In total, 513 managers participated in the survey including 15 EDs, 62 HoA, 295 HoCS, and 141 DoNs from the three targeted hospitals. Table 1 provides details of the target population and response rates for each management level by hospital. With the exception of one subgroup (the HoA at XXH), the response rates were satisfactory.
Demography and employment details
The gender ratios varied by management level from 1.8:1 for clinical managers to 0.14:1 for nursing managers. Overall, the mean age of participants of the three management groups ranged from 40.6 to 47.2 years. DoN tended to be younger than all other management positions. Managers generally spent about 13 years working in non-management roles before advancing to management positions. HoCS spent approximately two years longer than managers in other positions before taking up management role. Table 2 details the above differences between positions.
Less than half (44%) of the participants possessed a postgraduate qualification. Of these 56% were PhDs and 44% master’s degrees (Table 3). Clinical directors had the highest percentage of postgraduate qualifications (57%) with 94% of PhDs. Directors of Nursing had the lowest percentage of postgraduate qualifications (21%). The clear majority of the postgraduate degrees (98%) were held by managers at QFSH. None of the managers from XXH and LCQH and none of the Directors of Nursing at QFSH had acquired a PhD. Only 13 out of the 96 Master Degrees (14%) and three out of 122 PhDs (2.5%) were management related. Most of degrees were in the discipline of medical science.
In addition, 28 directors were currently completing either a Master’s degree or PhD. However, only three of these degrees were management related (Table 4).
Informal management related training
Overall, between 50 – 64% of the managers from three different management positions participated in some form of management related training before taking up their current management positions. The rates varied by management level and hospital. The participation rate increased to 66 – 79% after taking up the management role (Table 5). The participation rates of HoCS were slightly lower than other management levels.
DoNs consistently had the highest participation rates before and after taking up their management roles. Looking at the data separately by hospital and management level (Table 5), less than 50% of the HoCS at LCQH and XXH took part in management related training before taking up the management roles; this represents the lowest participant rate amongst all management positions across the three hospitals. However, the participation rate for these managers increased by more than 14% after taking up the management position. HoA at LCQH and DoN at QFSH had the highest participation rate of slightly more than 80% after taking up the management position. Overall, the participation in management related training was consistently higher after taking up the management role compared to before across management positions and hospitals.
Management training topics
In total, 16 topics of management related training were provided to participants for multiple selection. Table 6 details the mean scores for training before and during current management role by hospital and management level. Managers at QFSH attended significantly more management training in terms of types both before and during taking up their management positions compared to the other two hospitals. Directors of nursing attended significantly more training than the other types of directors. Figures 1 and 2 represent the data graphically.
Appendices 2a and 2b present the percentage of managers completing the training topics before and after taking up their current management positions, by management level and hospital. Managers at QFSH completed more training types both before and during their current management positions compared to the other two hospitals. HoCS completed significantly less management related training before taking up their management roles. In contrast, DoNs completed significantly more types of management related training both before and after taking up the current management position than all other management positions. Across all hospitals and management levels, more training was completed after taking up the management roles compared with before.
Of all the management training areas, conflict resolution, employee relationships, safety training, performance management, leadership, human resource management and communications were the seven areas which attracted the highest participation (26-37%) across all management positions before taking up the management positions. After taking up their management roles, an additional five topics (time management, decision-making, resource management, quality control and policy & procedure) also attracted higher participation rates (27-35%).
Commitment to training and professional development
Participants were also asked to recall whether they had participated in any of the training as listed in Table 7 for more than 10 hours per year in the past three years. The table indicates the percentage of managers participated in the types of training for no less than 10 hours per year in the last three years are included in the table. Overall, 71% of all managers participated in management related training organised internally and 42% of all managers participated in management related training externally for more than 10 hours annually. However, less than half of the managers from each type of management positions committed more than 10 hours annually in self-study on management-related topics. The participation rate for HoCS was only 22%.
Difficulties encountered in the management position
Participants were also asked to indicate the difficulties encountered while in their current management position. A list of 15 difficulties were provided for multiple selection. Table 8 shows the mean difficulties scores by hospital and management level. The scores of those selected by QFSH managers are significantly higher than the other two hospitals. In addition, the scores of the directors of nursing are significantly higher than the other management positions.
Appendix 3 shows the percentage of managers selecting the difficulties by management level and hospital. Except for HoAs at QFSH, patient conflict was the commonest difficulty selected by the directors (36-62%). Other commonly selected difficulties (greater than 25%) included peer conflict, team conflict, innovative teamwork, employee performance, decision-making, new skill acquisition, expected work quality and management outcomes expectations. There was considerable variation between hospitals and management levels; managers at QFSH tended to report more difficulties than the other hospitals.
Perceived importance and self-assessment of management competencies
All participants were asked to indicate the importance of each of the six core management competencies to their current management role and whether they had acquired these competencies prior to taking up the current management position. Using a 5-point Likert importance scale, the vast majority of the managers (ranging from 84% to 98%) perceived the six competencies as important or very important to their management role. Less than 3.5% of all managers indicated any of the six competencies being unimportant or very unimportant (data not shown).
Another 5-point Likert scale was used to ask managers to indicate the extent to which the competencies had been acquired before taking up their current management role. Table 9 details the percentage of directors identifying the extent that they had acquired each of the competencies before taking up their current management roles.
Table 9 indicates that, for each of the six competencies, 11% to 24% of all directors perceived themselves as having fully acquired the competencies. More managers acquired competencies 3 and 4 (21.6% for Knowledge and 24.1% for Communications) than competencies 2 and 6 (10.8% for Resources and 13.3% for Change). Conversely, between 14 to 44 percent of all directors indicated that they had not acquired, only acquired to a limited degree or were unsure for all competencies, the highest were for competencies 2 and 6 (41% for Resources and 43.9% for Change)
Competency level – self-assessment
According to the description of MCAP Likert scale (appendix 1), a competency score of five (5.0) or greater indicates that participants could demonstrate the competency in their role independently without guidance. Table 10 provides details of the mean scores for the six competencies and by management level.
All six competencies were scored less than five for all managers levels. Competencies 2 & 6 were scored less than four overall (‘fully demonstrate in my role but with regular guidance’). Examining the scores by the three management levels, HoA recorded scores less than four (means ranging from 3.22 to 3.87) for the six competencies. DoNs also recorded mean scores lower than four for competencies 1, 2, 5 & 6. Mean scores for competencies for HoCS ranged between 4.14 and 4.70. Competency mean scores for HoCS were all higher than HoA and DoN, and the differences between the management levels were all highly significant as measured by ANOVA (F = 8.532 - 14.862; p - <0.00005). Figure 4 is typical of all the competencies.
If the hospital variable is included as a predictor in the univariate analysis of variance model, there are significant differences between hospitals with managers at QFSH assessing themselves significantly higher than managers at the other two hospitals (Mean Square =23.857; F =11.403; p < 0.00005). Figure 4 is typical of all the competencies.
Other statistically significant predictors of the self-perceived competency levels in a bivariate relationship included sex (M > F), age (positive correlation), total number of years as a manager (positive correlation) and postgraduate qualification (PG > UG). However, when added to a univariate model with the hospital and management level variables, both sex and the number of years as a manager ceased to have a significant effect on all competencies. Age remained a significant predictor for all six competencies and the combined competency. Manager type remained a significant predictor for all competencies except C5. Postgraduate education also remained a significant predictor for competencies C3, C4, C5, C6 and combined competencies. Hospital level remained significantly significant for competencies C1, C4, C5 and the combined competencies. The model included an interaction term of age times number of years as a manager, as these two variables were moderately highly correlated. Table 11 shows the results of the univariate model for C4 (Communications).