Competency Descriptions & Definitions
In 1992 a tri-Service Department of Defense study group identified 36 skills as being essential for successful performance as commander of a military medical treatment facility (MTF). Subsequently these 36 skills, or competencies, were regrouped into related competency areas, reducing the number of competencies to 34. This set of 34 competencies was the basis for a comprehensive opinion survey of approximately 200 MTF commanders.
The MTF commanders not only verified the 34 competencies, but also identified new competencies for addition to the list. The flag level Joint Medical Executive Skills Development Group (JMESDG) reviewed the MTF commanders= recommendations and agreed that six additional competencies should be added producing a new total of 40. These 40 competencies are defined in the Joint Medical Executive Skills Development Program Core Curriculum, Third Edition, February, 2000.
This set of competencies identifies the basic skills that a potential MTF commander or lead agent should possess before assuming command. The Surgeons General of the Army, Navy, and Air force have approved the methods by which competencies may be acquired by departmental officers. Army officers may be awarded competencies through military education, graduate education, and progressive job experience. Navy and Air Force officers may also attain competencies through professional certification. Because career patterns (e.g., assignments, educational opportunities, and contingency operations experience) vary widely between and within the Services, potential Military Health System (MHS) leaders may find they have not achieved qualification in these competencies and will wish to do so.
Competencies earned by individual officers are recorded and documented within an interim management information system . . .
Information on the submission of graduate degree curricula and professional certifications for competency award will be published separately. Contact your Service representative for additional information (see page 3 for contact information).
The purposes of this publication are to present the members of the three medical departments with comprehensive information concerning these essential competencies, to identify the DoD and Service courses that teach the competencies, and to provide readily accessible information that Service members can use to help them improve their qualifications for MTF command or key positions as lead agents and primary staff.
The Executive Skills competencies arranged by competency area are:
Military Medical Readiness Competencies
Total Force Management
National Disaster Medical Systems Management/Department of Veterans
Medical Readiness Training
General Management Competencies
Change and Innovation
Health Law and Policy Competencies
Medical Staff By-Laws
Health Resources Allocation and Management Competencies
Human Resource Management
Ethics in the Health Care Environment Competencies
Personal and Professional Ethics
Individual and Organizational Behavior Competencies
Public and Media Relations
Clinical Understanding Competencies
Alternative Health Care Delivery Systems
Clinical Performance Improvement
This list of competencies is not exhaustive although it is the set confirmed by surveys of approximately 200 MTF commanders, 43 senior military medical department executives, and 21 civilian medical facility chief executive officers. The methodologies for delivery of health care continue to change in the Department of Defense as well as in the civilian community. Although the Services agree that these competencies are essential skills for prospective commanders, anyone seeking the command experience must constantly strive for improvement in these administrative skills and in other professional subject matter relevant to managed care and his or her chosen area of expertise.
The 40 competencies are described in operational terms below. See the Joint Medical Executive Skills Development Program Core Curriculum, Third Edition, February 2000, for the detailed behavioral statements that further describe the behaviors one would expect of a MHS leader who is competent in each of these defined skills.
Executive Skills Taxonomy
Within the Executive Skills Core Curriculum each competency has an assigned taxonomy, or proficiency level to which officers should be qualified. This taxonomy represents the minimum qualification level deemed necessary for an MTF commander or lead agent. Refer to the core curriculum for explanation of the taxonomy and for a historical perspective on its development. The three proficiency levels are:
Education is a life-long process. We learn about specific topics in many different and individual ways beginning with an introductory or familiarization level of understanding and progressing to more sophisticated, in-depth understanding. Advanced levels of understanding are marked by demonstrated expertise to apply what has been learned, to lead comprehensive discussions on the subject, and to even expand the field of knowledge on the subject. Officers generally begin their military careers and competency acquisition at introductory levels in Service orientation courses and entry duty positions that impart basic understanding. They progress through increasingly complex and difficult duty assignments and courses constantly improving their grasp of competency nuances and their ability to apply the competencies in real world situations.
The JMESDG encourages officers to constantly strive for improvement in their grasp of these Executive Skills competencies and to take note of the taxonomy levels that are considered essential for competency qualification. The proficiency level expected of a MTF commander, lead agent, or key member of a lead agent=s staff is indicated in parenthesis beside the competency name in the following list of definitions.
*The competencies are not mutually exclusive. Rather, they are inter-related skills that individually and collectively define the minimum capabilities determined to be essential for MTF command or to manage a health care region. They are the skills necessary to lead and manage a health care management organization (HCMO) within the Department of Defense.
MILITARY MEDICAL READINESS COMPETENCIES
Medical doctrine describes the fundamental principles by which medical forces guide their actions in support of military objectives. Medical doctrine provides a common perspective and requires judgment in application.
Understanding the Military Mission(Expert)
The military mission establishes the relationship of the HCMO with the line.
Joint operations/exercises require participation in realistic individual, collective, and unit medical readiness training to include joint and combined exercises or deployment.
Total Force Management(Application)
Total Force Management includes doctrine and procedures regarding management of all military medical components.
National Disaster Medical Systems Management/Department of Veterans Affairs Role(Application)
The National Disaster Medical System (NDMS) is a joint Federal, state, and local mutual aid organization that provides a coordinated medical response in time of war, US national emergency, or major US domestic disaster. Other Federal agencies that share responsibilities include the Department of Health and Human Services (DHHS), Department of Transportation (DoT), the Federal Emergency Management Agency (FEMA), and the Department of Veterans Affairs (DVA).
Medical Readiness Training(Expert)
Medical readiness training incorporates those courses, hands-on training programs, and exercises designed to develop, enhance, and maintain military medical skills. Military readiness training includes individual, collective, and unit training experiences required to ensure health care personnel and units are capable of performing operational missions.
Contingency planning requires the preparation for delivery of medical services/care in emergencies involving military forces. Natural disasters, terrorists, subversives, or military operations may lead to these service requirements. Contingency planning includes readiness planning, organization, management, logistics, personnel, and patient care to meet operational and peacetime requirements.
GENERAL MANAGEMENT COMPETENCIES
Strategic Planning (Application)
Strategic planning is the iterative organizational process for assessing the situation, establishing direction, developing, and executing HCMO strategic goals in support of mission requirements.
Organizational design is the configuration of the HCMO=s design elements for efficiency and effectiveness.
Decision making is the process of selecting courses of action from alternatives.
Change and Innovation(Application)
Change and Innovation present opportunities to shape the future of the HCMO.
Leadership is the art and science of influencing others to accomplish the mission. It requires a complex set of skills and values to work with and through others.
HEALTH LAW AND POLICY COMPETENCIES
For the HCMO, public law includes all laws that specify requirements in areas such as public health, patient consent/rights, and environmental standards.
Medical liability includes tort and criminal offenses that may incur risk to the health care facility or individual providers.
Medical Staff By-Laws(Application)
Medical staff by-laws outline the conduct and privileges of the medical staff. The by-laws are typically developed and amended by the medical staff using Joint Commission on the Accreditation of Health Care Organization (JCAHO) requirements regarding medical staff governance.
Regulations include Federal (including DoD), state, and local guidance that affects the HCMO.
External accreditation is an evaluative process performed by an accrediting organization that is an objective review of health care delivery practices within a health care facility. These accreditations are sought by medical facilities for various reasons, most important being the assurance to the facility seeking accreditation that it meets quality standards of patient care. Some of the more prominent accrediting organizations include the Joint Commission on the Accreditation of Health Care Organizations (JCAHO), Inspector General (IG), College of American Pathologists (CAP), and National Committee on Quality Assurance (NCQA).
HEALTH RESOURCES ALLOCATION AND MANAGEMENT COMPETENCIES
Financial Management (Application)
Financial management includes the use of analytical techniques to assure that adequate resources are available to meet the HCMO=s mission. Financial management includes operating the HCMO in a managed care environment, maintaining financial records, controlling financial activities, identifying deviations (especially shortfalls) from planned performance, and strategic resourcing of the HCMO.
Human Resource Management(Application)
Human resource management includes the staffing, management, and retention of personnel.
Labor-management relations are the interactions between HCMO management and civilian staff. They include collective bargaining, the ability to recognize and implement fair labor practices, deal effectively with union negotiators, and handle grievances productively.
Materiel management is the phase of medical logistics that includes managing, cataloging, requirements determination, procurement, distribution, maintenance, and disposal of supplies and equipment.
Facilities management is the maintenance and upkeep of real property, such as a building, structure, or utility system. It includes ensuring compliance with regulations (Occupational Safety and Health Administration (OSHA), fire codes, and requirements for handicap access) and oversight of facility design and construction.
Information management includes the principles, methods, and techniques for collecting, analyzing, processing, and delivering information to support readiness and the business processes of the HCMO.
ETHICS IN THE HEALTH CARE ENVIRONMENT COMPETENCIES
Ethical Decision Making (Application)
Ethics consists of the processes, structures, and social constructs by which the rightness or wrongness of actions is assessed. Ethical issues emerge from a complex environment of reciprocal, intersecting, and, occasionally conflicting rights, duties, expectations, values, and morals. Ethical dilemmas arise when there is a conflict between two legitimate, but mutually exclusive, demands. Ethical decision-making is the process of resolving such conflicts.
Personal and Professional Ethics(Expert)
Personal ethics are bases on which individuals determine the rightness or wrongness of conduct; professional codes of ethics represent articulated group or association statements of the morality of the members of the profession with regard to their professional roles.
The discipline of bioethics represents the application of normative ethics to the life sciences, including medicine and associated research. It includes clinical ethics, which is typically restricted to the recognition and resolution of ethical problems involved in the care of a single patient but is more broad in scope, addressing the more general application of ethics through policy.
Organizational ethics describes the structures and processes by which an organization ensures conduct appropriate to its mission and vision. It is typically formalized in a code which addresses such matters as marketing, admission, transfer, discharge, pricing and billing, and describes the ethical dimensions of the internal and external relationships the organization has with its staff, contractors, educational institutions, and payers.
INDIVIDUAL AND ORGANIZATIONAL BEHAVIOR COMPETENCIES
Individual Behavior (Expert)
Individual behavior is the effect of the commander=s behavior and personality on the HCMO.
Group dynamics is the interaction among members of a group. To facilitate effective group behavior, the commander may employ team building, empowerment, responsibility, and motivation.
Conflict management involves the identification and use of techniques to effectively manage interpersonal, intra- and inter-group, and organizational conflicts. It requires impartiality, and use of negotiating and listening skills.
Communication occurs when the receiver understands the sender=s intended message. Effective communication relies on formal and informal channels established between sender and receiver both internal and external to the HCMO.
Public speaking is the set of verbal and organizing skills that permits one to effectively communicate ideas and concepts to others. It involves the ability to speak to audiences of many types, such as military and dependent beneficiaries, hospital staff, professional groups, community organizations, and others.
Public and Media Relations(Application)
Public and media relations are the activities of shaping public opinion as the outcome of effectively delivering one=s message in ways that cause it to be understood as intended.
CLINICAL UNDERSTANDING COMPETENCIES
Epidemiological Methods (Application)
Epidemiology is the science that deals with the current prevalence and incidence of disease within a population. Epidemiological methods include medical surveillance, interventions, and risk communications as key aspects of force medical protection.
Clinical investigation encompasses the acts surrounding the initiation, performance, completion, publication, and use of research. It requires compliance with multiple regulatory agency requirements, and federal, state, and local laws concerning the use of human and animal subjects.
Alternative Health Care Delivery Systems(Application)
Alternative health care systems provide health care options in diverse, integrated delivery and finance systems (i.e., HMOs, PPOs, hospices, home health care organizations, and other community based health care delivery organizations).
PERFORMANCE MEASUREMENT COMPETENCIES
Quality Management (Application)
Quality Management (QM) encompasses the procedures that emphasize involvement, empowerment, and continuous performance improvement. It focuses on customer satisfaction, critical processes, statistical measurement, and analysis as the primary tools for organizing and interpreting data. Effective QM addresses systemic problems and deficiencies.
MHS quantitative analysis ensures that information is available for decision-making through the use of analytical tools and methodologies to collect, organize, arrange, analyze, interpret, and evaluate data.
Outcome measurements permit the HCMO commander to make fact-based decisions.
Clinical Performance Improvement(Application)
Managing clinical performance is an ongoing, iterative process used to ensure the HCMO exploits opportunities for constant improvement. The effective program includes ongoing assessment of patient care, customer feedback, risk management, provider qualifications, utilization review, and the implementation of corrective and follow-up actions, where indicated.