Shewchuk Richard M, O'Connor Stephen J, Fine David J
Department of Health Services Administration, University of Alabama at Birmingham, USA.
J Healthc Manag. 2005 Jan-Feb;50(1):32-47; discussion 48.
Rapid change in the healthcare environment has pressured healthcare organizations, health management professional associations, and educational institutions to begin examining more carefully what it means to be a fully competent healthcare executive. As a result, interest in healthcare management core competencies has increased. Most competency development initiatives seek to build consensus and typically result in the generation of five or six broad competency domains--but consensus around what? Most competency initiatives are based on literature reviews and consensus-building efforts. Typically, such efforts in healthcare management have involved defining general competency domains and attempting to specify representative behavioral exemplars that demonstrate mastery of the general competency domain. This study describes an approach that used a purposeful sample of ACHE affiliates who represent different geographic regions and health industry segments to construct a framework composed of critical healthcare issue clusters. A panel of healthcare executives then specified five sets of entry-level behavioral competencies that would be required to address the clusters of critical issues. Although the behavioral competencies identified by the executives in this study are anchored to a framework, their empirical association with performance has not been tested. Before implementing broad curriculum redesign, the effect of these competencies on performance should be established. Additionally, competencies should be examined in the context of potential moderating influences such as specific educational program focus, educational delivery format, and type and preparation of students entering healthcare management education programs. Competency, competencies, competency models, and competency-based training are all Humpty Dumpty words meaning only what the definer wants them to mean. The problem comes not from malice [or] stupidity... but instead from some basic procedural and philosophical differences among those racing to define the concept and to set the model for the way the rest of us will use competencies (Zemke 1982).
医疗保健环境的迅速变化给医疗保健组织、健康管理专业协会和教育机构带来了压力，促使它们开始更仔细地审视成为一名完全胜任的医疗保健管理人员意味着什么。因此，对医疗保健管理核心能力的兴趣有所增加。大多数能力发展举措旨在达成共识，通常会产生五六个广泛的能力领域——但围绕什么达成共识呢？大多数能力举措都基于文献综述和建立共识的努力。通常，医疗保健管理中的此类努力包括定义一般能力领域，并试图指定具有代表性的行为范例，以证明对一般能力领域的掌握。本研究描述了一种方法，该方法使用了来自不同地理区域和健康行业领域的美国医疗保健执行官协会（ACHE）会员的有目的样本，构建了一个由关键医疗保健问题集群组成的框架。然后，一个医疗保健管理人员小组指定了五套入门级行为能力，以解决关键问题集群。尽管本研究中管理人员确定的行为能力以一个框架为基础，但其与绩效的实证关联尚未得到检验。在实施广泛的课程重新设计之前，应确定这些能力对绩效的影响。此外，应在潜在调节影响的背景下审视能力，如特定教育项目重点、教育交付形式以及进入医疗保健管理教育项目的学生类型和准备情况。能力、能力体系、能力模型和基于能力的培训都是一些含义仅由定义者决定的随意用词。问题并非源于恶意或愚蠢……而是源于那些竞相定义这一概念并为我们其他人使用能力的方式设定模式的人之间存在的一些基本程序和哲学差异（泽姆克，1982年）。
