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By: Bethany Abramczyk, Kelcie Beck, and Elaine Chiasson

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Obtaining and maintaining specific leadership competencies in staff is essential for all organizations. To be in a position of leadership, one must have “competence” in a variety of areas. The literature that discusses this topic broadly supports using leadership competencies as evaluative modalities for organizations. Some of these leadership competency themes discussed in literature include strong ethics and safety, self-organizing, efficient learning, nurtures growth, and connection and belonging. Individuals that many recognize as “great leaders” are seen as so because they are experts in areas like cultural competence, inter-professional values, effective communication, ethical decision making, and perspective thinking. When you hear these qualities you may think of the CEO of Starbucks, Howard Schultz. Even fictional Hollywood movies and television recognize that leadership competencies affect the efficiency/motivation of their leaders and staff and how an organization is run overall. Movies like The Devil Wears Prada, The Proposal, and Remember the Titans all contain examples of leadership competencies, or lack thereof.

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Leadership competencies are not a specific leadership “style”, but rather the many attributes, skills, behaviors, and motives that make an effective leader and professional/practitioner. Competencies apply to both those in leadership roles and staff as well. Many organizations, healthcare especially, are concerned with making sure their employees and leaders develop and maintain a certain level of “competence” in a variety of topics and issues. The five competency domains include:

Cognitive Domain (Knowing) - The OT will be able to identify various factors that can affect performance and identify resources available to assist employers in accessing services.

Critical Reasoning Domain - The OT will integrate knowledge from many sources to create a description of prior work performance and identify strategies that have not been effective in the past.

Affective Domain (Appreciating and Valuing) - The OT will document in a way that reflects worker identity and values the involvement of parents in the process of planning intervention.

Psychomotor Domain (Physical Performance) - The OT will be able to attach and detach all basic attachments to a work simulator and demonstrate proper lifting techniques to clients.

Ethical Reasoning Domain - The OT will be able to identify ethical principles and limits in knowledge and understanding of ethical principles in order to know when to seek guidance from others.

Competencies can be initial, annual, physical agent modality-related, age-specific, equipment-related, specialized for practice, or specific skills/procedures. Assessing competencies helps organizations to create job descriptions, recruit new employees, evaluate staff, promote existing employees, and create annual assessments. Methods for assessment of competencies include posttests, return demonstration, observation of daily work, case studies, exemplars, peer reviews, and self-assessment.

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Competent - successfully performing a behavior or task as measured according to a specific criterion

Competency - an individuals actual performance in a particular situation

Competencies - explicit measures, indicators, or statements that define specific areas of knowledge, skills, and abilities related to essential functions and assigned duties within a job or role

Competence - the knowledge, critical thinking, motives, traits, characteristics, or skills to achieve a specific goal or perform job responsibilities

Certification - formal recognition that an individual has proficiency within, and a comprehension of, a specified body of knowledge

Professional development - may include a program of continuing competence, but also includes a focus on one’s career development in terms of achieving excellence or achieving independent practitioner and expert role status, and in terms of assuming new, more complex roles and responsibilities

Novice - learners focus on learning the rules of a particular skill

Advanced Beginner - learners focus on applying the rules of a skill in specific situations that become increasingly dependent on the particular context of the situation

Competency - learners see actions in terms of long-range goals or plans and are consciously aware of their skills

Proficiency - learners perceive situations as “wholes” rather than “aspects,” and their performance is guided by intuitive behavior

Expert - learners integrate mastered skills with their own personal styles

Entry-level competence - the level of competency expected of all entry-level practitioners to a given profession

Portfolios - collection of documents, artifacts, and evidence of learning, as well as learning activities, that serves as an assessment instrument and learning tools for the development and documentation of competence

Specialized practice competencies - competencies that relate to abilities that are not expected to be reflected in the entry-level practice of all professionals but that do not require advanced clinical judgement, prior experience, or complex clinical reasoning in order to demonstrate competence

Continuing competence - A dynamic and multidimensional process in which the OT and OTA develop and maintain the knowledge, performance skills, interpersonal abilities, critical reasoning, and ethical reasoning skills necessary to perform current and future roles and responsibilities within the profession

(Braveman, 2016)

Global Executive Competencies - these competencies include being open-minded and flexible in through and tactics; cultural interest and sensitivity; able to deal with complexity; resilient, resourceful, optimistic, and energetic; honesty and integrity; stable personal life; value-added technical or business skills

(Leadership Competencies, 2008)

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Menguc, B., Seigyoung, A., & Shih E. (2007). Transformational leadership and market orientation: Implications for the implementation of competitive strategies and business unit performance. Journal of Business Research, 60, 314-321.

Demonstrating leadership competency can improve one’s ability to advance in an organization. According to Menguc et al., (2007), developing a leadership style can improve the outcomes for an organization or a business’s goals. For example, using transformational leadership tends to use more marketing skills that influence cost savings for the business (Menguc, et al., 2007). For businesses and organizations looking for specific leadership types to promote their values, it is essential to recognize the individual’s competencies first.

Palarca, C., Johnson, S., Mangelsdorff, A. D., & Finstuen, K. (2008). Building from within: Identifying leadership competencies for future navy nurse executives. Nursing Administration Quarterly, 3, 216-225.

Using leadership competencies can determine attributes of future occupations. Palarca et al., (2008), used the Delphi technique to determine qualities needed for future leadership positions in naval nursing.

The Delphi technique is a series of questions based on a certain topic that are discussed among a panel of experts to formulate a conclusion.

After completing two series of asking over 400 nurses, researchers concluded that the following competencies are required:

Business management

Executive leadership

Professional development

Global awareness/interoperability

Communications

Personnel management

Ethical values, communication skills, and mentorship were also amongst the highest skills necessary for success within this particular job.

Giles, S. (2016, March 15). The most important leadership competencies, according to leaders across the world. Harvard Business Review. Retrieved from https://hbr.org/2016/03/the-most-important-leadership-competencies-according-to-leaders-around-the-world

It is a neurological fact that employees feel safer at work when employers clearly communicate expectations and have ethical and moral standards (Giles, 2016). The brain is more in a parasympathetic state than a “fight or flight” mode that causes unhealthy stress and unhealthy habits. When employees feel accepted and safe at work, they are more likely to stay with the company longer and produce better work for performance outcomes.

According to Giles (2016), from the Harvard Business Review, the top ten leadership competencies that were recommended by business leaders from across the world are listed in the chart below.

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Competencies are defined by knowledge, skill, and abilities related to a specific role. Based on the competencies of the leader, this will determine if the leader is effective in their role within the organization. Each organization defines the level of competence required for the specific leadership position. Competency levels can range from entry-level to specialized practices that are necessary for specific organizations.

Examples of general leadership competencies include:

Ethical

Empowering

Strong Communication

Emotional Intelligence

Conflict Resolution

When applied to healthcare, competency areas are similar and include:

Cultural competence

Inter-professional value

Effective communication

Ethical decision making

Perspective thinking

The evolution of healthcare management as a profession has been strongly influenced by competencies. In many countries, formal degrees in healthcare management and related professional associations have helped establish the field as a distinct profession. Other low or middle income countries have not yet developed the professionalization of health care management, as no formal training programs have been created to define minimum standards and competencies for the profession. In some countries, healthcare managers have created national associations to share knowledge, information, and expertise (Hahn & Gil Lapetra, 2019). The different contexts where healthcare managers operate create major discrepancies, however, there is still a common responsibility to enhance leadership and promote the profession. Therefore, the International Hospital Federation developed the Leadership Competencies for Healthcare Services Manager (Global Competency Directory) to serve as a catalyst for resources and to define the skills, knowledge, and abilities needed for the healthcare management profession (Hahn & Gil Lapetra, 2019).

As a response to uncertainties and challenges related to healthcare reform and continued budget deficits, successful leaders will need to become more entrepreneurial, strategic, and resourceful in developing research alliances, executing research operations, and continually advancing performance at all levels of the Health Research Organization. This in turn will improve patient outcomes, clinical care, and community health (Davidson et al., 2012).

Aspiring and established leaders agreed that “knowledge”, “people skills”, “emotional intelligence”, and “vision” were all characteristics of effective leaders and critical to the success of aspiring physician  leaders. The added characteristics of “organizational orientation” and “organizational altruism” extended the leaders to include an understanding of the institution as well as dedication to its success (Taylor et al., 2008).

Core competencies that entrepreneurial healthcare leaders should obtain to ensure the survival and growth of US healthcare organizations include:

1. Healthcare system and environmental competencies

2. Organization competencies

3. Interpersonal competencies

Identifying core competencies and designing a competency model is useful for practitioners in leadership positions in complex health care organizations. Through the understanding and practice of these 3 areas of core competencies, practitioners can become more effective healthcare leaders. Following a competency model can also further an organization’s strategic vision and create individual improvements (Guo, 2009).

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The Proposal: Margaret Tate

As a boss, Margaret was insensitive, valued work above everything, and displayed no interest in building relationships with coworkers. Once she found out she will be deported, she blackmailed her assistant to marry her to keep her work visa. Some examples of poor characteristics of a leader in this situation include lack of empathy toward her coworkers, highly-demanding, and using her position as a threat to her assistant.

The Devil Wears Prada: Miranda

As editor-in-chief of a fashion magazine, Miranda is ruthless, highly-demanding, lacks respect for people, and manipulative to her employees. Some examples of her poor leadership skills include exerting fear amongst her assistants, giving vague instructions on tasks, and giving unreasonable demands.

Grey’s Anatomy: Miranda Bailey

As a doctor, Miranda Bailey supervised interns, medical students, and residents and demonstrated great leadership. While Dr. Bailey presented as tough and unfriendly to her interns, she began to show great characteristics as a leader. Some examples include her ability to be compassionate, honest, empower others, motivating, empathetic, and personable with her coworkers.

Remember the Titans: Coach Boone

Coach Boone demonstrates great leadership as a coach for a high school football team. He demonstrated good leadership qualities such as instilling confidence, knowledgeable of the sport, motivating, showed equality amongst the players, and was committed to making his team the best players they could be.

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The Devil Wears Prada (1/5) Movie CLIP - Gird Your Loins! (2006) HD

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Howard Schultz, CEO of Starbucks

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How is Schultz different from other owners and CEOs of large companies? Using leadership concept levels from Dubar (2015) helps explain the skills required for leading a complex work environment.

Interprofessional Value - Schultz looks out for his clients. During the 2008 recession, he temporarily closed down 7,100 stores to focus on his employees skills of making the perfect espresso (Loudenback, 2015). He took the time to ensure that the coffee products reflect the inspiration from his travels and education in Italy on making a quality cup of coffee. His sales boosted from $315 million to $945 million by 2010. He cared for his product, the way that it was served, and focused his attention on improving his barista's coffee skills.

Cultural Competence - He understands the needs of Americans. He vowed to hire 10,000 veterans at his stores by 2018. In 2019, he overachieved this goal by hiring over 25,000 veterans and since then plans to hire at least 5,000 a year (Dahlstrom, 2019). He also understands the needs of college students and offers a tuition assistance program.

Effective Communication - Caring about his customers, employees, and how the coffee is made and brewed are all areas of the company that Schultz indulges. In an interview with Carmine Gallo (2011) from Forbes magazine, Schultz explains that Starbucks is more than just about the coffee. “We’re not in the coffee business. It’s what we sell as a product but we’re in the people business—hiring hundreds of employees a week, serving sixty million customers a week, it’s all human connection,” (Gallo, 2011).

Ethical Decision Making - Schultz made it a priority for all employees to have access to healthcare insurance. Starbucks was one of the first companies to allow part time and full time employees affordable healthcare (Starbucks Co., 2013). The program options available are also the same for both full time and part time positions. This idea came from Schultz’s father who worked so hard at his job, but was never offered healthcare insurance plans. His father was injured at work, but never received compensation for the injury and could not pay for medical care. Schultz did not want the same for his company.

Perspective Thinking - From the forward thinking of healthcare for most employees, tuition assistance for college students, and hiring veterans who are in need of jobs after returning from active duty, Schultz has been effectively expanding his company while looking at the needs of his employees and interests of the customers.

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Occupational Therapy Student Example (YOU!)

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Occupational Therapy Student Example (YOU!)

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In order to sit for the NBCOT certification examination, students must first graduate from an educational program accredited by ACOTE. In order to graduate from such a program, students must not only receive a passing grade in a large number of courses by demonstrating competencies in multiple domains of learning but also successfully complete mandated full-time clinical fieldwork. Once the student passes the NBCOT examination and obtains certification, they are then able to enter a leadership role as an occupational therapist. Overall, focusing on obtaining and maintaining leadership competencies and skill development promotes better leadership (Braveman, 2016).

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Braveman, B. (2016). Leading and managing occupational therapy services: An evidence-based approach (2nd Ed). Philadelphia PA: F.A. Davis Company.

Dahlstrom,  L. (2019, July 19). A life of service: Meet some of the 25,000 veterans and military spouses Starbucks has hired. Starbucks Stories & News. Retrieved from https://stories.starbucks.com/stories/2019/meet-some-of-the-25000-veterans-and-military-spouses-starbucks-has-hired/#:~:text=In%202013%2C%20Starbucks%20made%20a,more%20each%20year%20going%20forward.

Davidson, P. L., Azziz, R., Morrison, J., Rocha, J., & Braun, J. (2012). Identifying and developing leadership competencies in health research organizations: A pilot study. The Journal of health administration education, 29(2), 135–154.

Dunbar, S. (2015). Leadership theories. In S.B. Dunbar & K. Winston’s (eds.) An occupational perspective on leadership: Theoretical and practical dimensions (2nd ed.) pp. 3-14. Thorofare,NJ: SLACK Incorporated.

Gallo, C. (2011, March 25). Starbucks CEO: Lesson in communication skills. Forbes Magazine. Retrieved from https://www.forbes.com/sites/carminegallo/2011/03/25/starbucks-ceo-lesson-in-communication-skills/?sh=421ad40a72b8

Giles, S. (2016, March 15). The most important leadership competencies, according to leaders across the world. Harvard Business Review. Retrieved from https://hbr.org/2016/03/the-most-important-leadership-competencies-according-to-leaders-around-the-world

Guo, K. L. (2009). Core competencies of the entrepreneurial leader in health care organizations, The Health Care Manager, 28(1), 19-29. doi: 10.1097/HCM.0b013e318196de5c

Hahn, C. A., & Gil Lapetra, M. (2019). Development and use of the leadership competencies for healthcare services managers assessment. Frontiers in public health, 7, 34. https://doi.org/10.3389/fpubh.2019.00034

Leadership competencies. (2008, March 1). SHRM. Retrieved January 17, 2021, from https://www.shrm.org/

Loudenback, T. (2015, October 21). The incredible rags to riches story of Starbucks billionaire Howard Schultz. Business Insider. https://www.businessinsider.com/howard-schultz-profile-2015-10

Menguc, B., Seigyoung, A., & Shih E. (2007). Transformational leadership and market orientation: Implications for the implementation of competitive strategies and business unit performance. Journal of Business Research, 60, 314-321.

Palarca, C., Johnson, S., Mangelsdorff, A. D., & Finstuen, K. (2008). Building from within: Identifying leadership competencies for future navy nurse executives. Nursing Administration Quarterly, 3, 216-225.

Starbucks Corporation, (2013, Aug 26). Our commitment to comprehensive health care. Starbucks Stories & News. Retrieved from https://stories.starbucks.com/press/2013/health-care/

Taylor, C. A., Taylor, J. C. & Stoller, J. K. (2008). Exploring leadership competencies in established and aspiring physician leaders: An interview-based study. Journal of General Internal Medicine 23, 748–754. https://doi.org/10.1007/s11606-008-0565-5