Definition/Introduction

Management skills in the healthcare setting are composed of sets of competencies essential for healthcare professionals who effectively and efficiently manage a variety of medical, nursing, or public health resources to attain goals that ideally align with improving the overall health of the population and healthcare system.

In this activity, healthcare professionals who manage at any level of the health systems serve as healthcare managers, encompassing a wide range of specialties, including physicians (clinicians, surgeons, public health physicians, and other specialists), nurses, laboratory professionals, public health managers, dentists, among other healthcare professions.

As expressed in references both for theoretical and practical guidance documents, management skills are often separated from leadership skills as these two sets of skills were known to be generally different.[1] However, this activity does not constrain itself to the (theoretical) management skills per se. It is because effective and efficient healthcare managers require elements of leadership skills to fulfill managerial roles and responsibilities at the best possible level. The necessary skills of healthcare managers involve planning, organizing, implementing, monitoring, and evaluation skills. Planning refers to the preparation of the steps and protocols needed to achieve an ultimate end goal and the proper allocation of anticipated resources (including human resources) to the objectives and goals of the healthcare organization. Development of a plan can refer to action plans addressing small-scale activities for individual staff as well as operational and strategic plans for small groups (i.e., sections, units, departments) or organization-wide level. A pre-requisite to a well-developed plan with SMART (specific, measurable, attainable, realistic and time-bound) objectives is that the healthcare manager must be able to perform proper scanning and focusing skills, which are actually “leadership practices.” Scanning refers to knowing one’s self and environment together with the opportunities, threats, and risks to one’s staff and the organization as a whole while focusing refers to concentrating each staff member's work in the healthcare organization relative to its vision and mission statements. Organizing is the ability to bring together the systems, processes, and procedures with the designated staff in an organization so that the right people will be able to do the proper work for the right purpose. Implementing skills, on the other hand, is focused on the performance of the assigned work based on planned activities. As a healthcare manager, one must know how to harmonize workflow within all concerned staff, ensuring that the individual and overall plans get implemented effectively. The leadership practices essential in organizing and implementing (management) skills include aligning and mobilizing the staff. While management skills are focused on the use of organizational resources as mentioned, the goal of leadership skills centers on the mobilization of the members of the organization. For instance, a healthcare manager organizing human resource with the actual operations will not be complete and will not properly work in its implementation phase if some of the staff lack the motivation, which could be caused by the loss of teamwork. Or, in other circumstance, some staff may have unclear roles and responsibilities, resulting in their confusion at work and eventually low performance and productivity. Aligning and mobilizing is making all staff, including healthcare managers, share a common vision and commitment for the healthcare organization. Lastly, monitoring and evaluating skills must be part of the practice of healthcare managers on whatever type of healthcare organization. Monitoring skills mean the ability to check the progress of the organization in terms of achieving its plans while evaluating skills means that a healthcare manager can assess the attainment of desired results (output) after the whole process is carried out. In simpler terms, monitoring occurs “during” while evaluation is done “after” the implementation of an organizational project or program. Furthermore, these combined skills of monitoring and evaluation (often termed as M&E) involve the provision of feedback that will further improve plans and implementation. However, feedback must not be limited to the management systems and processes. It should also include feedback from staff, as to whether their commitment is sustainable, and they are still motivated to perform the work; this is where the leadership practice of inspiring the team applies. A good healthcare manager can provide trust and confidence to staff and can appreciate staff efforts. The inspiration of staff can manifest by providing supportive supervision to all members of the organization.In practicing these healthcare management skills, it is evident that leadership skills are equally vital. Healthcare organizations should not develop professionals who can only manage or who are leaders alone – because such a man will be unsuccessful. The development and enhancement of management skills can come from a variety of learning strategies and actual experiences.[2] Healthcare management, as a specific profession, stresses its value and importance apart from the clinical aspects performed on the bedside. It is important to note that management skills applied in the fields of medicine and public health do not only intend to provide better health services but also to optimize the health status of the patients and the community at large.

Issues of Concern

In recent years, some issues on management (and leadership) skills, particularly in the healthcare setting, begin to arise. The emergence of these issues highlights the need for improvement of healthcare management:

Association between management skills and the efficiency of hospitals - The study looked at nurses and obstetrician’s managers.[3] Another study found out that improving management skills can further enhance the quality of health services.[4]

Education and training needs for healthcare management as basic preconditions for the development and implementation of adequate programs - Researchers performed a needs assessment in this research, which served as a basis for developing solutions in meeting the gap between healthcare managers and the competencies that they need.[5] In another study, it revealed that while there is a high demand for leadership roles for physicians, medical education is still lacking with appropriate management skills for training future medical doctors.[6] Communication and critical thinking skills in addition to other relational and organizations skills for healthcare management, were seen as essential competencies for development.[7][8] Physicians are expected to be pivotal leaders, especially during transitional periods in the healthcare system.  In the last decade, there has been an increasing emphasis placed on targeting potential areas to improve the various facets of medical training.  Training in management skills, leadership, and practice management modalities have been gaining increasing traction in the literature.[8][9] Regardless of the approach, the current curriculum must be revisited and improved to address this issue according to the type of approach provided by medical schools (either traditional, system-based, or hybrid curriculum).

Training of practicing managers beyond clinical skills - For middle managers, additional skills for managing subordinates and coordinating with top-level managers is necessary, which includes capabilities such as communication skills (not with patients but with colleagues and other stakeholders), self-awareness, change management, conflict resolution, and other leadership skills.[10] For frontline managers, a study revealed that they experience challenges in terms of integrating different professions as required by the health services they provide. Clarity on the roles and responsibilities of existing and new professionals working in healthcare is necessary.

Collaborative interprofessional practice - Due to the reforms in transformational education and significant changes in health systems, there is a need to develop interprofessional education to cultivate the value of teamwork despite differences across health professions.[11] In the past, the physicians alone were believed to fulfill leadership positions in healthcare because of their an interprofessional knowledge and clinical skills in terms of diagnosis and treatment of diseases. But as the health system evolves within countries, states, and communities, the need for other health professionals in performing leadership and management work has been observed. In one of the low-and-middle-income countries (LMICs) where the number of physicians is not adequate, an issue has been raised regarding the filling up of leadership positions for the ministry (department) of health offices where the basic qualifications contain a medical degree. Other competent professionals who are not physicians feel that such opportunities become limited from them and could be a factor for slow improvement in health systems implementation. While this needs further investigation, it can be addressed appropriately depending on the context of the health system concerned. Interprofessional healthcare management can resolve the issue of superiority and inferiority among healthcare professions – medicine, nursing, allied health including laboratory and pharmacy, among others. Furthermore, it reinforces humility and teamwork while acknowledging the importance of each profession for the improvement of health. In the hospitals, where clinicians and medical specialists work together, options for treatment and management of patients come in a team-based fashion wherein different medical specialists give their expert opinions to the case and will not merely depend on the decision of the attending physicians as in the past.  As the healthcare system continues to evolve, increasing emphasis should focus on cultivating physician, and hospital alignment strategies as mutually beneficial collaborative efforts are at least a significant component of delivering high-quality health care while keeping costs and resource utilization sustainable for the future of the healthcare system.[12]

The leadership of self as key to leading others - This paper discusses the course for public health leadership where participants are expected to develop their plans for nurturing their leadership skills.[13] If a healthcare manager knows how to lead himself, it then becomes easier for him to familiarize and knowing more both the members and the organization well.

Healthcare management as a profession -This is a field of health service delivery where formal and informal learning opportunities become available across countries. There have been academic degrees which make it a distinct profession.[14] In other countries, training for healthcare management become available. Moreover, in other technical areas of expertise, healthcare management practices and principles have been incorporated into the training curriculum to address the needs of specific healthcare managers at work. Meanwhile, though a formal education makes learning systematic, students and trainees must be able to gain practical experiences in the field so that academic concepts will be fully realized and applied in the actual healthcare setting.

Clinical Significance

The practice of management skills applied in the healthcare setting indirectly affects the patients. When healthcare managers manage the teams of the organization well, positive work culture (and work climate) become reinforced. In turn, the motivated staff at all levels of the organization increase their work performance as reflected through the optimal clinical (or health) services they provide to their patients. Therefore, the belief is that well-managed staff can lead to well-managed patients. Hence, sound management (and leadership) skills can impact positively on patients’ health outcomes.

The evolving healthcare system has been indicating that there is an increasing requirement for cultivated interprofessional relationships spanning across all health professions and subspecialties.  Physician-Hospital alignment strategies have been receiving increasing levels of attention in the literature given the already identified critical nature of optimizing these relationships.[12]  Despite their often tumultuous histories, physicians and hospitals collectively are recognizing more and more the driving forces leading toward common goals.  While each situation is inherently different, and each path toward idealized alignment is fraught with inevitable barriers and conflicts, it is essential for each party to identify and highlight the underlying principles that drive each other toward the process of achieving high-quality care at a reasonable cost.[15]