by Colonel Ronald Rojas

President, Society of AF Reserve MSC Officers

The issue of executive skills development for healthcare administrators continues to be a critical factor of the industry as a whole. Primarily driven by shrinking financial resources and a customer base more conscious of healthcare quality, the turbulence prevalent in healthcare management is demanding a new breed of strong, focused, visionary leaders, a breed that is, however, in very short supply. A recent article in the magazine Modern Healthcare states:" The gap, say concerned healthcare leaders and recruiters, is showing in longer searches, higher compensation packages and declining board satisfaction with applicants for top jobs"(1).

This concern for healthcare executive skills development had already been addressed by the Department of Defense during the later years of the past decade. During the 1997-98 time frame, the Health Services offices from all military branches recognized that inattention to executive skills development had become a significant hindrance to the evolving healthcare needs of the modern military forces. In response, a Joint Medical Executive Skills Development Group was established, with Major General Robert Claypool (USA) as chairman. This working group published a comprehensive assessment of executive skills needs, currently accepted as the foundation for most executive skills programs offered by the Navy, Army and Air Force (2). The model suggested by the committee included seven major competency fields, for which optimal skill sets were identified. Specifically, the seven major competency fields identified are military medical readiness, general management, health law & policy, health resources allocation, ethics, individual and organizational behavior, clinical understanding and performance measurements. In characterizing the executive skills of the military medical manager, the committee reported a list of 40 different skills essential to these seven competency fields.

Despite this joint initiative and the comprehensive nature of this executive skills model, key questions remain unanswered. First, in an effort to offer a broad perspective of medical manager skills for purposes of establishing a curriculum, the model remains vague as to its implementation and practical application. In a time of reduced finances, turbulent restructuring and increased workload for healthcare executives within the Department of Defense, finding the time and resources to implement broad programs that improve executive skills development remains, to this day, an imposing challenge. Next, the large number of skills suggested by this committee may require the design of valid and reliable assessment tools for prioritizing an executive's current skill-state against the model's desired state. This would allow executives to target improvement on the fragile skill-sets first, and a means to measure progress. Third, perhaps rather than concentrating on "skills knowledge", the term "skills performance" should remain the intent of the model. A thorough intellectual understanding of a skill is quite different than a desired skill performance level. Finally, the list of members that prepared the model is lacking representation from the reserve components. The unique circumstances of the National Guard and Reserve healthcare executives suggest variables that may simplify or complicate the implementation timeline of any executive skills improvement program. The reality of skills reciprocity (the ability to use specific civilian skills in military settings and vice-versa), a severe availability requirement (only UTAs and annual tours) and dual careers (a member may have a non-medical related career in civilian life) are just some examples of circumstances unique to the reserves. Furthermore, DoD is becoming more dependent on reserve medical forces to fulfill specific mission areas. For instance, approximately 95% of all Aeromedical Evacuation assets within the Department of Defense belong to the Air Force reserve component. In essence, the needs of the reserve component healthcare professional across all services remains an area also deserving of a strategic response.

The effects of this critical development factor are clearly observable within the Air Force Reserve. In a survey mailed out to 597 reserve Medical Service Corps (MSC) officers just a few years ago, the statistics collected confirm a parallel alarming trend in professional development among members of our own military healthcare community. One of the most relevant findings from this survey was the fragility of professional development opportunities offered by two presumably key programs, that of mentoring and professional affiliations. There are studies within the healthcare industry that document the value of mentoring (3) and involvement in professional affiliations (4) as mechanisms for sound, executive development. Yet the survey of reserve MSCs highlights the need for stronger focus on these programs. The survey data shows that of 157 respondents, 48% (76) stated they had no one as their mentor. The majority of these were Majors (0-5s), which also happens to be the sector that will become the MSC leadership within the next 5- 8 years. Furthermore, the number of respondents affiliated to DoD approved professional organizations (ACHE or AAME) is also disconcerting. Of the 157 respondents in the survey sample, only 15% (24) were members of ACHE and 2.5% (4) were members of AAME.

If anything, the bleak industry-wide status of healthcare executive development serves as a strong justification for the efforts initiated by both the Senior Executive Council of Reserve MSCs, and the Society of AF Reserve MSCs. The Council's leadership, career development and information technology tracks continue to offer tailored programs with positive measurable results since their inception. As a more recent example, the first MSC Symposium (held in Denver Colorado last year) was rated by the participants as one of the best professional activities they had attended in years. In addition, the Society's thrust during the yearly AMSUS Conventions continues to be oriented towards career opportunities and skills development. Certainly the Society's newsletter will continue to be a source of general information, but the survey data also prompts the consideration of a more in-depth publication for Reserve MSCs. With this first edition of the AF Reserve MSC Digest, we at the Society, have started another deliberate effort to offer more professionally focused articles directed at creating a deeper and broader perspective of the career field. Finally, a skills development workshop in partnership with the Veterans Affairs Educational Services, is currently in its final stages of design and validation. The primary objective of this workshop is to offer practical "skills-lab" opportunities for Majors and Captain's, a sector that represents close to 60% of the Reserve MSC population.

In summary, it seems that alleviating the scarce supply of healthcare leadership in both DoD and in the industry remains a clear aim for both the Senior MSC Council and the Society of Air Force Reserve MSCs. As we continue to offer programs as a contribution to close this gap, our only expectation is that each Medical Service Corps officer realizes the significance of deliberate and intense skills development as a reality of the healthcare management profession.

References:

(1) Jaklevic, M.C. (2000). "Wanted: A few good leaders". Modern Healthcare, 30, 38-40.

(2) The document can be viewed at http://nshs.med.navy.mil/jmesdp/index.htm

(3) Walsh, A.M., & Borkowski, S.C. (1999). "Mentoring in health administration: The critical link in executive development." Journal of Healthcare Management, 44, 269-273.

(4) Walsh, A.M. (1999). "Managing environmental uncertainty: An analysis of executive behavior in the health and social service sector." Journal of Healthcare Management, 44, 47.