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Without sufficient skills, first-line managers do not benefit an organization. The first step to increase the number and education of managers is to provide effective training designed to specifically improve organizational performance.

Currently, healthcare costs are high. When all elements of healthcare reform are implemented, higher costs may ensue. There will be a demand for more change and greater resilience from our management teams. Unless we have managers who are resourceful in their management skills, we will not achieve new and improved ways to succeed in the goals of safe, high-quality care at a reasonable cost.

Promoting a technical worker to a manager role requires training. The new manager needs an educational program with inspired faculty, dedicated mentors, and an innovative curriculum designed to deliver the new skills needed to a diverse group of adult learners.

How do you train up employees to be effective, ethical, strategic, and skilled managers? It is a tall order that requires a constant battle to balance the benefits of training with the requirements of daily operations.

Succession planning for managers is often short sighted. Many organizations spend time and money on planning for successors for their executives, but the vast majority of organizations do not have a plan in place for their middle managers. This leaves organizations with unexpected gaps in the frontline and encourages recruitment of unskilled and frequently poorly prepared staff-level employees to assume these critical positions.

We have a choke point in our educational system because most learning curriculums do not provide the tactical skills required of managers in their daily lives on the job. Most organizations choose only one technique from the myriad options available to them, such as:

• Expect that seasoned practitioners will inherently have skills and be selected on the basis of informal leadership traits
• Believe all that is needed is an orientation program to how your organization “does things”
• Silo each discipline into their own management leadership educational program believing that each has such an abundance of special needs that it justifies a unique program
• Hold a boot camp that will provide skill training in short time (and expected it to stick)
• Think one-day programs are sufficient
• Use faculty who are all internal members of the organization
• Use online programs that allow participants to study in private at their own pace
• Send one person at a time to single, off-site programs
• Pair a novice with an experienced member of the team who will transfer skills on a 1:1 basis
• Pick a focus and invest in a process excellence model such as Six Sigma, Lean, or other frameworks and expect this will develop leadership skills
• Leave the provision of education to the academics in an executive education program
• Choose an approach to curriculum development and buy the package from a consultant.
• Select a leadership book and take each chapter as a trigger for discussion

Unfortunately, I usually see these options attempted in isolation to any other option. With so many options, which path should be followed?

We need to mobilize our common sense, mutual talents, mutual experiences, and not expect to come up with a single best method. We should understand that there are some universal attributes of management education.

Let’s stick to what makes sense to the people in operations who know what matters and what skills they, as employers, expect of their management team.

Then we need to chart the best course that will lead to the best impact on the business we are in. We are in the business of providing safe, effective healthcare to our community with skilful engaged employees at a price the community can afford.

Implementing a needed management education program requires skill, experience, courage, and collaboration among all stakeholders.

I suggest we begin this discussion with some validation of two common beliefs or assumptions:

• The ripple effect of new managers’ lack of knowledge and self-confidence can be seen in poor statistics for manager retention, staff retention, patient safety, patient satisfaction, physician satisfaction, community engagement, interdepartmental collaboration, and financial survival of the organization.
• Management requires a skills and a knowledge base. Not all informal leaders are good managers and not all managers are good leaders. You want frontline managers to perform in both areas of management tactical skills and creative leadership in an effective manner. Most healthcare management candidates do not have a knowledge base of the necessary tactical and leadership skills necessary to adequately contribute to highly functional and performing teams within a dynamic and complex healthcare system.

We need to turn to evidence-based theory of adult education to apply those tenets. Knowles (1998) developed principles that stipulate:

• Adults need to know why they should learn something
• Most adults were educated in school systems that fostered dependent vs. self-directed learning
• Draw upon the experience of the learner
• Adults want to be motivated to better their real-life tasks
• Adults want to know how new learning will impact their lives
• Adults are motivated by issues such as job satisfaction, self esteem, and quality of life

The management education question becomes: what content should be covered, how much content, and which delivery option do you use? But what will matter most in the long run is that learners participate in the program with the encouragement of peers, superiors, and subordinates.

My talking points for your discussion are:

• Resolve that management education is necessary.
• Executive buy-in and visible support by leaders is essential.
• Knowing what business goals you want to achieve from any educational program will ensure better outcomes.
• Be clear about what skills managers need to achieve the goals.
• Management education programs should have an evaluation method with predetermined outcome metrics to evaluate the effectiveness of your organization’s program. The individual performance and engagement in the participant’s career and positive interactions with colleagues should also be measured.
• Select the right faculty: Consider the values of internal and external faculty. Faculty must be credible, but not a person who signs the participant’s annual evaluation. Supervisors could be seen as in a position of authority to jeopardize the participant’s job if they have difficulty in the program. You want faculty who can bring both new ideas into the organization and yet provide support to the culture you wish to enhance.  
• Select diverse delivery methods that provide prolonged engagement with the learning process. Skills are not embedded into behavior overnight.

Have a mix of internal and external faculty. Honor and acknowledge organization wisdom and challenge participants to reach out to new voices and new approaches.

Know your first efforts will not be your last efforts.

Reference: Knowles, M. (1998). The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development. Houston, TX: Gulf Publishing.

Betty Noyes, RN, MA, is president of Noyes & Associates, Ltd., a nationwide healthcare consulting service. For more information, visit www.noyesconsult.com.

There are significant gaps in regulatory efforts nationwide to keep nurses from avoiding the consequences of misconduct by hopping across state lines, even with a 24-state compact created to help get good nurses to areas where they are needed most. Under the decade-old partnership, a license obtained in a nurse's home state allows access to work in the other compact states. But an investigation by the non-profit news organization ProPublica found that the pact also has allowed nurses with records of misconduct to put patients in jeopardy. In some cases, nurses have retained clean multistate licenses after at least one compact state had banned them. They have ignored their patients' needs, stolen their pain medication, forgotten crucial tests or missed changes in their condition, records show.