Curriculum
Improvement
Competency Illustrations Mean
Score
Standard
Deviation
Agree
n(%)
Disagree
n(%)
My job gives me the autonomy to develop the
curriculum the way I see fit.
3.86 1.07 31(70.5) 6(13.6)
The organization provides me with the tools and
resources needed to do my job.
3.70 .97 29(67.4) 7(16.3)
The amount of work expected of me is
reasonable.
3.18 1.21 24(59.1) 18(40.9)
My organization is willing to prioritize content
related to healthcare leadership over other course
content.
3.23 .97 15(34.9) 9(20.9)
My job gives me the opportunity to stay abreast
of changes in the healthcare industry.
4.27 .85 39(88.6) 3(6.8)
I have adequate opportunities for training to
improve my skills in curriculum development.
3.88 1.01 27(62.8) 4(9.3)
I am empowered to make updates to the
curriculum.
4.11 1.06 35(79.6) 5(11.4)
My college/university has established
relationships with professional associations in
healthcare administration.
4.23 .95 36(83.7) 4(9.3)
(1=strongly disagree to 5=strongly agree)
Furthermore, the organizational influences were considered in terms of how long the
program director has been in the position, number of leadership courses offered in a program, as
well as whether the programs were offered in a private or public institution. The perceptions of
the program directors on a number of statements relating to organizational context and culture
varied greatly. For instance, in response to the statement that “My job gives me the autonomy to
develop the curriculum the way I see fit,” 23.5% of program directors whose programs had
fewer than five leadership courses, 16.7% of program directors from public institutions and
13.8% of program directors serving for fewer than five years disagreed (see Table 13). Some of
the areas of improvement emerging from the organizational models and settings include
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 81

ensuring autonomy in curriculum development, provision of tools and resources, reasonable
expectations with regard to the work of a program director, empowering directors to make
updates to the curriculum, establishing associations with professional associations, providing
training opportunities, and prioritizing content related to leadership content over other content
in the curriculum. Table 13 presents a summary of the directors’ perceptions on organizational
influences related to the integration of leadership competencies into their programs.
Table 13
Descriptive Summary of the Program Directors’ Responses to Organizational Influences

Organizational Influences
Public vs. Private Tenure of
accountability
Number of
Leadership
Courses
Overall

n(%) Public
n(%)
Private
n(%)
<5years
n(%)
>5years
n(%)
<5
n(%)
5 to 10
n(%)
My job gives me the
autonomy to
develop the
curriculum the way
I see fit.
Agree 17(70.8) 14(73.7) 22(75.9) 9(64.3) 27(73.0) 3(75) 31(70.5)
Disagree 4(16.7) 2(10.5) 4(13.8) 2(14.3) 5(23.5) 0(0) 6(13.6)
The organization
provides me with
the tools and
resources needed to
do my job.
Agree 17(70.8) 12(63.2) 23(79.3) 6(42.9) 25(67.6) 3(75) 29(67.4)
Disagree 2(8.3) 5(26.3) 4(13.8) 3(24.4) 6(16.2) 0(0) 7(16.3)
The amount of work
expected of me is
reasonable.
Agree 16(66.7) 6(31.6) 16(55.2) 6(42.9) 18(48.6) 3(75) 24(59.1)
Disagree 8(33.3) 10(52.6) 11(37.9) 7(50) 16(43.2) 1(25) 18(40.9)
My organization is
willing to prioritize
content related to
healthcare
leadership over
other course
content.
Agree 10(41.7) 5(26.3) 11(37.9) 4(28.6) 14(37.8) 1(25) 15(34.9)
Disagree 4(16.7) 5(26.3) 5(17.2) 4(28.6) 6(16.2) 2(75) 9(20.9)
My job gives me
the opportunity to
stay abreast of
changes in the
healthcare industry.
Agree 21(87.5) 18(94.7) 28(96.6) 11(78.6) 34(91.8) 3(75) 39(88.6)
Disagree 2(8.3) 1(5.3) 1(3.4) 2(14.3) 2(5.4) 1(25) 3(6.8)

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 82

Table 13, continued

Organizational Influences
Public vs. Private Tenure of
accountability
Number of
Leadership
Courses
Overall

n(%) Public
n(%)
Private
n(%)
<5years
n(%)
>5years
n(%)
<5
n(%)
5 to 10
n(%)
I have adequate
opportunities for
training to improve
my skills in
curriculum
development.
Agree 14(58.3) 13(68.4) 19(65.5) 8(57.1) 22(59.4) 3(75) 27(62.8)
Disagree 3(12.5) 1(5.3) 2(6.9) 2(14.3) 3(8.1) 1(25) 4(9.3)
I am empowered to
make updates to the
curriculum.
Agree 19(79.2) 16(84.2) 23(79.3) 12(85.7) 31(83.8) 3(75) 35(79.6)
Disagree 2(8.3) 3(15.8) 3(10.3) 2(14.3) 4(10.8) 0(0) 5(11.4)
My
college/university
has established
relationships with
professional
associations in
healthcare
administration.
Agree 18(75) 18(94.7) 24(82.8) 12(85.7) 31(83.8) 3(75) 36(83.7)
Disagree 3(12.5) 1(5.3) 3(10.3) 1(3.4) 4(10.8) 0(0) 4(9.3)

Interview data. In the interviews, the respondents highlighted various areas that rank
higher on their priority list when addressing what the organization has them spending the
majority of their time doing. One respondent said “ultimately its moving students forward in
their completion of our degree is what I spend time doing. I spend my day helping other people
so they can also help our students achieve their degree.” Furthermore, another respondent
indicated that every day is different further noted that
In my role, I am doing, I am engaging with faculty around curriculum. I am hiring
adjunct instructors, I am involved in many discussions at the division level, the
department level as well as school level. Matters of budget and resources and a lot of the
higher-level decisions relating to operations. I do some community outreach related
stuff. I do some philanthropic work in terms of engaging with alumni. Really, I am the
person the students will come to when there is a problem and that needs my attention.
So, I take responsibility and I'm leading eight people basically.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 83

Finally, the last respondent indicated that her day varies based on time of the year. She
indicated “I spend time over the summer trying to get a sense of who our incoming students are
going to be, I look at curriculum. I look at bigger picture planning around what we are going to
do for professional development and engagement with alumni.”
Several organizational influences were identified relative to the priorities established by
the organization which include preparing their students for the market, ensuring integrity in the
program, and helping students achieve their individual career goals. From the directors’
perspective, the findings presented above emphasize that overall, their organizations offer
opportunities to stay abreast to changes in the industry, opportunities for training, and
empowerment. Based on the interviews, the directors spent about 10% to 20% of their time
interacting with industry leaders, employers, and professional associations. Table 14 gives a
summary of the areas of improvement from the perspective of the program directors.
Table 14
Summary of Organizational Influences Themes that Emerged from the Telephone Interviews
Organizational influences
Question Themes Frequency
In what ways does your
school or program
engage employers to
develop curriculum
within the healthcare
industry?
No engagement 1
Professional advisory council 2
Partnerships 2
Supporting conferences and workshops 2
Linkages office 1
Alumni engagements 1
A combination of tenure track contract
faculty and senior industry expert
lecturers
1
What type of resistance
is there when
developing the
curriculum, if at all?
No resistance 3
Resistance to change 2
Biases and opinions 1
Approval processes 1
Copyright clearances 1

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 84

Table 14, continued
Organizational influences
Question Themes Frequency
What are your
priorities?
Student branding 2
Program integrity 2
Enhance student experience 1
Student retention 1
Cultivating positive relationships with the
industry
1
Monitoring student employment rates 1
How much time do you
spend interfacing with
industry leaders, employers
and professional
associates?
15 to 20% 3
Not enough 1
I don’t know 1

Impact of organizational influences on stakeholder knowledge and motivation. The
interaction of the KMO influences reveal that in general, the program directors felt confident in
their knowledge and skills (M = 3.97, SD = .54), motivation (M = 4.49, SD = .48), and
organizational influences (M = 3.80, SD = .68). Table 15 and Figure 9 give a graphical overview
of the three variables. The self-report data reveals that participants indicated a high degree of
motivation and less knowledge and organizational support.
Table 15
An Interaction of the Knowledge, Motivation, and Organizational Influences
Competency Illustrations Mean
Score
Standard
Deviation
Knowledge influences 3.97 .54
Motivational influences 4.49 .48
Organizational influences 3.80 .68
(1=strongly disagree to 5=strongly agree)

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 85

Figure 9. A graphical overview of the knowledge, motivation, and organizational influences.
It is important to highlight that during the interviews, the program directors frequently
referenced opportunities for their academic institution to provide resources or support. For
instance, during the interviews, one respondent indicated that
I believe that one of the areas that we need to work on is actually the leadership area.
Maybe more straightforward leadership as I previously described. And how the
administration has helped our organization, and human resources and finance linked
together for our students.
Another respondent discussed the importance of reflection and building time into the
program for everyone to reflect on the process noting that “a lot of learning takes during
processes of reflection and self-assessment.” This program director further indicated that “in
general, that's something that we as a program and I think general to healthcare administration
programs, could probably improve upon.” When discussing a typical day in the life of a
program director one respondent indicated that “there really isn’t a typical day but there are a lot
of projects going on.” Another respondent indicated that “during the semester most of the day
would be focused on something related to the courses she was teaching.” While yet another said
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 86

“well, I do not know that any day is typical. There’re so many different types of things that go
on. Competing priorities with research and publishing obligations and administrative tasks were
among the many remarks.” The response by one respondent highlights a common thread among
all the respondents in terms of resources, multiple job responsibilities, competing priorities with
the requirement to build the program and conduct research. One responded indicated the
following:
I do have people helping with it, but I probably spend about 10 to 15% of my time
dealing with student advising, career advising, practicums, admitting, that kind of thing.
I probably only spend about 5% of my time on curriculum-related issues. Faculty are
pretty good. They do most of that. I'm like, okay, we need to do this. They agree, and
then it's just paperwork, so that's not so bad. I probably spend at least 10% of my time
on CAHME, on accreditation issues, tracing data, getting data, getting people to get
data, whatever that looks like, analyzing data, preparing for meetings. I am right now
about 70% covered on time on research. I have a couple of big grants on foundation
work that I spend time on. I do a lot of networking, but some of that's outside.
Weitzner and Deutsch (2015) discuss the ongoing efforts of organizations to understand
priorities with a particular emphasis on stakeholders in a broad sense. The salience framework
which suggests that urgency is reflected based on the stakeholder’s request for immediate action
or attention to something (Weitzner & Deutsch, 2015). There are differences in how the
program directors see their work priorities as opposed to how the organization does. Given the
different perspectives on work priorities if the program director does not create a sense of
urgency around the alignment of their priorities the organization may not recognize the need to
pivot or address their concerns. Thus, salience reflects how the leader or organization would
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 87

respond to the stakeholder (Mitchell, Agle & Wood, 1997) which in this regard would be the
program director’s plea for help, guidance, and resources. The program directors themselves
have competing stakeholders that they must respond to as well which include other
organizational leaders, students, external entities and the like. Therefore, when exploring the
interactions between the knowledge and motivational influences relative to the organization,
motivation can be impacted if the program director does not feel the requisite support to achieve
his or her goals. Knowledge has a direct link to motivation relative to the program directors
feeling of self-efficacy to perform their job to the best of their abilities. The next section will
discuss additional findings that are not directly linked to the research questions but supported
problem of practice.
Additional Findings: Participant Solution Recommendations
During the interview process, program directors were asked “What are some areas
where your program can improve with respect to developing leadership skills in your
students?” The thematic analysis of the interview transcripts reveals various emerging
themes about what participants believe institutions should do to improve in terms of
developing the graduate students’ leadership skills. The first theme involved the integration
of foundational core of public health knowledge since the students are missing out on the
connections between health policy and epidemiology, and community health. The area of
leadership in general also emerged as another area requiring improvement. One respondent
indicated that that there are some knowledge gaps and their program does not have an
integrated foundational core of public health knowledge and students are missing out on the
connections between health policy and epidemiology and community health. According to
another respondent, the areas of administration of healthcare organizations, human
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 88

resources, and finance should be looked at, and the best way to integrate them considered.
With regard to leadership, one respondent felt that the area of self-reflection and self-
assessment is also lacking. Finally, another director emphasized the theme of self-
assessment, saying,
I would like to see us do more evaluation around the assessment process in terms of
really measuring whether students are utilizing the competency elements that are in
the assignments, and then measuring closely what they're learning from that process.
Table 16 gives a summary of the areas of improvement from the perspective of the
program directors.
Table 16
Summary of Improvement Areas
Question Themes Frequency
What are some
areas where your
program can
improve with
respect to
developing these
leadership skills in
your students?
 Having the right faculty
 Integration of materials
1
2
 Leadership areas 2
 Self and group reflection 3
 Evaluations around the assessment process and
critical thinking

2
 Business processes and soft skills 1
 Mid-point assessments 1
 Balancing between academic thinking and the
practical application of knowledge
 Follow students in the workplace
 Quality improvement
 Curriculum changes: courses content covering
strategic issues, positioning, long-term
planning, change management, power and
influence
 Need to be more real-world and provide
practical application
 Emphasis on team-building and team
management
 Help to better create context for the students

1
1
1

3

1

3
1
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 89

Document analysis data. The document review data collection process yielded
additional information that was evaluated against the data from both the surveys and interviews
to get a sense of how leadership was reflected in some programs across the United States. The
program websites reviewed represented a random sample from the healthcare administration
programs that were participating schools. These schools were used as a double-check to
triangulate interview and survey data. Of the 10 websites reviewed, four (40%) had specific
courses for leadership in the course title. However, only one of the ten courses had a course
specifically devoted to leadership in healthcare organizations. To further get a sense of the
course objectives the course descriptions were reviewed.
The course description indicated that the student would learn based on an entry to
mid-level manager’s role focusing on the requisite skills to be an effective leader in
healthcare. Additionally, the course description indicated that “course topics are discussed
and explored within the context of key organizational dimensions to include environment,
structure, process, human resources, performance and adaptability.” The other three course
descriptions all discussed leadership in addition to other topics. In all cases, there was no
information about the details of the identified courses beyond the course descriptions. The
course description for the Leadership and Career Development in Healthcare Administration
course focused on the development of the students’ leadership potential by improving their
abilities in various domains such as creative thinking, communication and conflict
management. In this course, one learning objective was to work with the students to increase
personal effectiveness by learning a number of strategies such as goal setting and increasing
self-awareness. These concepts align with interview data related to competencies for
leadership identified in Figure 5. Other programs emphasized that their program would
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 90

prepare graduates for higher levels positions such as hospital administration, nursing home
administrator, group practice leaders and senior positions managing departments or business
units.
With respect to the programs providing students opportunities for experiential
learning through internships and or fellowship programs, eight out of ten or 80% of the
programs offered internships while one program offered fellowship opportunities.
Fellowships offer students post-graduate opportunities to engage in formal training to gain
hands-on experience through working directly in a healthcare organization (AUPHA, 2014).
Internships offer students the opportunity to learn generally toward the end of the program
and immediately prior to graduation with the same emphasis of creating opportunities for
exposure and to gain hands-on experience. McLelland (1973) discussed the importance of
enabling students the opportunity to improve their capabilities through practical experience.
He further emphasized that programs should measure a student’s competency coupled with
their skills and abilities to predict future work performance.
Finally, six healthcare administration graduate programs reviewed identified the use
of a competency model in the program, three of which were minimally based on the NCHL
model evaluated for this study. Each of the models were vastly different in content but
similar in structure in that they were based on large overarching themes or domains
followed by specific competency statements. Table 17 provides a summary of the document
review data. The methods used to assess whether students actually developed these
competency statements was not reflected on the program websites. Three of the programs
had the NCHL competency logo on their website but did not specifically use the model for
their program competency. The survey indicated that on average 2.29 leadership courses
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 91

were a part of the respondent’s program curriculum. In review of the data from the
document analysis the average number of leadership courses was 1. In review of the course
descriptions during the document analysis very few courses mentioned leadership as a topic.
In contrast, during the interviews many program directors noted that leadership may not be a
specific course but the various leadership concepts taught in many courses.
Table 17 provides a concise overview of the data obtained from the school’s
program website related to experiential learning opportunities, the number and type of
leadership courses and the structure of the competency framework the program is based on.
Table 17
Summary of Documentation Review from University Websites
School Internship Fellowship Leadership
Courses
Competency Model
1 Yes Yes  Leadership
Professionali
sm and
Career
Development
4 Domains
 Cross-Cutting
 Self-actualization
 Management
 Contextual/Envir
onmental
Understanding
2 Yes No  Managing
Healthcare
Organization
s
 Leadership in
Healthcare
Organization
s

5 Domains
 Knowledge of the
Healthcare
environment
 Critical Thinking
and Analysis
 Business and
Management
Knowledge
 Political and
Community
Development
 Communication
3 No No None None identified

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 92

Table 17, continued
School Internship Fellowship Leadership
Courses
Competency Model
4 Yes No  Leadership and
Career
development in
healthcare
administration
None identified
5 Yes No  Change
Leadership in
Health
Services
Organizations
3 Focus areas
(Context, Content &
Capabilities) with six
competencies within
the focus areas.
 Healthcare
industry
knowledge
 Management
 Ethics and
Professionalism
 Emotional
Intelligence
 Critical Thinking
 Communication
Skills
6 Yes No  Principal
Based
Leadership in
Healthcare
5 Domains
 Leadership and Ethics
 Business Knowledge and
Skills
 Strategic and Critical
Thinking
 Relationship
Management and
Teamwork
 Communication
7 Yes No None Listed Competencies not identified:
The program uses nationally
recognized competencies in
the curriculum to ensure
students are prepared to be
leaders in the field.
8 No No  Organizational
Behavior and
Leadership
None Identified
9 Yes No None Identified 27 competency statements
10 Yes No None Identified 10 competency statements

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 93

Recommendations for Practice
There are several recommendations to address the knowledge, motivation, and
organizational influences. The following section will elaborate on four knowledge
recommendations that will assist in improving the three knowledge domains with particular
emphasis centered on developing their knowledge about the competencies and how to
effectively incorporate them into their curriculum. Significant gaps did not emerge from the
motivation influence. However, given that program directors did not allocate a significant
amount of time to curriculum related activities or engagement with peers or professional
associations to support these activities there are two context specific recommendations for the
motivation influence focused on engagement and collaboration. The area with greatest
opportunities existed with the organizational influences with four recommended solutions that
are focused on organizational support relative to aligned goals and priorities. The KMO
influence recommendations are rooted in behavioral, leadership, organizational change theories
with literature to support the identified recommendations to improve practice. The following
section provides the recommendations for these influences.
Knowledge recommendations. There are five primary knowledge recommendations
that will improve procedural, metacognitive, and declarative knowledge. In order to address the
procedural knowledge domain, as a part of a training workshop, the program directors are to be
provided with written information regarding the HLA competencies and the NCHL competency
model to complement their existing knowledge and skills required of graduate students. In
addition, as a part of the workshop through collaborative discussions with other program
directors and workshop facilitators, they will have the opportunity to assess whether
connections have been made with existing knowledge regarding leadership competencies and
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 94

the HLA competencies and the NCHL competency model. Program directors will also be asked
to identify what they know and what they do not know about leadership and how to develop
these competencies through their program curriculum as a pre-workshop assessment activity.
Program directors will be trained on the competencies and how to incorporate them into their
curriculum. The workshop will also include training on how to create curriculum that will
facilitate the development of experiential knowledge and skills for their students through
opportunities to practice developing a competency-based curriculum using various tools such as
worked examples, flow-charts, step-by-step guides and matrices with the opportunity for one on
one support and feedback.
Table 18
Summary of Knowledge Influences and Recommendations
Knowledge Influences Principle and Citation Context-Specific Recommendation
Program directors need
knowledge of the HLA
competencies and the
NCHL model.
Procedural knowledge
increases when declarative
knowledge required to
perform the skill is available
or known. (Clark et al., 2008).

Connecting current context
and experiences to appropriate
prior knowledge helps people
make sense of new (Schraw &
McCrudden, 2006).
As part of a workshop, provide written
information for the program directors
regarding the HLA competencies and the
NHCL competency model that will
complement their existing knowledge and
skills required of graduate students.
Program directors need
to be willing to self-
assess their own
knowledge, skills and
abilities in relation to
the development of
leadership competencies
in their degree program.
Metacognitive knowledge is
important because it allows
the individual to assess their
level of cognitive awareness
(Krathwohl, 2002).

As individuals increase their
metacognitive awareness, they
become self-regulated learners
and increase their ability to
determine what strategies
work for them and when it is
appropriate to use those
strategies (Mayer, 2011).
As a part of a pre-workshop assessment
activity ask program directors to identify
what they know and what they do not
know about leadership and how to
develop these competencies through their
program curriculum.
As a part of a workshop provide program
directors an opportunity to reflect on their
thought processes upon completion of
curriculum review, development, or
change activities to reflect on their
process and decisions made.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 95

Table 18, continued
Knowledge Influences Principle and Citation Context-Specific Recommendation
Program directors need
knowledge of how to
develop the type of
curriculum, courses, and
assignments that will
facilitate the
development of
experiential leadership
competencies for
healthcare.
Mastery can be developed by
acquiring component skills,
practicing integrating these,
and developing an
understanding of when to
apply which skills to apply in
which context (Krathwohl,
2002; Schraw & McCrudden,
2013).

As a part of a workshop, train program
directors on curriculum development
with a focus on establishing experiential
knowledge and skills. Training will
provide the program directors with
opportunities to practice developing a
competency-based curriculum using
various tools such as worked examples,
flow-charts, and step-by-step guides and
matrices with the opportunity for one on
one support and feedback which includes
knowing what the competencies are and
how to integrate new industry
competencies into the curriculum.

Motivation recommendations. While the data did not identify major gaps with self-
efficacy or attribution, there are three context-specific recommendations pertaining to
motivation to further enhance these influences. Program directors noted during the interviews
and survey that they have busy schedules and did not spend a significant amount of their
workday on curriculum related activities although they expressed a desire to do more. Program
directors all struggled with the same challenges related to the curriculum and staying abreast of
what is happening in the industry to better inform the requisite changes required. The
aforementioned would suggest that program directors did not fully attribute their lack of
prioritization of these tasks to outcomes related to student readiness. The researcher
recommends that program directors allocate time in their busy work schedules to provide each
other guidance, targeted feedback, and scaffolding when incorporating the HLA and NHCL
competencies in their curriculum. This recommendation will enable program directors to obtain
feedback on their process for curriculum development and share tools, learn best practices
which will make the process easier and less time intensive. The aforementioned processes can
occur if the program directors are engaged with professional communities of practice with peers
and professionals in the field to provide and obtain peer feedback, mentorship and share
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 96

examples of how other program directors have developed competency-based curriculum.
Cataldo (2009) discussed the benefits of engaging in communities of practice to cultivate a
learning environment. Moreover, the program directors should create a matrix that identify specific
competencies and the types of assignments required in the classroom that will develop these skills.
Additionally, identify how the competency could improve specific organizational outcomes and key
performance indicators (KPIs) to demonstrate how concepts learned translate to the work environment.
To improve the program director’s personal attribution toward career work path readiness, these
recommendations will enable them to recognize the key role of the curriculum in preparing
students for the leadership demands of the field they will be working in.
Table 19
Summary of Motivational Influences and Recommendations
Motivational Influences

Principle and Citation Context-Specific Recommendation
Program directors must
believe they have the ability
to effectively educate
students about the
leadership competencies
and provide the ability to
develop experiential
knowledge and skills
during the learning process.
Feedback provided that
is specific, clear, and
timely enhances
performance (Shute,
2008).

Feedback and modeling
increase self-efficacy
(Pajares, 2006)
Through the engagement with AUPHA
established forums, Program directors
should work on curriculum related activities
in collaboration with their peers and
professionals in the industry so that when
they are engaged in curriculum related
activities, the program director’s will have
the guidance, targeted feedback, and
scaffolding while incorporating the HLA
and NHCL competencies in the curriculum

Program director must engage in existing
professional communities of practice
through AUPHA to provide and obtain peer
feedback, mentorship and share examples of
how other program directors have
developed competency-based curriculum.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 97

Table 19, continued
Motivational Influences Principle and Citation Context-Specific Recommendation
The program directors need
to acknowledge that they
play a significant role in the
problem of quality of
healthcare and that they can
do something about it by
better preparing students.
Learning and motivation
are enhanced when
individuals attribute
success or failures to
effort rather than ability.
(Anderman &
Anderman, 2009).
Program director to create a matrix that
identify specific competencies and the types
of assignments required in the classroom
that will develop the specific competency.
Additionally, identify how the competency
could improve specific organizational
outcomes and key performance indicators
(KPIs).

Organization recommendations. University leadership could develop a streamlined
curriculum evaluation and assessment process inclusive of specific, measurable, realistic, and
time-bound (SMART) goals with expedited review processes and guidelines. The university
must balance giving faculty academic freedom to implement the new or revised syllabus with
some level of standardization. The college administrator must ensure that the program directors
have clear, reasonable, and concrete goals that identify specific actions to be completed with
due dates related to development of a competency-based curriculum that incorporated the
NCHL or HLA competencies into their program. The college leadership must provide resources
and remove barriers such as budget, training and competing priorities to enable program
directors to focus on their priorities. Program directors and their direct reports are to establish a
list of work priorities and goals from the beginning of the performance year so that, when there
are competing priorities the guidance for the program directors has already been predetermined.
Leaders must assist program directors in balancing other institutional commitments such as
publishing, teaching load and administrative responsibilities to allow time to devote toward
curriculum development, review and revisions. College administrators must develop a system
for collecting formal and informal “organizational intelligence” about what the program
directors spend their time doing so that they can proactively identify and address their concerns
related to competing priorities.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 98

Table 20
Summary of Organizational Influences and Recommendations
Organizational
Influences
Principle and Citation Context-Specific
Recommendation
Program directors
experience challenges
with updating and
implementing new
curriculum due to the
processes defined by the
university.
A strong organizational culture
controls organizational behavior and
can block an organization from
making necessary changes for
adapting to a changing environment
(Schein, 2004).

University leadership must
develop a streamlined
curriculum evaluation and
assessment process inclusive of
SMART goals (specific,
measurable, realistic and time-
bound) with expedited review
processes and guidelines
coupled with processes to
manage how program directors
hold faculty accountable and
measure the effectiveness of
how they have implemented the
curriculum in the classroom to
allow academic freedom but
with some required
standardization.

The school should
prioritize and hold
program director
accountable for the
integration of NCHL and
or the HLA
Competencies model into
their programs’ curricula
via aligned assignments
and class activities that
will facilitate the
development of
leadership competencies.
Organizational performance increases
when leaders set clear, measurable
goals aligned with the vision of the
organization (Locke & Latham, 2002;
Smith, Locke & Barry, 1990)
The college dean or other
leadership must ensure that the
program directors have clear,
reasonable and concrete goals
that identify specific actions to
be completed with due dates
related to development of a
competency-based curriculum
that incorporated the NCHL or
HLA competencies into their
program that will enable
experiential learning
opportunities for the students.

Program directors are
burdened with other job-
specific responsibilities,
causing a lack of focus
and time on program
curriculum and aligning
with the multitude of
changes in the healthcare
industry.
Effective organizations insure that
organizational messages, rewards,
policies and procedures that govern
the work of the organization are
aligned with or are supportive of
organizational goals and values (Clark
& Estes, 2008).

Program directors and their
direct reports are to establish a
list of work priorities and goals
from the beginning of the
performance year so that when
there are competing priorities
the guidance for the program
directors has already been
predetermined.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 99

Table 20, continued
Organizational
Influences
Principle and Citation Context-Specific
Recommendation
Effective change efforts ensure that
everyone has the resources
(equipment, personnel, time, etc.)
needed to do their job, and that if there
are resource shortages, then resources
are aligned with organizational
priorities (Clark & Estes, 2008).
Leaders must assist program
directors in balancing other
institutional commitment such
as publishing, teaching load and
administrative responsibilities to
allow time to devote toward
curriculum development, review
and revisions timely.

The aforementioned program and processes can be implemented using Kirkpatrick and
Kirkpatrick’s (2016) four levels of evaluation model. The model should be incorporated prior,
during and after completion of the program.
Conclusion
Management in a healthcare organization requires a unique set of skills given how
dynamic and complex healthcare is in comparison to other industries (Hartman & Crow, 2002;
Landry & Hearld, 2013). Healthcare administration graduate degree programs strive to make
changes to their curriculum to meet the needs of employers, professional associations, and
accrediting bodies (Jones et al., 2016) but continue to produce graduates ill-prepared to hold
leadership roles from perspectives of organizational preceptors (Clement et al., 2010). In
healthcare, competency-based curriculum is not new and has become a recognized standard
(Calhoun, Vincent, Calhoun & Brandsen, 2008; CAHME, 2007; Cherlin, Helfand, Elbel, Busch,
& Bradley, 2006). Development of students’ competencies continues to be an ongoing
challenge for healthcare administration graduate degree program directors (Friedman &
Frogner, 2010).
The purpose of this study was to examine the factors influencing the development of
leadership competencies of healthcare administration graduate students, to understand the
factors affecting career readiness from a leadership perspective, and to determine what is
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 100

needed for graduate students to have the applied and experiential knowledge required to
successfully manage healthcare organizations. Developing these competencies would improve
the management of healthcare organizations and support the implementation of structures and
processes required for positive organizational outcomes, thus closing gaps in organizational
performance results (Calhoun, Vincent, Calhoun & Brandsen, 2008). Given the lack of focus on
the leadership competencies required of those leading organizations, departments and business
units within healthcare academic institutions must focus on essential leadership competencies to
assure they are being taught to future healthcare leaders (Nowacki et al., 2016). To understand
what is required to build the capacity of those managing healthcare organizations, it was critical
to examine the knowledge, motivation and organizational influences and requisite theories that
support the development of applied and experiential leadership competencies in healthcare
administration graduate degree programs.
The results of the study revealed a number of opportunities for improvement in how
leadership competencies should be reflected in graduate degree program curriculum and how
they manifest in career readiness of students upon graduation. Moreover, it is important to
underscore that that majority of gaps identified were not at the level of the program directors’
knowledge and motivation but more so in the area of organizational influences. The healthcare
industry and academic institutions would benefit from additional research evaluating specific
leadership competencies of graduates during their first two years of employment post-
graduation with the intention of understanding which competencies most benefited
improvements in organizational outcomes, department and or business unit key performance
metrics.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 101

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Appendix A
Participating Stakeholders with Sampling Criteria
for Interview, Survey and Observation
Survey Sampling Criteria and Rationale
Criterion 1. As with existing data sampling criteria, schools were required to members
of the AUPHA to facilitate contact with program directors. The organization provides resources
to allow dialogue about healthcare administration degree programs.
Criterion 2. Participants had to be members of AUPHA working as healthcare
administration program directors. This criterion is critical because there are other members who
have other job titles in the academic community and do not have overall accountability for the
healthcare administration degree program.
Survey Recruitment Strategy and Rationale

Program director participants were identified based on membership in the AUPHA. An
individual email was sent to individuals listed in the membership directory to announce the
study and request participation.
Existing Data Sampling Criteria and Rationale

Use of existing data sets to answer research questions is a common practice (Doolan
&Froelicher, 2009; Merriam & Tisdell, 2016). Existing data sampling involves the
identification and review of available program material on the college’s website. Content
analysis was used to evaluate the data obtained from these websites. Amy (2015) promoted the
use of content analysis due to its flexibility and benefits associated with reviewing unstructured
data. In addition, Krippendorff (2012) identified that this method of qualitative data review will
enable the researcher to “analyze relatively unstructured data in view of the meanings, symbolic
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 123

qualities, and expressive contents they have and of the communicative roles they play in the
lives of the data’s source” (as cited in Merriam & Tisdell, 2016, p. 179). Given that the data
used were not developed for the purpose of research, other data collection methods were used to
complement and validate the artifacts obtained from public information available on the college
websites. The aforementioned sources were the foundation for the data.
Criterion 1. Participants’ degree program information had to be readily available
through the school’s website and other internet sources. In addition, resources such as the
syllabi, degree requirements and information on programmatic and student learning had to be
accessible through the school’s website. This was important because capture of data would be
difficult without online access.
Criterion 2. Schools had to be members of the AUPHA. This criterion was selected due
to ease in contacting and engaging with the program directors. This organization has a blog and
other resources that allow for ongoing communication and dialogue about various aspects of
specific schools’ healthcare administration degree programs.
Criterion 3. The program had to lead to a graduate degree in healthcare administration
or equivalent graduate degree with a concentration in healthcare administration or management.
The rationale for this criterion was to ensure the degree was focused on the healthcare industry.
Healthcare administration programs embedded within another degree program or college may
not emphasize healthcare administration content or may blend this content with business, public
administration or another discipline. Blended data may skew the results of the study, as the
competencies studied herein are particular to healthcare.

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Existing Data Identification Strategy and Rationale

Using the above criteria, a nonrandom, purposive sample was developed based on
accessibility and availability of data online about courses, program design, curriculum, required
courses and access to the program director. Ritchie, Lewis, Elam, Tennant, and Rahim (2013)
suggested purposive sampling when there are defined criteria for consideration in the sample.
Participants were identified based on membership in AUPHA because of their membership and
ability to review healthcare administration degree program material on the internet. Membership
in AUPHA was chosen because the association website provides readily identifies healthcare
administration graduate programs and the program directors. Furthermore, this association is the
only global non-profit network of colleges, institutions and healthcare professionals that works
to improve healthcare services and healthcare management education. Based on this review, 130
program directors were surveyed. Of those who responded to the survey, 10 of the 24 program
directors who agreed to be interviewed, were selected for interview largely based on their
availability and 10 randomly selected school websites were evaluated using a data collection
tool.
Interview Sampling Criteria and Rationale
Criterion 1. Program directors had to be members of AUPHA. The rationale for this
was that AUPHA was able to provide a list of program directors making it easier to readily
identify who they were and their contact information.
Criterion 2. Participants had to be working as healthcare administration graduate degree
program directors. This criterion was critical because there are other members who have other
job titles in the academic community who do not have overall accountability for the healthcare
administration degree program and, therefore, could not address the research questions.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 125

Criterion 3. Participants had to answer the survey. This criterion was critical because
this was how interview participants were identified.
Telephone Interview Recruitment Strategy and Rationale

Telephone interview participants were identified based on their response to question 24
of the survey which asked if they would be willing to be interviewed. The participants were
offered a $50 gift card if they were selected to be interviewed. This recruitment strategy was
used because it made it simple for program directors to present their willingness to engage in
the final data collection process through the Qualtrics survey.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 126

Appendix B
Protocols

Survey Protocol

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 127

This questionnaire is part of a project for a doctoral dissertation. The purpose of the project is to
understand how healthcare administration programs affect students’ career readiness. The
survey is based on the perspective of the program director

Your responses are greatly appreciated. However, there is no obligation to participate; your
participation is completely voluntary and entirely anonymous. If you feel uncomfortable
answering any questions, please do not feel obliged to. You can withdraw from the survey at
any point.

Your survey responses was confidential and data from this research will not focus on individual
responses. The focus is on aggregated data. If you would like a copy of the study upon
completion, you may email me privately with your contact information at Shawishh@usc.edu.

By undertaking this survey, you are consenting to be a part of this study.

It will take approximately 15 minutes to complete the questionnaire.

SURVEY QUESTIONS:

1. What type of graduate degree(s) in healthcare administration does your college offer (i.e.,
MHA, MSHA, MBA with concentration in healthcare, etc.).
o Master’s in Healthcare Administration (MHA)
o Master of Science in Healthcare Administration (MSHA)
o Master of Business Administration in Healthcare (MBA)
o Master of Public Administration in Health (MPA)
o Master of Public Health (MPH)
o Other (please specify)

2. In what part of the U.S. is your University located?
o Northeast
o Midwest
o South
o West
o Other ___________________________________________

3. The University that employs you is:
o Private university
o Public university
o Other (please specify)

4. The University that employs you delivers programs via distance education.
o Yes
o No
o Other: ________________________
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 128

5. How long have you been accountable for the healthcare administration graduate degree
program?

6. In your program, how many leadership courses are required to graduate?

7. How are students evaluated for the leadership competencies gained from the program?

8. Describe the challenges that you face when updating the healthcare administration
curriculum.

9. Which organization provides accreditation and/or certification for your program?
o AUPHA Certification
o Higher Learning Commission
o CAHME Accreditation
o CEPH Accreditation
o Other: __________________________

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 129

10. To what extent do you agree with the following statement: Students who graduate from my
program will have the applied and experiential knowledge they need to be considered career
ready by healthcare employers?
o Strongly Disagree
o Disagree
o Neither Agree nor Disagree Agree
o Agree
o Strongly Agree

11. To what extent do you agree with the following statement: Students who graduate from my
program will have the leadership competencies required to manage in a healthcare
organization?
o Strongly Disagree
o Disagree
o Neither Agree nor Disagree Agree
o Agree
o Strongly Agree

12. Overall, how satisfied are you with the Healthcare Administration Graduate Program
Curriculum at your school?
o Completely Dissatisfied
o Dissatisfied
o Neither Satisfied or Dissatisfied
o Satisfied
o Completely Satisfied
13. Overall, how satisfied are you with the content your program provides graduate students
specifically related to leadership?
o Completely Dissatisfied
o Dissatisfied
o Neither Satisfied or Dissatisfied
o Satisfied
o Completely Satisfied
14. Please indicate the extent to which you agree with the following statements related to your
knowledge of the healthcare administration competencies and career readiness:
Question Strongly
Disagree
Disagree Neither
Agree nor
Disagree
Agree Strongly
Agree
I am aware of the National
Center for Healthcare
Leadership Competency Model.

I am aware of The Healthcare
Leadership Alliance
competencies.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 130

The leadership courses in the
curriculum are designed to
develop the students’ leadership
skills.

I am aware of the NACE
definition of career readiness.

In my program, graduates were
career ready based on the
NACE definition by the time
they graduate.

I know how to evaluate the
effectiveness of the curriculum
at my school.

I can identify the tools that are
used to identify the core
competencies required of an
MHA/MSHA program
curriculum.

I can describe the process used
to align course requirements to
core competencies required of
those managing in healthcare
organizations.

15. Please indicate the extent to which you agree with the following statements related to your
motivation to engage in and facilitate program and course curriculum improvements:
Question Strongly
Disagree
Disagree Neither
Agree nor
Disagree
Agree Strongly
Agree
Engaging with professional
associations is important for me
in the conduct of my job duties.

I would feel personally
responsible if students say they
“do not feel career ready.”

I am comfortable with my role
in curriculum development.

I feel responsible for student
learning outcomes in my
program.

My role as a program director
has a direct impact on a
student’s preparedness to enter
the workforce.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 131

16. Please indicate the extent to which you agree with the following statements related to your
organization’s impact on your ability to perform your job as program director effectively:
Question Strongly
Disagree
Disagree Neither Agree
nor Disagree
Agree Strongly
Agree
My job gives me the autonomy
to develop the curriculum the
way I see fit.

The organization provides me
with the tools and resources
needed to do my job.

The amount of work expected
of me is reasonable.

My organization is willing to
prioritize content related to
healthcare leadership over
another course content.

My job gives me the
opportunity to stay abreast of
changes in the healthcare
industry.

I have adequate opportunities
for training to improve my skills
in curriculum development.

I am empowered to make
updates to the curriculum.

My college/university has
established relationships with
professional associations in
healthcare administration.

My college or university
believes in my professional
development as a program
director who is responsible for
the healthcare administration
program.

17. Please indicate the extent to which you agree with the following statements related to your
program’s impact on the development of applied and experiential knowledge of leadership
competencies for those managing in healthcare organizations: Our Healthcare
Administration Graduate degree program….
Our Healthcare Administration
Graduate degree program….

Strongly
Disagree
Disagree Neither Agree
nor Disagree
Agree Strongly
Agree
Develop the student’s
transformational skills as a
leader (i.e., visioning,

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 132

energizing, change
management, etc.)
Our curriculum and course
assignments develop the
student’s execution skills that
enables them to learn how to
translate vision and strategy into
optimal organizational
performance.

We teach our students people
skills to create an organizational
climate that values employees
from all backgrounds and
provides an energizing
environment for them.

18. Please rank your responsibilities in order of importance
o Budgeting
o Coordinating teaching assignments
o Curriculum review/changes and other activities to maintain a high-quality academic
program
o Recruitment of faculty
o Accreditation program review coordination
o Assessment activities
o Maintaining current course syllabi for the program
o Holding program meetings
o Maintaining program records
o Other responsibilities not listed

19. Does your school have an internship requirement for healthcare administration graduate
students?
o Yes
o No

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 133

20. Does your school have an administrative fellowship program for healthcare administration
graduate students?
o Yes
o No

21. In your opinion, how important is it that students graduate with demonstrated leadership
abilities to lead in a healthcare organization?
o Very unimportant
o Unimportant
o Neither important or unimportant
o Important
o Very important

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 134

Document & Artifact Protocol

Leadership Competencies Review in Graduate Healthcare Administration Degree
Program Document Analysis Protocol

University
Type of Program
Number of Leadership
Courses
Fellowship Required
Internship Required
Program Director Name

Yes No
Does the school have a definition of leadership?
Does the school reference the use of HLA competencies
on website or program materials?
Does the school reference the use of NCHL
competencies on website or program materials?

Review of Program Website Program Curriculum and Syllabi if available.
1. Does the school have a definition of leadership?
2. Does the school reference the use of any competency model?
a. If not, what if any competency model does the university use?
b. Can you associate the courses to the HLA or NCHL competencies in the title
or course descriptions?
3. Does the school reference the use of NCHL competencies on website or program
materials?
4. Does the competency model have a leadership domain or focus area?
5. Is there a course title that covers leadership domain competency?

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 135

Telephone Interview Protocol
Name: __________________
Date: __________________

Before we begin, can you tell me which gift card you would like for your time? Thank you
again. I appreciate you taking the time to speak with me.

o Amazon Gift Card
o Starbucks Gift Card

Date & Time sent: ____________________________

I would like to ask you some questions regarding the graduate degree program in
healthcare administration for which you are the program director. I will start with some
general questions and transition to more specific questions regarding your knowledge,
motivation and organizational influences that regarding leadership competencies for the
healthcare industry that are reflected in your graduate degree program.

I. Questions Regarding Knowledge Influences

1. Can you discuss how your program develops leadership competencies in your
students?
a. What would I see in the curriculum that would demonstrate the integration of
these competencies?
2. What are your thoughts on the Healthcare Leadership Alliance competencies?
(Value)
3. What are your thoughts on the NCHL competencies? (Value)
4. How do you know what employers are looking for in your MHA graduates?
5. When you think of “healthcare career readiness” what comes to mind? (Knowledge)
a. When you think of leadership competencies, what comes to mind?
b. How would you define leadership readiness in the context of a healthcare
administration professional?
6. What are some areas where your program can improve with respect to developing
these leadership skills in your students?
7. Describe the process used to align course requirements to core competencies
required of those managing in healthcare organizations.
8. How is your curriculum implemented?
a. Is it your responsibility or another member of the team?
b. If not you, what role do you have in implementing the curriculum content?

Please let me know if you need a break or if it is ok to continue. If so, at this time, we will
change directions and move into the discussion the healthcare industry and the relation to
program content and career and leadership readiness.

II. Questions Regarding Motivation Influences
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 136

1. How do you maintain your own knowledge of the types of leadership skills that are
required in the practice of healthcare administration?
2. How would you describe your role in student career / work path readiness?
(Attribution)

Prior to ending the interview, I would like to ask some additional questions related to your
school and the program.
III. Questions Regarding Organizational Influences
1. In what ways does your school or program engage employers to develop curriculum
within the healthcare industry?
a. What about the assignments and other deliverables for a course?
b. What type of resistance is there when developing the curriculum, if at all?
i. Who are the resisters, faculty, other employees/departments at the
university, curriculum developers? If so why?
2. Please describe a typical day in the life of an MHA program director?
a. What does the organization have you spend the majority of your time doing?
b. What are your priorities?
c. How much time do you spend interfacing with industry leaders?
i. What about employers?
ii. And professional associations?
This concludes the interview. I would like to thank you for your time and candor in
answering these questions. Have a wonderful semester/quarter.

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Appendix C
Credibility and Trustworthiness
As the researcher, I played a critical role in ensuring the credibility and trustworthiness
of my defined research process and methods. I was the person collecting and interpreting the
data; as such I served as the primary investigator. Process integrity is a critical part of research.
Patton, as cited in Merriam and Tisdell (2016), suggests that “one has to trust that the study was
carried out with integrity and that it involves the ethical stance of the research” (p. 260).
Therefore, as a researcher, I kept in mind the role I play in establishing trust with the
community I was evaluating and engaging during the research process. To this end, Patton notes
that “trustworthiness of the data is tied directly to the trustworthiness of those who collect and
analyze the data and their demonstrated competence in doing so” (as cited in Merriam &
Tisdell, 2016, p. 260). I used triangulation, which is employing a number of different data
collection methods and sources to determine findings (Creswell, 2014; Maxwell, 2013; Merriam
& Tisdell, 2016) which promotes credibility. Examining information collected through both the
data analysis and surveys enabled me to corroborate findings across data sets and reduce the
impact of potential biases in a single data collection method. Furthermore, as noted by Merriam
and Tisdell (2016), an electronic narrative of all steps taken was completed to document and
create transparency of the process. This facilitated trust between the investigator and the
participants. Finally, all of the aforementioned was critically important to me as a researcher
given my role in the industry as both an educator and leader in the healthcare community. Thus,
it was important to me that my own biases associated with past experiences did not cloud my
review of the data. I ensured this by reporting the data without commentary or narrative that
was not supported by the literature.
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Appendix D
Validity and Reliability
Reliability and validity of any research largely depends on the personal ethics of the
researcher (Creswell, 2014). Bryman and Bell (2015) noted that validity refers to the constructs
being measured and whether the tools are reliable in yielding the data for that particular concept
or construct. As the researcher, I played a critical role in ensuring the validity and reliability of
my defined research process and methodologies that were employed (Creswell, 2014). It was
my responsibility to ensure that all protocols are followed in terms of validating the survey tool
to ensure the data could be captured with the items on the survey (Creswell, 2014; Maxwell,
2013; Merriam & Tisdell, 2016). Triangulation, the use of multiple data capture methods, is one
of the primary methods used to promote validity of the survey results (Creswell, 2014; Salkind,
2017). Due to the confidential nature of the survey, respondent validations were difficult.
Therefore, prior to commencing the survey, pilot testing was done. Given my role in the
industry as both an educator and leader in the healthcare, I had to ensure that my own biases
associated with past experiences did not cloud my review of the data. Thus, as recommended by
Creswell (2014), I engaged in peer review and examination strategies which enhanced my
ability to assess the findings. I asked the program directors I currently work for to participate in
the pilot study to ensure that the research methods, tools and processes yielded the type of
information required to answer the research questions.

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Appendix E
Ethics
There are a number of different responsibilities that I had with respect to involving the
program directors as human participants in this research. The information sheet was provided to
the participants with all the information pertaining to objectives of the research. This document
provided the purpose, rationale, selection, methodology and other key elements of the research.
The aforementioned material provided sufficient information about the research. The
information sheet demonstrated to prospective participants that they were able to freely choose
to participate, decline or disengage in participation at any point without explicit or implicit
coercive tactics. Participants received the information sheet, and no signature was required of
them. Those who agreed to be interviewed received an email asking for permission to record the
telephone interview. On the day of the telephone interview, I asked again to ensure their
preference for recording had not changed. Krueger and Casey (2009) explore the concept of
informed consent and the importance of this process during the institutional review board
review and approval processes. In the case of this research the participants provided consent for
being recorded during their interview and why the recording was necessary, how the recordings
would be secured during data analysis and when they would be destroyed. Finally, the
information sheet ensured that the participants were duly informed and understood participation
was voluntary and would be given by a person who is of sound mind and body with the
competency to make an informed decision. The information gathered from the record review,
survey and interview data was kept in a locked cabinet to protect the integrity of the process
(Rubin & Rubin, 2012).
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Information pertaining to participants, schools, and directors was confidential. Given the
type of research involved, there were not any risks associated with participation. However, a
brief disclosure related to any potential harm to the prospective participants was provided.
Benefits of engagement included detailing how healthcare competencies are infused into
program curricula to promote career readiness (Abby, Schumacher, Dellifraine, Clement,
O’Connor & Stefl, 2016). My contact information was provided to enable the prospective
participants to contact me with questions during and after the conclusion of the study. Finally,
there was a broad statement that the research was intended for the completion of a doctoral
dissertation with no intended uses beyond that point. There was a disclosure that all
dissertations are published on ProQuest with an emphasis that the participants’ identities would
be confidential and that information about the programs themselves would also not be included.
Relationship to the Healthcare Industry Assumptions and Biases
This research is not related to a specific organization but to a field-based study, seeking
to evaluate healthcare administration curriculum. Thus, there is no specific investigator-
organization relationship about which to be concerned. However, given the researcher’s
extensive healthcare industry background, faculty positions at two universities, and leadership
position at one, potential bias and conflicts of interest must be identified and managed even if
there are no direct subordinate work relationships with the participants.
Additionally, I have held many leadership positions within healthcare organizations and
worked with employees who received degrees in healthcare administration from different
programs in Southern California. These experiences could contribute to a biased review of the
data. The interest that I had in this study was whether and how program directors integrate
leadership competencies into their programs. Furthermore, my interest lay in understanding how
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 141

these competencies were reflected in the syllabi in the form of deliverables that would enable
students to develop applied and experiential knowledge of these competencies. Ideally, this
information was of interest and has utility for the program directors as well. The questions
identified should also be issues of importance to the program directors as key stakeholders in
student success. Given the perceived value of the study, I anticipated that the prospective
participants would enjoy their involvement in the study. Furthermore, how colleges and
universities identify expectations about the competencies required from various courses was
also of interest.
The participants were not in a subordinate role to me as the investigator, so I did not
foresee any concerns regarding conflicts due to my faculty or leadership status in the industry.
While there is no hierarchy from my perspective between participants and me, there could have
been some bias with how the information was presented given my employment as an area chair
and adjunct faculty at competing universities. Due to these positions, it was important for me to
ensure that the prospective participants had truly internalized the rationale for the research and
how the outcome would benefit the healthcare administration program academic community.
Finally, bias is an intentional or unintentional influence that I, as the researcher, could
have had on the study. Given my experience in the healthcare industry and academia, there may
be some biases about my perception of the academic programs’ incorporation of both the HLA
and the NCHL competencies models into the academic programs. One assumption was that
there were likely differences based on the type of campus (non-profit and for-profit) and type of
program (online or on-ground). I also would assume that there were curricular differences based
on the structure and location of the program within the university, such as the program being a
stand-alone healthcare administration program in the college or school of health sciences versus
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 142

being placed in the school or college of business or public health. The structure of the program
within these institutions may have an impact on the focus of healthcare leadership content and
the incorporation of healthcare specific competencies within the curriculum. The only known
bias and built-in assumptions were those related to my own experiences as a member of the
academic and professional healthcare leadership community. Merriam and Tisdell (2016)
discuss the importance of identifying known or suspected biases so as not to affect the integrity
of the research process. Thus, I wanted the aforementioned biases and assumptions to be known
up front as my study’s reliability and validity were dependent upon the trustworthiness that I
established with the participants.

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Appendix F
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
The Kirkpatrick and Kirkpatrick (2016) training and evaluation model was the
theoretical framework used to guide and support the recommendations for the problem of
practice in this study. The model is based on four levels: reaction, learning, behavior, and
results. Reaction seeks to assess the degree to which the program directors find the training
favorable, engaging and relevant to their jobs. Learning involves the degree to which the
program directors acquire the intended knowledge, skills, attitude, confidence and commitment
based on their participation in the training sessions. Behavior evaluates the degree to which the
program directors were able to apply what they learned during training when they were back in
the office working on curriculum development activities. Lastly, results entail the degree to
which targeted outcomes occur as a result of the program directors receiving training, support
and being accountable (Kirkpatrick & Kirkpatrick, 2016).
Kirkpatrick and Kirkpatrick’s model is effective under the assumptions that prior to
engaging in this effort, the participants understood that incorporating leadership competencies
in a prescribed way into their program benefited the program and the students. Thus, the
participants must recognize the utility in the training program. Furthermore, they must have a
true sense of the return on expectations which is generally the highest indicator that will
promote engagement. This model is viewed as a hierarchical model but has four discreet levels
that are generally applicable to all educational interventions (Roland, 2015). This means that the
model does not have a defining starting point other than the outcome or performance
expectation that the training program is attempting to address.
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Organizational Purpose, Need and Expectations
The healthcare industries’ mission is to improve quality and patient outcomes and to do
so in a fiscally responsible manner by having leaders who have the requisite knowledge, skills
and abilities to successfully lead complex healthcare organizations. To work toward the
achievement of this goal, it is imperative that leaders of healthcare organizations advance their
knowledge and leadership capabilities. Thus, the more granular mission of healthcare
administration is important to note.
By August 2020, 100% of program directors will integrate the HLA Competencies and
the NCHL competency models into their degree program curriculum that using experiential
learning methods. By 2023, 85% of organizations, business units and or departments managed
by recent healthcare administration graduate students will realize improvements in their key
performance indicators (KPIs) such as cost, quality, patient experience and employee
engagement. To achieve the industry goal, there are a number of micro-outcomes that must be
realized. There must be an increase in the program directors’ knowledge about the HLA and
NCHL competencies. All degree issuing programs must be accredited by an accrediting body
that requires competency-based curriculum. There must be development of training programs,
toolkits and job aides to teach program directors how to incorporate leadership competencies
into their program effectively such that students develop the experiential knowledge, skills and
abilities and are career ready from a leadership perspective when they graduate. There must be
development of a standardized program director job description that has key functions
irrespective of school or program that require a set amount of experience and or ACHE Board
Certification. Furthermore, program directors will have improved resources through the
AUPHA organization site that promotes consistency of curriculum information relative to
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leadership competencies. To ensure that these outcomes are achieved, program directors must
have the appropriate training and validated knowledge of how to facilitate the development of
curriculum that will promote the acquisition of knowledge in manner that enables students to
readily apply the knowledge, skills and abilities mastered during their degree program. Lastly,
the timeline to implement the proposed solution is dependent on each University academic
calendar and the commitment of external agencies such as AUPHA and professional
associations to participate in these proposed solutions.
Level 4: Results and Leading Indicators
There should be observations during training programs, post-training evaluation surveys
and moderated e-training modules with graded activities to measure the program directors’
knowledge of the trained processes. Industry-wide surveys should be conducted triennially to
determine if strategies are still effective.
Table 21
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
1. Increased employer
satisfaction with program
graduate’s leadership skills,
knowledge and abilities.
% Employer satisfaction
rating of their new hires that
were recent graduates from
the program.

Recent graduate leadership
readiness survey results.

Employer feedback
surveys on graduate’s
leadership readiness that
focuses on their ability
to apply learned
leadership skills

Student feedback
surveys on their
leadership readiness
once in the field.
2. Healthcare Administration
industry leader participation in
the curriculum review and
approval process.
Number of programs that
have industry leaders
involved in the curriculum
review and approval
process.
Survey of graduate
programs that confirm
industry participation on
curriculum review
committees.
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Table 21, continued
Outcome Metric(s) Method(s)
External Outcomes
3. Within healthcare
organizations improved
organizational outcomes such
as reduction in clinical and
administrative errors,
improved patient satisfaction,
employee engagement,
financial performance and
other KPIs for departments or
work units managed by
healthcare administration
graduates
% of hospital rating of 9 or
10 on HCAHPS: Hospital
Rating Report and element
measuring if a former
patient would recommend
the hospital
Budget variance reports
showing positive variance

% reduction in adverse
events medical errors in
healthcare organizations
HCAHPS survey
provided discharge
patients. Finance reports
such as departmental
budget variance reports,
sentinel events
monitoring reports,
employee engagement
reports

Error reporting through
accreditation and
department of health
services
Internal Outcomes
1. Program Directors gained
knowledge of the HLA and
NCHL competencies.
Percentage of program
directors who attest to
having knowledge of the
HLA and NCHL
competencies.
Evaluate the program
directors pre- and post-
knowledge of the HLA
and NCHL
competencies.
2. Program Directors utilized the
HLA and NCHL competencies
to develop competency-based
curriculum that enabled
students to develop their
leadership knowledge, skills
and abilities.
% Employer satisfaction
rating of their new hires that
were recent graduates from
the program.
Employer feedback
surveys on graduate’s
leadership readiness that
focuses on their ability
to apply learned
leadership skills.

Student feedback
surveys on their
perception of their own
leadership readiness
once in the field. Recent
graduate leadership
readiness index.
3. Increased time for program
directors to work with students
on career work path readiness.
Average and sum of time
program directors spend
with students on career work
path readiness activities and
discussions.
Self-reported
productivity data from
program directors on 1-
on-1 time with students.

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Level 3: Behavior
Critical behaviors. Kirkpatrick and Kirkpatrick (2016) note that Level 3 is related to
ensuring that taught behaviors are internalized such that the program directors are able to
effectively apply what they have learned during training to developing curriculum targeted
toward development of leadership competencies. Thus, it is important to see the transfer of
knowledge from the trainer to the program directors and from the training environment to the
actual work setting. There are four critical behaviors that the program directors will have to
demonstrate to achieve the outcomes desired: take the in-person or web-based training
programs, allocate consistent amounts of time on curriculum development activities, be willing
to collaborate and include healthcare administration leaders in the review and approval of the
curriculum, and establish relationships and engage with industry leaders to understand the types
of knowledge and skills related to leadership that they are looking for in their employees.
Table 22
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s)
Method(s)
Timing
1. The program
directors will
complete the in-
person or web-based
training programs.
Number of program
directors who have
completed the in-person
or web-based training
programs on the
competency models.
AUPHA, HLA and
or NCHL will
publish training
completion reports.
Bi-annually review
the training
completion reports.
2. Program directors
will have to allocate
consistent amounts of
time on curriculum
development
activities
Sum and average
amount of time program
allocate toward
curriculum
development.
Program Directors
self-reporting of
time spent on
curriculum
development.
At minimum
monthly but more
often if warranted
based on what is
happening in the
industry.

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Table 22, continued
Critical Behavior Metric(s)
Method(s)
Timing
3. Program directors
must be willing to
collaborate and include
healthcare
administration leaders in
the review and approval
of the curriculum
Number of program
directors that have
healthcare administration
leaders on their
curriculum review
committees.
Report of program
curriculum review
committee
membership
requirements.
Annually.
4. Program directors
must establish
relationships and engage
with industry leaders to
understand the types of
knowledge and skills
related to leadership that
they are looking for in
their employees
Number of times the
program directors meet
and engage with industry
leaders and employers
regarding the types of
knowledge skills and
abilities they are looking
for in their
organizational leaders.
Self-reporting of time
spent engaging with
healthcare leaders
through personal
communications,
meeting and
conferences.

At minimum
quarterly.
More often
if warranted.

Required drivers. Program directors require support from their direct reports, peers and
organizations’ leaders to reinforce, encourage and monitor their workflows and processes when
engaged in the development of leadership competencies and how they are reflected throughout
the program curriculum. Furthermore, they need support with internal and external training
programs, allocation of time, and guidance with competing priorities. Kirkpatrick and
Kirkpatrick (2016) package this under the concept of required drivers to support the critical
behaviors program directors need to achieve their goals. Table 23 identifies the required drivers
to support these critical behaviors associated with the development of the request knowledge
and motivation to achieve their goals.

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Table 23
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical
Behaviors
Supported
1, 2, 3 Etc.
Reinforcing

Provide program directors with opportunities to openly
discuss what they do and do not understand about the
HLA and NCHL leadership competencies
Annually 1,3,4
Provide program directors with feedback and scaffolding
when they are in the process of incorporating the
competencies into the program curriculum.
Ongoing as
curriculum
changes are made.
1, 3,4
Program directors’ direct reports must help program
directors identify what they know and have
demonstrated relative to leadership competencies to
build confidence in their own knowledge and skill
Ongoing 1,2
Encouraging

Provide program directors with ongoing feedback and
scaffolding from their direct report and peer community
of practice regarding tasks already completed regarding
leadership competencies and curriculum development.
Direct Report:
During 1-on-1
meetings at
minimum of
monthly.
Peer Group: At
minimum of
quarterly or after
each curriculum
revision.
3,4
Rewarding

Program directors direct report will survey employers
and students on successful work performance and their
perception of career work path and leadership readiness
as a result of the support structures established by the
program director and received while in the college
program and how that benefited them post-graduation.
The program directors will receive the feedback of the
students’ performance and have a sense of fulfillment by
the great performance of their graduates.
Annually 2,3,4

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Table 23, continued
Method(s) Timing
Critical
Behaviors
Supported
1, 2, 3 Etc.
Monitoring

Conduct a survey of key stakeholders in the curriculum
review and development process to identify effectiveness of
implemented strategies to streamline the processes.

Organizational leadership to identify a target processing time
to review, revise and implement new / updated curriculum
and report that metric against the actual process time spent
and explanation of delays when applicable.

Develop a curriculum change implementation toolkit with
specific expectations around implementation practices.
Monitor curriculum implementation to ensure curriculum
implemented aligned with the toolkit requirements.

Annually

Quarterly or as
frequent as changes
occur to the
curriculum

Quarterly or as
frequent as changes
occur to the
curriculum
3

2,3

2,3,4
Program directors must report on status annual goals during
1-on-1 meetings with direct report to provide transparency
on tasks completed and provide an opportunity to refocus on
priorities if necessary
Monthly 2,3

Organizational support. The program directors will need support from their
organizations to ensure that the required drivers are implemented. The researcher recommends
for different ways for the organization to provide this support to the program direct. First, the
program directors will need to work within their community of practice to implement the
identified successful and best practices related to the incorporation of the leadership
competencies into their program curriculum. Engagement with their peers will provide the
support, resources and tools they require, as the peer group can function as a think tank when it
comes to assignments and other deliverables and how they support the development of the
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 151

specific leadership competency. Communities of practices allow groups with a common
objective or goal to engage in meaningful discussions through digital means to remove barriers
associated with time and location (Moore, 2008). Second, their specific organizations can
support this endeavor by allowing the program directors the opportunities to have meaningful
engagement with their peer group by providing resources to attend conferences, conduct site
visits, and participate in education and training sessions related to curriculum development.
Third, the organizational leaders can support this effort by revisiting the job descriptions of
program directors to ensure the requisite time to focus on all the activities required to ensure the
curriculum is relevant, current and reflects the needs of healthcare employers. Finally, the
organization can identify resources from other departments with the subject matter expertise to
assist and guide the efforts for curriculum development such that the program directors have
organizational support for these responsibilities. The aforementioned will ensure that the
program directors believe they have the resources and support to be successful and to develop a
world class curriculum.
Level 2: Learning
Learning goals. In order to perform the critical behaviors identified in Table 7, upon
completion of the recommended solutions, the program directors should be able to:
1. Articulate the required leadership competencies for healthcare administration graduate
degree programs. (D)
2. Explain the importance and expectation of maintaining current knowledge of what the
healthcare industry requires in the area of leadership competencies to incorporate into
curriculum. (D)
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 152

3. Describe the types of course assignments and other deliverables that facilitate the
development of leadership competencies in students. (D)
4. Identify how to convey their knowledge of healthcare competencies through their
curriculum, courses, and assignments to facilitate the development of applied and
experiential leadership skills in their students. (P)
5. Demonstrate they are capable of implementing a competency-based curriculum that
enables students to develop applied and experiential knowledge while in their degree
program. (Self-Efficacy)
6. See themselves as responsible for student career and work path readiness to identify and
solve problems that impact healthcare organizations (Attribution)
Program. The recommended educational program is a three-day workshop for program
directors. This program was done multiple times in different parts of the country to allow for as
many program directors to participate as possible. The recommended program is one where the
program directors learn how to incorporate leadership competencies into their curriculum such
that students develop applied and experiential knowledge of the industry prior to graduation. To
achieve this effort, the program was developed based on 13 identified learning goals which are
reflected in the previous section. The program is based on the identified gaps in knowledge and
motivation coupled with recommended strategies on how to mitigate the organizational
influences within the colleges and universities that the program directors work. The program is
a three 8-hour day workshop. Prior to the first day of the workshop, all attendees will be
provided a survey geared toward their assessment of their current knowledge regarding the two
sets of competencies, leadership skills required of those managing in healthcare organizations
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 153

and competency-based curriculum development. This survey will help capture pre- and post-
workshop data.
Day 1 of the training would consist of providing theoretical content related to the HLA
competencies and the NCHL competency model, leadership knowledge, skills and abilities
required of healthcare leaders and concepts related to competency-based curriculum
development. Day 2 will complete the curriculum development content and begin the simulated
activities and communities of practice discussions with thinktank tables with scenarios for
addressing specific leadership competencies so the peers can discuss how best to reflect the
competencies in the curriculum. The objective of day 2 is for the participants to start to develop
assignments and other deliverables to address specific competencies. Day 3 is show and tell
where the think tank groups share the work for the specific competencies to the larger groups.
All of the work completed during the training was a part of the toolkit of resources for future
use. On day 3, the same survey that was disseminated prior to the workshop will be
redistributed to identify the results of the same elements post-workshop to identify if the
participants’ knowledge and motivation improved as a result of the workshop. Immediately
following the workshop, participants will be asked to register for participation in the
communities of practice through the AUPHA where the resources and tools was housed.
Participants can be assigned peer mentors during the workshop or at any point by engaging with
AUPHA.
Evaluation of the components of learning. The purpose of the training program
workshop is to develop the participants’ conceptual (declarative), procedural and metacognitive
knowledge of the processes required in order for all to develop and implement a robust
competency-based curriculum. Furthermore, the training is meant to ensure that program
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 154

directors have the know-how, understanding, and confidence in their ability to develop an
effective competency-based curriculum such that students graduate with the requisite
knowledge, skills and abilities required of those in healthcare administration careers. Table 24
identifies the various methods and activities that was used to evaluate each of the workshops
learning components.
Table 24
Evaluation of the Components of Learning for the Program.
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”

Report outs and presentations during the workshop. Over the 3-day workshop there are
opportunities for group report outs
and team presentations.
Knowledge checks during discussions with direct report
and peer communities of practice.
Periodically after the learning
event when engaged in curriculum
development or review activities
or more often if necessary.
Collaborative discussions about written material and job
aids with direct report and peer community.
During and immediately following
the information sharing and
training.
Procedural Skills “I can do it right now.”

Skills assessment along with case studies to demonstrate
application of concepts and processes.
During the 3-day training event.
Attitude “I believe this is worthwhile.”

Completion post-training evaluation survey to identify
what the program director felt about the training and if it
was beneficial to help them meet the goals.
Immediately after the training
session.
1-on-1 discussions with the program directors with their
direct report on the benefits of this training effort.
After the learning event and
program director has returned to
work.
Confidence “I think I can do it on the job.”

Feedback from peer program directors and the program
directors direct report.
After the learning event and
ongoing as the program director
engages in curriculum activities.
Discuss the program directors’ concerns about
implementing specific competencies in the curriculum.
During the learning event.
Commitment “I will do it on the job.”

During the training ask the program directors to share
how they will incorporate the material into their job.
Prior to the completion of the
learning event.
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During the program directors 1-on-1 meetings with their
direct report provide their direct report with what they
have already done to obtain feedback and scaffolding
and to demonstrate their commitment to applying what
they have learned.
After the learning event.

Level 1: Reaction
Understanding the extent to which the program directors found the training valuable,
engaging and applicable to their job is an important element to understand (Kirkpatrick &
Kirkpatrick, 2016). The program directors’ response to the training will dictate if they are able
to apply what they have learned over time. Thus, according to Kirkpatrick and Kirkpatrick
(2016), formative and or summative evaluation methods are recommended to capture their
reactions to the training. Table 21 identifies the component that are being measured to assess
their reaction to the training program.
Table 25
Components to Measure Reactions to the Program.
Method(s) or Tool(s) Timing
Engagement

Program directors complete a questionnaire self-
assessing their level of engagement
For use immediately following
the training
Relevance

Feedback survey with open-ended questions on what
additional information could be added, what was
particularly relevant and least relevant to their job
functions.
Prior to ending the learning
event.
Program directors complete a survey rating the course
material, content, setting, helpfulness, job relevance, etc.
For use immediately following
the training and another survey
30-day post-training.

Customer Satisfaction

Anonymous customer satisfaction survey of the entire
training experience
Immediately following the
training event.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 156

Evaluation Tools
Immediately following the program implementation. A hybrid post-workshop
training evaluation tool will be used immediately following the conclusion of the program based
on the four levels of Kirkpatrick and Kirkpatrick (2016) model. The hybrid tool will evaluate
the four levels of the model so that the training can continue to evolve and improve based on
participant feedback. The tool was developed by determining how each of the levels would be
measured, starting with the participants reaction to the training and followed by the participants
learning using a before and after methodology based on the identified learning performance
objectives. The before and after will be evaluated at the conclusion of the training using the
hybrid evaluation tool. This process enables the participant to truly reflect on each element
when completing the ratings. The third piece of the tool is the evaluation of the participants’
behaviors. Given that behaviors are difficult to assess immediately following a training
workshop, questions will be geared toward the participant’s perception of their behavior
changes as a byproduct of attending and successfully completing the workshop. Kirkpatrick and
Kirkpatrick (2016) note that behaviors could be affected by the favorability of the
organizational conditions. Thus, the participants will be queried on their behavior relative to the
cultural models and setting present in their organizations. Finally, Level 4 results will be
evaluated based on measures of performance by the program director’s perception of the
curriculum development processes and outcomes of the students; the latter was difficult to
immediately evaluate (Appendix A & B).
Delayed for a period after the program implementation. Three months after
completion of the training workshop a second survey will be administered to the workshop
participants. The survey will assess all four levels of the Kirkpatrick model (Kirkpatrick &
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 157

Kirkpatrick, 2016) with the intent to evaluate the participants after the drivers have commenced
and they have engaged in the critical behaviors. Thus, the survey will assess behavior while at
work, drivers and critical behaviors required of the program directors which will provide the
data to support the cost benefit of the program. The three-month time period will allow the
participants ample opportunity to apply their new knowledge and skills at work. While there are
a number of formats to gather this information due to the distribution of the program directors
geographically, this delay post-program evaluation was completed through an electronic
Qualtrics survey which will facilitate data aggregation and analysis.
Data Analysis and Reporting
It is important to have a mechanism to track and trend performance overtime. With this
study, the reporting process would require a concerted effort to gather data on all program
directors, employers and students. Thus, the data analysis and reporting could only occur on an
annual basis by a party external to each of the colleges and universities queried. The Level 4
goal for all program directors to incorporate leadership competencies into their curricula using
one of two industry recognized competency models. Additional data are related to the
perception of preparedness by the students who were trained using the new curriculum. The
third element would be feedback from employers of recent graduates from the program. The
data for the survey would be requested from each participating program director. The AUPHA
was responsible for aggregating the data to present on the key performance indicator report.

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 158

Table 26
Key Performance Indicator Report
Key Performance Indicators Fiscal Year Ending
Performance Measure Goal 2019 2020 2021 2022 2023
Program director us of competency-
based models to incorporate into their
curriculum
100%
Program directors participate in
communities of practice
90%
Percentage of students who rate
themselves as being career/work path
ready when they graduate
95%
Percentage of employers who rate new
graduates as having the required
leadership competencies to be
successful
75%
Percentage of programs teaching
healthcare administration content that
are CAHME accredited
100%

Summary
The New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) provided the
framework to identify the needs of the stakeholder community to address deficits in their
knowledge, motivation and organizational influences that affect their performance. There are a
number of different models that could be used to achieve a similar outcome. However, the
benefit of this model is that the preferred end result is known, which enables determining
primary drivers that keep the outcome from being achieved. When evaluating the elements that
can cause performance deficits, the model requires analysis of behaviors and factors that can
affect goal achievement. Ultimately, the tool evaluates the strategies identified to train to the
deficiencies of the stakeholder group of focus: the program directors.
There are four critical behaviors that were noted to be required for the stakeholders to
achieve their goals. These behaviors are used to determine if the program directors have
effectively transferred the knowledge gained from the workshop to their real work environment.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 159

Thirteen learning goals were identified based on the recommendations outlined in the
knowledge, motivation, and organizational influences tables and narratives. Furthermore, two
evaluation tools were created one that was used immediately following the survey to the
participants, reaction, learning, behavior and expected results. The second evaluation tool
covers the same elements but is sent to the workshop participants 90s-day post-training to not
only reassess the aforementioned but to provide insights into how the tool has actually worked
for them in their natural work setting. Finally, in order for the value of the program to be
realized and resources allocated, the cost and benefit of the program must be realized through
improved performance results over time. Thus, a key performance indicator report will be used
to demonstrate trends in performance overall.
LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 160

Appendix G
Miscellaneous
NCHL Permission to Use, Cite or Reprint

LEADERSHIP COMPETENCIES IN GRADUATE EDUCATION 161

AUPHA Program Director List

Abstract (if available)

Abstract This field evaluative study focused on program directors’ knowledge, motivation and organizational influences related to integrating the Healthcare Leadership Alliance and National Center for Healthcare Leadership Competencies into their degree programs such that students would develop experiential leadership competencies. Graduate programs in healthcare administration have an opportunity to develop these competencies by providing their students with opportunities for experiential knowledge and skills throughout their degree program. The study employed a mixed methods sequential explanatory research design with a Qualtrics survey conducted first, followed by telephone interviews and document analysis. The results of the study identified that program directors were motivated to incorporate leadership competencies but several of the participants lacked the specific knowledge regarding the identified competencies. There was no universal set of leadership competencies that all directors expected of students prior to graduation and minimal time was spent on curriculum related activities due to other competing priorities in their roles as program directors. Furthermore, the results also revealed several organizational influences such as teaching load, publishing requirements and administrative tasks kept the program directors from focusing on student career and work-path readiness. The outcome of this study resulted in recommendations for training of program directors on how to make changes in their curriculum to align with industry requirements and for the academic institutions to re-evaluate the program directors’ expectations and priorities to enable them to focus on tasks that will better inform needed curricular changes. Future research in this area should be focused on how to better assess how leadership competencies are manifested in the work setting by recent graduates.

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Asset Metadata

Creator Haynes, Shawishi Tadamika (author)

Core Title Leadership competencies in healthcare administration graduate degree programs: an evaluative study

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 11/09/2018

Defense Date 10/24/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag career-readiness,competencies,graduate students,healthcare,healthcare administration graduate students,Healthcare Leadership Alliance competencies,healthcare quality,leadership,National Center for Healthcare Leadership competencies,OAI-PMH Harvest,work-path readiness

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Seli, Helena (committee chair), Kellar, Francis (committee member), Robles, Darlene (committee member)

Creator Email haynes.family2@sbcglobal.net,Shawishh@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-104819

Unique identifier UC11676776

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Legacy Identifier etd-HaynesShaw-6950.pdf

Dmrecord 104819

Document Type Dissertation

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