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CAHME International Healthcare Management Education Daniel J West, Jr., Ph.D., FACHE, FACMPE Professor and Chairman Department of Health Administration & Human Resources Panuska College of Professional Studies University of Scranton Gary Filerman, Ph.D Senior Vice President Atlas Research, LLC Bernardo Ramirez, MD, MBA Assistant Professor College of Health and Public Affairs Department of Health Professions University of Central Florida Jill Steinkogler, MHSA Senior Consultant Atlas Research, LLC ACKNOWLEDGEMENTS This study was made possible through a grant from the ARAMARK Charitable Fund at the Vanguard Charitable Endowment Program Additional contributions were received from the University of Scranton, Department of Health Administration and Human Resources and Atlas Research, LLC CONTENTS ACKNOWLEDGEMENTS 2 INTRODUCTION 5 OVERVIEW OF THE STUDY 6 Domestic Methodology 8 International Methodology 9 The University Survey 9 The Survey of Informed Leaders 10 SURVEY FINDINGS AND OBSERVATIONS 11 Domestic 11 Overview 11 Limitations 11 CAHME Survey Results . 12 Observations 12 International 13 The 16 Country Programs: An Overview 13 CONCLUSIONS 21 Domestic 21 SUGGESTIONS FOR FURTHER STUDY 24 APPENDIX A: INTERNATIONAL DATABASE 26 APPENDIX B: COUNTRY PROFILES AND PROGRAM TEMPLATES 27 Australia 27 Australia: Programs 31 Brazil 41 Brazil: Programs 46 Chile 50 Chile: Programs 54 China 58 China: Programs 63 France 67 France: Programs 71 India 77 India: Programs 82 Israel 93 Israel: Programs 96 Mexico 99 Mexico: Programs 103 Philippines 111 Philippines: Programs 115 Saudi Arabia 117 Saudi Arabia: Programs 117 Singapore 122 Singapore: Programs 126 South Africa 127 South Africa: Programs 131 Spain 135 Spain: Programs 138 Sweden 139 Sweden: Programs 142 Turkey 144 Turkey: Programs 148 United Kingdom 150 United Kingdom: Programs 155 APPENDIX C: CAHME SURVEY RESULTS 168 APPENDIX D: PRESENTATIONS AND CONFERENCES 198 APPENDIX E: SAMPLE LETTER TO INFLUENTIAL LEADERS 199 COUNTRY HEALTH SYSTEM ABSTRACT SOURCES 200 CAHME |5 INTRODUCTION We live in a global village where the geopolitical landscape changes rapidly In fact, change is the only constant in the globalization equation This global transformation involves all sectors of the global economy and provides unique challenges and opportunities to rethink business strategy The academic landscape is also changing Ben Wildavsky in this book “The Great Brain Race” (2010) offers insight into the new university globalization movement suggesting that higher education is now a form of international trade According to Wildavsky: Three of the most important higher education trends of the last half century – mass access, growing reliance on the merit principle, and significantly greater use of technology- will all be accelerated by globalization And there is no reason to believe that gains for one academic player will mean losses for all the other Indeed, academic free trade may be more important than any other kind (p 8) A recent article in “The Chronicle of Higher Education” titled “University Mergers Sweep Across Europe” (January 7, 2011, p 1) suggests that mergers and acquisitions among universities will continue as efforts are made to improve research quality, economic competitiveness and international reputation Academic free trade will have national and international implications that reshape higher education worldwide Joint programs of study, cross-disciplinary research and other venues for collaboration will emerge in response to global economic pressures The idea of a borderless world in higher education, as well as a movement towards consolidation, is augmented by the infusion of investments in investor owned universities in China, India, Mexico and Saudi Arabia, among other countries The international mobility of students and faculty along with for-profit growth will only serve to enhance and reshape the global academic landscape Opportunities for new growth and innovation will expand and attract new investments The accreditation of healthcare delivery programs in Europe during the 1990s responded to national efforts to improve quality of healthcare This investment has been reviewed by WHO and reported by others (Shaw, C.D., Kutryba, B., Braithwaite, J., Bedlicki, M & Warunek, A., 2010) It is clear that the trend for each country to develop its own standards is not new CAHME |6 Career ladders for professionals vary by regions, and the recognition of credentialing processes is not uniform and consistent across professional organizations Given the diversity of countries and the variation in professional identity for health care management professionals, accreditation has a variety of purposes and orientations among regions of the global community Medical tourism provides another variable in the globalization of healthcare This trade movement has a significant economic access and quality of care impact The idea that clinical outcomes can be linked to quality management and hospital performance is not new, but is not accepted globally The institutional framework and competencies of each profession suggests that although a common body of knowledge exists, there can be different expected levels of competencies, and that competencies can be country specific especially in the areas of law, ethics, financial management and public policy Nationalistic concerns for quality may out weigh international criterion Given the aforementioned mega-trends, in addition to the Development Goals (DGs) for emerging economies an opportunity exists to develop an international platform to examine health management education competencies, certification, and accreditation There is room for discussion, but the context and origin of standards raises issues in many countries The high level of diversity among countries, varying levels of professional identity, a tendency towards national standards, and an orientation that currently values public health, all suggest that new models are needed within an international framework that embraces diversity rather than homogenous thinking The International Hospital Federation (IHF) may provide a framework to examine the relationship of hospitals, competency development, models of certification or credentials for healthcare managers, and the emergence of health management education as a viable professional preparation The World Health Organization has been trying to improve competencies for managers especially in low and middle income countries, but their professional orientation is towards public health administration Business schools have an increasing presence, but not have significant recognition as a health care management training venue, especially at the CEO, CMO, COO, and CNO levels This being said, a niche exists for health management education in countries where professional organizations and identity are established OVERVIEW OF THE STUDY This survey research is an initiative of the Commission on Accreditation of Healthcare Management Education (CAHME), implemented by the University of Scranton and Atlas Research, LLC It is supported primarily by the ARAMARK Charitable Fund with contributions from the University of Scranton and Atlas Research, LLC The project team included: Daniel J West, Jr., Ph.D., FACHE Principal Investigator The University of Scranton Gary L Filerman, Ph.D., MHA Senior Vice President Atlas Research, LLC CAHME |7 Bernardo Ramirez, MD, MBA Assistant Professor & Consultant University of Central Florida Jill Steinkogler, MHSA Senior Consultant Atlas Research, LLC The study was limited in scope due to the constraints of the grant However, the effort is considered to be Phase I of a multi-phase study It is assumed that Information gained in the first phase will be used to structure future studies in Phase II and Phase III The grant award had a domestic initiative/methodology and an international initiative/methodology Specifically the study was structured to: 1) Examine the supply and demand for professionally trained healthcare administrators in sixteen countries A country profile template was created Within each country program profiles were created that provide information on universities, degrees awarded, and other information 2) Provide a summary of the health systems of the 16 countries 3) Use an expert panel to provide opinions, advice, and access to information 4) Assess the extent of international healthcare management education activities of CAHME accredited programs and their faculties and describe involvement in international health administration education 5) Prepare recommendations on future areas of study with relevant research questions for Phase II and Phase III 6) Suggest ideas for conferences, presentations, and other venues to disseminate the results of the project As part of the study five monthly progress reports were prepared and submitted to CAHME Continuous input and contact was maintained with Mr John Lloyd providing clarification and utilizing appropriate feedback The expert panel was used extensively throughout the study by Dr Gary Filerman and his staff at Atlas Research, LLC The University of Scranton provided marketing and publicity associated with the study Suggestions have continuously been sought from a variety of sources on presenting results of the study in journals and at professional meetings/conferences, both in the USA and to international audiences The project study team met for the initial planning session on June 21-22, 2010 at the University of Scranton, Scranton, Pennsylvania A study strategy was discussed and agreed upon, along with descriptions of responsibilities, allocation of resources and time frames Desirable outcomes were explored as well as study limitations Throughout the study contacts were maintained via telephone conferences on a monthly basis as well as weekly telephone calls and e-mail Reports were shared as they became available with other team members As stated previously, Dr West CAHME |8 prepared and submitted monthly progress reports to Mr John Lloyd at CAHME, who in turn shared information on the study with the CAHME Board of Directors and international advisory committee Domestic Methodology The study required a survey of CAHME accredited programs and their faculties and a description of their involvement in international health administration education In the design of the survey instrument, specific information points of interest to CAHME were considered Information and questions used on an earlier AUPHA survey prepared by Drs Dominquez, West and Ramirez was reviewed The survey responses on the Global Healthcare Management Faculty Survey were very small so the results could not be used with the CAHME study Authorization was received by authors of the Global Healthcare Management Faculty Survey to use some questions on the new “CAHME International Health Management Education Survey.” A literature review was conducted to see if other international healthcare management questionnaires had been previously constructed and administered Finally, faculty and colleagues with international health management education experience were asked to review the constructed survey and offer suggestions for improvement The project team reviewed the survey construction, format and question design prior to IRB review The CAHME International Survey was administered to a pilot group of faculty at other AUPHA programs to insure clarity, determine length of time to complete the study, and to receive suggestions in the ordering of questions in the various sections of the survey This field test was useful to the final design and wording of questions The project team submitted an IRB/DRB Application Form B on October 12, 2010 at the University of Scranton IRB approval was received on November 3, 2010 The CAHME website and office was contacted to secure a listing of all CAHME accredited programs in the United States and Canada A total of 72 programs were listed Two accredited programs had two separate CAHME accreditations but the University was only surveyed once A total of 70 surveys were administered The survey was titled “CAHME International Health Management Education Survey” and was composed of 39 items The questions were grouped into five sections: demographic information, international involvement, international courses and curriculum, alumni, and ideas/opinions on global healthcare management education A copy of the survey is illustrated in Appendix C All program directors were asked to complete the online survey at: http://www.surveymonkey.com/s/HPKJF53 The initial survey request was sent to all CAHME accredited programs on November 12, 2010 Mr John S Lloyd, President and CEO, CAHME sent a letter of support to all CAHME program directors on December 3, 2010 encouraging participation A second notice and request was sent on December 9, 2010 to program directors who had not responded to the initial e-mail A 3rd notice and request was sent on December 17, 2010 to program directors who had not responded A 4th and final request was sent to 12 program directors on December 29, 2010 In CAHME |9 addition to e-mail requests, telephone calls were made to program directors on two separate occasions to increase participation in the CAHME survey Only one CAHME accredited program expressed an unwillingness to participate in the survey The survey was closed on January 5, 2011 As of that date out of 72 programs surveyed, 66 responded and did not respond The overall CAHME participation rate was 91.67% International Methodology The study team had the benefit of counsel from an advisory committee that reviewed the design and suggested sources of information about programs The members of the committee were: • Gilles Dussault, Ph.D Professor, National Institute of Hygiene and Medicine, Portugal • Alex Preker, MD, Ph.D Lead Health Economist, The World Bank • Bernardo Ramirez, MD, MBA, Assistant Professor and Director, Global Health Initiatives, University of Central Florida • Anne Rooney, RN, MS, MPH, Vice President, Consulting and Education Services, Joint Commission International • Jorge Talavera, Ph.D Rector, Universidad Esan and Executive Director, CLADEA, Peru The University Survey The intent of the international study was to identify university and other providers of programs that lead to a credential that is recognized by the health services delivery system/community as attesting to the successful completion of a course of study that is appropriate preparation for management practice We identified, researched, and contacted many potential sources of information about specific health care management education programs Unlike the case of schools of medicine, public health and nursing, there is no international directory, registry or other guide to programs in health services administration It was therefore necessary to contact many sources of information on components of the field Each of them was sent an e-mail inquiry that included the project general information sheet As the data base expanded, a summary paper for each country was developed that included sections listing key professional organizations, governmental agencies, employers and education providers and their contact information The summary paper was forwarded to many of the contacts with the request they review it, adding missing details and correcting any information The identification effort included inquires to: • • • • The American College of Healthcare Executives, for international members Joint Commission International, for the members of regional advisory committees The World Health Organization Division of Human Resources and regional offices for Europe, India and Southeast Asia The Pan American Health Organization, Divisions of Health Services and Human Resources C A H M E | 10 • • • • • • • • • • • • • The World Bank, various regional health sector leaders The European Healthcare Management Association The King’s Fund The International Hospital Federation The Global Business School Network Association of University Programs in Health Administration for subscribers to the JHAE World Association of Schools of Public Health The Association of Schools of Public Health in the European Region The World Federation of Public Health Associations The African Association of Business Schools AACSB International, for accredited business schools European Foundation for Management Development: European Quality Improvement System(EQUIS),European Programme Accreditation System (EPAS) for accredited business schools Consejo Latinamericano de Escuelas de Administracion The education provider section of the summary paper was developed based upon the information provided by the above listed organizations, program files, personal contacts and journal articles The result is that our inventory of the sixteen countries is the most comprehensive data base for them that has been developed since the publication of the AUPHA directories in the 1970’s and 1980’s A web search was conducted on each education provider A profile of each was then developed The profile and the project description were then sent to each program for which we found an email contact with a request that it be checked for accuracy and completeness and be returned Appendix A, a separate document is an Excel spreadsheet providing indepth information on each program Appendix B provides an in-depth list of the country profiles and program templates filled out for each country Over 200 contact emails were sent with a response rate of about 10% Useful information about programs in China arrived too late for the profiles to be sent to the programs for confirmation before the end of the study *Note: due to current UK legislation, contact information for program staff (professors and department leadership) may no longer be provided online through university websites The Survey of Informed Leaders The survey consisted of a letter with three questions and an open-ended request for opinions and observations (Appendix E) The primary target was 22 members of the JCI regional advisory committees who are located in the 16 study countries We assumed that they are important and informed observers who would be interested in the study The letters were sent by email, using the JCI address list, the first week of December and we had one response by the end of the month
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