Knowledge and Skills Needed for Future Health Administrators: A Systematic Review (2024)

Ethical approval

The study was approved by the National Agency of Strategy Research Medical Education, Tehran, Iran with the code of ethics IR.IUMS.REC.1400.107.

Data extraction

The search strategy was based on the electronic search and hand searching. The main keywords in this systematic review were ‘Knowledge, Skill, Education, and Health administrator’. Such databases as MEDLINE (PubMed), Scopus, Web of Science, ProQuest, Google Scholar, Iran Medex, Magiran, and SID were searched.

Search strategy

Our initial search syntax for SCOPUS was as follows: (ALL(“Knowledge and skills” ) OR TITLE-ABS(“health administers”) OR TITLE-ABS (“Education”)) OR AND (TITLE-ABS (Tearing) OR ALL(Education) OR ALL(skills) OR TITLE-ABS (“Knowledge Education”) OR ALL(“Knowledge management”) OR ALL(“skills Education”) OR ALL(“Student Education”) OR ALL(“Student skills ”) OR TITLE-ABS (“Tearing Students ”) OR ALL(“health administers Education ”) OR TITLE-ABS (Students)OR ALL(skills) OR ALL(“Knowledge management”) OR ALL(“Student”) OR TITLE-ABS (Tearing) OR ALL(“Student Knowledge management”) OR ALL(“Knowledge management”) OR ALL(“Education”) AND (PUBYEAR < 2021 AND PUBYEAR > 1990).

After that, the search was performed, and the articles were selected based on the titles and abstracts.

After screening, the full text of all the articles was examined. The extraction of relevant information was based on the PRISMA flow chart (Fig. 1).

Inclusion and exclusion criteria

In all the studies searched in this systematic review, knowledge and skills were taken into account by the researchers, and the studies related to knowledge, attitudes and skills of students or health care workers were not considered. Therefore, all studies related to health-care workers, nurses, and curricula were excluded from the study. This study also focused on the knowledge and skills of health care management students, and thus all unrelated studies were excluded (i.e., the knowledge and skills of health care workers and the knowledge and performance of nursing students).

Quality assessment

In this study, all the searched studies were transferred to EndNote software (EndNote X7 ^™, Thomson Reuters) and duplicate references were removed. Afterwards, two authors independently screened the original articles. In this way, first the title and abstract of the articles were reviewed and then the selected articles were divided into three groups: relevant, irrelevant, and unreliable.

The articles found to be irrelevant by two reviewers were removed from the study, and then each reviewer reviewed the full text of the remaining articles and compiled a list of articles he/she had included. Afterwards, the two lists were compared and the discrepancies between them were discussed. In cases where no agreement was reached, the third person from the team made the final decision to include the article.

From each study included in this systematic review, such pieces of information as the author’s name, year of publication, purpose, and the most important findings of the study were extracted, as shown in Table 1. Then, the knowledge and skills of health care management students were obtained according to the researcher’s data extraction form

The questions in this checklist consist of four main sections: author’s name, type of study, findings, and year. All studies included in this systematic review were independently reviewed based on the questions in this checklist CASP.

As can be seen in the PRISMA flow chart, out of 7083 studies that were searched with the syntax search term in the databases, based on the compliance of the title and abstract of the articles with the inclusion and exclusion criteria of this study, the full text of 6165 articles were reviewed, and finally 13 articles were included in this study. Therefore, the knowledge and skills of health care management students were extracted from the findings of these studies, and they were analyzed by means of the thematic analysis method. Out of the total number of searched studies after removing duplicate cases, 6100 studies were excluded due to the lack of inclusion criteria. Therefore, despite focusing on the subject of knowledge and skills, the studies that did not address health care students were excluded from the present study. Finally, although 13 studies aimed at identifying the knowledge and skills of health care students were included in the search results,

The full texts of 65 studies were reviewed based on the checklist, and 42 studies were excluded due to a lack of factors related to the purpose of the current systematic review, namely identifying the knowledge and skills of health care management students. Moreover, out of 16 studies that were reviewed in full text, only three qualitative studies were identified, and they were excluded in the screening stage due to their non-compliance with the inclusion criteria. Hence, 13 studies conducted quantitatively and qualitatively were included in the study (Table 1).

Table 2:

Identification of the knowledge and skills of health care management students based on a systematic review

Knowledge-related factors

Education is the systematic acquisition of skills, rules, concepts or attitudes and is one of the most important components of any organization’s strategy. Awareness of the structure and processes in the field of health and knowledge of management sciences is one of the factors related to knowledge in the field of health services.

Knowledge of management science

There is a growing demand for formal and informal education programs, especially for physicians in leadership positions (6). Education for strategic planning and management was effective in the strategic decision-making of hospital management teams (7). These skills are the needs for hospitals in an increasingly competitive, complex and challenging context. For the first time, half of the public hospitals involved in team education have developed a formal strategic plan. The positive effects of the formal education program justify further investment in future education (5, 7). In a study by Barti et al., hospital as the most important organization in providing health services needs effective and efficient management more than other organizations, and the skills and abilities of hospital managers are considered important issues, and hospital management requires special skills and abilities. Therefore, health decision-makers and policymakers should select the hospital manager based on these skills (3). Moradi et al.’s study considered the managers’ competence in terms of management skills as one of the most important factors for the continuous success of any organization. They also stated that the use of such skills is positively helpful in the effectiveness of the organization and improvement of staff performance in line with organizational goals (8).

Awareness of the structure and processes in the field of health

Health care organizations are complex and dynamic systems that enhance interactions between multiple patient-related factors, health care physicians, health care teams, physical and social environments, organizational contexts, legislation, and accreditation. They affect the quality and results of care with a wide range of problems that the health care sector faces today, such as increasing the medical needs of the community and reducing the budget of health care managers and their decisions. In addition, technology has had a significant impact on the availability and accessibility of data for health care managers. Access to data is a timely strategic step that can enable managers to better cope with the complexity of health care organizations by relying on the best available evidence to improve their decision-making, resulting in better organizational outcomes (3, 6, 9, 13).

Factors related to skills

Identifying and validating competency requirements of core management are the first fundamental steps towards developing a competent management workforce to provide sustainable hospital services. Skill-related factors include planning, coordination, organization, leadership, control and evaluation, financial resource management and budgeting, service management, communication and information management, human resource management, implementation of participatory and team activities, crisis management, innovation, entrepreneurship and marketing, policy-making, and decision-making. (6, 12)

Planning

Strategic management and contingency planning involve the implementation and evaluation of cross-functional decisions that enable the organization to achieve its long-term strategic goals. Changes in the external environment (i.e. demographic and epidemiological transmission, economic fluctuations, and public and political expectations) and within the health care system (i.e. health market, demands, costs, new technologies, and regulations) have exerted pressure on hospital managers (12, 13). Implementing strategic management programs to meet environmental challenges. Leadership development using organizational plans implies that a strategic plan must exist in order to achieve these goals with the mission, vision, strategic goals, and operational plans of the organization. A hospital develops strategies that must be derived from a situational or strategic analysis, often by analyzing strengths, weaknesses, opportunities, and threats (1, 6, 12).

Organization and coordination

The greatest advances in operational management skills are the organization of daily activities, internal and external coordination, motivation and guidance, monitoring, group discussion, and situation analysis. Identified predictors of improvement include fewer years of managerial experience, type of manager, type of profession, understanding the importance of managerial skills (such as oral communication), evidence-based decision-making, and supervising the work of others. Some studies indicated that certain types of managers, such as deputies, and certain occupations, such as economists or head nurses, showed less improvement in some managerial skills, including group discussions, supervision, internal and external coordination, motivating and guiding others and the use of ethical techniques. In recent years, studies have shown that the active participation of physicians in strategic decision-making and in team-work leads to improved hospital performance, achievement of organizational goals and higher quality of care (1, 9, 12).

Leadership

The role of the hospital managers as the main leaders of the hospitals is undeniable. The manager is the official representative of the organization and is responsible for coordinating and increasing the effectiveness of the organization. On the other hand, the success of an organization depends on achieving goals. Managers as key decision-makers play an important role in dealing with organizational issues and problems (1, 12, 13). Managers should have the most competence in legal and ethical issues, health provision, planning, and change management. People management, leadership, strategic management, and problem solving are ranked as the most important factors for efficient and effective management of hospitals. Studies have shown that the biggest gaps are strategic leadership, management, and problem solving, and the smallest skill gap is in the areas of legal and ethical issues, health care delivery, and change management (2, 6, 12).

Control and evaluation

Health managers at every level need education to acquire the knowledge, skills, and attitudes required to manage complex health organizations. In addition, public health including the application of scientific knowledge and social processes, control and evaluation, accreditation, clinical governance, and supervision is effective in promoting healthy life through active participation in community and national resource mobilization for health measures (2, 13). Monitoring during the management and evaluation of the taken measures can increase the quality of health services, which in itself can indicate the competence of managers in the health system (12, 13).

Quality management

Low-income countries do not show much information about major efforts to improve the quality of hospital management, although these efforts are a key component of improving health care delivery. Health management education programs include capacity building, service quality control, process management and improvement, and benchmarking, which are deemed basic principles. In addition, the educational activities of health managers are very effective in resource development (2, 12, 13).

Financial resource management and budgeting

Operations, management and resource management, awareness of health care environment and organization, communication quality and management of relationship, leading individuals and organizations, empowerment and change management and professionalism, health economics and financial resource management, budgeting skills, and financing in the field of health are identified as the main managerial competencies required by the managers of mid-level and senior hospitals. However, the ability of individuals, organizations and society must be considered as a whole for management at three levels of individual, organization and society (2, 13). At the individual level, capacities focus on the skills and knowledge of individuals. By providing facilities such as IT equipment and access to magazines and financial resources, organizations provide a framework for individuals’ capacities to connect and achieve collective goals. Larger systems provide an environment in which organizations can operate. (6, 7, 13)

Communication and information management

One of the pillars of the integrated development strategy of managers is communication and information management, which is taken into account to achieve organizational goals and is the most appropriate solution to meet the needs of effective communication and communication management in managers (1, 13). One of the main factors in a workplace that limits the transfer of learning is the lack of participation of senior managers (8). Educational programs should be characterized by the principles of good practice, namely focusing on the accurate assessment of educational needs, proper selection of participants, learning outcomes, content and methods, and evaluation. (3, 7, 12, 13)

Human resource management

Human relation skills depend on the ability to create an environment for coordination and cooperation, to delegate tasks to others, to have effective activities as a group member, to understand individuals’ motivations, and to influence behavior (14). Teamwork in solving organizational problems and making decisions leads to better efficiency and performance (3). Studies have shown that educating managers for strategic management and planning, human resource management, and strategic decision-making improves hospital management teams. Human resource management is one of the most important and complex institutions in health care systems that all managers should consider (11, 12, 13).

Crisis management

Crisis management in an emergency is one of the skills required by hospital managers. Studies have shown that the most important skills and competencies required for nursing managers are effective relationships in emergencies (9). Other studies have also emphasized the importance of relationship skills for managers of health centers, especially hospitals (2). Managers’ skills lead to an increase in their acceptance and attractiveness among employees, resulting in a reduction in employees’ stress and an improvement in their performance in emergencies (8). A systemic mindset is a conceptual framework for problem solving that occurs by focusing on problems and during execution. Problem solving in this method is achieved by finding a pattern to increase organizational perception and to focus on problems (13).

Implementation of participatory and team activities

Achieving the performance goals of any organization depends on many factors, including resources, organizational structure, organizational and group communication, teamwork, organizational culture and norms, information systems and most importantly the management of that organization. Therefore, the development of managerial skills and teamwork is one of the requirements for the development and progress of organizations (13). Any development and change in the organization necessitate providing training for the managers of that organization. Health care organizations, especially hospitals, are constantly challenged by internal and external environmental forces such as demographic change and the use of new technologies, and this in turn challenges the capabilities of managers in the organization, requiring them to review and revise their competencies and skills (2, 12, 13).

Innovation, entrepreneurship and marketing

One of the managers’ competencies is the use of innovation and entrepreneurship. The ability to establish professional relationships with individuals in order to facilitate public relations is to understand effective needs and motivations. Team leadership will lead to the ability to direct individual and group activities towards a goal (7, 12, 13).

Policymaking and decision-making

Studies show that people management, leadership, strategic management and problem-solving/analysis skills, and evidence-based decision-making are of primary importance for hospital management in policymaking and decision-making (13, 15), with the largest gaps in these areas. Because hospital managers play a key role in organizational transformation and creating an accountable, efficient, and effective system, their skills need to be relevantly and appropriately strengthened. Organizations that train hospital management should design curricula and courses accordingly. The needs of the workplace and up-to-date management knowledge in the hospital have made it necessary to identify innovative approaches for training hospital managers in order to fill the existing gap in managerial competencies and meet the needs of current and future managers (3, 7, 12, 13).

This study suffered from some limitations. Due to significant differences in such factors as age, gender, and educational level among students, it was not possible to explain the exact and definite results and to conduct a comprehensive study.

Conflict of interest

None declared.

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