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BY: CYNTHIA CARTER HADDOCK, PhD; ROBERT A. McCLEAN, PhD; and ROBERT C. CHAPMAN

Dr. Haddock is professor and chair, Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, KS; Dr. McLean is professor and director, Master of Health Services Administration Program, Creighton University, Omaha; and Mr. Chapman is president and CEO, Eastern Health System, Birmingham, AL.

A Survey Reveals a Spirit of Service to Be the Most Important Ingredient

Despite the fact that the field of health care administration offers satisfying, challenging, and often lucrative career paths, it remains a nearly invisible profession. Its public image is murky at best. Misinformation about careers in health care management and about what health care executives do is at least as abundant as good information. Even people considering graduate study in the field have a poor understanding of it. Fortunately, however, every year men and women are called to positions and begin careers in this challenging arena.

After many years of teaching, mentoring, and advising students and others who were beginning health administration careers, the authors of this article set out to explore, first, the various ways people go about discovering opportunities available in the field, and, second, some of the pitfalls they have learned—sometimes too late—to avoid. We also sought advice for people beginning health administration careers. In this article we summarize the answers we found in three years of research into these questions.*

We asked a broad sample of graduate and undergraduate programs in health care administration and several professional associations to suggest the names of graduates and association members for us to contact (see below). We asked these individuals to answer a few basic questions about how they came to pursue a career in health administration, how they prepared themselves, what their greatest challenges and rewards have been, and what advice they would give to someone entering the field.

The 51 individuals included in our sample were diverse in the occupational titles they held, in the health care areas in which they worked (for example, hospitals, both Catholic and secular; group practices; long-term care organizations; consulting firms; and professional associations), and in the geographical locations where they lived. Some survey respondents had entered health administration only recently, whereas others were near the end of long, distinguished careers. The respondents had taken many different personal and professional paths to their current positions. They were also diverse in terms of gender and ethnicity. Even so, the advice they offered new entrants to the field contained a number of common themes and was surprisingly consistent.

Making the Decision
If you were to ask a thousand eight-year-olds what they want to be when they grow up, you would be unlikely to find even one who would reply, "A health care administrator." Ask a sample of high school seniors interested in health professions what courses of study they want to pursue, and you are likely to find prospective physicians, nurses, dentists, physical therapists, and pharmacists—but probably not a single health care executive. We found that the decision to enter the field occurs at various stages of life and is often accidental, rather than intentional. A majority of the respondents to our survey made the decision to pursue a career in health administration after considering other alternatives or, in some cases, pursuing other options. One respondent came to health care management after experiencing a strong religious calling, for example.

However, some respondents made the decision early, as undergraduate students. This group tended to have family members or friends involved in health care, to have had powerful personal experiences (some good, some bad) in health care, or to have stumbled onto an undergraduate major in health administration. The group making later career choices tended to be have been influenced more by available employment opportunities, an assignment from a religious order, a relationship with a mentor, or, in the case of a recently commissioned military officer, the necessity of deciding how he would fulfill his service obligation.

Completion of this process of career discovery made all of our respondents deeply convinced that they had made the right choice. However, the authors of this article are concerned that many talented individuals who might make important contributions to health administration never discover the profession. Professional societies such as the American College of Healthcare Executives (ACHE) should continue to intensify their efforts, in concert with colleges and universities and with the Association of University Programs in Health Administration, to enhance public awareness of health care administration and the opportunities it provides.

Educational Options
The variety of educational experiences represented in our survey's sample is striking. Unlike medicine or law, no test must be passed (except in nursing home administration) and no minimum credentials must be obtained to enter a career in health administration. No standard entry point to a career in this field exists. The degrees held by members of the sample included master of arts, master of business administration, master of health administration (and its many variations), master of public health, master of science in public health, master of science in nursing, master of public administration, doctor of medicine, doctor of dental medicine, doctor of jurisprudence, doctor of public health, and doctor of philosophy. The undergraduate majors represented in the sample vary even more widely than the graduate degrees. As one might expect, given the way our sample was created and the fact that a master's degree is the typical educational credential for people entering health services management, all but one of our respondents held a graduate degree of some kind.

Career achievement and educational initials seemed not to be related in the sample. To the extent that the educational process prepares people for their careers, there must be something common to this wide range of degrees that contributes to success in health administration. This fact seems to fly in the face of the popular belief (at least among warring camps of academics) that there is but a single best way to prepare for a career. It may be that the discipline, problem-solving skills, and critical thinking encouraged by graduate study lead to career success, as much as does any particular course content.

Career Mobility
People who wind up in managerial roles in health care tend to take one of three routes:

• One can move across occupations or job functions; it is possible for a nursing supervisor to become a chief operating officer, for example.
• One can move across the many segments that make up the health care sector—from long-term care to acute, inpatient care, for example.
• One can move geographically—from one state, city, or region to another—even if, in doing so, one remains in the same occupational category and industry segment.

Mobility of all three kinds has been the norm for our sample of managers and executives. Virtually all respondents experienced mobility in job function and most experienced mobility across industry segments. About half have made major geographical moves during their careers (those in the military medical service corps were the most mobile, in this sense), and about half have not. Clearly, the time when one could spend one's entire career as an "operations manager in acute inpatient care in Peoria," if it ever existed, is long gone.

Advice for New Entrants to the Field
The members of our sample provided sound counsel for aspiring health care managers. We have grouped their words of advice into nine areas. Under each category, we offer several quotations from our respondents.

Know Yourself This is clearly the place to begin any career. Our respondents spoke eloquently of the importance of knowing one's own values and principles, keeping a sense of perspective on what is truly valuable, leading a balanced life, and "doing what you love" as foundations for a successful career. Remarks by respondents in this area included the following:

• "Understanding oneself and being accountable for one's actions are essential for the journey."
• "With the many demands on my time, I believe in bringing a balance to life—in your spiritual life, family life, and professional life. . . . If any one of the three gets out of balance, the other two are affected. Being healthy in mind, body, spirit is important for a balanced life as well."
• "I think the best advice I can offer a person who is entering the field of health care administration is to respond to your heart's calling. . . . Understanding your own personal value set and having it enhanced within the work environment is critically important."
• "If you find a job you love, you'll never have to 'work' the rest of your life."
• "The best advice I can give anybody regarding a career choice is to find something you love to do so much that you would volunteer to do it."

Commit to Excellence A commitment to excellence in all one does will make the difference between success and failure. Our respondents noted that this commitment extends to all parts of the job, down to seemingly minor aspects (being on time, for example). Concerning a commitment to excellence, they said:

• "Commit to excellence in all you do."
• "Always follow through on your commitments."
• "A strong work ethic is highly valued."
• "Make a commitment to high standards of performance and ethics, and never compromise them."
• "Be on time and correct in your tasks (surprisingly enough, you will be in the minority)."

Get Involved Many people in our sample spoke of the importance of professional and community service. For people just beginning careers in health care administration, they said, getting involved in professional and community activities can both provide incredible growth opportunities and serve as a way to raise the visibility of one's organization. It is also a way for one to both "give back" to society, thereby carrying out a traditional professional responsibility, and reap great personal rewards. About such involvement, our respondents said:

• "Community service not only provides us with personal satisfaction, but also gives us a greater appreciation of what it takes to make a healthy community."
• "Volunteer in your community at varied not-for-profit organizations, whether health-related or not, to gain the requisite organizational and communication skills."
• "Get connected to your community through a volunteer organization—that's how you learn about the needs of your community."

Embrace Change The health care sector is one of the most rapidly changing sectors in American society. The inevitability of change in health care was a recurring theme in our respondents' remarks. Because change will occur, they advised people beginning careers in health care administration to embrace it and, indeed, help lead it.

• "Do not be afraid to take risks; show initiative by putting yourself in a position to embrace new opportunities."
• "Be flexible and learn to embrace change. . . . Learn to thrive on ambiguity."
• "Become a change agent."
• "Be flexible. Health care is a dynamic field that is changing daily. If you are rigid in your ways, you probably ought to consider some other type of business."

Never Stop Learning Again and again, our respondents emphasized the critical need for continuing education and lifelong learning. This was perhaps the most commonly recurring theme in their advice for people beginning health care administration careers. Several mentioned the importance of participation in education programs offered by the ACHE and other professional associations. They said:

• "Constantly strive to change yourself. Complacency quickly leads to professional obsolescence."
• "Be prepared for continuous learning because health care is a field where learning never ends."
• "Immerse yourself in learning all you can once you enter the workforce."

Actively Seek Mentors Respondents emphasized the key role that mentors can play in one's growth and development as a manager and executive. Many cited specific individuals who had played the role of mentor in their own careers. It is vital for those seeking health administration careers to find people who can act as role models for them, offer them constructive advice and feedback, help them evaluate strengths and weaknesses, answer their questions, and help promote them in the field. Our respondents said:

• "Network and surround yourself with mentors you believe in."
• "Find a mentor; learning from other leaders is very important."
• "The best advice I can give to someone entering the health administration field is to seek out a mentor who will help through the rough spots, as well as the smooth ones."

Develop Balanced Skills and See the "Big Picture" Using the right skills in a balanced way is one key to advancement for a health care professional. Those beginning careers in health care administration must have strong technical skills, for they will rely on these skills to find and succeed in their first jobs. At the midcareer and senior levels, technical skills remain important, but communication and interpersonal skills become even more critical. At the most senior level, health care executives will need technical and interpersonal skills, as well as a broad understanding of the health care environment. Our respondents said:

• "Take and always hold onto the 'system view' of the enterprise you work in. . . . Learn about the entire organization—the business the organization is in and the interrelationship of the parts."
• "Learn how organizations fit together."
• "Keep a broad perspective of the industry."

Spend Time with Clinicians Several people in our sample spoke of the need to spend time with clinicians and to learn and appreciate what is important to them. It is, after all, a health care organization's service to patients and communities that is its reason for being. The role of a health care administrator is to facilitate the work of clinicians. Understanding clinicians' perspectives and being able to work effectively with them are critical to personal and organizational success. About this topic, our respondents said:

• "I encourage those entering health services management to spend time with those who deliver care. Visit an operating room and observe cases, spend a few days in an emergency room, or volunteer in a hospital. These activities will lift your understanding of health care delivery [,] and your effectiveness in driving change will increase accordingly."
• "Be enthusiastic about your role of service, always remembering that administration exists only to serve those who are indispensable to health services—the women and men who provide direct service to patients and families. The mission of administration is to strive to assure that each encounter of service be as effective as possible."
• "Learn operations and the clinical/patient care aspects of those operations. These are the reasons that health care organizations exist."
• "Get to know the people who do the work that creates and delivers health care. Management's purpose is to ensure that health services delivery happens with an appropriate stewardship of resources and respect for each individual."

Stay Focused on the Patient and the Community Patients and communities are the reasons health care organizations exist. Some such organizations (hospitals and long-term care centers, for example) provide direct service to clients, while others (for instance, insurance firms, managed care companies, and health care consultants) play an indirect, though still critically important, role in ensuring access to high-quality health care services. Staying focused on patients and communities is essential to doing the best job you can do as a manager or executive; it also provides satisfaction through the work you are doing. Our respondents said:

• "Do not forget the patient, since you will likely be one someday."
• "Never lose sight of why we're in the business—to take care of the sick in an atmosphere of compassion and high-quality service."
• "People's lives depend on you and your decision, and current and future patients will look to you for guidance and support."
• "Have a passion for helping others. No matter whether you are seeking a position in the for-profit or not-for-profit side of health care, those without passion are eventually pushed aside. Those that do well in health care have a human service mentality."

Fundamental Principles
The diversity of the people in our sample provides clear evidence that there is no single "right" way to prepare for and to progress in a career in health services administration. There are many entry points and many paths to explore.

However, the common themes in their advice suggest that there are some fundamental principles for building a career in health administration. In the final analysis, the best foundation for a career—one that perhaps sums up all the others—was given by one of our respondents: "Learn from everything you do," this person said. "There is no bad experience."

A Word about the Survey's Respondents

In planning this article, the authors asked the directors of 29 accredited graduate programs and 12 certified undergraduate programs in health care administration to submit the names of exemplary graduates at various career stages. Seventeen graduate programs and five undergraduate programs responded (an overall response rate of 53.6 percent), with the number of contacts provided varying from two to more than 10.

We sought similar lists of names from the professional staffs of the American College of Healthcare Executives, American College of Health Care Administrators, the American College of Medical Practice Executives, American College of Physician Executives, Association of Nurse Executives, Healthcare Financial Management Association, and National Association of Health Service Executives. Four of those seven organizations responded. To the persons they recommended we sent letters inviting participation in our project. We also invited the participation of a few people known to us personally.

The final sample consisted of 51 people. Of those, 18 (35.7 percent) were women and eight (15.7 percent) were members of ethnic minorities. The sample included senior managers; operations managers; functional specialists; teachers; and consultants drawn from integrated delivery systems, hospitals, physician practices, professional associations, the military, academic health centers, and universities. Two members of the sample were members of religious congregations.

—Cynthia Carter Haddock, PhD; Robert A. McLean, PhD; and Robert C. Chapman