Queen Essays

Appreciative Inquiry and Evaluation – Getting to What Works

David J. MacCoy First Leadership Limited

Toronto, Ontario

Abstract: Appreciative Inquiry (Ai) is described as the cooperative search for the best in people, their organizations, and the world around them. Th is article describes how Ai has been applied to evaluation in ways that build upon strengths and gener- ate support for improvements. An initial criticism of AI can be that it focuses only on positivity and fosters an unrealistic view of human experience. Contributing to tension with the AI process is a mistaken belief that negative phenomena must be ignored. However, evaluators using AI have found that its appreciative questions, reframing, and generative features set the stage for sound assessment of worth as well as off er potential for powerful solutions.

Keywords: Appreciative Inquiry, defi cits, generativity, positivity, reframing, social constructionism

Résumé : L’approche de l’enquête appréciative (AEA) connue en anglais sous l’appellation “Appreciative Inquiry” se défi nit comme étant la recherche collective de ce qu’il y a de meilleur chez les gens, dans leurs organisations et dans les milieux dans lesquels ils évoluent. Le présent article vise à démontrer comment l’AEA a été utilisée dans des exercices d’évaluation pour mettre en relief les forces déjà en place et créer des conditions propices à l’amélioration. On reproche souvent à l’AEA de ne miser que sur les éléments positifs d’une situation et ainsi de promouvoir une perspective idéalisée et irréaliste de la dynamique humaine. Cette critique refl ète la croyance erronée voulant que l’AEA passe sous silence tous les éléments négatifs d’une situation, croyance qui a pour eff et de susciter encore plus de méfi ance envers l’approche. Toutefois, il a été démontré par des évaluateurs que les façons de recadrer le thème et de formuler des questions telles que proposées par l’AEA contribuent à eff ectuer des évaluations solides et fi ables tout en permettant de générer des solutions pertinentes et effi caces.

Mots clés : l’approche de l’enquête appreciative, défi cits, générativité, positivité, rec- adrage, constructivisme social

Corresponding author: David J. MacCoy, First Leadership Limited, 45 Elm Ridge Drive, Toronto, ON, Canada M6B 1A2; david.maccoy@fi rstleadership.com

© 2014 Canadian Journal of Program Evaluation / La Revue canadienne d’évaluation de programme 29.2 (fall / automne), 104–127 doi: 10.3138/cjpe.29.2.104

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Appreciative Inquiry (AI) is a process of search and discovery designed to fi nd the best in people, their organizations, and the world around them. As an organization development intervention, it is a collaborative, participative approach that involves asking questions to strengthen a system’s capacity to heighten positive potential, generating new ideas and actions. In the AI process, questioning moves from determining what is valued and appreciated to combin- ing strengths and activating people’s creative energy to ignite change (Cooper- rider & Serkerka, 2003).

Th is article discusses what Appreciative Inquiry is, how it has been used in various domains, and how it has been applied to evaluation. It draws upon the conceptual literature including empirical reports of application, results, and the author’s practical experience. It is intended to be of value to evaluators who might consider using AI or some of its components in their work.

Th is article contains four major parts. Th e fi rst part provides a brief history of Appreciative Inquiry, its applications, and an overview of the process. Th e second part describes a diffi cult AI evaluation case application and several tools and strat- egies that were used to make it work. It also includes several brief case examples to illustrate the use of tools in the evaluation approach. Th e third part off ers some thoughts on making the AI process work, based on the author’s experience. Th e fourth part discusses when the AI approach to evaluation may be appropriate, followed by some conclusions.

A BRIEF HISTORY OF APPRECIATIVE INQUIRY Initially, Appreciative Inquiry (AI) was constructed as a research method and an organization development intervention. David Cooperrider is credited with the origination of Appreciative Inquiry in the 1980s while he was a doctoral student at Case Western Reserve University (Cooperrider, 1986; Bushe, 2012). His study of physician leadership at the Cleveland Clinic focused on data while the organiza- tion was most eff ective and truly at its best. He has continued to provide thought leadership, though he is quick to dispute his role as “founder,” sharing credit with many others for refi ning AI as an organization change technique.

Social constructionism, which argues for human science as social construc- tion (Gergen, 1982), had a profound impact on Cooperrider’s thinking and is em- bedded in AI philosophy. Social constructionism actually distinguishes AI from what is popularly called positive thinking in that it maintains reality is constructed in the social interactions of people and not in the mind of an individual. AI is a highly relational approach to systemic and structural change that is about asking questions and engaging people in learning about and co-constructing the change they want (Watkins & Mohr, 2001).

In 1993, the Taos Institute was founded by scholars and practitioners, includ- ing Gergen and Cooperrider, as a nonprofi t educational organization dedicated to the development of social constructionist theory and training for organizations, consultants, family therapists, educators, and others.

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In 1998, a newsletter, AI Practitioner: Th e International Journal of Apprecia- tive Inquiry, evolved into a widely read monthly journal for sharing ideas and experiences (Bushe, 2012). Case Western Reserve University has continued to be a focal point for teaching, research, and information sharing about AI. Th rough the Appreciative Inquiry Commons, practitioners and researchers share tools and academic resources focused on the discipline of positive change (http:// appreciativeinquiry.case.edu).

During the 1990s, books, papers, and training courses describing the prin- ciples, methods, and applications of AI began to appear (e.g., Cooperrider & Whitney, 2000; Elliott, 1999; Hammond, 1996; Mohr, Smith, & Watkins, 2000). In addition, many large-scale processes such as Imagine Chicago, the Global Excellence in Management Initiative (GEM), and the United Religions Initiative brought AI to the forefront of organization development and transformation (Watkins & Mohr, 2001).

Th e literature on Appreciative Inquiry continues to grow, with emphasis on practice advances and the various organization development applications of the approach. In addition, the growing literature on Positive Organizational Scholar- ship (Cameron, 2013), Positive Psychology (Seligman & Csikszentmihalyi, 2000), Positivity (Fredrickson, 2009), and projects focused on learning from success such as those reported by Sykes, Rosenfeld, and Weiss (2007) contributes to the work of appreciative inquiry practitioners in all areas of application.

Appreciative Inquiry Applications Appreciative Inquiry has been applied in a wide variety of contexts and settings in the private and public sectors. Th e choice to use the AI approach has oft en resulted from limitations encountered in using problem-focused or defi cit approaches. Th e problem-focused approach was generally very eff ective in solving existing problems and “fi xing” them, but oft en less eff ective in identifying what is going “right” and taking it to the next level.

AI has been applied extensively in change management (Anderson & McKenna, 2006; Cooperrider & Whitney, 2000; Preskill & Catsambas, 2006), stra- tegic planning (Stavros & Hinrichs, 2007), organization design and development (Cooperrider & Srivastva, 1987), team building (Whitney, Trosten-Bloom, Cher- ney, & Fry, 2004), performance review (Shaked, 2010), leadership development (Bushe, 2001), quality assurance (Catsambas, Kelley, Legros, Massoud, & Bouchet, 2002), coaching (Orem, Binkert, & Clancy, 2007), and research (Reed, 2007).

Th e AI Summit, a methodology for whole system positive change, has been used to engage large groups of people, most oft en in the hundreds or even thousands in medical centres, universities, manufacturing, transportation, high- technology companies, service organizations, and the United Nations (Cooper- rider, Whitney, & Stavros, 2003; Cooperrider, Zandee, Godwin, Avital, & Boland, 2013). However, most AI engagements are more modest, involving appreciative interviews, group work, and surveys with smaller numbers of people including boards of directors, management teams, and staff of organizations.

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Appreciative Inquiry and Evaluation Th e AI approach is also used in evaluation, though there was a limited amount written about it until the late 1990s and early 2000s. Early applications of Ap- preciative Inquiry (AI) to evaluation were described in Elliott (1999), Mohr et al. (2000), Odell (2002), and Jacobsgaard (2003). Slightly later, more focused attention on the rationale for using AI in evaluations and application examples are described by Preskill and Coghlan (2003), Webb, Preskill, and Coghlan (2005), Preskill and Catsambas (2006), and Skov Dinesen (2009). Webb et al. were guest editors of the February 2005 edition of Appreciative Inquiry Practitioner that fo- cused on the application of AI in evaluation. Preskill, who served as president of the American Evaluation Association in 2007, has made extensive contributions as teacher, innovator, and thought leader to evaluation practice in general and to the use of AI in evaluation specifi cally.

A powerful example of choosing the AI evaluation process rather than a defi – cit approach is described by Mohr et al. (2000) in their work with a transnational pharmaceutical company that wanted an evaluation of their process management training program for 400 research managers. Th e consultants explained that one option would be a traditional review to determine whether the program had an impact and then focus on bridging any gaps or defi cits. Th ey also explained that another option would use an appreciative approach. Th is would involve searching for and understanding examples of times when participants successfully applied the intended learning. Th en they would fi nd ways to recreate, enhance, and ex- pand those conditions. Th e company chose the latter and successfully enhanced the training program.

Another example of choosing the AI process for an evaluation is found in a book chapter by Catsambas and Webb (2003) that describes the rationale for using the appreciative approach in the evaluation of the International Women’s Media Foundation (IWMF) Africa Program. Th e IWMF senior staff person recognized the need for participation, dialogue, and discovery of best practices. In particular, the AI interview process, based on story-telling as a means for learning the per- ceptions of participants and stakeholders, was seen as an ideal fi t for the African culture with its oral history traditions. Th e evaluation provided an opportunity for identifying controversial issues, taking action on concerns, increasing commit- ment, and clarifying roles and responsibilities. Th e IWMF concluded two years later that the evaluation process and results had been eff ective in addressing lead- ership issues, strengthening the roles and responsibilities of the African advisory committee, and teaching staff how to learn and grow from successes.

AI is certainly not the only collaborative and participatory approach to evalu- ation. In her article in this issue, Stame discusses the diff erences between AI and several other approaches that can support positive thinking and action, includ- ing Most Signifi cant Change, the Success Case Method, Positive Deviance, and Developmental Evaluation. Th e value of participatory, stakeholder, and learning- oriented approaches (Cousins & Earl, 1995) has been an important theme in eval- uation for many years. Th e similarities of Appreciative Inquiry and participatory

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approaches to evaluation have also been noted by others (Preskill & Coghlan, 2003). However, AI is not evaluation per se, though it off ers an approach, a per- spective, and a set of tools for conducting a full evaluation or various phases of an evaluation. Preskill and Catsambas (2006) describe the use of AI in focusing an evaluation, conducting appreciative interviews, developing evaluation systems, and building evaluation capacity. Th ey also point out that AI is not a panacea for the challenges of evaluation.

The Appreciative Inquiry 4-D Cycle As a process, AI is commonly identifi ed with the 4-D cycle (i.e., four Ds: Discover, Dream, Design, and Destiny; Whitney & Trosten-Bloom, 2003) that provides a guide to identify data about the “best of what is” (Figure 1). Th e process employs the four steps to guide participants in exploring appreciative questions at various points in time. Initially, the guiding questions focus on the discovery of the “what gives life?” now and then to dream “what might be?” in the ideal future. Th is is followed by designing or co-creating “what should be?” Th e fi nal step initiates actions on des- tiny, or “what will be?” (Whitney & Trosten-Bloom, 2003). In evaluation initiatives,

Figure 1. AI 4-D Model (Cooperrider, Whitney, & Stavros, 2003)

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the EnCompass Model of AI (Preskill & Catsambas 2006), the 4-I process with slightly diff erent terms (Inquire, Imagine, Innovate, and Implement), are oft en used.

Tensions: It Is Not Only About the Positive Although AI is intended to elicit generative conversation that moves toward the highest aspirations and potential in human systems (Johnson, 2013), it can lead to tension for those learning to apply the approach as well as participants when they are introduced to AI. A frequent concern is the possibility that a focus on positive stories and experiences during the initial dialogue or discovery phase will invalidate the negative organizational experiences of participants and may repress potentially important and meaningful conversations that need to take place (Bushe, 2007; Egan & Lancaster, 2005; Miller, Fitzgerald, Murrell, Preston, & Ambekar, 2005; Pratt, 2002).

Clearly, an alternative perspective that “bad is stronger than good” (Baumeister, Bratslavsky, Finkenauer, & Vohs, 2001) is worth considering as we plan evaluation strategy. A common reaction seems to be “If it’s bad, it could harm (or kill) us; if it’s good, that’s nice but so what, there’s no threat.” Th is leaves many clinging to the view that the only important or worthwhile phenomena to look at in their program are those that are dysfunctional and threatening. Neverthe- less, there are also many who are keen to understand why some things work well, “what gives life to systems,” and what can be learned from success. Th is is where the “inquiry” part of AI is so vital. Creative, appreciative questioning can take the inquiry to many dynamic destinations (Adams, Schiller, & Cooperrider, 2004; Whitney & Trosten-Bloom, 2003).

AN UNEASY EARFUL ABOUT POSITIVITY: EVALUATION OF THE TENANT PARTICIPATION SYSTEM It is diffi cult for practitioners to maintain a completely defi cit-free process when problem-identifi cation and problem-solving have been the predominant process- es for virtually everyone in organizational life (Johnson, 2013). Some participants in an AI evaluation of a program, or some other application such as strategic planning, may be fearful that an AI process would not allow them to mention anything that is not positive. Th ey may be frustrated because they cannot ignore facts, thoughts, and feelings that involve failure, errors, pain, and various forms of suff ering that they may feel are off -limits in the process. If they speak of defi cit situations, facilitators could see them as resisters that have to be managed. Work- ing through this is a signifi cant challenge for practitioners of AI, and avoiding the challenge can be a missed opportunity (Bushe, 2007).

Below is an example of an evaluation team struggling with the assumption of a participant who believed she and her colleagues were forbidden to speak about defi cits in the evaluation process.

My colleague and I were engaged to conduct an evaluation of the Tenant Participation System (TPS) in a large, urban social housing corporation (McGuire,

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2006). Aft er preliminary preparation work, we provided an introduction to AI and led an opening exercise with a group of 50 or so tenants to focus and plan the evaluation. Many of these tenants, an equal number of men and women, had been elected Tenant Representatives who asked questions for clarifi cation about AI and voiced support for the approach.

Aft er about 45 minutes, a woman from the group pulled us aside. She was obviously enraged and literally spitting. She loudly yelled that this AI method fo- cusing on the positive would not get to the truth of their situation. To get the full story, she said, “You have to look at all the problems: bedbugs, fi lth, unfair elec- tions of representatives, extreme heat in the summer, extreme cold in the winter, theft , violence, mental illness, crack houses, broken appliances, and unreliable elevators. No one will fi nd anything positive to talk about!” She described the TPS as a sham that could do nothing to address the real problems she had outlined. She added that she didn’t believe we were there to listen to the tenants and were under the control of insensitive bureaucrats in the corporation.

We were shocked and a bit frightened at the depth of her anger. We explained that we were engaged to look at the role and scope of the TPS, but not specifi cally at all the problems of the tenants living in social housing. Acknowledging the distressing situation and her anger, I added that we would engage as many tenants as possible, start with what is working well in the TPS, and listen for what people really wanted in the future. We pointed out that, even as we would focus initially on what was working well, problems would be identifi ed in the conversations and hopefully the process would help to generate useful ideas for making the overall system better. Th is defence of the AI approach and explanation of what we would do further infuriated her. In our haste to explain the approach, we had failed her test miserably. We had mistakenly left her with the impression that any negative talk was still forbidden!

A few minutes later, she started again in a high-pitched, rapid-fi re voice, “Th is evaluation won’t lead to any changes. You won’t even know what needs to change! Nothing works in the TPS. Th ey do nothing to make things better, and you aren’t even going to let us talk about it. What a waste of time!” With that she stormed off out of the room, leaving other participants and our team perplexed. How could we take into account her input and not let it be the focus of the engagement?

We were puzzled because the critic had been part of the introduction to the approach and initial briefi ngs. She had been quiet then reacted strongly, emotion- ally, and with conviction against the idea of evaluating what might be “working” in the system that she had determined was hopeless and horrible. Still, we realized she may have spoken for many of her peers, even if it was based on misunder- standing the purpose, the process, and the possibilities. To her, the focus of the evaluation had to be on “bad,” and no “good” could be acknowledged. We were seen as stifl ing open dialogue and leaving no room for debate about the extent of “badness” and what needed to be corrected. In her view, our approach was a sell- out to the housing authority and all that didn’t work. Upon refl ection, we recog- nized that we were fearful of the “shadow” and needed to learn how to manage it.

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Despite being extreme, the passion of her opposition made us stop, think, and regroup. It was common knowledge that, despite all eff orts, some of the housing conditions were terrible and life in this situation was intolerable for tenants and staff . We knew that, despite some hope, there was a lot of dissatisfaction with the TPS and many were resigned to continuation of what didn’t work. However, it was our task to evaluate this system in a way that engaged a signifi cant number of people aff ected by it. It wasn’t just that we didn’t have the right words or sell- ing proposition to convince her. Even our best persuasion skills and reframing strategies were not going to have any impact with this critic. She had likely given up on the possibility of change long before our encounter. We had not specifi cally disallowed talk about problems, but she couldn’t see any merit in trying to identify value by looking at what works or what was positive. Further, she believed our motives were suspect. We agreed that we would have to address her issues in some way to make the evaluation process useful.

With the best intentions, some practitioners have presented the AI process as having no room for negativity. A common concern has been that delving into negativity tends to lead to more negativity and hopelessness. Some practitioners have erroneously led participants to believe that defi cit issues are undiscussable in AI initiatives. However, push-back on a positive-only focus in Appreciative Inquiry has been an area of tension that practitioner-scholars have described as a struggle with the dark side or “shadow” (Bushe, 2010, 2012; Fitzgerald & Oliver, 2006; Fitzgerald, Oliver, & Hoxsey, 2010; Hoxsey, 2012; Johnson, 2013; Kolodziejski, 2004).

Cooperrider (2012) suggests that it is necessary to recognize and reverse a common 80/20 defi cit bias that pervades our culture and most organizations. Th e AI strategy is to ensure that defi cits do not monopolize the process and therefore to reverse the bias to 80/20 positivity. Taking this into account in the TPS evaluation, AI was used to engage hundreds of stakeholders, focus the evalu- ation, develop key questions, reframe issues, generate potential solutions, and put the evaluation plan together. Interviews, surveys, and public meetings were conducted using appreciative questions. And yes, defi cit areas, problems, and ob- stacles of the past and present were identifi ed leading to co-created future vision and design of what they believed needed to change in the TPS.

Th e consulting team realized that careful introduction of the AI process is vital to help those who may be unsure of the appropriateness of the approach. It was also necessary to reinforce the commitment of those who thought AI made sense for them. Tenants wanted the evaluation to bring about change and, from this encounter, it was clear that some could even be off ended by the notion that strengths or positives could be used to bring about change. It was necessary to fi nd ways to assure them that their complaints and problems would not be ignored while focusing on “what we want more of ” (Watkins & Mohr, 2001). It was critical to develop appreciative questions and use them to conduct positive interviews and an AI-oriented survey. With these data it was possible to work with subgroups to tell stories and generate new ideas and solutions. In addition, it was necessary to

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accept talk about defi cits and help participants to reframe them toward what they desired in the TPS. To further assist, time was invested in individually coaching TPS representatives and staff of the housing corporation on how to best use the appreciative approach and tools.

Refl ecting further on this experience, though our AI critic did not remain involved, the consulting team was able to help other participants who benefi ted from learning how to reframe and who saw merit in the approach. (Key AI tools such as generativity, appreciative questions, and reframing are described and discussed in the section below.)

In the end, we, with the help of tenants, were able to make recommendations that were valuable to the housing authority and, most importantly, to tenant rep- resentatives. A few examples of recommendations were providing equipment and access to the Internet for tenant representatives; the provision of training to help representatives and housing staff to carry out their roles; agreement to mediation processes to address confl ict between staff and tenants; and establishing a moni- toring system to regularly measure progress toward the objectives of the TPS. Like most evaluations, it did not always go smoothly, though it provided more useful recommendations and outcomes than previous reviews. It demanded a thoughtful combination of evaluation discipline and application of AI processes that tested our team considerably. In many circumstances negatives did seem stronger than positives, and there is still more to be learned about combining evaluation dis- cipline and Appreciative Inquiry to manage this eff ectively. Notwithstanding his commitment to an extreme strength-based approach, Cooperrider’s (2012) advice to AI practitioners to use the 80/20 positivity ratio was helpful in engaging those who cannot ignore negative phenomena in their experience.

The Generativity of Appreciative Inquiry One of the major benefi ts of appreciative inquiry when used in an evaluation process (as well as in other applications) is its capacity to generate new under- standings of problems and even new approaches to instigating enhanced system performance (Bushe, 2007, 2013). For many new to the approach, techniques such as the 4-D model (Watkins & Mohr, 2001) described above or the 4-I cycle (Preskill & Catsambas, 2006) are oft en mistakenly thought of as Appreciative Inquiry. However, it is the collaborative inquiry into the “life-giving forces” or strengths of a system combined with imagining a desired future and co-creating solutions to get there that is closest to the essence of AI.

Two process tools or strategies that contribute to the generative nature of AI and that may be particularly pertinent when used as part of an evaluation approach are appreciative questioning and reframing, which are described below with examples. Appreciative Questions

Aft er defi ning the focus of an inquiry, the starting point of AI is asking—in interviews, surveys, and group work—powerful, positive questions that seek to

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defi ne the “positive core” of a system. Th en, rather than identifying and solving problems, AI concentrates, through co-construction, on imagining and design- ing the future (Avital, Boland, & Cooperrider, 2008; Bright & Cameron, 2009; Cooperrider & Avital, 2004; Th atchenkery, Cooperrider, & Avital, 2010). As both a highly participatory, inquiry-based process and a philosophy (Martinetz, 2002), AI is grounded in the belief that the intervention into any human system will move the system in the direction of the fi rst questions that are asked. Th us, in an evaluation using an appreciative framework, the fi rst questions asked would oft en focus on stories of best practices, positive moments, greatest learnings, success- ful processes, and generative partnerships. Th is enables the system to look for its successes and create images of a future built on those positive experiences from the past (Watkins & Mohr, 2001).

Several principles for preparing interview questions that are used in AI ap- plications including evaluation were developed by Cooperrider et al. (2003). AI questions are craft ed to evoke positive images that lead to positive actions. Ques- tions begin with a positive preface and plant the seed of what is to be studied, whether in a change management process, strategic planning, evaluation, or any of the other AI applications. Th ere are two parts to each question:

• Th e fi rst part must be designed to evoke a real personal experience and narrative story that helps participants to identify and draw on their best learning from the past. For example, “What was the high point of your experience in the program?”

• Th e second part goes beyond the past to envision the best possibility of the future. For example, “Th inking about your past experiences, what would you want to take forward to the future?”

AI practitioners talk about using questions in the search for or inquiry into “life-giving forces,” the individual and collective strengths that are evident when a system is performing at its most creative, productive, and eff ective (Watkins & Mohr, 2001). Th is search involves co-inquiry with stakeholders involved in the evaluation asking questions about their peak experiences, what works, what people value, and what they want. In this context, organizations have been described as “mysteries to be embraced” rather than “problems to be solved” (Cooperrider & Whitney, 2000). Indeed, proponents declare that you get more of what you ask about; hence a focus on assets brings more assets to the inquiry (Watkins & Mohr, 2001).

Below is a sample of questions used in an evaluation assignment with Dusk Dances, a not-for-profi t, multilocation, modern dance program presented on summer evenings in community parks. Previous evaluations, focused on defi cits of the program, had led to little or no change to the program. Th e AI questions were craft ed aft er a process of identifying the affi rmative topic for the evaluation (i.e., enhancing the best community dance program in Ontario) and were then used in a paired interview format with stakeholders.

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1. “In your experience with Dusk Dances, what has been the high point for you personally? Share a story of this in detail. What, from this high-point experience, would you like to bring forward to the future of the organiza- tion?”

Aft er working with these questions, stakeholders identifi ed exciting events that took place in their productions and began to share approaches for market- ing, audience building, and management coordination that worked well for them and could be shared with other local Dusk Dances companies. Th is built energy in the process and set the stage for identifying what they wanted to carry forward for future years.

2. “Let’s talk for a moment about some things you value deeply; specifi cally, the things you value about yourself, about the nature of your work, and about this organization:

a. When are you feeling best about your work? What about the task itself do you value?

b. What do you value most about this organization? c. What is the most important thing this organization has contributed

to your life? To the community?”

Participants shared views on the strengths (and defi cits) of the culture of their production groups and what they personally contributed to make it work. Th ey sought to describe the core strengths that defi ned their Dusk Dances groups. Th ey specifi ed the shared values that were needed to help them be successful and the extent to which they were embedded. Th is became common ground for the vari- ous programs and set the stage for greater sharing in years to come.

3. “What “three wishes” would you make to heighten the vitality and health of this organization?”

As participants identifi ed their “wishes,” they could see what they wanted or needed to change to make their productions and the overall organization more eff ective. Some of the wishes were to address defi cits in their programs such as improving weak marketing initiatives, inadequate accounting practices, poor con- tingency planning for inclement weather, and insuffi cient youth programming. As dialogue and storytelling progressed, those programs that had positive experi- ences in these areas were able to share their approaches to success. Th e combina- tion of “high point” stories, “things they valued deeply,” and “wishes” became the main ingredients in the design of plans for developing and implementing change.

Overall, the Dusk Dances managing director and the festival director consid- ered the AI evaluation process a powerful experience that provided information and motivation for stakeholders to make changes that set the stage for the next fi ve years of the program. Interesting new ideas were generated, including approaches

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to fundraising, providing central support services to programs, and a concept for licensing that would be made available to interested communities. Appreciative Inquiry Reframing

Reframing is a process of looking at things another way, changing the meaning of something, or changing one’s perspective (Watzlawick, Weakland, & Fisch, 1974). It is used in various therapeutic interventions such as neurolinguistic program- ming (NLP) and is a core strategy in coaching processes.

Although traditional problem solving is not a core part of an Appreciative Inquiry, defi cits or problems do come up quite naturally in dialogue. As people engage in dialogue about hopes, their description of wishes for the future are very oft en the fl ip-side of what doesn’t work and, as such, problems are voiced. Put another way, the defi cits people fi nd in a program or organization represent an absence of something they hold in their minds as an ideal image they may want to achieve (Cooperrider et al., 2003). From experience this has emerged as an ac- curate description in the AI process.

Reframing is frequently used in Appreciative Inquiry in response to defi – cits that are voiced (e.g., “We have big problems in this program”) to shift to a solution- or asset-focused perspective. Th at is, the approach is to reframe these statements or questions so they are appreciative in nature (e.g., “Despite problems, under what conditions has this program been most successful?”). In his article in this issue, Perrin refers to the importance of positivity for supporting learning and developing a positive frame. Th e rationale is that, with a positive frame, peo- ple can open their minds to seeing new connections between ideas, people, and situations, oft en resulting in a fl ash of insight that is generative (Th atchenkery & Metzker, 2006).

One memorable fl ash of insight that I witnessed came from a very skeptical psychiatrist who eventually proclaimed aloud in the third day of an AI summit designed to evaluate and rethink a stagnant eating disorders program, “Wow, this AI stuff has really opened our minds to some great ideas!” Th e group of 50 physi- cians, nurses, nutritionists, social workers, and psychologists were able to reframe and rebuild the program from initial questions about failure to powerful solu- tions. Th ey were able to shift from wallowing in negativity to talking about what their program would be if it was truly working in its optimal state. Th is shift was possible because they shared stories about high points in their experience and imagined what it would take to get the system to these high points as a standard way of doing business. Two years later, it was reported that they had used their fi ndings to redesign the program with shorter wait-lists, more program capacity, expanded services, and improved results for patients.

Reframing Questions Th e example in Table 1 describes, in simplifi ed form, the reframing questions initially used in the evaluation of the Tenant Participation System (TPS) to help shift thinking from defi cit defi nitions of the situation to positive or asset-focused

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defi nitions. It was important to help tenants and staff develop reframing skills to generate thinking and proposals for change beyond hopelessness and pessimism. Th e defi cit issue reframed as a question is usually the starting point for creative thinking and generation of solutions.

Th e reframing, with many additional questions, gave participants a new per- spective on what they wanted to gain from this evaluation of the TPS. Th ey did not forget about the defi cits, but looked for positive descriptions of what they wanted for the future of the system. Many commented that they had complained in vain about the problems in the past and reframing gave them greater confi dence that they could describe the desired end point clearly and focus their eff orts.

A Homelessness Program Evaluation: Reframing Applied In an evaluation of a multiagency homelessness program, a slightly diff erent reframing approach was needed to help a large group of stakeholders overcome a defi cit bias (McGuire, 2005). Stakeholders started by describing what they be- lieved to be the real causes of their failure as a community support system. Th ey talked about having earlier done a SWOT analysis (an analytical tool for assessing strengths, weaknesses, opportunities, and threats).

Our team learned from appreciative interviews that they had experienced some successes. We urged them to describe the real causes of their success- ful experiences with the system. We noted that in their dialogue they seemed overly focused on weaknesses and threats. We reframed this by proposing a SOAR analysis (strengths, opportunities, aspirations, results desired) created by Stavros and Hinrichs (2007). When this was tried, a very diff erent and more productive conversation took place.

For example, as they spoke of terrible communications among community partners, we urged them to reframe this by identifying periods when commu- nications were compelling and eff ective. Again, a very diff erent and productive conversation resulted. A key outcome of the evaluation was that stakeholders identifi ed ways in which they now could all work together, including the need to save resources by closing a program of one agency. Prior to the evaluation

Table 1. Reframing Defi cits to Assets

Problem or defi cit-focused issue Solution or asset-focused

Tenant Participation System is terrible at representing tenant concerns.

What are the best examples of where the TPS has eff ectively represented tenants?

The TPS is not democratic and its activities are not transparent?

What are the most eff ective aspects of the TPS? What is needed to support eff ective practices across the system?

The TPS has failed to perform in these areas….

What possibilities exist that we have not yet considered in the Tenant Participation System?

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this had been strongly resisted, but the surprising action was proposed by the leadership of the agency that would have one of its programs closed. In the re- framing process they concluded that limited resources were spread too thinly and the system would be better served by augmenting the resources of another agency. Over time this decision led to better system coordination to the benefi t of homeless clients.

Some people, like our social housing critic in the Tenant Participation System evaluation, have a genuine need to describe only problems and the hopelessness of their situation. AI does not ignore negative situations and terrible realities of organizations or programs. As we saw in the earlier example of the critic, any sense of ignoring the “bad” may lead to anger, frustration, and unwillingness to engage. It is frequently necessary to hear out the critics while off ering diff erent possibilities for consideration. As mentioned previously, asking people to identify their wishes for their organization or program doesn’t always bring out a positive response. Th e wish is frequently for the end to a problem that is part of their experience. For example, it is not uncommon to hear participants say “I wish we had leaders who would listen to our ideas.” Th is comment about the failure of leaders to listen can be instructive for a program and an organization.

A key principle is that Appreciative Inquiry practitioners do not use defi cits as the basis of analysis or action (Whitney & Trosten-Bloom, 2003). Th ey ask people what they want more of as they go forward to the future. Still, they must be sensitive to the situation and the experiences of people. Reframed descriptions should not deny defi cits or deter people from working on challenging problems. Reframing can off er an opportunity to let the vision of the future guide think- ing as a means of addressing or minimizing the problem. Describing a vision of what is desired in the future oft en enables groups to think about what steps they need to take to get there and can include obstacles or challenges they have to overcome. Th is was the starting point for the homelessness evaluation described above. As they articulated what they wanted, more of their vision became clearer. In addition, they cogenerated ideas about how to overcome obstacles and build on their assets.

MAKING THE AI APPROACH TO EVALUATION WORK Below are several observations about what works in using the AI approach in evaluation. Th ese are not ironclad by any means, but function as guidelines that have worked for many practitioners.

Teach Team Members and Participants the AI Approach Based on my experience, it is important to ensure that all members of the evalu- ation team who are new to AI are well grounded in the approach. Th e common human tendency to revert to a “defi cit” thinking under pressure is strong (Wat- kins & Mohr, 2001). As pointed out above, it is also important to be aware that many participants will have a defi cit focus and will need to learn the basics of the

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approach. Th is will likely feel awkward to them. It was important to continuously remind participants and members of our team about the foundations as well as the subtleties of AI to eff ectively facilitate the process.

Emphasize Facilitation Skills As in most evaluation work, the importance of facilitation skills cannot be overes- timated (Watkins & Mohr, 2001). Th e AI cycle (4-D or 4-I) requires careful design and creative facilitation with stakeholders. Careful design means that there is a relevant, realistic agenda; basic skills are taught; and guidelines are easily under- stood by all participants. Eff ective facilitation ensures that you bring every voice to the process and enable stakeholders to generate their best eff orts. Facilitation of priority setting, confl ict mediation strategies, action planning, and consensus building are regularly needed.

Not all engagements involved applying the AI cycle in the same way or had an emphasis on large meetings or summits. (For a description of the AI Sum- mit see Ludema, Whitney, Mohr, & Griffi n, 2003.) In some cases, appreciative interviews were conducted by a team of consultants; in others, stakeholders themselves were trained in the AI process to conduct interviews. In many others, paired interviews with stakeholders lasting a few hours were used to start the cycle (Watkins & Mohr, 2001). Appreciative surveys were used in some projects (Catsambas & Webb, 2003; Preskill & Catsambas, 2006). Findings from various sources were then considered by large or small groups of stakeholders to “make meaning” of the data.

We were frequently surprised at how group process led to discoveries on the part of stakeholders that we had not imagined. In the homelessness case de- scribed above, we facilitated a large group of stakeholders representing more than a dozen homelessness organizations using inquire, imagine, and innovate phases to overcome longstanding unsolvable challenges involving turf and ownership. As they worked in small groups and then in the whole group of 40 people, we listened as they described what worked, came up with new insights, reframed old assumptions, and charted new solutions (McGuire, 2005). Th is would not likely have happened had there not been thorough preparatory work done through interviews and surveys to plan the evaluation. Furthermore, if we had intervened too quickly during small group phases when there appeared to be lulls, we might have lost the rich dialogue that eventually led to co-creation of new ways of doing business (Weisbord & Janoff , 2007).

Prepare Stakeholders to Lead Recruiting and training stakeholders to lead the AI evaluation process has sig- nifi cant potential (Watkins & Mohr, 2001). In ArtReach Toronto, a youth arts program, it was essential to prepare a core evaluation team that could undertake various leadership roles in the process. Several young people led interview teams using the appreciative process, others did the write-ups of group dialogue, and still others actually facilitated the Appreciative Inquiry 4-I process.

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One session for about 50 young people, described as a “Learning Circle,” was held in a youth-managed art gallery. It was a high-energy meeting of people who rarely met, with a noise level that made it unlikely that appreciative ques- tions could be used with the group. However, the young man and young woman who had been given training and coaching in AI took charge as I watched with some trepidation. Within minutes they had this noisy, excited audience work- ing in paired interviews, recording themes and priorities, and later working in small groups to “make meaning” of the dialogue (Whitney & Trosten-Bloom, 2003). In concluding the evaluation, the core evaluation team of youth was com- mitted, creative, and indefatigable. Over time, many others took on facilitation, interview, and data-analysis roles and were able to engage a much wider group of stakeholders. Th e ArtReach Toronto evaluation satisfi ed the monitoring needs of the various funders from federal, provincial, and municipal governments and foundations. More importantly the results took the program to new levels of performance. It also developed the evaluation and leadership skills of the young people who were part of the evaluation team.

Ensure Adequate Time for the AI Process Th e AI process requires time for interviews, dialogue, and small group interaction aimed at working with the data. Sometimes stakeholders will want to rush into the process with little knowledge of the time required. Th e basics of AI can be introduced in 45 minutes. However, the process can take several days or weeks, depending on the scope of the undertaking. It is vital to have adequate time to help people understand and use it eff ectively (Watkins & Mohr, 2001). Usually this can be accomplished on a gradual basis. I have seen insuffi cient time virtually derail an evaluation. An example of this is described below.

Th ere was a strong stated interest in using an AI approach in an evaluation of Withdrawal Management Centres. A plan that would involve all managers from across the province in a one-day AI Summit at their annual conference was agreed to. Initial data gathering was undertaken well in advance, using an appreciative survey, program statistics, and interviews of a sample of managers and staff . However, the evaluation team was given a rather rude surprise on the fi rst day of the conference when our full-day summit was reduced to a 60-minute meeting. Despite very careful contracting with system leadership, there were likely many reasons why this happened that were left unexplained. In the end, the key outcome was a diluted process that weakened the needed AI engagement and dialogue with key stakeholders. Our team concluded that the engagement was partially appreciative and only moderately successful. Th e lack of time for a one- day summit ensured that we could not obtain the creative ideas and commitment to innovation that was aimed for in this evaluation.

Th is was an important learning experience that has led to more careful assess- ment of the readiness of an organization and its leadership to use an AI approach. In some cases it has meant that a thorough training session for all leaders was needed before a fi nal decision was made to use the approach (Watkins & Mohr,

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2001). Ideally, this can involve sharing articles on AI and facilitating an introduc- tory session of up to three hours to ensure awareness of what is involved, including time requirements. It is an important investment for evaluators and participants.

WHEN AN AI APPROACH MAY BE MOST SUITABLE FOR USE IN EVALUATION

Yet incorporating AI into evaluation practice pushes the boundaries of traditional evaluation in ways that may not be met with approval by all professional evaluators. At the same time, Organizational Development practitioners may wonder if adapt- ing Appreciative Inquiry to evaluation where the entire AI process may not be used invalidates AI’s purpose or impact. (Preskill & Catsambas, 2006, p. 140)

Rogers and Fraser (2003) point out that one of AI’s major strengths is its fundamental recognition that an evaluation is an intervention that causes rip- ples in the life of an institution. With this in mind, it is important to align the situation and needs of the users of the evaluation with the approach to be used. When the situation permits and encourages ongoing contact with managers and staff throughout the evaluation, the AI approach can be very eff ective. Where that contact with stakeholders is resisted or the nature of the evaluation does not provide for this, AI is not recommended.

Preskill and Catsambas (2006) describe AI as another means for framing and conducting complete evaluations. Th ey stress that it is crucial to embed the guid- ing principles of evaluation with respect to logic and data rigour. In that light, my colleagues and I have used AI processes to focus an evaluation, design surveys, craft interview questions, facilitate paired interviews, and design an evaluation system. It has also been used in a complementary fashion with more quantita- tively focused engagements (e.g., evaluation of Positive Leadership training at a large teaching hospital). Frequently, we have thought of AI as the “Intel Inside” the evaluation process, as there were oft en other tools needed to ensure a quality evaluation. Metaphorically, AI was the intelligent “chip” inside that guided the process.

Appreciative Inquiry is most suitable where evaluation data are needed to enhance or design the future of a program (Coghlan, Preskill, & Catsambas, 2003; Skov Dinesen, 2009). AI has potential to contribute to evaluation practice in contexts where previous evaluation has failed, there is fear or skepticism about evaluation, there is a sense of hopelessness, the environments are hostile or vola- tile, change needs to be accelerated, there is a need to build evaluation capacity, dialogue is needed, or there is a need for a participatory, collaborative approach to increase support for evaluation and the program being evaluated. Practitioners agree that the AI process can be useful when there is interest in learning and im- provement, and a key objective of the evaluation is to support and use the fi ndings (Preskill & Coghlan, 2003).

My colleagues and I have found that an evaluation with the primary aim of measuring what is taking place to satisfy an external requirement will not

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really benefi t from the AI evaluation approach. Although that primary aim can be appropriate, we have found that the AI process and the time requirements can frustrate the users (e.g., the Withdrawal Management Centres Evaluation described above). However, in evaluations that aim for use, the success of an AI approach in infl uencing future directions (e.g., Dusk Dances, ArtReach Toronto) depends upon the ability to infl uence leaders and stakeholders at all levels in an organization to buy in and support using the approach. Without genuine accept- ance or true buy-in from leaders for using AI, it will prove diffi cult to produce useful outcomes.

We have also found that organizations or systems in which parties are at seri- ous odds with each other can benefi t from the AI evaluation approach (e.g., the homelessness evaluation). A traditional approach that focuses on problems tends to lead to blame, stalemate, or a worsening of these situations. Frequently, as sug- gested by Preskill and Coghlan (2003), those who have had less than satisfactory experiences with previous evaluations and are open to trying something new can benefi t from the AI approach. Our challenge with the Tenant Participation System was that past reviews created signifi cant divisions and confl ict. An AI approach had greater potential to build consensus, reframe defi cits, and fi nd creative solu- tions for the future.

As a general observation, the AI approach to evaluation aims at supporting change in practice versus just measuring what is taking place; it supports qual- ity versus just measuring how much quality there is (Skov Dinesen, 2009). As such, it has a utilization-focused characteristic. Dusk Dances’ leaders were keen to know how much “quality” their program had, but also to expand that “quality knowledge” to all locations of their program. Similarly, the Eating Disorders pro- gram leaders wanted to understand what worked, but also to consider signifi cant changes to how their program would function in years to come.

In every evaluation engagement in which my colleagues and I have used the AI process, several features were evident. Th e fi rst questions used were crucial for focusing and setting the tone. Questions that focused on high points of perfor- mance, what worked well, and strengths were powerful as opposed to those focus- ing on failure, problems, and weaknesses. In every phase, new questions emerged as stakeholders learned to reframe issues (Watkins & Mohr, 2001). Frequently, they were able to fl ip negative concerns into the positive phenomena they desired. As concerns about program defi cits, confl icts, and problems emerged, they were addressed through reframing dialogue. As we focused at least 80% of the group’s attention on what was working, solutions emerged that previously had not been considered or had been deemed impossible (Cooperrider, 2012). Stakeholders’ commitment to change was accelerated and genuine as they craft ed solutions that were fair and eff ective.

CONCLUSIONS At its most basic level, to evaluate means to make judgements about worth (Webb et al., 2005). To achieve this, a planned systematic process is used to collect data

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about a program or organization that will expand knowledge and enable decision- making about the program, process, or organization (e.g., Patton, 2003; Preskill & Torres, 1999; Scriven, 1991). Appreciative Inquiry as a philosophy and process with powerful questioning, innovative methods of reframing, and high engage- ment can contribute signifi cantly to evaluation.

As documented by Preskill and Catsambas (2006), the AI approach has been applied in a wide range of evaluation initiatives and contexts (e.g., intranet, staff education, confl ict resolution, a holistic health centre, a coalition of sexual assault programs, a Girl Scouts’ program, youth programs, seniors programs, healthcare, and development aid programs). Reed and Turner (2005) describe an evaluation of development strategies in cancer services. My colleagues and I have used an AI approach with social housing, homelessness, the arts, healthcare, arts programs, leadership development initiatives, and in several recruiting, selection, learning, and staff development programs within various United Nations agencies.

Not limited to social programs in the public and not-for-profi t sectors, AI has been applied even more extensively in the private sector. Th e early evaluation study of Glaxo, Smith, Klein in the UK by Mohr, Smith, and Watkins (2000) was the fi rst private-sector introduction to the AI application in evaluation. Since then, for example, I have used the approach with a Canadian insurance company as well as a logistics and transportation company as part of a process to evaluate the impact of their strategic plans. Naturally, there were those who wanted to focus on defi cits and failures and others who were tired of the defi cit focus and wanted something useful going forward. In the end, however, they derived value for their companies from the appreciative approach through a better understanding of what worked, reframing defi cits and generating innovative actions for the future. In his articles on knowledge management and evaluating innovation, Perrin (2002, 2006) provides many clues to how an appreciative approach could be used to identify good practices in an evaluation process.

Th ere have been and will continue to be criticisms of Appreciative Inquiry (Golembiewski, 1998; Grant & Humphries, 2006; van der Haar & Hosking 2004) that will no doubt strengthen its practice. Many practitioners brought up on traditional organization development processes such as SWOT (Strengths, Weak- nesses, Opportunities, Th reats; Chapman, 2007) and root cause analysis (Hirsch & Wallace, 2001) are well steeped in defi cit approaches and can be initially skeptical about the AI approach, feeling that the apparent focus on “the positive” represents a distorted view of reality. Some have argued that AI glosses over and stifl es the pain of people by establishing the veneer of positivity. Bushe, writing extensively (2001, 2004, 2007, 2011, 2012) on Appreciative Inquiry applications as well as its strengths and weaknesses, has carefully examined the views of critics. He has been able to point out the misinterpretations, misunderstandings, and valuable insights of critics as well as areas for further research. He describes Cooperrider’s impor- tant comments about defi cit theories of change shared in personal correspond- ence between them: “We are still in our infancy in understanding non‐defi cit, strength‐based, or life‐centric approaches to change,” says Cooperrider, and “I

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don’t think we really understand the possibilities in that kind of change yet and we aren’t going to understand them until we take this to the extremes” (Bushe, 2011, p. 19).

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Martinetz, C. F. (2002). Appreciative inquiry as an organizational development tool. Perfor- mance Improvement, 41(8), 34–39. http://dx.doi.org/10.1002/pfi .4140410809

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McGuire, M. (2006). Toronto Community Housing Corporation – Evaluation of the Tenant Participation System using an Appreciative Inquiry approach. Retrieved from http:// cathexisconsulting.ca/2006/07/evaluation-of-the-city-wide-tenant-participation- system/

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Miller, M. G., Fitzgerald, S. P., Murrell, K. L., Preston, J., & Ambekar, R. (2005). Apprecia- tive inquiry in building a transcultural strategic alliance. Journal of Applied Behavioral Science, 41(1), 91–110. http://dx.doi.org/10.1177/0021886304273060

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Orem, S., Binkert, J., & Clancy, A. L. (2007). Appreciative coaching: A positive process for change. San Francisco, CA: Jossey-Bass Business & Management.

Patton, M. Q. (2003). Inquiry into appreciative evaluation. In H. Preskill & A. T. Coghlan (Eds.), Using appreciative inquiry in evaluation: New Directions for Evaluation, 100 (pp. 85–99). San Francisco, CA: Jossey-Bass.

Perrin, B. (2002). How to—and how not to—evaluate innovation. Evaluation, 8(1), 13–28. http://dx.doi.org/10.1177/1358902002008001514

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AUTHOR INFORMATION David J. MacCoy is a founding partner of First Leadership Limited, an organization devel- opment and coaching fi rm, based in Toronto, Ontario. He is a practitioner of Appreciative Inquiry, an organization analysis and development approach to planning, implementing, and evaluating change. With over 35 years of consulting experience in North America and Europe, his particular interest is assisting leaders and teams in the co-construction of solutions for improved performance.

at SciVerse ScienceDirect

Journal of Hand Therapy 26 (2013) 282e286

Contents lists available

Journal of Hand Therapy

journal homepage: www.jhandtherapy.org

JHT READ FOR CREDIT ARTICLE #275. Practice Forum

A systems change: Leading the way to meeting health needs

Mirella Deisher OTD, MS, OTR/L, CHT *

St. Luke’s Physical Therapy, Anderson Campus-Hand Therapy, 1700 Riverside Circle, Easton, PA 18045, USA

a r t i c l e i n f o

Article history: Received 2 March 2013 Accepted 3 March 2013 Available online 4 May 2013

Keywords: Program development Leadership Strategic planning SWOT analysis Needs assessment Hand therapy Carpal tunnel syndrome Cubital tunnel syndrome

* Tel.: þ1 484 714 8925. E-mail addresses: [email protected], dm

0894-1130/$ e see front matter � 2013 Hanley & Bel http://dx.doi.org/10.1016/j.jht.2013.03.001

a b s t r a c t

Demonstrating the efficacy of our practice requires a paradigm shift. Becoming an effective leader and clinician can facilitate opportunities for program development and clinical research. The use of strategic planning strategies, such as needs assessment and SWOT analysis, can help lead the way to such change. The following illustrates the use of strategic planning to develop The Carpal and Cubital Tunnel Syndrome Program (CCTSP) within a growing orthopedic practice.

� 2013 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.

In today’s changing healthcare environment, hand therapists find themselves in positions where they need to advocate for themselves and for their patients. This therapist describes her process of utilizing business concepts to implement a new program in her clinic to better serve patientsdVictoria Priganc, Ph.D., OTR, CHT, CLT, Practice Forum Editor.

Carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) continue to be a primary referral for the hand surgeon. However, as observed within a growing orthopedic practice, the lack of evidence regarding the efficacy of many hand therapy interventions directly impacts referral patterns. To date, the only therapy-related interventions that have been acknowl- edged as efficacious by the American Academy of Orthopedic Surgeons (AAOS) for conservative management of carpal tunnel syndrome are the use of orthotics and low dose ultrasound.1

Consequently, interventions that we have observed to con- tribute to good outcomes, such as activity modification and nerve gliding, are not recognized as being efficacious due to insufficient evidence. Anecdotal evidence is no longer adequate to justify therapy referral; instead referral is appropriately driven by scientific evidence that demonstrates some level of effectiveness.

[email protected].

fus, an imprint of Elsevier Inc. All

Strategic planning: a means to evoke change

Accordingly, it falls upon the hand therapist to lead the way in demonstrating the efficacy of our practice. To facilitate this change, we need a paradigm shift. We must think of ourselves as effective leaders, as well as clinicians. Leaders initiate change within orga- nizations or systems to support identified health needs, as well as clinical research needs. Thus, to create change within our ortho- pedic practice and increase the role of hand therapy in the management of patients with CTS and CuTS, strategic planning strategies were utilized. Namely, a needs assessment and a SWOT analysis were employed to develop The Carpal and Cubital Tunnel Syndrome Program (CCTSP), a program that indicates a one session therapy evaluation and treatment patient satisfaction.

The needs assessment was used to identify health problems that should be addressed in future programs. It served as a starting point for planning, implementing, and evaluating the program, as well as providing information about which interventions were needed and the population to be served. In this case, the needs assessment was utilized to demonstrate how our patients, the hand surgeons, and the organization could benefit from the use of hand therapy in the management of mild to moderate CTS and CuTS.

Based on the AAOS Clinical Practice Guidelines1 for the treat- ment of carpal tunnel syndrome, the only hand therapy interven- tion that was routinely prescribed at this practice for mild CTS was a night orthotic. Patients with CuTS were treated similarly; referred

rights reserved.

Table 1 MATRIX: prioritizing needs for the CCTSP based on importance and changeability

Most important Least important

Most changeable Providing patient education. Screening for rehab needs. High patient satisfaction. Appropriate utilization of conservative treatment (rehab).

Increasing productivity of all staff. Increasing patient volumes. Creating treatment algorithms & internal clinical pathways.

Least changeable Peer buy-in to value EPB and clinical research. Creating buy-in to contribute toward clinical research and outcomes studies. Decreasing patient populations out of work time. Increasing patient adherence to HEP.

Getting the organization to invest in clinical research and outcomes research. Obtaining funding for program development and growth. Obtaining funding for related skill development and education.

M. Deisher / Journal of Hand Therapy 26 (2013) 282e286 283

to formal therapy only on occasion. Thus, the CCTSP program proposed that all patients receive at least one therapy session that would occur immediately after their appointment with the hand surgeon. This visit would include an evaluation to obtain impairment and disability measures, as well as providing one treatment session. The treatment session would include custom orthotics, home exer- cises including tendon and nerve gliding, and education regarding activity modification. At the end of the session, a patient satisfaction score would be obtained using a visual analog scale (VAS).

Likewise, patients scheduled for endoscopic carpal or cubital tunnel release were also typically not referred to therapy. While in most cases therapy was not indicated postoperatively, the CCTSP program proposed that these patients would be evaluated and treated prior to surgery. This preoperative session would provide the same exercises; however, patients would also be instructed on scar and edema management. Additionally, this preoperative session would serve as an opportunity to facilitate appropriate patient expectations with regards to the procedure, the healing process, and their outcomes.

Facilitating realistic and appropriate patient expectations were presented as a potential means to increase patient adherence, satis- faction, and ultimately outcomes.2 The data collected from the hand therapy sessionwould also provide uswith necessary information to assess the effectiveness of the program to achieve these objectives. It was ultimately this factor that unified all involved stakeholders in a decision to move forward with implementing the program.

Table 2 SWOT analysis of current practice environment. The Carpal and Cubital Tunnel Syndrom

Strengths W

� Provider of rehab services of growing orthopedic group. � Funding for on-site continuing education opportunities. � Good management with effective communication systems and procedures. � Interdisciplinary collaboration. � Multiple satellite locations for consumer convenience. � Steady referral stream from orthopedic surgeons. � Marketing funds and support to promote specialized treatment programs. � Orthopedic surgeons that value therapy input and conservative approaches. � Highly skilled staff, most having doctoral degrees and advanced training in

specialty areas. � On-line resources to support and/or advance practice. � High emphasis on patient centeredness and patient satisfaction.

� �

� � � �

�

Opportunities T

� Health care reform legislation signed into law: therapy cap exceptions process, market reforms and coverage of rehab and habilitation included, and protection of OTs scope of practice in prosthetics and orthotics.

� Regular referrals from sources outside of the network. � Provision of services on-site during orthopedic physician office hours with

follow-up provided at satellite clinic. � Partnership with University medical school thus bringing more visibility to the

growing healthcare network. � A teaching hospital provides opportunity to educate residents to the value and

diversity of rehabilitation services. � Growing orthopedic practice with plans to hire two additional hand surgeons. � The company is in the process of expanding, opening new satellites and hiring

additional therapists.

� �

� � � �

�

Implementation of The Carpal and Cubital Tunnel Syndrome Program

In an effort to demonstrate a plan for efficient and effective implementation of the proposed program, thematrix in Table 1was created to prioritize identified needs based on importance and changeability. For example, high patient satisfaction was identified as being both important and changeable to all stakeholders, such as the physicians, hospital administration, therapists, and patients. Therefore, patient satisfaction was a measure the program was designed to improve and assess. Ultimately, all of the components of the needs assessment helpedmake this program defendable, and it helped create “buy-in” from the involved stakeholders.3

In addition to performing a needs assessment, a SWOT analysis was also performed. SWOT is an acronym for Strengths, Weak- nesses, Opportunities, and Threats, and it provides a thorough analysis of an organization’s internal and external environments. The analysis of the internal environment identifies strengths and weaknesses, whereas the analysis of the external environment identifies opportunities and threats.4

The purpose of performing a SWOT analysis from a healthcare provider perspective is to improve the provision of rehabilitation services, increase the consumer base, and improve quality of care, patient outcomes, and patient satisfaction. While these purposes complementeachother, they requiredistinct strategicplanningwhich the SWOT analysis helps to highlight.4 Thus, while the support of the

e Program (CCTSP)

eaknesses

Prolonged delay or lag-time in implementing plans for change or development. Decreased opportunity to regularly collaborate and build relationships with staff due to multiple satellite locations. Decreased intervention time due to productivity requirements. Productivity requirements influencing treatment design. Schedule conflicts to attend all in-services and meetings. Lack of carryover or compliance to home exercises and postural/ergonomic recommendations affecting DASH scores. Minimal role of therapy with carpal and cubital tunnel patients with the excep- tion of orthotics.

hreats

Decreased utilization of services due to high co-pays and weak economy. Acquiring updated equipment and modalities to all satellites for consistent state- of-the-art care. Strict reimbursement guidelines/denial of coverage/audits. Reimbursement limitations based on efficacy studies or lack thereof. Competition of other growing orthopedic groups having their own rehab staff. The effect of increasing costs to small business (healthcare, taxes) on employee benefits and pay. Financial, social and political barriers to support balanced and productive healthcare reform.

Fig. 1. Algorithm: development of The Carpal and Cubital Tunnel Syndrome Program (CCTSP).

M. Deisher / Journal of Hand Therapy 26 (2013) 282e286284

referring hand surgeon was an identified internal strength, therapy productivity requirementsproved tobea ‘weakness’ that needed tobe navigated in order to maintain stakeholder support (see Table 2).

Understandably, hospital administration was concerned about the involved overhead in providing services that would not be billed; providing a billable service was important from their perspective. Conversely, the hand surgeon was concerned about billing for therapy particularly when the patient had minimal impairment. Thus, a consensus needed to be reached regarding what would constitute a billable service. Ultimately, it was agreed that only patients demonstrating impairments that warranted formal therapywould be billed. The evaluationwould be conducted on site and the treatment sessions would occur at the satellite location of their choice. Patients who were provided only a home program would not be billed.

Ultimately, the CCTSP promoted a systems change through three initiatives: 1) the provision of services that had not been routinely prescribed, namely a comprehensive home program for preopera- tive patients as well as those managed conservatively; 2) the implementation and documentation of a systematic protocol, to provide appropriate services to patients with CTS and CuTS seen during physician office visits, as well as to screen for those that would benefit from formal outpatient hand therapy and 3) the analysis and evaluation of the protocol for development of formal outcome studies, such as the utilization of therapy services post operatively and the level of patient satisfaction.

In the end, both the needs assessment and the SWOT provided a roadmap for the successful implementation of The Carpal and

Cubital Tunnel Syndrome Program. The algorithm in Fig. 1 provides a simplified depiction of how these strategic planning techniques facilitated the process.

Results

During a six-week trial period, patient satisfaction scores for 28 preoperative patients averaged 8.7 out of 10 on a visual analog scale (VAS). As a result of implementation of the CCTSP, 15 patients were referred for outpatient therapy services, and 59 other carpal and cubital tunnel patients were given home exercises. One of the most significant outcomes of the program, however, has been the increased involvement of hand therapy to manage this patient population. During this trial period, 20% of patients with one of these two diagnoses were referred to outpatient hand therapy.

Conclusion

Within this orthopedic practice, the success of the CCTSP has shown that demonstrating the efficacy of hand therapy to produce favorable patient satisfaction outcomes directly impacts the utilization of our skills and expertise. Of greater significance, however, it has reinforced that clinicians can facilitate a ‘systems change.’

Stepping into a leadership role and utilizing a systematic approach for program development force us to redefine the tradi- tional role of a clinician. However, the ensuing collaborative process among involved stakeholders can facilitate meeting evolving health

M. Deisher / Journal of Hand Therapy 26 (2013) 282e286 285

needs, support clinical research, and ultimately contribute to the legacy of our evolving profession.

References

1. American Academy of Orthopedic Surgeons. Clinical practice guidelines: treat- ment of carpal tunnel syndrome. J Am Acad Orthop Surg. 2008. http:// www.aaos.org/research/guidelines/guide.asp. Retrieved 10.10.10.

2. Marks M, Herren DB, Vilet Vlieland T, Simmen BR, Angst F, Goldhahn J. Deter- minants of patient satisfaction after orthopedic interventions to the hand: a review of the literature. J Hand Ther. 2011;24(4):303e311.

3. Issel M. Health Program Planning and Evaluation: A Practical, Systematic Approach for Community Health. Sudbury, Massachusetts: Jones and Bartlett Publishers; 2009.

4. Houben G, Lenie K, Vanhoof K. A knowledge-based SWOT analysis system as an instrument for strategic planning in small and medium sized enterprises. Decis Support Syst. 1999;26:125e135.

M. Deisher / Journal of Hand Therapy 26 (2013) 282e286286

JHT Read for Credit Quiz: #275

Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.

#1. The SWOT analysis advocated by the author is taken from the __________playbook

a. NFL b. Stanford MBA c. Johns Hopkins Medical School d. Ohio State OT School

#2. The only conservative intervention routinely suggested in the AAOS Clinical Practice Guidelines for CTS is

a. US b. nerve gliding c. AROM in the DTM d. resting orthotics

#3. According to the author the typical carpal tunnel or cubital tunnel patient

a. requires numerous therapy sessions post-surgical release b. does not re c. does not require therapy post-surgical release d. does not require a pre-surgical therapy session

#4. The primary problem that the author feels we need to address is

a. the ineffectiveness of our interventions b. lack of evidence to support our interventions c. the close-mindedness of the insurance industry regarding

reimbursement for our interventions d. to improve the leadership course work in our academic

training

#5. The author feels the profession is in need of a paradigm shift to

demonstrate our efficacy

a. true b. false

When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

AORN Journal  425  

PRESIDENT’S MESSAGE

20/20 Vision: Creating Our Future

Missi Merlino, MHA, RN-BC, CNOR, CSSM

The history of AORN is one of working to improve patient safety, establishing the standards of pro- fessional perioperative practice, and promoting

positive change to members and others in an ever- changing health care environment. Reflecting on the accomplish- ments of those who have held the office of AORN Presi- dent, I am reminded that, as nurses, we are never alone in striving for excellence. It is our combined efforts and camaraderie that have helped us to thrive through many transformations and to show the surgical community the power nurses have in influencing patient safety. However, we cannot dwell on our past successes; how we respond to today’s health care challenges will be our legacy. If we make the right choices today, AORN’s future will be even better than its past. For my presidential year, I selected the theme 20/20 Vision: Creating Our Future to represent setting the course for our future by looking back and looking forward and finding that balance in our practice and our Association.

STRATEGIC PLAN Every day, nurses balance the use of evidence- based guidelines with hospital policies, our knowledge and skills, and the needs of the patient. Similarly, to continue to move the Association forward, we need to balance the needs of members and industry partners. During the past several years, we have seen an increase in mergers and acquisi- tions in health care that have affected industry partners and the organizations in which we work. Amid these changes, AORN must continue to be diligent in its efforts to align with other organizations and be the indispensable resource for perioperative practice while supporting all members. The AORN Board of Directors is charged with setting the strategic direction of the Association. AORN’s 2019 strategic plan includes the following goals.

• Strengthen and grow membership value and benefits.

• Develop a communication and marketing strategy and plan that strengthens AORN’s reputation as the pri- mary perioperative solution for perioperative nurses, industry, and health care facilities.

• Combine the Ambulatory Surgery Division and the Outpatient Surgery Division to create a new division to address the needs of the ambulatory surgery market by combining resources to achieve maximum business opportunities.

• Invest and operationalize digital resources to grow and compete in the marketplace.

• Effectively manage the industry partners that support the mission of the AORN enterprise.

• Invest and collaborate with companies that will grow revenues and market share for AORN, Inc.

VOLUNTEER LEADERS AND MENTORS The organization I work for has a philosophy that all nurs- es are “bedside leaders.” To me, this exemplifies who we are; regardless of formal title, by virtue of being nurses we are expected to lead. I have observed that some attri- butes of leadership are universal. Leaders have a clear vision, teach, and inspire others to build platforms to drive change. Volunteer leadership is very much about learning, sharing, and mentoring for the betterment of the profes- sion and the Association. The strength of our Association lies in the committee and task force volunteers who help shape our products and policies. Below is just a sample of some of the volunteer efforts taking place in 2019.

This year, the AORN Clinical Nursing Practice Committee initiatives include developing a robotics orientation tool

http://doi.org/10.1002/aorn.12657 © AORN, Inc, 2019

426  AORN Journal

Merlino April 2019, Vol. 109, No. 4

kit and resources for handling intraoperative robotic sys- tem failure. Several position statements are up for review by micro volunteers, including

• Role of Health Care Industry Representatives in the Perioperative/Invasive Procedure Setting,

• Distractions and Noise in the Perioperative Practice Setting, and

• Environmental Responsibility.

The Guidelines Advisory Board initiatives will include review and revision of the guidelines for

• surgical attire,

• prevention of unplanned patient hypothermia,

• sharps safety,

• selection and use of packaging systems for sterilization,

• autologous tissue management, and

• environmental cleaning.

Your input through public comment is encouraged so the guidelines will remain relevant in all of our diverse settings.

The AORN Board of Directors approves a legislative poli- cy agenda based on the recommendations of the National Legislative Forum and the Government Affairs department. This is to ensure that we continue to strengthen and expand state- level relationships, advance RN circulator legislation, protect perioperative RN scope of practice, advocate for safe work environments (smoke evacuation and safe patient handling), and ensure perioperative nursing’s voice in feder- al reform efforts. All members are welcome and encouraged to participate in the monthly National Legislative Forum calls, which cover important legislative affairs.

In 2018, the Fellowship Level of Membership Task Force was created to explore the need for a fellowship level of membership and establish criteria. This year, we will advance this work through the Fellowship Selection Committee with the installation of AORN Perioperative Fellows, which recognizes the body of work these dedicated professionals have accomplished throughout their careers.

The importance of growing our own replacements was imparted to me early in my career. The Recruitment and Retention of Perioperative Nurses Task Force will con- sist of highly motivated nurse leaders to identify creative methods to recruit and retain nurses to the perioperative specialty. My vision is to focus not only on nurses new to

our profession but also to encourage experienced nurses to consider a career change and embrace the amazing world of perioperative nursing.

After reading AORN: Emergence and Growth, I am reminded that all generations have faced the challenge of balanc- ing longstanding traditions and the wisdom of those who have shaped the profession and the Association with the need to grow new leaders; this is not a new concept, as described in the following quote.

Today’s young and ambitious members have different needs and values and practice a dif- ferent kind of nursing. These younger mem- bers must be given a similar opportunity to build “their” Association with the benefits— but not the fetters—of the past.1(p185)

Engaging the next generation of leaders to be as commit- ted as those who have led us in the past will help ensure a strong future for our profession and our Association. Throughout the year, there will be more volunteer opportu- nities. I encourage you to share your passion and knowledge of perioperative nursing through volunteering, so please watch for Periop Today newsletters for more information.

CONCLUSION I love the history and traditions of AORN, and my career has been enriched and framed by those who took the time to teach, share stories, and mentor me. As your President, I will encourage our members to combine their efforts, talents, insights, enthusiasm, and inspiration as we work together to create our future. I am honored and humbled by this opportunity to serve you and the profession I dearly love.

REFERENCE 1. Murphy EK. Emergence and growth throughout the

years. In: Glass LK, Murphy EK, eds. AORN: Emergence and Growth. Denver, CO: AORN, Inc; 2002.

Missi Merlino, MHA, RN- BC, CNOR, CSSM, is the AORN President and staff nurse II at Baylor Scott & White Medical Center, Temple, TX. Ms Merlino has no declared affiliation that could be perceived as posing a potential con- flict of interest in the publication of this article.

Reproduced with permission of copyright owner. Further reproduction prohibited without permission.

ACHE HEALTHCARE EXECUTIVE 2020 COMPETENCIES ASSESSMENT TOOL

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives1

The American College of Healthcare Executives’ Healthcare Executive Competencies Assessment Tool is offered as an instrument for healthcare leaders

to use in assessing their expertise in critical areas of healthcare management.

How to Use This Tool This tool can be used in several different ways to identify areas of strength and areas that may need professional skill development as well as formulating a development plan. Some examples of how this tool can be used are listed below.

• Self or organizational assessment. The tool is designed to help you identify strengths and areas for development in relation to ACHE’s competencies. It may provide valuable information in your performance planning and review.

• Team or group development. The tool may help link individual performance to the goals of the organization. Integrating knowledge and skills needed for effective leadership will allow team members to achieve corporate goals, objectives and values.

• Employee selection or job descriptions. The tool may provide the ability to look beyond the individual and understand the composition of the entire workforce by exploring the strengths, weaknesses and gaps across the organization. You can make more informed decisions regarding training initiatives, allocate resources more effectively and align development opportunities with organizational goals.

• Academic or professional development programs. The tool may help uncover knowledge and skills you may wish to update or improve. Once you have completed the ratings, you will get results that point to the competencies you should focus on when choosing professional development opportunities.

This tool is self-scored with no right or wrong answers. Use the results to make a development plan, and complete the ACHE Competencies Assessment Tool at desired intervals to measure growth over time.

To assess expertise in the five domains of this tool, consider where you, the person, or the team you are assessing would fall on the scale of skill acquisition.

• Novice (1)–An individual’s primary focus is understanding and gaining information in order to comprehend the skills needed. You have the level of experience gained in a classroom setting or on-the- job training. You are expected to need help when performing this skill.

• Competent (3)–People with considerable experience develop competence in solving problems within the learned guidelines and rules. You are able to successfully complete the competency as requested. Help from experts may be required from time to time, but you can usually perform the skill independently.

• Expert (5)–Experts work intuitively analyzing, recognizing patterns, critiquing and solving problems with ideas and expertise. You are known as the expert in this area. You can provide guidance, troubleshoot and answer questions related to this competency.

For your convenience, a complete list of ACHE resources, including readings, programs, assessments, and self-study courses are included in the back of the directory and referenced by number in each section of the assessment.

About This Tool The competencies are derived from job analysis surveys of healthcare leaders across various management and administration disciplines. They are aligned with the challenges and opportunities experienced by leaders today. The tool is reviewed and updated annually.

Professionalism

Leadership

Knowledge of the

Healthcare Environment

Business Skills and

Knowledge

Communication and Relationship

Management

*derived from HLA Model

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 2

Within the ACHE Healthcare Executive Competencies Assessment Tool, the competencies are categorized into five critical domains: Communication and Relationship Management, Leadership, Professionalism, Knowledge of the Healthcare Environment and Business Skills and Knowledge. The definitions for the domains are as follows:

1. Communication and Relationship Management The ability to communicate clearly and concisely with internal and external customers, establish and maintain relationships and facilitate constructive interactions with individuals and groups. This domain includes:

A. Relationship Management B. Communication Skills C. Facilitation and Negotiation

2. Leadership The ability to inspire individual and organizational excellence, create a shared vision and successfully manage change to attain the organization’s strategic ends and successful performance. Leadership intersects with each of the other four domains. This domain includes:

A. Leadership Skills and Behavior B. Organizational Climate and Culture C. Communicating Vision D. Managing Change

3. Professionalism The ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and community, a service orientation, and a commitment to lifelong learning and improvement. This domain includes:

A. Personal and Professional Accountability B. Professional Development and Lifelong Learning C. Contributions to the Community and Profession

4. Knowledge of the Healthcare Environment The understanding of the healthcare system and the environment in which healthcare managers and providers function. This domain includes:

A. Healthcare Systems and Organizations B. Healthcare Personnel C. The Patient’s Perspective D. The Community and the Environment

5. Business Skills and Knowledge The ability to apply business principles, including systems thinking, to the healthcare environment. This domain includes:

A. General Management B. Financial Management C. Human Resource Management D. Organizational Dynamics and Governance E. Strategic Planning and Marketing F. Information Management G. Risk Management H. Quality Improvement I. Patient Safety

Healthcare leaders should demonstrate competence in aspects of all five of these domain areas. As you work your way through the ACHE Competencies Assessment Tool, we hope you will find it valuable and that it provides guidance along your path of lifelong professional education as you face the ongoing challenges of management and leadership. We have made it available as a PDF file at ache.org/CareerResources and hope you will share it with other healthcare leaders.

About the Competencies The competencies were derived from job analysis surveys conducted by Healthcare Leadership Alliance associations. In addition to the American College of Healthcare Executives, members of the Healthcare Leadership Alliance are American Association of Physician Leadership, American Organization of Nurse Executives, Healthcare Financial Management Association, Healthcare Information and Management Systems Society and Medical Group Management Association.

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives3

COMPETENCY LEVEL

Novice Competent Expert

1. Communication and Relationship Management

A. Relationship Management

Organizational structure and relationships 1 2 3 4 5

Build collaborative relationships 1 2 3 4 5

Demonstrate effective interpersonal relations 1 2 3 4 5

Develop and maintain medical staff relationships 1 2 3 4 5

Develop and maintain supplier relationships 1 2 3 4 5

Identify stakeholder needs/expectations 1 2 3 4 5

Provide internal customer service 1 2 3 4 5

Practice and value shared decision making 1 2 3 4 5

Other professional norms and standards of behaviors as defined by professions such as AHA, physician’s oaths and other professional pledges 1 2 3 4 5

Creating an ethical culture in an organization 1 2 3 4 5

Readings: 3, 11, 17, 18, 21, 23, 31, 34, 57, 59, 67, 74, 84, 86, 88, 91, 101, 102, 108, 112 Programs: 8, 9, 10, 14, 15, 21, 36, 37, 39, 44, 48, 50, 51, 60 Leadership Assessments: 1, 2, 6, 7, 8 Self-Study Courses: 2, 3, 18

B. Communication Skills

Public relations 1 2 3 4 5

Principles of communication and their specific applications 1 2 3 4 5

Sensitivity to what is correct behavior when communicating with diverse cultures, internal and external 1 2 3 4 5

Communicate organizational mission, vision, objectives and priorities 1 2 3 4 5

Identify and use human and technical resources to develop and deliver communications 1 2 3 4 5

Prepare and deliver business communications, including meeting agendas, presentations, business reports and project communications plans 1 2 3 4 5

Present results of data analysis to decision makers 1 2 3 4 5

Provide and receive constructive feedback 1 2 3 4 5

Use factual data to produce and deliver credible and understandable reports 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 4

COMPETENCY LEVEL

Novice Competent Expert

Readings: 11, 21, 23, 25, 86 Programs: 9, 14, 36, 38, 48, 58 Leadership Assessments: 7, 8

C. Facilitation and Negotiation

Mediation, negotiation and dispute resolution techniques 1 2 3 4 5

Team building techniques 1 2 3 4 5

Labor relations strategies 1 2 3 4 5

Build effective physician and administrator leadership teams 1 2 3 4 5

Create, participate in and lead teams 1 2 3 4 5

Facilitate conflict and alternative dispute resolution 1 2 3 4 5

Facilitate group dynamics, process, meetings and discussions 1 2 3 4 5

Readings: 3, 11, 22, 36, 69, 74, 84, 87, 98, 100, 106, 108, 112 Programs: 3, 36, 38, 44, 48, 60 Leadership Assessments: 5, 7, 8 Self-Study Courses: 2, 18, 19, 24

COMMUNICATION AND RELATIONSHIP MANAGEMENT DEVELOPMENT PLAN

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives5

COMPETENCY LEVEL

Novice Competent Expert

2. LEADERSHIP

A. Leadership Skills and Behavior

Leadership styles/techniques 1 2 3 4 5

Leadership theory and situational applications 1 2 3 4 5

Potential impacts and consequences of decision making in situations both internal and external 1 2 3 4 5

Adhere to legal and regulatory standards 1 2 3 4 5

Champion solutions and encourage decision making 1 2 3 4 5

Develop external relationships 1 2 3 4 5

Collaborative techniques for engaging and working with physicians 1 2 3 4 5

Incorporate and apply management techniques and theories into leadership activities 1 2 3 4 5

Foster an environment of mutual trust 1 2 3 4 5

Support and mentor high-potential talent within the organization 1 2 3 4 5

Advocate and participate in healthcare policy initiatives 1 2 3 4 5

Readings: 3, 6, 15, 19, 22, 23, 36, 38, 50, 54, 57, 59, 76, 81, 82, 83, 85, 86, 88, 105, 106 Programs: 3, 8, 9, 21, 32, 34, 38, 44, 48, 50, 59, 60 Leadership Assessments: 1, 2, 4, 7, 8 Self-Study Courses: 1, 3, 5, 7, 13, 19

B. Organizational Climate and Culture

Create an organizational climate that encourages teamwork 1 2 3 4 5

Create an organizational culture that values and supports diversity 1 2 3 4 5

Knowledge of own and others’ cultural norms 1 2 3 4 5

Assess the organization, including corporate values and culture, business processes and impact of systems on operations 1 2 3 4 5

Readings: 21, 23, 31, 37, 45, 57, 82, 87, 90, 95, 102, 106 Programs: 2, 8, 10, 16, 23, 33, 36, 48, 50, 60 Leadership Assessments: 8 Other: 3

C. Communicating Vision

Establish a compelling organizational vision and goals 1 2 3 4 5

Create an organizational climate that facilitates individual motivation 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 6

COMPETENCY LEVEL

Novice Competent Expert

Encourage a high level of commitment to the purpose and values of the organization 1 2 3 4 5

Hold self and others accountable for organizational goal attainment 1 2 3 4 5

Gain physician buy-in to accept risk and support new business ventures 1 2 3 4 5

Readings: 18, 22, 23, 36, 74, 82, 84, 85, 87, 88, 106, 112, 123 Programs: 2, 10, 14, 36, 37, 48 Leadership Assessments: 8 Self-Study Courses: 1, 13, 19

D. Managing Change

Promote and manage change 1 2 3 4 5

Explore opportunities for the growth and development of the organization on a continuous basis 1 2 3 4 5

Promote continuous organizational learning/improvement 1 2 3 4 5

Anticipate and plan strategies for overcoming obstacles 1 2 3 4 5

Anticipate the need for resources to carry out initiatives 1 2 3 4 5

Develop effective medical staff relationships in support of the organization’s mission, vision and strategic plan 1 2 3 4 5

Readings: 1, 2, 3, 6, 11, 17, 18, 21, 22, 23, 26, 35, 36, 39, 57, 61, 67, 74, 82, 84, 85, 87, 88, 90, 100, 102, 104, 108, 112 Programs: 2, 8, 25, 32, 34, 36, 37, 38, 39, 48, 59, 60 Leadership Assessments: 4, 6 Self-Study Courses: 2, 13, 18

LEADERSHIP DEVELOPMENT PLAN

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives7

COMPETENCY LEVEL

Novice Competent Expert 3. PROFESSIONALISM

A. Personal and Professional Accountability

Patient rights and responsibilities 1 2 3 4 5

Ethics committee’s roles, structure and functions 1 2 3 4 5

Consequences of unethical actions 1 2 3 4 5

Organizational business and personal ethics 1 2 3 4 5

Cultural and spiritual diversity for patients and staff as they relate to healthcare needs 1 2 3 4 5

Conflict of interest situations as defined by organizational bylaws, policies and procedures 1 2 3 4 5

Professional roles, responsibility and accountability 1 2 3 4 5

Professional standards and codes of ethical behavior 1 2 3 4 5

Balance professional and personal pursuits 1 2 3 4 5

Uphold and act upon ethical and professional standards 1 2 3 4 5

Adhere to ethical business principles 1 2 3 4 5

Other professional norms and standards of behaviors as defined by professions such as AHA, physician’s oaths and other professional pledges 1 2 3 4 5

Creating an ethical culture in an organization 1 2 3 4 5

Readings: 34, 36, 67, 84, 86, 93, 94, 119 Programs: 21, 34, 48, 51 Other: 1, 2, 4, 5, 6, 8

B. Professional Development and Lifelong Learning

Professional norms and behaviors 1 2 3 4 5

Professional societies and memberships 1 2 3 4 5

Contribute to professional knowledge and evidence 1 2 3 4 5

Time and stress management techniques 1 2 3 4 5

Conduct self-assessments 1 2 3 4 5

Network with colleagues 1 2 3 4 5

Participate in continuing education and career planning 1 2 3 4 5

Acquire and stay current with the professional body of knowledge 1 2 3 4 5

Readings: 28, 36, 86, 95, 117, 121 Programs: 8, 10, 32, 50, 60 Leadership Assessments: 2, 3, 7, 9 Self-Study Course: 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 8

COMPETENCY LEVEL

Novice Competent Expert

C. Contributions to the Community and Profession

Ethical implications of human subject research 1 2 3 4 5

Serve as the ethical guide for the organization 1 2 3 4 5

Practice due diligence to carry out fiduciary responsibilities 1 2 3 4 5

Mentor, advise and coach 1 2 3 4 5

Advocate for patients, families and communities 1 2 3 4 5

Advocate with physicians for the importance of hiring professionally trained and certified administrators and supporting their professional development 1 2 3 4 5

Participate in community service 1 2 3 4 5

Readings: 2, 21, 50, 57, 75, 94 Programs: 9, 27 Self-Study Courses: 1, 7, 19 Other: 7, 8

PROFESSIONALISM DEVELOPMENT PLAN

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives9

COMPETENCY LEVEL

Novice Competent Expert

4. KNOWLEDGE OF THE HEALTHCARE ENVIRONMENT

A. Healthcare Systems and Organizations

Healthcare and medical terminology 1 2 3 4 5

Managed care models, structures and environment 1 2 3 4 5

The interdependency, integration and competition among healthcare sectors 1 2 3 4 5

Levels of healthcare along the continuum of care 1 2 3 4 5

Levels of service from a business perspective 1 2 3 4 5

Evidence-based management practice 1 2 3 4 5

Healthcare economics 1 2 3 4 5

Requirements for nonprofit healthcare organizations 1 2 3 4 5

The interrelationships among access, quality, cost, resource allocation, accountability and community 1 2 3 4 5

Readings: 1, 5, 21, 25, 31, 35, 57, 62, 63, 64, 99, 104, 107 Programs: 2, 10, 30, 37, 50, 57

B. Healthcare Personnel

Ancillary services 1 2 3 4 5

Physician roles 1 2 3 4 5

The healthcare sectors 1 2 3 4 5

Staff perspective in organizational settings 1 2 3 4 5

Nurse and allied health professionals’ scope of practice 1 2 3 4 5

Support services 1 2 3 4 5

Role of nonclinical professionals in the healthcare system 1 2 3 4 5

Educational funding for healthcare personnel 1 2 3 4 5

Workforce issues 1 2 3 4 5

Readings: 14, 21, 22, 29, 40, 59, 65, 71, 86, 95, 106, 123 Programs: 8, 30, 44, 50, 51 Self-Study Courses: 3, 19

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 10

COMPETENCY LEVEL

Novice Competent Expert

C. The Patient’s Perspective

The patient’s perspective (e.g., cultural differences, expectations) 1 2 3 4 5

Readings: 2, 7, 46 Program: 29 Self-Study Course: 12

D. The Community and the Environment

Socioeconomic environment in which the organization functions 1 2 3 4 5

Healthcare trends 1 2 3 4 5

Implications of community standards of care 1 2 3 4 5

Healthcare technological research and advancements 1 2 3 4 5

Organization and delivery of healthcare 1 2 3 4 5

Community standards of care 1 2 3 4 5

Corporate compliance laws and regulations 1 2 3 4 5

Regulatory and administrative environment in which the organization functions 1 2 3 4 5

Governmental, regulatory, professional and accreditation agencies 1 2 3 4 5

Legislative issues and advocacy 1 2 3 4 5

Readings: 1, 15, 34, 46, 48, 57, 70, 81, 83, 104, 124 Programs: 9, 27, 37 Self-Study Course: 12 Other: 8

KNOWLEDGE OF THE HEALTHCARE ENVIRONMENT DEVELOPMENT PLAN

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives11

COMPETENCY LEVEL

Novice Competent Expert

5. BUSINESS SKILLS AND KNOWLEDGE

A. General Management

Ability to analyze and evaluate information to support a decision or recommendation 1 2 3 4 5

Ability to distinguish relevant from irrelevant information 1 2 3 4 5

Ability to integrate information from various sources to make decisions or recommendations 1 2 3 4 5

Collect and analyze data from internal and external sources relevant to each situation 1 2 3 4 5

Basic business contracts 1 2 3 4 5

Techniques for business plan development, implementation and assessment 1 2 3 4 5

Justify a new business model or business plan 1 2 3 4 5

Principles of public affairs and community relations 1 2 3 4 5

The functions of organizational policies and procedures 1 2 3 4 5

Analyze the current way of doing business and clinical processes 1 2 3 4 5

Anticipate cause-and-effect relationships 1 2 3 4 5

Conduct needs analysis, identify and prioritize requirements 1 2 3 4 5

Define problems or opportunities 1 2 3 4 5

Distinguish between important and unimportant aspects of business and clinical situations as a basis for sound decision making 1 2 3 4 5

Identify alternate processes and potential solutions 1 2 3 4 5

Promote and apply problem-solving philosophies 1 2 3 4 5

Utilize comparative analysis strategies 1 2 3 4 5

Demonstrate critical thinking and analysis 1 2 3 4 5

Prioritize or triage as necessary to ensure critical functions are repaired, maintained or enhanced 1 2 3 4 5

Broad systems connections—potential impacts and consequences of decisions in a wide variety of situations both internal and external 1 2 3 4 5

Systems theory 1 2 3 4 5

Systems thinking 1 2 3 4 5

Champion systems thinking 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 12

COMPETENCY LEVEL

Novice Competent Expert

Identify how a system design accommodates business processes 1 2 3 4 5

Seek information from a variety of sources 1 2 3 4 5

Evidence-based practice 1 2 3 4 5

Facilities planning 1 2 3 4 5

Inventory control systems 1 2 3 4 5

Project management 1 2 3 4 5

Purchasing procurement 1 2 3 4 5

Develop work plans 1 2 3 4 5

Perform audits of systems and operations 1 2 3 4 5

Management functions 1 2 3 4 5

Assess organizational perception of systems effectiveness and departmental effectiveness 1 2 3 4 5

Develop requests for information and requests for proposals 1 2 3 4 5

Manage vendor contracts 1 2 3 4 5

Measure quantitative dimensions of systems and departmental effectiveness 1 2 3 4 5

Organize and manage the human and physical resources of the organization to achieve input, buy-in and optimal performance 1 2 3 4 5

Readings: 5, 21, 22, 23, 31, 35, 41, 57, 58, 62, 67, 71, 79, 80, 86, 91, 98, 99, 102, 116, 123 Programs: 11, 44, 46, 62 Leadership Assessments: 1, 3, 7 Self-Study Courses: 4, 5, 9, 17, 20, 23

B. Financial Management

Basic accounting principles 1 2 3 4 5

Financial management and analysis principles 1 2 3 4 5

Financial planning methodologies 1 2 3 4 5

Financial statements 1 2 3 4 5

Outcomes measures and management 1 2 3 4 5

Reimbursement principles, ramifications and techniques, including rate setting and contracts 1 2 3 4 5

Principles of operating, project and capital budgeting 1 2 3 4 5

Fundamental productivity measures 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives13

COMPETENCY LEVEL

Novice Competent Expert

Financial controls and auditing principles 1 2 3 4 5

Revenue generation 1 2 3 4 5

Asset management, including depreciation schedule, facilities, equipment, etc. 1 2 3 4 5

Analyze financial reward versus risk 1 2 3 4 5

Apply financial planning methodologies to organizational objectives 1 2 3 4 5

Develop accounting and financial control systems 1 2 3 4 5

Develop and use performance monitoring metrics 1 2 3 4 5

Develop coding and reimbursement policies and procedures 1 2 3 4 5

Establish business relationships with financial advisors 1 2 3 4 5

Maintain compliance with tax laws and filing procedures 1 2 3 4 5

Negotiate third-party contracts 1 2 3 4 5

Provide stewardship of financial resources 1 2 3 4 5

Potential impacts and consequences of financial decision making on operations, healthcare, human resources and quality of care 1 2 3 4 5

Financing including funding sources, the process of obtaining credit and bond ratings, and issuing bonds 1 2 3 4 5

Philanthropy and foundation work, including source of funding for non-profit organizations or to target for-profit organizations’ activities 1 2 3 4 5

Supply chain systems, structures and processes 1 2 3 4 5

Readings: 10, 16, 26, 31, 41, 43, 44, 45, 49, 52, 57, 77, 90, 101, 114, 122 Programs: 2, 3, 5, 15, 23, 24, 25, 31, 44 Self-Study Courses: 14, 20, 22, 23

C. Human Resource Management

Human resources laws and regulations 1 2 3 4 5

Performance management systems 1 2 3 4 5

Recruitment and retention techniques 1 2 3 4 5

Staffing methodologies and productivity management 1 2 3 4 5

Employee satisfaction measurement and improvement techniques 1 2 3 4 5

Employee motivational techniques 1 2 3 4 5

Compensation and benefits practices 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 14

COMPETENCY LEVEL

Novice Competent Expert

Worker safety, security and employee health issues 1 2 3 4 5

Conflict resolution and grievance procedures 1 2 3 4 5

Organizational policies and procedures and their functions 1 2 3 4 5

The need for and/or desirability of outsourcing 1 2 3 4 5

The varying work environments in which staff work 1 2 3 4 5

Define staff roles, responsibilities and job descriptions 1 2 3 4 5

Manage departmental personnel processes, including performance appraisals; incentives; staff recruitment, selection and retention; training and education; coaching and mentoring 1 2 3 4 5

Job classification systems 1 2 3 4 5

Develop and implement policies and procedures with physicians to address physician behavioral and burnout issues 1 2 3 4 5

Develop and manage employee performance management systems 1 2 3 4 5

Develop effective physician recruitment and retention programs 1 2 3 4 5

Develop employee benefit and assistance plans 1 2 3 4 5

Engage in workforce planning 1 2 3 4 5

Evaluate and manage employee efficiency and productivity 1 2 3 4 5

Potential impacts and consequences of human resources 1 2 3 4 5

Decision making on operations, finances, healthcare and quality of care 1 2 3 4 5

Selection techniques, including commonly available assessments and relative benefits 1 2 3 4 5

Labor relations practices and strategies 1 2 3 4 5

Job design processes 1 2 3 4 5

Succession planning models 1 2 3 4 5

Readings: 5, 11, 22, 29, 31, 40, 41, 50, 69, 71, 86, 93, 108 Program: 8, 10, 36, 40, 50, 62 Self-Study Courses: 1, 7, 18, 19

D. Organizational Dynamics and Governance

Organization systems theories and structures 1 2 3 4 5

How an organization’s culture impacts its effectiveness 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives15

COMPETENCY LEVEL

Novice Competent Expert

Governance theory 1 2 3 4 5

Governance structure 1 2 3 4 5

Medical staff structure and its relationship to the governing body and facility operation 1 2 3 4 5

Public policy matters and legislative and advocacy processes 1 2 3 4 5

Organizational dynamics, political realities and culture 1 2 3 4 5

Principles and practices of management and organizational behavior 1 2 3 4 5

Build trust and cooperation between/among stakeholders 1 2 3 4 5

Construct and maintain governance systems 1 2 3 4 5

Document and implement policies and procedures 1 2 3 4 5

Evaluate and improve governing bylaws, policies and processes 1 2 3 4 5

Facilitate physician understanding and acceptance of good business management 1 2 3 4 5

Manage the performance of subsystems in a manner that optimizes the whole synergy 1 2 3 4 5

Interpret and integrate federal, state and local laws and regulation 1 2 3 4 5

Readings: 3, 21, 22, 29, 30, 36, 41, 54, 57, 97, 100, 101, 108, 123 Programs: 1, 10, 16, 34, 48 Self-Study Course: 19 Other: 8

E. Strategic Planning and Marketing

Business plan development and implementation process 1 2 3 4 5

Business planning, including business case and exit- strategy development 1 2 3 4 5

Evaluate whether a proposed solution aligns with the organizational business plan 1 2 3 4 5

Marketing principles and tools 1 2 3 4 5

Marketing plan development 1 2 3 4 5

Manage projects and/or resources 1 2 3 4 5

Healthcare system services 1 2 3 4 5

Implementation planning 1 2 3 4 5

Crisis and disaster planning 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 16

COMPETENCY LEVEL

Novice Competent Expert

Characteristics of strategic decision support 1 2 3 4 5

Strategic planning processes development and implementation 1 2 3 4 5

Develop and monitor departmental strategic and tactical objectives 1 2 3 4 5

Develop a benefits realization model that measures product or service performance to ensure that strategic goals are met 1 2 3 4 5

Organizational mission, vision, objectives and priorities 1 2 3 4 5

Plan for business continuance in the face of potential disasters that could disrupt service delivery 1 2 3 4 5

Pursuing and establishing partnerships and strategic alliances 1 2 3 4 5

Readings: 32, 39, 41, 52, 56, 57, 61, 69, 96, 97, 99, 104, 106, 114, 115, 116, 120 Programs: 4, 16, 23, 34, 37, 38, 48, 56, 59 Self-Study Courses: 8, 10, 11, 16

F. Information Management

Application software 1 2 3 4 5

Characteristics of administrative systems/programs 1 2 3 4 5

Characteristics of clinical systems/programs 1 2 3 4 5

Confidentiality principles and laws 1 2 3 4 5

Data analysis, including manipulation, understanding of and ability to explain data 1 2 3 4 5

Electronic education and information resources and systems 1 2 3 4 5

Health informatics 1 2 3 4 5

Information systems planning and implementation 1 2 3 4 5

Technology trends and clinical applications 1 2 3 4 5

Principles of database and file management 1 2 3 4 5

Technology privacy, confidentiality and security requirements 1 2 3 4 5

Role and function of information technology in operations 1 2 3 4 5

Testing and evaluation activities of IT systems 1 2 3 4 5

Information systems continuity 1 2 3 4 5

Analyze problem reports for trends 1 2 3 4 5

Conduct demonstrations, evaluate and select healthcare IT systems 1 2 3 4 5

Ensure accuracy and integrity of data 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives17

COMPETENCY LEVEL

Novice Competent Expert

Compatibility of software, hardware and network components to facilitate business operations 1 2 3 4 5

Ensure staff members are trained to use information systems 1 2 3 4 5

Evaluate results of a system security/privacy effectiveness assessment 1 2 3 4 5

Integrate IT systems that support decision making 1 2 3 4 5

Link the IT plan to the business plan 1 2 3 4 5

Monitor IT systems’ sustainability, reliability and maintainability 1 2 3 4 5

Monitor and adjust IT system capacity 1 2 3 4 5

Recommend policies and procedures for information management systems 1 2 3 4 5

Information systems continuity, including disaster planning, recovery, backup, security, sabotage and natural disasters 1 2 3 4 5

Factors that influence selection, acquisition, and maintenance of IT systems, including upgrades and conversions, and technology lifecycles 1 2 3 4 5

Healthcare analytics 1 2 3 4 5

Readings: 16, 31, 35, 41, 49, 58 Programs: 11, 21, 62

G. Risk Management

Risk management principles and programs 1 2 3 4 5

Confidentiality principles and laws 1 2 3 4 5

Corporate compliance laws and regulations 1 2 3 4 5

Medicare/Medicaid/third-party payment regulations 1 2 3 4 5

Inspection and accrediting standards, regulations and organizations 1 2 3 4 5

Patients’ rights, laws and regulations 1 2 3 4 5

Compliance with regulatory agencies and tax status requirements 1 2 3 4 5

Contingency planning 1 2 3 4 5

Corporate history and record-keeping procedures 1 2 3 4 5

Credentialing, medical malpractice and professional liability 1 2 3 4 5

Personnel and property security plans and policies 1 2 3 4 5

18

COMPETENCY LEVEL

Novice Competent Expert

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2019 by the Healthcare Leadership Alliance and the American College of Healthcare Executives

Professional resource networks for risk-related activities 1 2 3 4 5

Risk assessments and analyses 1 2 3 4 5

Risk mitigation 1 2 3 4 5

Risks related to personnel management 1 2 3 4 5

Risks related to quality management and patient safety 1 2 3 4 5

Conflict resolution and grievance procedures 1 2 3 4 5

Establish patient, staff and organizational confidentiality policies 1 2 3 4 5

Maintain compliance with government contractual mandates 1 2 3 4 5

Plan for business continuance in the face of potential disasters that could disrupt service delivery 1 2 3 4 5

Readings: 6, 15, 37, 66, 71, 80, 81, 104, 110, 111 Programs: 37 Self-Study Courses: 4, 11, 17

H. Quality Improvement

Benchmarking techniques 1 2 3 4 5

Medical staff peer review 1 2 3 4 5

Clinical methodologies 1 2 3 4 5

Utilization review and management regulations 1 2 3 4 5

Clinical pathways and disease management 1 2 3 4 5

National quality initiatives, including patient safety 1 2 3 4 5

Knowledge of tools for improving patient safety 1 2 3 4 5

Customer satisfaction principles and tools 1 2 3 4 5

Data collection, measurement and analysis tools and techniques 1 2 3 4 5

Patient communication systems 1 2 3 4 5

Quality improvement theories and frameworks 1 2 3 4 5

Quality planning and management 1 2 3 4 5

Recognition of quality as a strategic initiative 1 2 3 4 5

Training and certification 1 2 3 4 5

Develop and implement performance and process improvement programs 1 2 3 4 5

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives19

COMPETENCY LEVEL

Novice Competent Expert

Develop and implement quality assurance and patient satisfaction programs 1 2 3 4 5

Develop clinical pathway structure and function 1 2 3 4 5

Readings: 2, 7, 8, 9, 16, 31, 37, 41, 47, 60, 75, 78, 104, 111, 118 Programs: 2, 5, 11, 38, 44, 58 Self-Study Courses: 6, 10

BUSINESS SKILLS AND KNOWLEDGE DEVELOPMENT PLAN

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 20

COMPETENCY LEVEL

Novice Competent Expert

I. Patient Safety*

Establish and sustain a safety culture 1 2 3 4 5

Collaborate with public agencies and private organizations to support patient safety 1 2 3 4 5

Create a common set of safety metrics that reflect meaningful outcomes 1 2 3 4 5

Funding for research in patient safety and implementation science 1 2 3 4 5

Address patient safety across the care continuum 1 2 3 4 5

Support the healthcare workforce by providing a safe and healthy work environment to optimize safe patient care 1 2 3 4 5

Partner with patients and families for the safest care 1 2 3 4 5

Ensure that technology is secure and optimized to improve patient safety 1 2 3 4 5

*These competencies were adapted from original source material from the Institute for Healthcare Improvement at www.IHI.org with its permission, ©NPSF 2015.

Readings: 37, 68, 111 Programs: 50, 62 Other: 9, 10

PATIENT SAFETY DEVELOPMENT PLAN

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives21

ACHE RESOURCE LISTINGS

Readings:

1. Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation by Marc Bard, MD, and Mike Nugent 2. Achieving Service Excellence: Strategies for Healthcare, Second Edition, by Myron D. Fottler, PhD; Robert C. Ford, PhD; and

Cherill P. Heaton, PhD 3. A New Compact: Aligning Physician-Organization Expectations to Transform Patient Care by Mary Jane Kornacki, with Jack

Silversin 4. An Insider’s Guide to Physician Engagement by Andrew C. Agwunobi, MD 5. An Insider’s Guide to Working with Healthcare Consultants by Andrew Agwunobi, MD 6. Anticipate, Respond, Recover: Healthcare Leadership and Catastrophic Events by K. Joanne McGlown, PhD, RN, FACHE, and

Phillip D. Robinson, FACHE, editors 7. A Physician Guidebook to The Best Patient Experience by Bo Snyder, FACHE 8. Applying Quality Management in Healthcare: A Systems Approach, Fourth Edition, by Patrice L. Spath and Diane L. Kelly,

DrPH, RN 9. The Best Patient Experience: Helping Physicians Improve Care, Satisfaction, and Scores by Robert M. Snyder Jr., FACHE 10. Best Practice Financial Management: Six Key Concepts for Healthcare Leaders, Third Edition, by Kenneth Kaufman 11. Better Communication for Better Care: Mastering Physician-Administrator Collaboration by Kenneth H. Cohn, MD, FACS 12. Boost Your Nursing Leadership Career: 50 Lessons that Drive Success by Kenneth R. White, PhD, RN, FACHE, and Dorrie

Fontaine, PhD, RN 13. Capital Projects and Healthcare Reform: Navigating Design and Delivery in an Era of Disruption by Robert D. Levine and

Georgeann B. Burns 14. Consumer-Centric Healthcare: Opportunities and Challenges for Providers by Colin Konschak, FACHE, FHIMSS, and

Lindsey P. Jarrell, FACHE 15. Contemporary Issues in Healthcare Law and Ethics, Fourth Edition, by Dean M. Harris, JD 16. The Core Elements of Value in Healthcare by Paveljit S. Bindra, MD 17. Creating the Hospital Group Practice: The Advantage of Employing or Affiliating with Physicians by Eric Lister, MD, and Todd

Sagin, MD, JD 18. Creating Sustainable Physician-Hospital Strategies by Jay C. Warden 19. Developing Physician Leaders for Successful Clinical Integration by Carson F. Dye, FACHE, and Jacque J. Sokolov, MD 20. Dimensions of Long-Term Care Management: An Introduction, Second Edition, by Mary Helen McSweeney-Feld, PhD; Carol

Molinari, PhD; and Reid Oetjen, PhD, editors 21. Diversity on the Executive Path: Wisdom and Insights for Navigating to the Highest Levels of Healthcare Leadership by

Diane Dixon, EdD 22. Dunn and Haimann’s Healthcare Management, Tenth Edition, by Rose T. Dunn, CPA, FACHE, FHFMA 23. Dyad Leadership and Clinical Integration: Driving Change, Aligning Strategies by Alan Belasen, PhD 24. Economics for Healthcare Managers, Fourth Edition, by Robert H. Lee, PhD 25. The Economics of Health Reconsidered, Fourth Edition, by Thomas Rice, PhD, and Lynn Unruh, PhD, RN 26. 18 Levers for High-Impact Performance Improvement: How Healthcare Organizations Can Accelerate Change and Sustain Results

by Gary Auton 27. Electronic Health Records: Strategies for Long-Term Success by Michael Fossel, MD, and Susan Dorfman, DHA 28. The Emerging Healthcare Leader: A Field Guide, Second Edition, by Laurie K. Baedke, FACHE, FACMPE, and Natalie D.

Lamberton, FACHE 29. Employed Physician Networks: A Guide to Building Strategic Advantage, Value, and Financial Sustainability by David W. Miller,

FACHE; Terrence R. McWilliams, MD;and Travis C. Ansel 30. Essential Operational Components for High-Performing Healthcare Enterprises by Jon Burroughs, MD, FACHE 31. Essentials of Healthcare Management: Cases, Concepts, and Skills, Second Edition, by Leigh Cellucci, PhD; Michael R.

Meacham, JD; and Tracy J. Farnsworth, EdD 32. Essentials of Strategic Planning in Healthcare, Second Edition, by Jeffrey P. Harrison, PhD, FACHE

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 22

33. Ethics and Professionalism for Healthcare Managers by Elizabeth J. Forrestal, PhD, FAHIMA, and Leigh W. Cellucci, PhD 34. Evaluating the Healthcare System: Effectiveness, Efficiency, and Equity, Fourth Edition, by Charles E. Begley, David R. Lairson,

Robert O. Morgan, Paul J. Rowan and Rajesh Balkrishnan, PhD 35. Evidence-Based Management in Healthcare: Principles, Cases and Perspectives, Second Edition, by Anthony R. Kovner, PhD, and

Thomas D’Aunno, PhD, editors 36. Exceptional Leadership: 16 Critical Competencies for Healthcare Executives, Second Edition, by Carson F. Dye, FACHE, and

Andrew N. Garman, PsyD 37. Five Disciplines for Zero Patient Harm: How High Reliability Happens by Charles Mowll, LFACHE 38. Followership: A Practical Guide to Aligning Leaders and Followers by Tom Atchison, EdD 39. From Competition to Collaboration: How Leaders Cultivate Partnerships to Drive Value and Transform Health by Tracy L.

Duberman, PhD, FACHE, and Robert H. Sachs, PhD 40. Fundamentals of Human Resources in Healthcare, Second Edition, by Bruce J. Fried, PhD, and Myron D. Fottler, PhD, editors 41. Fundamentals of Medical Practice Management by Stephen L. Wagner, PhD, FACHE, FACMPE, FACEM, FACHT 42. Futurescan 2017: Healthcare Trends and Implications 2017–2022, copublished with the Society for Healthcare Strategy and

Market Development 43. Gapenski’s Cases in Healthcare Finance, Sixth Edition, by George H. Pink, PhD and Paula H. Song, PhD 44. Gapenski’s Fundamentals of Healthcare Finance, Third Edition, by Kristin L. Reiter, PhD, and Paula Song, PhD 45. Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies for Clinical and Financial Success by Kenneth H.

Cohn, MD, FACS, and Steven A. Fellows, FACHE 46. The Global Healthcare Manager: Competencies, Concepts, and Skills by Michael Counte, PhD; Bernardo Ramirez, MD; Daniel

J. West Jr., PhD; FACHE, FACMPE; and William Aaronson, PhD 47. Going Lean: Busting Barriers to Patient Flow by Amy C. Smith; Robert Barry, PhD; and Clifford E. Brubaker, PhD 48. The Guide to Healthcare Reform: Readings and Commentary by Daniel B. McLaughlin 49. Healthcare Applications: A Casebook in Accounting and Financial Management by Thomas E. McKee, PhD, and Linda J. B.

McKee, PhD 50. The Healthcare C-Suite: Leadership Development at the Top by Andrew N. Garman, PsyD, and Carson F. Dye, FACHE 51. Healthcare Executive Compensation: A Guide for Leaders and Trustees by David A. Bjork, PhD 52. Healthcare Facility Planning: Thinking Strategically, Second Edition, by Cynthia Hayward, FA AHC 53. Healthcare Finance: An Introduction to Accounting and Financial Management, Sixth Edition, by Louis C. Gapenski, PhD, and

Kristin L. Reiter 54. Healthcare Governance: A Guide for Effective Boards, Second Edition, by Errol L. Biggs, PhD, FACHE 55. The Healthcare Leaders Guide to Actions, Awareness, and Perception, Third Edition, Carson F. Dye, FACHE, and Brett D. Lee,

FACHE 56. Healthcare Marketing: A Case Study Approach by Leigh Cellucci, PhD; Carla Wiggins, PhD; and Tracy Farnsworth, EdD 57. The Healthcare Nonprofit: Keys to Effective Management by Stephen F. Gambescia, PhD; Sylvia V. Bastani; and Bruce Melgary 58. Healthcare Operations Management, Third Edition, by Daniel B. McLaughlin and John R. Olson, PhD 59. Healthcare Philanthropy: Advance Charitable Giving to Your Organization’s Mission by Betsy Chapin Taylor 60. The Healthcare Quality Book: Vision, Strategy, and Tools, Fourth Edition, by Maulik Joshi, DrPH; Elizabeth Ransom, MD;

David Nash, MD; and Scott Ransom, DO 61. Healthcare Strategic Planning, Fourth Edition, by John M. Harris 62. Health Economics: Core Concepts and Essential Tools by Steph Bernell, PhD 63. Health Informatics: A Systems Perspective, Second Edition, by Gordon D. Brown, PhD; Kalyan S. Pasupathy, PhD; and

Timothy B. Patrick, PhD 64. Health Insurance, Second Edition, by Michael A. Morrisey, PhD 65. Health Policy Issues: An Economic Perspective, Seventh Edition, by Paul J. Feldstein, PhD 66. Health Policymaking in the United States, Sixth Edition, by Beaufort B. Longest Jr., PhD, FACHE 67. Health Services Management: A Case Study Approach, Eleventh Edition, by Ann Scheck McAlearney, ScD, and Anthony

Kovner, PhD 68. High-Reliability Healthcare: Improving Patient Safety and Outcomes with Six Sigma, Second Edition, by Robert Barry, PhD;

Amy C. Smith, DNP, FACHE; and Clifford E. Brubaker, PhD

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives23

69. Hospitalists: A Guide to Building and Sustaining a Successful Program by Joseph A. Miller; John Nelson, MD; and Winthrop F. Whitecomb, MD

70. Hospitals and Community Benefit: New Demands, New Approaches by Connie J. Evashwick, ScD, LFACHE 71. Human Resources in Healthcare: Managing for Success, Fourth Edition, by Bruce J. Fried, PhD, and Myron D. Fottler, PhD, editors 72. Influential Leadership: Change Your Behavior, Change Your Organization, Change Health Care by Michael E. Frisina, PhD 73. Information Systems for Healthcare Management, Eighth Edition, by Gerald L. Glandon, PhD; Detlev H. Smaltz, PhD,

FACHE, FHIMSS; and Donna J. Slovensky, PhD, RHIA, FAHIMA 74. Inside the Physician Mind: Finding Common Ground with Doctors by Joseph S. Bujak, MD, FACP 75. Inspired to Change: Improving Patient Care One Story at a Time by Linda Larin 76. Intangibles: The Unexpected Traits of High-Performing Healthcare Leaders by Amer Kaissi, PhD 77. Introduction to the Financial Management of Healthcare Organizations, Seventh Edition, by Michael Nowicki, EdD, FACHE,

FHFMA 78. Introduction to Healthcare Quality Management, Third Edition, by Patrice L. Spath 79. Introduction to Health Policy, Second Edition, by Leiyu Shi, DrPH 80. Launching a Capital Facility Project: A Guide for Healthcare Leaders, Second Edition, by John E. Kemper 81. The Law of Healthcare Administration, Eighth Edition, by J. Stuart Showalter, JD 82. Leadership for Great Customer Service: Satisfied Employees, Satisfied Patients, Second Edition, by Thom A. Mayer, MD, FACEP,

FA AP, and Robert J. Cates, MD 83. Leadership for Public Health: Theory and Practice by James W. Holsinger Jr., MD, PhD, and Erik L. Carlton, DrPH 84. Leadership in Healthcare: Essential Values and Skills, Third Edition, by Carson F. Dye, FACHE 85. Leadership’s Deeper Dimensions: Building Blocks to Superior Performance by Tom Atchison, EdD 86. The Leaders Within: Engagement, Leadership Development, and Succession Planning by Stephen Mason, LFACHE; Kathryn

Dies, PhD; and Larry Morgan 87. Leading a Hospital Turnaround: A Practical Guide by Anthony Jones 88. Leading Transformational Change: The Physician-Executive Partnership by Tom Atchison, EdD, and Joseph S. Bujak, MD, FACP 89. Lean Done Right: Achieve and Maintain Reform in Your Healthcare Organization by Thomas G. Zidel 90. Make it Happen: Effective Execution in Healthcare Leadership by Daniel B. McLaughlin 91. Management of Healthcare Organizations: An Introduction, Third Edition, by Peter C. Olden, PhD 92. Managerial Epidemiology: Cases and Concepts, Third Edition, by Steven T. Fleming, PhD 93. Managerial Ethics in Healthcare: A New Perspective by Gary L. Filerman, PhD; Ann E. Mills; and Paul M. Schyve, MD 94. Managing Healthcare Ethically: An Executive’s Guide, Second Edition, edited by Paul B. Hofmann, DrPH, FACHE, and

William A. Nelson, PhD, HFACHE 95. Managing Stress and Preventing Burnout in the Healthcare Workplace by Jonathon R.B. Halbesleben, PhD 96. Marketing Health Services, Third Edition, by Richard K. Thomas, PhD 97. Marketing Matters: A Guide for Healthcare Executives by Richard K. Thomas, PhD, and Michael Calhoun 98. Mastering the Negotiation Process: A Practical Guide for the Healthcare Executive by Christopher L. Laubach 99. The Middleboro Casebook: Healthcare Strategy and Operations, Second Edition, by Lee F. Seidel, PhD, and James B. Lewis, ScD 100. The New Hospital-Physician Enterprise: Meeting the Challenges of Value-Based Care by David Wofford and Stephan Messinger 101. Optimize Your Healthcare Supply Chain Performance: A Strategic Approach by Gerald R. Ledlow, PhD, FACHE; Allison P.

Corry; and Mark A. Cwiek, JD, FACHE 102. Organizational Behavior and Theory in Healthcare: Leadership Perspectives and Management Applications by Stephen L. Walston, PhD 103. Partnership of Equals: Practical Strategies for Healthcare CEOs and Their Boards by Peter McGinn, PhD 104. Population Health: Principles and Applications for Management by Rosemary Caron, PhD 105. Principles of Healthcare Leadership by Bernard J. Healey, PhD 106. Reaching Excellence in Healthcare Management by John R. Griffith, LFACHE, and Kenneth R. White, PhD, RN, FACHE 107. Readmission Prevention: Solutions Across the Provider Continuum by Josh D. Luke, PhD, FACHE 108. Redesign the Medical Staff Model: A Guide to Collaborative Change by Jonathan Burroughs, MD, FACHE 109. Risk Adjustment for Measuring Health Care Outcomes, Fourth Edition, by Lisa I. Iezzoni, MD, editor 110. Risk Management and the Emergency Department: Executive Leadership for Protecting Patients and Hospitals by Shari J. Welch,

MD, FACHE, FACEP; Kevin Klauer, DO, EJD, FACEP; and Sarah Freymann Fontenot, JD

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 24

111. The Safety Playbook: A Healthcare Leader’s Guide to Building a High-Reliability Organization by John Byrnes, MD and Susan Teman, RN, CPPS

112. Separately Together: A New Path to Healthy Hospital-Physician Relations by C. Marlena Fiol, PhD, and Edward J. O’Connor, PhD 113. Social Media in Healthcare: Connect, Communicate, Collaborate, Second Edition, by Christina Beach Thielst, FACHE 114. Strategic Allocation and Management of Capital in Healthcare: A Guide to Decision Making, Second Edition, by Jason H.

Sussman, CPA, FACHE 115. Strategic Analysis for Healthcare: Concepts and Practical Applications by Michael S. Wayland and Warren G. McDonald, PhD 116. Strategic Healthcare Management: Planning and Execution, Second Edition, by Stephen L. Walston, PhD 117. Take Charge of Your Healthcare Management Career: 50 Lessons That Drive Success by Kenneth R. White, PhD, RN, FACHE,

and J. Stephen Lindsey, FACHE 118. The Toyota Way to Healthcare Excellence: Increase Efficiency and Improve Quality with Lean, Second Edition, by John Black,

with David Miller and Joni Sensel 119. The Tracks We Leave: Ethics and Management Dilemmas in Healthcare, Second Edition, by Frankie Perry, RN, LFACHE 120. Transformative Planning: How Your Healthcare Operation Can Strategize for an Uncertain Future by Jim Austin 121. Tyler’s Guide: The Healthcare Executive’s Job Search, Fourth Edition, by J. Larry Tyler, FACHE, FA AHC, FHFMA 122. Understanding Healthcare Financial Management, Seventh Edition, by Louis C. Gapenski, PhD, and George H. Pink, PhD 123. The Well-Managed Healthcare Organization, Ninth Edition, by Kenneth R. White, PhD, RN, FACHE, and John R. Griffith,

LFACHE 124. World Health Systems: Challenges and Perspectives, Second Edition, by Bruce J. Fried, PhD, and Laura M. Gaydos, PhD, editors

Programs:

1. Achieving a Strategic Partnership With Your Board: Thrive in the Midst of Accountability 2. Achieving a Sustainable Transformation to Operational Excellence 3. Achieving Speed, Spread, Scalability and Sustainability for Health Systems 4. Advanced Strategic Planning to Transform Your Organization 5. Aggressively Improve Margin and Market Growth: 2019 National Research for C-Suite 6. Agility and Resilience in Healthcare Leadership: Key Behaviors for Leading Change 7. A Proven Formula for Achieving Enterprise Operational Excellence 8. The Art and Principles of Physician Leadership and Engagement 9. Behavioral Health Challenges, Strategies and Solutions: The Business Case for Meeting Community Needs 10. Behavior Smarts: Increasing Healthcare Leadership Performance 11. Big Data and Analytics: A Perspective for Healthcare Leaders (online seminar) 12. Board of Governors Exam Review Course 13. Closing the Gap in Physician Engagement, Alignment and Integration in a Value-Based Environment 14. Compelling Communication: Creating Engagement, Understanding and Results 15. The Courage to Lead: Critical Skills for Healthcare Leaders 16. Critical Financial Skills for Hospital Success 17. Critical Success Factors in Moving Toward Value-Based Care 18. Culture, Process and Outcomes: Where Strategy Begins 19. Developing Leadership Competencies That Build Effective Teams and Create Extraordinary Physician Engagement 20. Developing Physician Leaders for Clinical Integration (online seminar) 21. Driving Significant Financial Returns: Using Analytics to Improve Your Bottom Line 22. Effective Approaches in Leading Patient Safety and Error Reduction 23. Exceptional Leadership (online seminar) 24. Executive Program 25. Growth in the Reform Era 26. Health Law Essentials (online seminar) 27. Health Systems as Stewards of Health: A Construct for Leading Transformation 28. Hospitals and Health Systems of the Future: Transforming to Thrive

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives25

29. Improving the Patient Experience to Build Customer Loyalty 30. Improving the Performance of Physician Services Organizations in Integrated Health Systems 31. Key Financial Principles for the Nonfinancial Healthcare Executive 32. Leaders Conference 33. Leadership and Accountability in Project Management and Programs 34. Leading and Managing in Changing Times 35. Leading for Change: Creating a Humanistic Approach for Patient, Family and Staff Engagement 36. Leading for Success: Creating a Committed Workforce 37. Leading in a Changing Environment: Focus on Population Health 38. Leading Strategic Change 39. Management Mistakes, Moral Dilemmas and Lessons Learned (online seminar) 40. Managing Conflict, Confrontations and Disputes 41. Managing Healthcare Facility Design and Construction Programs 42. Monetizing Quality in a Pay-for-Value World 43. Physician Alignment and Engagement: Do’s and Taboos (online seminar) 44. Physician and Executive Partnerships: Hard Facts, Soft Skills 45. Population Health: The Road to Transformation (online seminar) 46. Possibilities, Probabilities and Creative Solutions: Breakthrough Thinking for Complex Environments 47. Power and Politics in Healthcare Organizations 48. Practical Leadership Strategies in an Age of Change 49. Process and Technique of Negotiating 50. Professional Burnout in Healthcare: Lead Your Organization to Wellness 51. Redesign and Operationalize Your Medical Staff for Health Reform 52. Retooling for the Future in Healthcare Operations: The Changing Roles of Leaders 53. Secrets of Great Healthcare Organizations in Leading Change 54. Senior Executive Program 55. Solving the Enigma of Medical Group Performance: Methods to Identify and Add Meaningful Value 56. Strategic Planning: From Formulation to Action 57. Strategic Planning That Works: Integrating Strategy With Performance (online seminar) 58. The Strategic Use of Healthcare Analytics 59. Superior Productivity in Healthcare Organizations (online seminar) 60. Taking an Emotionally Intelligent Leadership Approach to Change Management 61. Thriving During Times of Change 62. Toxic Behaviors in Healthcare: How Everyday Civility Increases Patient Safety and Team Performance 63. Transitioning From the Military to Civilian Healthcare

Leadership Assessments:

1. Benchmarks® (A 360° Assessment) 2. Building an Authentic Leadership Image 3. Career Anchors Assessment 4. Change Management Leadership Assessment 5. Conflict Management Assessment 6. Emotional Intelligence Assessment 7. Extended DISC Assessment 8. Leadership Assessment 9. Power/Influence Assessment

ACHE Healthcare Executive Competencies Assessment Tool Copyright © 2020 by the American College of Healthcare Executives 26

Self-Study Courses:

1. Accelerating Leadership Development in Yourself and Your Organization 2. Achieving the Group Practice Advantage 3. Advancing the CEO’s Role in Healthcare Philanthropy 4. Building Clinical Systems That Produce Excellent Outcomes 5. Building Self Awareness to Prevent Career Derailment 6. Coordinated Care: Improving Clinical and Financial Performance 7. Creating Readiness for Change: Preparing Physicians and Administrators for Collaboration 8. Effective Strategy Execution 9. Healthcare Leadership That Makes a Difference: Creating Your Legacy 10. Improve the Experience of Care in Your Emergency Department 11. Integrating Global Trends into Your Organization’s Strategic Planning 12. The Law and Patient Confidentiality: A Commonsense Guide to HIPAA and Beyond 13. Leading with Meaning: Tapping the Deeper Dimensions 14. Making Better Capital Investment Decisions 15. Managing the Risks of Social Media 16. Marketing Your Healthcare Organization 17. Reducing Burnout by Developing a Participative Culture 18. Tools and Techniques for Physician Engagement 19. Understanding and Influencing Physician Behavior 20. Understanding Cost Allocation and Profit Analysis 21. Understanding Financial Statements 22. Understanding the Impact of Financing Decisions 23. Using Pricing, Budgeting, and Revenue Cycle Management to Improve Performance 24. Working Together While Maintaining Distinctiveness: Healthy Administrator-Physician Relations

Other:

1. ACHE’s Career Center Products and Services (https://www.ache.org/career-resource-center) 2. ACHE’s Code of Ethics (https://www.ache.org/about-ache/our-story/our commitments/ethics/ache-code-of-ethics) 3. ACHE’s Diversity Resources (https://www.ache.org/about-ache/resources-and-links/diversity-resources) 4. ACHE’s Ethical Policy Statements (https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/

aches-ethical-policy-statements) 5. ACHE’s Ethics Self-Assessment (https://www.ache.org/about-ache/our-story/our-commitments/ethics/ethics-self-assessment) 6. ACHE’s Ethics Toolkit (https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-

ethical-culture-within-the-healthcare-organization/ethics-toolkit) 7. ACHE’s Mentoring Network (member’s-only area) (https://www.ache.org/career-resource-center/advance-your-career/

leadership-mentoring-network) 8. ACHE’s Policy Statements (https://www.ache.org/about-ache/our-story/our-commitments/policy-statements) 9. Free From Harm: Accelerating Patient Safety Improvement Fifteen Years After To Err Is Human from the National Patient Safety

Foundation. Boston, MA: National Patient Safety Foundation; 2015. 10. Leading a Culture of Safety: A Blueprint for Success by ACHE and the IHI/NPSF Lucian Leape Institute (http://safety.ache.org/)

ACHE.ORG/JOIN

AONL

NURSE EXECUTIVE COMPETENCIES

The AONL Nurse Executive Competencies© represent the functional knowledge, skills, abilities and personal characteristics required to produce a set of activities that generate observable and measurable outcomes. The Nurse Executive Competencies© are based on the AONL Nurse Leader Core Competencies©.

In the AONL Nurse Leader Core Competency model©, the anchoring domain, Leader Within, anchors the five core domains: Business Skills and Principles; Communication and Relationship Building; Knowledge of the Health Care Environment; Professionalism; and Leadership. It is the driver of motivation, beliefs, values and interests, and recognizes that the influence and significance of education, experience and understanding oneself is essential.

A circle represents each core domain. The gradient border symbolizes the influence of both the art and science of nursing and the open center informs the role specific functional competencies driven by the core domain. The overlap depicts the interrelatedness of the domains in practice. The Leadership domain’s placement in the center supports and enables this interrelatedness of requisite knowledge, skills and abilities between and among the core domains.

OVERVIEW

AONE, AONL. (2022). AONL Nurse Leader Core Competencies, Chicago, IL: AONE, AONL. Accessed at: www.aonl.org • Accessible at: www.aonl.org/competencies • Contact: [email protected] or (312) 422-2800 © 2022 American Organization of Nurse Executives (AONE), American Organization for Nursing Leadership (AONL). All materials contained in this publication are available to anyone for download on www.aonl.org, for personal, non-commercial use only. No part of this publication may be reproduced and distributed in any form without permission of AONL, except in the case of brief quotations followed by the above suggested citation. To request permission to reproduce this material, please email [email protected].

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Reliability and validity for the AONL Nurse Leader Core Competencies are established by periodic job analysis/role delineation studies. These competencies are based on A National Practice Analysis Study, 2022.

REFLECTIVE PRACTICE

• Demonstrates reflective practice and an understanding that all leadership begins from within.

• Solicits feedback from trusted sources about personal strengths and opportunities for improvement, incorporating the information into practice.

• Recognizes the contribution of mental models on behavior.

FOUNDATIONAL THINKING

• Learns from challenges, setbacks and failures as well as successes.

• Recognizes the role of beliefs, values and influences in one’s own method of decision-making.

• Maintains curiosity and an eagerness to explore.

CAREER DEVELOPMENT

• Learns from challenges, setbacks and failures as well as successes.

• Recognizes the role of beliefs, values and influences in one’s own method of decision-making.

• Maintains curiosity and an eagerness to explore.

PERSONAL AND PROFESSIONAL ACCOUNTABILITY

• Participates in life-long learning.

• Maintains competency through nationally recognized certification.

• Participates in professional organizations that advance one’s leadership and career development.

• Prioritizes self-care health behaviors through daily practices and routines; practices healthy work-life integration.

LEADER WITHIN

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3

PROFESSION ACCOUNTABILITY

• Upholds professional ethical principles in decision-making through personal and organizational accountability.

• Supports, promotes and role models standards of nursing and leadership professional practice (clinical, educational, certification and leadership) for colleagues and constituents.

• Solicits feedback from trusted sources about personal strengths and opportunities for improvement and incorporates the information into practice.

• Maintains competency through nationally recognized leadership certification.

• Participates in professional organizations that advance one’s leadership practice and career development.

• Encourages staff to engage in their career development.

ORGANIZATIONAL ACCOUNTABILITY

• Aligns behavior with personal values and determines fit with the organization’s culture.

• Ensures the voice of the patient is central and present in decision-making.

• Ensures a culture of accountability by holding self and others accountable for measurable high quality and cost-effective outcomes.

• Follows up regularly with staff to ensure that desired outcomes are being achieved.

• Recognizes career opportunities for staff based on strengths and interests.

• Exhibits leadership presence (e.g., attending team meetings, vocal, fostering discussions, lead rounds, etc.).

HEALTH EQUITY AND SOCIAL DETERMINATES OF HEALTH

• Collaborates on the development of the needs assessment to identify if there are any current health equity issues.

• Creates action plan to see how to close the gap on department/ unit health equity issues.

• Provides staff with tools and resources to provide culturally competent care (e.g., translation resources, discharge materials, appropriate referrals).

• Supports staff in participation of community-based activities that address community care.

• Coordinates and facilities orientation related to culturally competent care.

• Evaluates culturally competent care through performance appraisals.

• Monitors performance data to ensure the delivery of culturally competent care.

GOVERNANCE

• Interacts and educates the organization’s governing body regarding health care and the value of nursing.

• Interacts and educates the organization’s governing body regarding quality and patient safety principles.

• Represents patient care issues to the organization’s governing body.

• Represents nursing in the boardroom and C-suite.

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RELATIONSHIP MANAGEMENT

• Develops relationships across the care continuum to build alliances and partnerships and achieve common goals.

• Manages conflicts and disagreements in a constructive manner.

• Identifies the internal and external relationships that impact the work of the department/unit to achieve department/unit goals.

• Interprets organizational and strategic realities (e.g., labor costs, different models of care delivery, key performance indicators (KPI), supply chain disruption etc.) to navigate changes.

• Recognizes the impact on staff from the organization’s decisions and takes appropriate action.

EFFECTIVE COMMUNICATION

• Communicates with clarity and integrity to build trust with all stakeholders.

• Identifies and understands different communication styles.

• Utilizes appropriate communication style when engaging different audiences.

• Practices transparency and honesty to demonstrate authenticity.

• Builds trust by listening to staff.

INFLUENCING BEHAVIORS

• Collaborate with others to exchange ideas to accomplish goals.

• Uses information from multiple sources (e.g., evidence from research, data, reports) to gain consensus and commitment from stakeholders.

• Coaches staff in their development (e.g., conflict management, active listening, communication, etc.).

• Create policies and initiatives to promote desired organizational behaviors.

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NURSING PRACTICE AND APPLICATION

• Transforms care delivery models and environmental design to ensure the delivery of safe patient care that is evidence-based, accessible, affordable, and equitable.

• Recognizes the impact of internal and external factors on care delivery and the organizational finances.

• Integrates patient quality & safety measures into the care environment.

• Formulates objectives and priorities to implement plans across the continuum of care and practice settings consistent with long-term interests of the organization.

ECONOMICS AND POLICY

• Aligns organizational strategies with current developments in healthcare economics, policy, and legislation.

• Employs a population health approach to improve outcomes.

• Influences health care policy as it affects safe quality, accessible and affordable health care through advocacy at all levels of government.

REGULATION

• Maintains knowledge of regulatory and accreditation standard/rule changes.

• Seeks resources in support of the organization’s compliance regarding regulatory requirements.

• Ensures compliance with accreditation standards and local, state, and federal regulatory standards.

• Participates with response to identified deficiencies.

EVIDENCE BASED PRACTICE

• Ensures a process is in place to evaluate strengths and barriers in implementing evidence-based practices.

• Promotes integration of evidence-based research into practice.

• Supports staff by providing resources for implementation of evidence-based practices.

PATIENT SAFETY AND QUALITY

• Maintains knowledge of patient safety and improvement sciences.

• Ensures the incorporation of patient safety and improvement sciences with organization’s practices.

• Participates in risk assessment (e.g., FMEA, root cause analysis, etc.) to ensure safe, compliant and effective care delivery.

• Develop processes that result in prompt escalation of potential performance gaps by system processes and staff.

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FINANCIAL MANAGEMENT

• Manages budget by understanding and utilizing organization’s financial processes.

• Monitors budget to ensure accuracy of expenses and identify variances.

• Maintains knowledge of reimbursement models that affect care delivery.

• Maintains knowledge of health care economics and business models to set priorities and measurable goals.

• Participates in the creation of department/division budget.

• Makes adjustment of budget as indicated by variances.

• Supports financial health particularly as it is influenced by nursing and other clinical decisions and outcomes.

STRATEGIC MANAGEMENT

• Collaborates with staff in the communication and implementation of high reliability concepts (e.g., safety huddles, use of evidence, deferring to expertise etc) as identified by the organization.

• Utilizes multiple sources of evidence-based data in goal setting and decision-making.

• Ensures organizational objectives are in place to achieve the strategic mission.

• Participates in the negotiation, monitoring and management of contract and service agreements.

• Aligns and creates nursing/clinical objectives, goals and tactics required to achieve the organization’s strategic outcomes.

• Recognizes and supports the benefit and impact of technology on care delivery, clinical information, and financial outcomes.

• Uses evidence-based metrics to align department/unit’s goals and objectives with patient outcomes.

HUMAN RESOURCE MANAGEMENT

• Builds and manages a diverse workforce based on organizational, professional nursing, clinical goals and outcomes, data, budget considerations, and staffing needs.

• Ensures that employees are recruited, selected, onboarded, educated, evaluated, and recognized according to established standards, applicable employment laws, and organization’s mission vision and values.

• Manages a multisector workforce and a variety of work situations.

• Assesses the organization’s culture to ensure the presence of a safe and healthy work environment.

• Addresses any gaps associated with the cultural assessment of safe and healthy work environment.

• Advances organizational policies that allow employees to practice at the top of education and or license.

• Establishes mechanisms that provide for identification and mentoring of staff for career progression.

LEADERSHIPLEADERSHIP

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SYSTEMS AND COMPLEX ADAPTIVE THINKING • Builds a shared vision that articulates and

influences others to translate vision into action.

• Develops new insights into situations by questioning conventional approaches.

• Encourages staff to develop new and innovative ideas.

• Removes barriers to help implement new cutting-edge programs/processes.

• Creates and executes strategies for complex situations (e.g., addressing safety issues with workload capacity, increase nursing time at bed side, selection, and deployment of Artificial Intelligence in nursing).

• Leads nursing strategic planning and execution.

• Participates in nursing and organizational strategy planning and execution.

CHANGE MANAGEMENT • Acts as a catalyst for change by seeking new

information and ideas.

• Adapts to new information, changing conditions and unexpected obstacles.

• Assesses through analytics (e.g., gap analysis, SWOT, etc.) if change is necessary.

• Utilizes common change models (e.g., Kotter, Lewin) and other tools for change (e.g., PDSA, LEAN methods).

• Supports staff in managing organizational changes.

DIVERSITY, BELONGING AND INCLUSION • Recognizes unconscious and systemic bias

occurs in care delivery, business operations, and through external influences.

• Leads and supports initiatives that address racism, discrimination and bias in care delivery and business operations.

• Encourages creative tension and differences of opinions.

• Fosters an inclusive workplace where diversity and individual differences are valued and maximized to achieve the vision and mission of the organization.

• Develops the ability of others to perform and contribute to the achievement of their goals consistent with the organization’s vision and mission corresponding with individual needs.

• Provides feedback and opportunities for others to learn through formal and informal methods corresponding with individual needs.

• Creates, promotes, and protects a culture that supports staff, patients/clients and stakeholders at the organization/system level.

DECISION MAKING • Capitalizes on opportunities and takes

calculated risks.

• Identifies and objectively analyzes problems; evaluates relevance and accuracy of information, generates and evaluates alternative solutions, makes recommendations and decisions.

• Makes timely decisions even when data are limited or solutions produce unpleasant consequences.

• Understands the impact and implications of decisions.

• Delegates appropriately.

• Fosters professional governance in both philosophy and structure.

TRANSFORMATION AND INNOVATION • Actively looks for opportunities and takes

calculated risks to advance organization’s mission and vision.

• Develops an organizational framework to advance innovation.

• Allocate resources for the development of innovation teams or methods.

• Supports the implementation of innovative ideas.

Credo Reference Promoting Equality in Management

Many companies today just seem to focus on meeting diversity in entry-level positions through equal employment opportunity (EEO) regulations, however that is where it ends. According to the 2011 Catalyst census women have made no significant inroads into management positions and are no further along the corporate ladder than they were six years ago. From the report:

Women held 16.1% of board seats in 2011, compared to 15.7% in 2010.

Less than one-fifth of companies had 25% or more women board directors.

About 10% companies had no women serving on their boards.

Women of color still held only 3% of corporate board seats.

Women held 14.1% of executive officer positions in 2011, compared to 14.4% in 2010.

Women held only 7.5% of executive officer top-earner positions in 2011, while men accounted for 92.5% of top earners.

Less than 20% companies had 25% or more women executive officers and more than 25% had no women executives.

White men held 74.5% of board seats on the 500 largest publicly traded companies, versus 5.7% for African American men and 1.9% for African American women.

By 2012, the percentage of African American male directors declined to 5.5%, while the percentage of African American female directors remained flat. White men continued to hold roughly 95% of board chair positions and 86% of lead director slots. McKinsey & Company, an international management consulting firm, found that in 2012 women accounted for 53% of entry-level jobs and made it to “the belly of the pipeline” in large numbers. But then female presence fell off a cliff, to 35% at the director level, 24% among senior vice- presidents and 19% in the executive suite (Barsh & Yee, 2012). These percentages are intriguing as they punctuate the problem with the leaking pipeline with a downward trend from 37% in 2012 to 28% women-to-men ratios at the director and vice-president levels respectively the prior year (2011). The gender gap was even wider for women of color. Among African American employees, both men and women expressed an above-average desire to advance to the next level. McKinsey's study (Women in the Economy, 2011), for example, found that 81% of African American men and 86% of African American women aspire to advance, compared with 74% of all men and 69% of all women, but only 35% of the African American women believed they will have a chance to move up, compared with 41% of all women. Black men felt even more empowered than whites as 49% believed they will move up, compared with 43% of men on average.

As members of two devalued identities, African American women face a very unique experience of dual discrimination. In the early 1970s, discrimination based on sexism and racism was termed “double jeopardy” to denote that the minority woman's experience in society is manifested simultaneously on the two fronts of gender and ethnic prejudices (Beale, 1970). This term is still applicable as no significant change to the presence of African American women in executive suites or boardrooms has recently been recorded. In 2013, 30% of the 250 largest corporations did not have a single African American director indicating that corporate boards have become less diverse over the past several years (Black Enterprise, 2013).

Barriers to Promotion and Participation

One of the most serious issues regarding the scarcity of women in top management teams (TMTs) and corporate boards is the perseverance of gendered leadership. Symptomatic to gender leadership is the use of negative stereotyping, discrimination, and prejudice, which traverse from traits (women are friendly, cooperative, relational, inclusive) to consequences (women are dominated and opportunities for upward mobility are blocked), creating a chilling effect discouraging and deterring women from reaching the top (Carnes & Radojevich- Kelley, 2011; McEldowney, Bobrowski, & Gramberg, 2009). High-potential women advance more slowly in both pay and career progression than men even though they are on par in employing career management strategies. Due to the expanded female stereotypes in the workplace, women may forgo applying for higher positions in a company.

Barsh and Yee (2012), who conducted a study of 60 leading Fortune 500 companies, found that diverse leadership programs in these organizations triggered stronger business results. They went on to suggest that other companies should get “closer to unlocking the full potential of women at work” (p. 2). However, these 60 companies had nearly 140,000 mid-level women managers but only about 7,000 (5%) became vice-presidents, senior vice-presidents, or members of the C-suite. The fact remains the same—regardless of their enormous value to the management of organizations, women are underrepresented in TMT positions and still have a long way to go before achieving parity with their male counterparts in the workplace.

Alice Eagly and Linda Carli (2007) describe the problem of gendered leadership and accessibility as labyrinth leadership. Ultimately, women who seek top management positions must weed through culturally formed stereotypes and at the same time avoid crossing culturally generated barriers. They work against a centripetal force, invariably unicursal, moving in a curvilinear path that is directed inward, keeping women from reaching upper-level positions. The prevailing gap between women's education and workforce participation has continued to persist, too: “In an era when women have made sweeping strides in educational attainment and workforce participation, relatively few have made the journey all the way to the highest levels of political or corporate leadership” (Pew Research Center, 2008, p. 3).

Organizational and cultural barriers converge with stereotypical biases, preconceptions of roles and abilities, and misrepresentation of the commitment to personal and family responsibilities as an inability to meet tough schedules (primarily for women) to block women's access to top positions. Furthermore, the systematic exclusion from informal networks of communication, lack of opportunities to assume line roles, and limited access to visible and/or challenging assignments prevent women from advancing to higher-level positions at the same rate as men. High-potential women are less likely to promote themselves as well as men, have less mobility within the organization, and are more dependent on formal advancement procedures than are men (Lyness & Thompson, 2000). This is especially true in highly male-dominated or masculine settings where women are challenged to act tough and exercise competitive styles to gain acceptance into influential networks (Timberlake, 2005). Unfortunately, it was found to be true also in academic settings.

Sarsons (2015) set out to explore whether bias arising from collaborative work helps explain the gender promotion gap in academic institutions by testing whether coauthored publications matter differently for tenure by gender. While solo-authored papers send a clear signal about one's ability, coauthored papers do not provide specific information about each contributor's skills. She found that female authors often suffered a “coauthor penalty” when they coauthored with men. The penalty was lower when coauthorship involves no men. The results provide suggestive evidence that gender bias exists in academic promotion decisions. The bias occurs when reviewers make a judgment on the part of the employer as to which author has made the greatest contribution to the paper. Figure 3.1 shows that when women solo-author, they also signal their abilities explicitly and therefore have roughly the same chance of receiving tenure as a man, but women who coauthor most of their work have a significantly lower probability of receiving tenure.

Figure 3.1 Relationship Between Composition of Papers and Tenure

Source: Sarsons (2015).

Employers update their beliefs upward as more solo signals are generated until both men and women are believed to be high types. The gap in tenure rates, therefore, should be smaller or eliminated as more solo-authored papers are produced by women. However, bias, whether conscious or subconscious, can have significant implications for the gender gap in promotion decisions. Table 3.1 shows that while 77% of the men in the sample study received tenure, only 52% of the women received tenure. There is no statistically significant difference in the number of papers that men and women produced although men have slightly more papers in high-ranked journals. Sarsons (2015) concluded that if women are tenured at lower rates because of such productivity differences, controlling for the number and rank of publications should explain the tenure gap.

Table 3.1 Summary Statistics

Source: Sarsons (2015).

Self-promotion and the Ability to Network

Women are still perceived as “risky” appointments for line roles that are often staffed by decisions of male-dominated committees (Herminia, Carter, & Silva, 2010). Successful completion of high-risk assignments typically comes with public recognition that is often translated into top positions. High-potential women have less access to challenging projects (e.g., international assignments) and high-risk assignments that also lead to visibility, so important for advancement to senior executive positions (Belasen, 2012). However, while men tend to place a high priority on visibility and recognition, women with a track record of success depend on peer support to advance their career. Paradoxically, just when women are most likely to need active mentoring or even sponsorship—as they aim for positions of power—they may be least likely to find it. Women executives are concentrated into certain types of jobs—mostly staff and support jobs—that offer little opportunity for getting to the top (Feminist Majority Foundation, 2014).

Women have limited access to or are excluded from informal networks in the workplace. These networks are vital during socialization processes, decision making communications, and conflict resolutions. Limited access can also make it more difficult for women to create willing or supporting alliances, negotiate their “cards” more aggressively, or become “go to” leaders. Exacerbating the problem is the fact that often human-resources officers may emphasize the positive skills that women possess, but may not actually follow through on

supporting women's advancement. Existing training and development programs tend to focus on current competencies and short-term performance expectations rather than long-term strategic goals putting women at an obvious disadvantage.

When you ask women, 77% of them will tell you they believe promotions are driven by a combination of hard work, long hours, and education credentials. However, 83% of men will readily acknowledge that “who you know” counts for a lot, or at least as much as “how well you do your job” … Hard work alone is not enough to get you promoted if nobody knows and acknowledges it. Many women work hard and expect their boss to realize it and it's just not enough. If you aren't standing up for yourself, who will?

(Halter, 2015)

Frustrated by the uphill battle and the injustice and without opportunities for self-promotion, women increasingly assume staff roles (as opposed to line roles) where there is little opportunity for advancing to the top. Reportedly (Belasen, 2012), by 2010, the largest proportion of women managers was in healthcare and social assistance (70%), educational services (57%), financial activities (50%), and leisure and hospitality (45%). A 2012 report by McKinsey (Women in the Economy, 2011) indicates that women, in general, opt at far higher rates than men for staff roles, not executive line positions. Some 50% to 65% of women at the vice-president level and higher are in staff roles, compared with only 41% to 48% of men. Contrast the siloing of women into strategic or line roles with significant profit and loss responsibilities, which are often reserved for men, with staff roles that limit women's upward mobility aspirations

RECOUNT BY A STUDENT IN PROFESSOR BELASEN'S LEADERSHIP DEVELOPMENT PROGRAM, APRIL 2016

I was in the field operations organization that consisted almost entirely of men. There were a few female supervisors and technicians and only one female mid-level manager. Female employees were generally placed in sales and human resources. For years, the company placed new hires in what they perceived to be appropriate for their gender. Women were not expected to be able to perform field jobs as well as a man could because it was more physical and “rough.” Women were given office positions where it was believed they were better suited. Advancement in the company, however, depended on field operations experience. There was a common belief that to move up in the company you had to be able to manage a field team. Since women were rarely placed in field positions, their opportunities for advancement were very limited or confined to just their business department.

By denying women field experience, the male-dominated culture continued to thrive in upper management. Some managers would communicate in a hostile and hyper-aggressive manner. These managers viewed feedback or opposing opinions as push back or as obstruction to their goals. Employees would not voice their opinions or ideas in fear of being berated or viewed as incompetent. Upper management was mostly male dominated and this type of management style was accepted and even encouraged through targeted promotion.

The culture took a swing when the company made a concerted effort to diversify its management and non-management teams across all departments. More females were placed in field supervisor and tech positions. Lower level managers were now included in decision making processes. Diversity and harassment training were mandatory and frequent. How employees communicated started to change. Terms like manpower were changed to workforce to reflect the reality. More importantly, female employees were now gaining needed experience to advance. In fact, at one point I reported to a female director who reported to a female regional vice president who herself reported to a female senior vice president. This was not only empowering and rewarding for employees, but it also created a sense of cohesion and trust.

Family Pulls and Work Pushes

High-ranking female role models are relatively scarce in middle management and executive positions remain elusive for most women. Known as the “leaky pipeline,” this has significant implications for succession planning and the perpetuation of unreachability due to the limited pool of potentially qualified women successors who are being left behind. Take Google as an example, in a report to the EEOC, Google indicated that of its 36 executives and top-ranking managers, just three are women (Google, 2013). Anecdotally, managers at Google invest time and effort to persuade women engineers to nominate themselves for promotion (Shellenbarger, 2012).

Barsh and Yee (2012) reported that women in their sample of Fortune 500 companies opted to take staff roles, got stuck in middle management, or simply left their organization. For example, about 50% of the mid-level women managers indicated that they are both the primary breadwinners and primary caregivers. And yet, only 3% of the male and female managers worked part time and less than 1% of the senior executives worked part time, making the balance of work and family quite challenging for women. Consequently, women appeared to slow their careers or downshift to less important roles to reduce uncertainty or lessen travel constraints.

Indeed, even among the successful women we interviewed, more than half felt they held themselves back from accelerated growth. Most said they should have cultivated sponsors earlier because a sponsor would have pushed them to take opportunities. These women said they did not raise their hands or even consider stretch roles. And when surveyed, more women than men reported that they would likely move next into support roles.

(Barsh & Yee, 2012, p. 7)

The pipeline, in effect, continues to suffer from leaks and blockages. Indeed, Kurtulus and Tomaskovic-Devey (2012) confirmed that an increase in the share of female top managers is associated with subsequent increases in the share of women in mid-level management positions. The four barriers to women's promotion—structural obstacles, lifestyle choices, institutional barriers and individual mindsets—have traditionally been intensified by the lack of sponsorship, limited flexibility and unconscious biases. They also restrict the movement of women into influential executive positions (see Figure 3.2).

Early in the pipeline, women and men are distributed across line and staff roles at similar levels, but women begin a steady shift into staff roles by the time they reach the director level. Structurally, women do not have the same opportunities to benefit from sponsor discussions, and so they lack support to stay in the line. Line jobs are less flexible than staff jobs, so as women form families, staff jobs look more appealing. Well intentioned leaders often do not even ask mothers to consider a tough assignment. And women know that line jobs carry greater pressure. The more issues like this we explored, the more we found the four barriers working in combination to make the problem impenetrable.

(Barsh & Yee, 2012, p. 6)

Hard Choices

Many women report that to be successful, they need to demonstrate consistent levels of commitment, higher levels of technical proficiency, show adherence to bottom-line results, have demonstrated competency in strategic thinking and decision making, be creative, have effective conflict resolution skills, and cope effectively with change and uncertainty—all coupled with long hours at work. What's more, women have to deal with the inconsistency of their own sense of success and the way organizations measure it. Women also experience cross- pressures for their time and the constant need to balance competing priorities across life and career goals that are different for men (Mainiero & Sullivan, 2006; O'Neil & Bilimoria, 2005). Consequently, many women choose to work part-time or not at all so they can attend to their families at home. Others telework from home, most commonly on a part-time basis. Indeed, Ruderman and Ohlott (2004) reported a higher turnover rate for women than male counterparts in executive positions with at least 10 years of experience.

Figure 3.2 Women Opt Out of Line Roles Fairly Easily

Source: Barsh and Yee (2012, p. 6).

EXTREME WORK DEMANDS CAN DRUM WOMEN OUT

The extreme demands of many 24/7 work corporate environments today represent an impasse to many women who wish to prioritize life outside of work more highly. I've written before and believe this wholeheartedly – women are not less ambitious than men. It is the COST of ambition – and the struggle women face in pursuing their professional ambitions – that is at the heart of why we have so few women leaders today, and why women are achieving less and not reaching as high as men in corporate America. As Betsy Myers, President Clinton's senior adviser on women's issues shared with me recently, women tend to view their work as only one piece of the pie that represents their total life experience. If they're forced to focus 24/7 on work for a majority of their professional lives, most women will choose not to pay that price.

(Caprino, 2013)

The majority of women, nonetheless, plan to return to work after a certain period of “leave of absence” but even if the break is only for a few months it becomes difficult to continue the intended career path or climb the senior leadership ladder. So the continuity of career advancement becomes a crucial factor for reaching the top of the pyramid. Any interruptions in working life reduce the likelihood to reach the highest positions in a company. And companies, aiming at frictionless flow, facility, and optimization rather than accommodating talented women seem to stay on course. For example, one study found that only 4% of companies surveyed even attempted to put women on a growth path towards becoming CEO (Oakley, 2000). And much of the buzz about the appropriate ways for “opted out” women to re-enter the workforce is met with a tough reality. JP Morgan and its “Workforce Re-entry Program”, which was launched in 2013, focused on recruiting out-of-work talent who once worked in financial services, but left the challenge of raising children or caring for the elderly to others. The program started with the asset management division and expanded to the legal and investment bank divisions in 2014 (Schonberger, 2015).

Today, however, family happiness, relationships, and balancing life and work, along with community service and helping others, are much more on the minds of Generation X and Baby Boomers. When the researchers asked respondents to rate the importance of nine career and life dimensions, nearly 100%, regardless of gender, said that “quality of personal and family relationships” was “very” or “extremely” important …. Whereas about 50% to 60% of men across the three generations told the researchers they were “extremely satisfied” or “very satisfied” with their experiences of meaningful work, professional accomplishments, opportunities for career growth, and compatibility of work and personal life, only 40% to 50% of women were similarly satisfied on the same dimensions.

(Ely, Stone, & Ammerman, 2014)

Some organizations, however, offer on-site daycare as well as flex-time where an employee can choose to work four days a week for 10 hours rather than five days a week for eight hours. The Johnson & Johnson (J&J) Finance Vice-President Kendall O'Brien stated:

If J&J hadn't had on-site daycare, if I hadn't had a supervisor supportive of my working flexible hours, if I weren't part of an organization that's cognizant of the talent pipeline and that recognized I didn't want to leave, I wouldn't be here today.

(Spence, 2010, p. 5)

Organizations must not only recognize the barriers that exist which prevent women from fully committing to work, but also offer support to help women balance their contradictory roles. Work–life integration and the willingness to relocate provide flexibility that can make women's talents and contributions both competitive and attractive for employers.

Diversity as a Source of Competitive Advantage

Inclusive leadership and participation of women on TMTs help boost companies’ public image and reputation through support of social responsibility and philanthropic programs. They add value to the company with unique adaptability skills and are masters in creating positive work climates based on inclusion and diversity. Not only does greater diversity help the business—and possibly creates a competitive advantage—it also creates an actively engaged workplace culture, which typically indicates satisfied employees, a win–win situation (Baldoni, 2013). Women-friendly organizations typically have a stronger moral orientation and project more social sensitivity than other organizations, a necessary attribute for a socially accountable company's board. It is not that women and men compete in a zero-sum game—it is that women bring something new and different to the table for an organization. Understanding consumers’ shopping habits and buying decisions is a good example. Women notoriously spend more time shopping and therefore purchase a greater amount of goods, whereas men tend to be more focused and just grab what they need and intended to purchase. Marketers need to focus on both genders but place more emphasis on women as

women make more than 85% of the consumer purchases in the United States, and reputedly influence over 95% of total goods and services purchased. Women as a whole are considered more sophisticated shoppers than men, taking longer to make a buying decision.

(Lewis, 2013)

Roy D. Adler, Professor of Marketing at Pepperdine University, conducted a comparative analysis involving the effects of women's presence on TMTs on firm performance. Data from Fortune 500 companies for the 1980 to 1998 period were collected to measure firm profits as a percentage of revenues, assets, and stockholders’ equity (Adler, 2001). A fourth measure of profitability was used to determine whether each firm was higher or lower than its relevant industry median. These results showed a clear pattern. Fortune 500 firms with a high number of women executives outperformed their industry median firms on all three:

On the measure of profits as a percentage of revenues, the subject firms outperformed the corresponding industry medians by 34%. The women-friendly firms averaged 6.4% while the average of their industry medians was 4.8%. When taken individually, almost two-thirds of the subject firms (66%) outperformed their median counterparts.

On the measure of profits as a percentage of assets, the subject firms out-performed the industry medians by 18%. The women-friendly firms averaged 6.5% while the average of their industry medians was 5.5%. When taken individually, 62% of the subject firms outperformed their median counterparts.

On the measure of profits as a percentage of stockholders’ equity, the 25 firms outperformed the industry medians by 69%. The women-friendly firms averaged 26.5% while the average of their industry medians was 15.7%. When taken individually, 68% of the subject firms outperformed their median counterparts.

DIVERSITY A SOURCE OF COMPETITIVE ADVANTAGE

Vanessa Torres, Head of Group Investments and Value Management, BHP Billiton—Women in Energy and Resources Leadership Summit

At BHP Billiton, we are working very seriously in order to reduce the time we need to achieve an inclusive environment and an optimal diversity balance which will make our organization not only better in terms of our workforce satisfaction, but also more and more productive through time. And, at BHP Billiton, it starts with our CEO, Andrew Mackenzie, who named diversity and inclusion as one of the strategic priorities in his message that informs business planning for the whole organization. As one of our business priorities, this focus translates in initiatives such as:

1. Assessment of our own data to support the business case, as our 2013 Employee Perception Survey showed that increased inclusion correlates with increased performance;

2. Establishment of Inclusion and Diversity councils throughout our organization;

3. Deployment of unconscious bias training in large scale, which has already started with our Group Management Committee and will be ultimately delivered to all our leaders and employees;

4. Indigenous representation targets throughout our businesses;

5. Identifying qualified women in succession plans for key leadership roles as well as piloting senior executive female sponsorship program;

6. Company-wide female retention and recruitment targets for each financial year, including a focus on recruiting female Graduates;

7. And, finally, by establishing inclusion and diversity as KPIs in the scorecards of all leaders across the company.

Importantly, inclusion is one of the themes of our Leadership Development Program which will ultimately reach 10,000 leaders in BHP Billiton. By investing in our leadership, we will be creating more inclusive environments where our employees feel valued and heard.

(Torres, 2015)

Successful female executives who have gone through accelerated career choices also enjoyed the benefit of a sponsor, have the know-how to build relationships, and step outside their comfort zone to fuel their personal and professional growth. High-achiever women adapt better to the male environments in their executive circles and have the ability to overcome the extraordinary challenges of meeting a variety of expectations through endurance, sponsor relationships, and high stamina. They are perceived by their male counterparts as having high work ethics, relentless focus on performance and results, are resilient to change, and are persistent in getting constructive feedback for self-improvement. These women managers are inspirational, collaborative, and inclusive, highly competent, and very effective team leaders.

The “Asking Advantage”

Babcock and Laschever (2007), co-authors of Women don't ask, found that male graduate students starting out in their first job earn 7.6% or almost $4,000 more than female grads. It turned out that only 7% of the female students had negotiated their starting salaries as compared to 57% of men who had asked for more money than they were offered. The most striking finding, however, was that the students who had negotiated (most of them men) were able to increase their starting salaries by 7.4% on average—a figure nearly matching the gender gap between men and women's starting salaries. This has implications as to why and how the gender pay gap is created and sustained due to socio-psychological forces that reinforce gender differences. White female physicians, for example, earn 40% less than white men. Women also tend to assume they will be offered compensation that is fair for the job —an assumption that sabotages future attempts at negotiation (Ly, Seabury, & Jena, 2016). Changes, however, have begun to take shape as millennials are now asking for (and getting) more pay than men. Women in technology, sales, or marketing with two years’ or less experience actually got salary offers that were 7% higher than those received by equally inexperienced men (Sahadi, 2016).

Girls are taught from early childhood to build relationship capital by focusing on what they need rather than what they're worth. Women are satisfied with relatively less pay. Both sexes subscribe to powerful stereotypes that keep women from asserting themselves—even if they repudiate the stereotype or feel immune to it. Women are more likely to experience barriers due to the masculinity of the negotiation process, which is not congruent with their authentic or prototypical behaviors. If they don't force their desired outcome, they'll be completely overlooked, and if they do, they'll be resented or even thwarted because they will be perceived as self-serving.

Women have traditionally adapted to such environments in a few different ways. One is “going along to get along,” in which females play along with locker-room talk in particular and do not report it. Another is to become “more male” by shedding traditionally “female” attributes such as empathy. The problem is that once women adopt the going along to get along style, they lose their authenticity and prototyped behavior. As Caprino (2013) suggested: “Whole-self authenticity is a must-have for many women, yet still impossible in many corporate environments.” The idea that authenticity and transparency, and being who women really are—and being recognized and appreciated for that—is a vitally important criterion for women's career success.

Consequently, women don't ask for what they want or feel they deserve because they're fearful they will not be liked, whereas men perceive asking as a useful means to achieve greater gains. This is what sociologists call “accumulation of disadvantage.” The bottom line is that even if women were asking for comparable things and were equally successful at getting what they ask for, this simple difference in the “asking propensity” of men and women inevitably leads to men having more opportunities in accumulating more resources. The net result is a sustained gender pay gap. Behaviorally and cognitively, women must understand, at a very deep level, the forces that shape their beliefs, attitudes, and impulses. Simply telling women what they should do differently without helping them understand the root causes of their behavior will not help them achieve meaningful change.

Gender Gap in Executive Pay

Shin (2012) analyzed a sample of 7,711 executives (of which 6% were women and 94% men) employed by 831 publicly traded US firms from 1998 to 2005 examining the relationship between female representation in compensation committees, the presence of female CEOs, and the reduction of wage disparities. Findings included:

In real dollar terms, men in the sample study were paid $1,443,607 (in 2000 dollars) on average, while women received $1,018,107 (in 2000 dollars) on average, or 42% less than men.

Having a greater proportion of women on compensation committees was found to reduce inequality in salaries paid to women compared to their male counterparts. The increase in the representation of women was not correlated with any adverse impact on salaries paid to male executives.

An overwhelming 81% of the firms in the sample had no female representation in their compensation committees, while only 10% of the firms had equal gender representation in compensation committees.

Firms with one woman on the compensation committee experienced an average total compensation (including annual salary, bonuses, stock options, and other long-term incentive pay) increase for women by $302,000, up 34%. Adding another woman to the compensation committee was correlated with yet another 38% jump in salaries for women, to an overall average of $1,635,000. Firms with at least two women on compensation committees (which is usually comprised of four members) eliminated salary disparities altogether.

Among top positions, females were more likely to hold lower-ranking positions of executive vice-president, senior vice-president, counsel, and secretary. Male executives typically landed the positions of CEO, chief operating officer (COO), president, and chairman.

Overall, the presence of female CEOs was not associated with a reduction in wage discrimination faced by other women executives in the same company.

Why is there no strong linkage between the presence of female CEOs and executive compensation for women (Shin, 2012)? One explanation is associated with the limited active mentoring relationships. For top managers who need to juggle demanding job requirements and performance pressures, developing effective mentoring relationships may be a challenge. Some female executives might succumb to the Queen Bee Syndrome (see Chapter 1), relegating the need to act as a supportive mentor to other women. This syndrome places a woman executive in the strained position of wanting to integrate herself with her network of associates but at the same time feeling pressured to separate herself from her female colleagues at lower ranks (Knight, 2011). In some cases, isolation, marginalization, and vulnerability to judgment of others create complex chain of mutually reinforcing events that cause women to gradually and subconsciously become risk-averse, overly focused on details, and prone to micromanagement (Kanter, 1993; Kram & McCollom-Hampton, 1998). Eventually they lose sight of the larger purpose as leaders and are framed into existing or known stereotypes (Ely, Ibarra, & Kolb, 2011). Unfortunately, if women have to hide their own values and submit to organizational pressure to mold into current norms and practices, their motivation to remain with the organization for a long period of time is lessened (Ruderman & Ohlott, 2004).

The US EEOC[1]

The US EEOC is responsible for enforcing federal laws that make it illegal to discriminate against a job applicant or an employee because of the person's race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability, or genetic information. It is also illegal to discriminate against a person because the person complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit. Most employers with at least 15 employees are covered by EEOC laws (20 employees in age-discrimination cases). Most labor unions and employment agencies are also covered.

The laws and regulations apply to all types of work situations, including hiring, firing, promotions, harassment, training, wages, and benefits. The EEOC has the authority to investigate charges of discrimination against employers who are covered by the law. The Commission's role in an investigation is to fairly and accurately assess the allegations in the charge and then make a finding. If it finds that discrimination has occurred, the Commission will try to settle the charge.[2] If unsuccessful, EEOC has the legal authority to use its judgment and in some cases file a lawsuit to protect the rights of individuals and the interests of the public. The EEOC, however, works to prevent discrimination before it occurs through outreach, education, and technical assistance programs.

The EEOC provides leadership and guidance to federal agencies on all aspects of the federal government's EEO program.[3] EEOC assures federal agency and department compliance with EEOC regulations, provides technical assistance to federal agencies concerning EEO complaint adjudication, monitors and evaluates federal agencies’ affirmative employment programs, develops and distributes federal sector educational materials and conducts training for stakeholders, provides guidance and assistance to Administrative Judges who conduct hearings on EEO complaints, and adjudicates appeals from administrative decisions made by federal agencies on EEO complaints.

COMMENT SUBMITTED IN PROFESSOR BELASEN'S CLASS, FALL 2015

In my previous employment, there was one department that notoriously poached/hired friends they had worked with in other organizations—they all looked alike, thought alike, behaved alike, etc. As HR [human resources], my role was not to make the actual selection; rather, it was to ensure the applicants forwarded to the hiring manager met the minimum requirements for the job. However, once I noticed the pattern (during the third hiring process), I started forwarding blind resumes (i.e., redacting all names/addresses/phone numbers— anything that would directly identify a candidate—I would even redact and categorize current and/or previous employer names—i.e., multinational Fortune 500 company, local non- profit organization, state-level government agency, etc.) so that the hiring manager could only compare applicants based on the qualifications listed on the resume. Certainly, this was not fool-proof, and categorizing the current/previous employer names was a bit drastic, but given the circumstances, it helped level the playing field for all applicants and minimized the risk of wrongful hire or other discrimination-based lawsuits. For standard external hires (or even first round internal promotions), organizations could use blind resumes to help initially level the playing field for all applicants. Once it goes to the interview round(s), it may or may not change the end result, but at least the qualified applicants have a fighting chance.

Inconsequential Enforcement of Equality Laws

Some concerns about the inability of the EEOC to fulfill its mission of handling employment discrimination complaints due to limited resources and inadequate budget were raised in 2001 and again a decade later. While EEOC developed a priority system in 1995 to facilitate the processing of cases, the huge backlog of unresolved complaints were piling up with extraordinary variation across offices in categorization practices and outcomes in resolving cases (Moss, Burris, Ullman, Johnsen & Swanson, 2001). A decade later, in 2011, the problem of unfunded mandate has continued to limit the EEOC ability to provide adequate resolutions to claims. In fact, the Evaluation of the Management of the EEOC's State and Local Programs (EEOC, 2011) showed clearly that from 2000–2008, as a result of declining appropriation levels and hiring freezes, EEOC lost approximately 25% of its full-time employees and its case backlog increased.

The evaluator concluded that

EEOC has not established any performance goals or objectives related to the Fair Employment Practices Agencies (FEPA) performance. Without any performance goals and objectives, the EEOC is not holding itself accountable for achieving program results. We recommend that management develop and implement strategic performance goals and objectives that are reflective of the program; are measurable and in accordance with the requirements of Government Performance and Results Act; and that the goals and objectives are included in the annual performance and accountability report.[4]

CENSUS BUREAU

Mom Is Designated “Parent,” Dad Is “Childcare Arrangement”

In a move that should frustrate advocates, mothers and fathers alike, the Census Bureau's recently compiled “Who's Minding the Kids?” report counts fathers staying home with their children as a “child care arrangement.” This puts fathers looking after their children—or what most people call parenting—in the same category as a working mother hiring a babysitter or sending her kids to day-care.

(Women's Law Project, 2012)

Employers’ Common Mistakes

During the Annual Meeting of the American Corporate Counsel Association in fall 2002, in her speech, EEOC Chair Cari Dominguez placed some of the burden of nonconformance issues on “judgment lapses” or common mistakes made by employers when dealing with EEOC regulations. She also offered ways to minimize conflict with EEOC (Dawson, n.d.; Shea, 2003):

Employers underestimate EEOC. Many employers and their counsel underestimate the competence and professionalism of the EEOC staff primarily to preconceived notions of a pro-employee bias by the Commission. Dominguez suggested that employers become prepared and stay out of EEOC's line of vision by playing fair and having a respectful work environment.

Employers do not communicate. Many employers and their attorneys fail to stay in touch with the EEOC while an investigation is taking place. Once the complaint has been initiated, the employer has the burden to show actions were nondiscriminatory. Proactive communication with the EEOC investigator builds credibility for the company and for the attorney who represents it.

Employers are dismissive. Apparently, too many on the employer's side assume that the EEOC will not litigate due to shortage of resources. Although litigation (rather than a dismissal and notice of rights) is definitely the exception, the EEOC has been known to go to court—especially when class relief is possible. The EEOC is generally a hard- working and effective adversary for any employer when they believe discrimination exists.

Employers retaliate. Retaliation charges count for about 28% of all of EEOC's charges. Even if the original charge is unfounded, the employer could still be found guilty of retaliation discrimination.

Employers avoid mediation. Employers tend to believe that EEOC mediators would not give them a fair shake. In many cases, the mediators are generally quite fair and savvy and have facilitated very economical resolutions for companies. Not every case is suitable for mediation, but more cases are mediation worthy. Passing up mediation, when offered, can suggest that you have no intention of resolution or to even listen to the employee(s).

Employers wait. Employers employ delay tactics in an attempt to weaken the EEOC. Employers should realize that once an employee files a charge, the statute of limitations on the federal antidiscrimination claims stops running until the EEOC disposes of the case. If found guilty, the liability, e.g., back pay, continues to accrue until the case is closed.

Employers act inappropriately. Employers do not always take corrective action when problems arise, and without an effective EEO policy and procedures to process EEO complaints of discrimination they fail to take proactive or preventive approaches to tackle discrimination issues. When EEO procedures are implemented and followed consequentially, they also help develop a good culture and expected norms of behaviors.

Employers prevaricate. To the extent that employers provide non-coercive advance preparation for their employees before EEOC interviews, or obtain legal representation before responding to charges, this is all perfectly legitimate and more than fair. However, employers who try to improperly conceal witnesses or evidence, falsify documents, threaten potentially adverse witnesses with discipline or discharge (or blacklisting), lie to the EEOC, or engage in other improper activity should watch it—they are hurting no one but themselves. Things will only get worse when employers are not open and honest with the EEOC.

Employers do not calibrate. Employers often fail to monitor the demographics of employment activity or enforcement of EEO procedures. This is the EEOC's top complaint. Many employers are not proactive with EEO laws, waiting until the risk becomes the problem. If you are a medium to large employer (over 50 employees), keep EEO and harassment policies up to date; have good processes in place for employees to complain if they believe that they have been treated unfairly; and provide effective management training on employee relations, discipline and discharge, discrimination, reasonable accommodation, retaliation, and harassment. It is also advisable to monitor legal actions filed against the company (including lawsuits and administrative charges), even if frivolous, because heavy activity may indicate serious morale or perception issues if not bona fide discrimination issues.

TOP FEMALE PLAYERS ACCUSE US SOCCER OF WAGE DISCRIMINATION

US Soccer, the governing body for the sport in America, pays the members of the men's and women's national teams who represent the United States in international competitions. The men's team has historically been mediocre. The women's team has been a quadrennial phenomenon, winning world and Olympic championships and bringing much of the country to a standstill in the process.

Citing this disparity, as well as rising revenue numbers, five players on the women's team filed a federal complaint … accusing US Soccer of wage discrimination because, they said, they earned as little as 40% of what players on the United States men's national team earned even as they marched to the team's third World Cup championship last year. The five players, some of the world's most prominent women's athletes, said they were being shortchanged on everything from bonuses to appearance fees to per diems.

The case, submitted to the Equal Employment Opportunity Commission, the federal agency that enforces civil rights laws against workplace discrimination, is the latest front in the spreading debate over equal treatment of female athletes. A tennis tournament director was forced to resign recently after saying that female players “ride on the coattails of the men,” and the N.C.A.A. has drawn scrutiny for the financial disparities between the men's and women's basketball tournaments.

(Das, 2016)

Best Practices for Employers and Human Resources/EEO Professionals

The following propositions and means to avert inequality, encourage diversity, and reinforce equity and civility in organizations are offered on the EEOC site.[5]

General

Train human resources managers and all employees on EEO laws. Implement a strong EEO policy that is embraced at the top levels of the organization. Train managers, supervisors, and employees on its contents, enforce it, and hold them accountable.

Promote an inclusive culture in the workplace by fostering an environment of professionalism and respect for personal differences.

Foster open communication and early dispute resolution. This may minimize the chance of misunderstandings escalating into legally actionable EEO problems. An alternative dispute-resolution program can help resolve EEO problems without the acrimony associated with an adversarial process.

Establish neutral and objective criteria to avoid subjective employment decisions based on personal stereotypes or hidden biases.

Recruitment, Hiring, and Promotion

Recruit, hire, and promote with EEO principles in mind, by implementing practices designed to widen and diversify the pool of candidates considered for employment openings, including openings in upper-level management.

Monitor for EEO compliance by conducting self-analyses to determine whether current employment practices disadvantage people of color, treat them differently, or leave uncorrected the effects of historical discrimination in the company.

Analyze the duties, functions, and competencies relevant to jobs. Then create objective, job-related qualification standards related to those duties, functions, and competencies. Make sure they are consistently applied when choosing among candidates.

Ensure selection criteria do not disproportionately exclude certain racial groups unless the criteria are valid predictors of successful job performance and meet the employer's business needs. For example, if educational requirements disproportionately exclude certain minority or racial groups, they may be illegal if not important for job performance or business needs.

Make sure promotion criteria are made known, and that job openings are communicated to all eligible employees.

When using an outside agency for recruitment, make sure the agency does not search for candidates of a particular race or color. Both the employer that made the request and the employment agency that honored it would be liable.

Terms, Conditions, and Privileges of Employment

Monitor compensation practices and performance appraisal systems for patterns of potential discrimination. Make sure performance appraisals are based on employees’ actual job performance. Ensure consistency, i.e., that comparable job performances receive comparable ratings regardless of the evaluator, and that appraisals are neither artificially low nor artificially high.

Develop the potential of employees, supervisors, and managers with EEO in mind, by providing training and mentoring that provides workers of all backgrounds the opportunity, skill, experience, and information necessary to perform well, and to ascend to upper-level jobs. In addition, employees of all backgrounds should have equal access to workplace networks.

Protect against retaliation. Provide clear and credible assurances that if employees make complaints or provide information related to complaints, the employer will protect employees from retaliation, and consistently follow through on this guarantee.

Harassment

Adopt a strong anti-harassment policy, periodically train each employee on its contents, and vigorously follow and enforce it.

Develop a clear explanation of prohibited conduct, including examples.

Have a clear assurance that employees who make complaints or provide information related to complaints will be protected against retaliation.

Articulate clearly the complaint process that provides multiple, accessible avenues of complaint.

Provide assurances that the employer will protect the confidentiality of harassment complaints to the extent possible.

Have a complaint process that provides a prompt, thorough, and impartial investigation.

Ensure that the employer will take immediate and appropriate corrective action when it determines that harassment has occurred.

MAVIS DISCOUNT TIRE TO PAY $2.1 MILLION TO SETTLE EEOC CLASS SEX DISCRIMINATION LAWSUIT

Tire Retailer Violated Federal Law by Systemically Refusing to Hire Women in Its Field Locations, Federal Agency Charged

Mavis Discount Tire, Inc./Mavis Tire Supply Corp./Mavis Tire NY, Inc./Cole Muffler, Inc., a large tire retailer based in the New York metropolitan area, will pay $2.1 million and provide other relief to settle a class sex discrimination lawsuit by the U.S. Equal Employment Opportunity Commission (EEOC), the agency announced today.

According to EEOC's lawsuit, Mavis engaged in a pattern or practice of sex discrimination by refusing to hire women for its field positions—managers, assistant managers, mechanics, and tire technicians—in the company's over 140 stores throughout Connecticut, Massachusetts, New York, and Pennsylvania. EEOC also charged that Mavis failed to make, keep, and preserve employment records.

Such alleged conduct violates Title VII of the Civil Rights Act of 1964. EEOC filed its lawsuit in U.S. District Court for the Southern District of New York (Case No. 12-CV-00741) after first attempting to reach a pre-litigation settlement through its conciliation process.

The consent decree settling the suit, entered by Judge Katherine P. Failla on March 24, 2016, provides that Mavis will pay $2.1 million, to be divided among 46 aggrieved women. Also, the decree provides for extensive safe-guards to prevent future discrimination by implementing hiring goals for women, a comprehensive recruitment and hiring protocol, and anti- discrimination policies and training. “We are pleased that as a result of this settlement, Mavis will be making concerted, verifiable efforts to hire more women at all of its field locations,” EEOC Acting Regional Attorney Raechel Adams said.

EEOC New York District Director Kevin Berry added,

This case exemplifies EEOC's commitment to remedying systemic bias. EEOC found that Mavis for years had maintained a pattern of not hiring women at its field locations. This settlement ensures that qualified women will continue to be hired in the future – and advances EEOC's first priority in its Strategic Enforcement Plan, eliminating barriers in recruitment and hiring.

EEOC General Counsel David Lopez said:

We are pleased that during Women's History Month, we were able to announce this settlement, which is one in a series of EEOC cases nationally to address discriminatory barriers for women. Moving forward, qualified female applicants will be judged by their talents and skill and not simply passed over because of their gender – and women who were denied positions will be compensated.

The elimination of recruiting and hiring practices that discriminate against women, racial, ethnic and religious groups, older workers, and people with disabilities is one of six national priorities identified by EEOC's Strategic Enforcement Plan (SEP).

EEOC's New York District Office oversees New York, Connecticut, Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, and parts of New Jersey. EEOC enforces federal laws prohibiting employment discrimination.

(EEOC, 2016)

Fair Pay Act

In a 2010 World Economic Forum report on corporate practices for gender diversity in 20 countries, 15% of the total set of responding companies track salary gaps between women and men, 13% track salary gaps between women and men and implement corrective measures, 54% do not track salary gaps and affirm that generally there are no gaps between male and female employees’ salaries in their companies, and, finally, 18% of the companies responded that they do not formally track salary gaps. Hence, 72% of the companies surveyed do not monitor gender pay gaps at all. The complete results are displayed in Figure 3.3.

In January 2016, President Obama renewed his call to Congress to pass the Paycheck Fairness Act, which would potentially close loopholes in the Equal Pay Act of 1963 and require employers to prove that pay gaps are due to legitimate business reasons, not discrimination. The proposal would cover more than 63 million employees—potentially providing a new

wealth of data for understanding the pay gap issue and determining whether certain workers are getting short-changed (Ortiz, 2016).

Figure 3.3 Policies on Tracking Salary Differences

Source: Zahidi & Ibarra (2010).

OBAMA MOVES TO EXPAND RULES AIMED AT CLOSING GENDER PAY GAP

President Obama on Friday moved to require companies to report to the federal government what they pay employees by race, gender and ethnicity, part of his push to crack down on firms that pay women less for doing the same work as men.

“Women are not getting the fair shot that we believe every single American deserves,” Mr. Obama said in announcing the proposal, timed to coincide with the seventh anniversary of his signing of the Lilly Ledbetter Fair Pay Act, which makes it easier for people to challenge discriminatory pay. “What kind of example does paying women less set for our sons and daughters?”

The new rules, Mr. Obama's latest bid to use his executive power to address a priority of his that Congress has resisted acting on, would mandate that companies with 100 employees or more include salary information on a form they already submit annually that reports employees’ sex, age and job groups.

“Too often, pay discrimination goes undetected because of a lack of accurate information about what people are paid,” said Jenny Yang, the chairwoman of the Equal Employment Opportunity Commission, which will publish the proposed regulation jointly with the Department of Labor. “We will be using the information that we're collecting as one piece of information that can inform our investigations.”

The requirement would expand on an executive order Mr. Obama issued[6] nearly two years ago that called for federal contractors to submit salary information for women and men. Ms. Yang said the rules would be completed in September, with the first reports due a year later.

(Hirschfeld, 2016)

Linking Diversity with Performance and Rewards

Organizations must undergo a fundamental change in the hiring, evaluation, selection, and promotion policies and criteria used to fill top leadership positions. They need to reassess their missions and core values and remove barriers that limit or inhibit women's access to upper-level positions. Even a small increase in the percentage of female managers is expected to contribute to the implementation of successful practices, such as participative decision making, equity, and transparent communications. Furthermore, research shows that employee participation in decision making is positively correlated with superior organizational performance (Fernie & Metcalf, 1995) as also evident in the fact that many decisions in organizations are made by groups, teams, or committees (Foote, Matson, Weiss, & Wenger, 2002). If women have preferences for specific leadership styles (i.e., democratic) that contribute to effective decisions (and outcomes), the likelihood that such styles and practices (i.e., involvement, interpersonal orientation) will become prevalent across organizational lines could also increase.

Women leaders have the capacity to be more balanced and seek out win–win solutions in their decision making. They examine causes and consequences of decisions and their potential impact on affected employees, customers, and shareholders. This big-picture thinking may help women deal more successfully with ambiguity in business (Coughlin, Wingard, & Hollihan, 2005). It is unlikely that a woman will consciously go through a logical decision making sequence to select the best option (Belasen & Frank, 2008). Instead, women, on the one hand, tend to look at details to create a bigger, more holistic picture of a situation before making a decision. Men, on the other hand, tend to gather as much information as women, but analyze it in a more linear path. Indeed, women scored higher on traits associated with conscientiousness (Belasen & Frank, 2012). Women were found to be better suited for leadership than their male colleagues when it comes to clarity, innovation, support, and targeted meticulousness (Øyvind & Glasø, 2013).

Melero (2011) found that workplaces with a higher percentage of female managers tend to allocate more time to group decision making processes and to giving and receiving feedback. In fact, Cook and Glass (2014) suggested that the integration of women into decision making roles reduces both the impact of male-to-female evaluation bias and the inclination for men to prefer hiring other men (Carrington & Troske, 1995; Cohen, Broschak, & Haveman, 1998; Ely, 1995). Managers are also more open to improving the collective performance and discussing career development opportunities with employees. When organizations include women in their management teams, they should expect above the average performance. Prejudices against female managers are also expected to become less pervasive, and the perception of tokens by peers and superiors when women participate in decision making will lessen.

Tokenism, on the one hand, is a phenomenon that leads to the informal isolation of minority members who, in turn, respond by keeping low profiles. On the other hand, participative decision making is inclusive and generates more discussions and options for solving problems as well as increases diversity and acceptance of viewpoints. Linking diversity goals with performance goals and financial incentives should be formalized through human-resources policies and reinforced through senior management commitment (Giscombe & Mattis, 2002). For example, Sodexo USA has developed a diversity scorecard (Anand, 2014) that links the human-resources cycle (i.e., recruitment, retention, development, promotion) with diversity and engagement goals, business goals, and strategies (Dolezalek, 2008). Senior executives must communicate the message that gender diversity is a business imperative and actively model the way through decisions and actions. Senior executives should also encourage performance dialogues, invest in women's leadership development, and use evidence-based discussions to spearhead best practices that drive success. Establishing a leadership priority for change has been the most successful of all diversity initiatives (Kalev, Dobbin, & Kelly, 2006). Gender diversity should become the new organizational mantra, the DNA of successful organizations.

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4.

www.eeoc.gov//eeoc/oig/2010-09-aep.cfm?renderforprint=1.

5.

www.eeoc.gov/eeoc/initiatives/e-race/bestpractices-employers.cfm.

6.

President Obama signs a new Executive Order to prevent workplace discrimination and empower workers to take control over negotiations regarding their pay, www.whitehouse.gov/blog/2014/04/08/taking-action-honor-national-equal-pay-day.

Citation Information:

Belasen, A. (2017). Promoting Equality in Management. In Women in Management. Routledge. Retrieved September 25, 2023, from https://search.credoreference.com/articles/Qm9va0FydGljbGU6NDgzNTIwMg==.

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