Commanders of military treatment facilities (MTFs) and leaders of the Military Health System face major challenges managing financial uncertainty, organizational reform, readiness requirements, deployment operations, delivery of health services, and maintaining quality and access of health care for beneficiaries. The field of health care practice and the academic programs designed to prepare health care administrators long have been, and remain to be, challenges that recognize and deal with the demands of continual change.¹ The U.S. Army-Baylor University Graduate Program in Health Care Administration (HCA) has evolved over 50 years, meeting those challenges, and educating current and future leaders in the Federal sector.^2-7 Over the past decade, the faculty and students of the U.S. Army-Baylor University Graduate Program in HCA have amassed a body of administration research, documenting executive competencies and skills in health care, which 1) contributes to the literature and academic inquiry within the health services and sciences fields, 2) provides guidelines for the development and revision of relevant curricula within the graduate program, and civilian sector executive development education programs, and 3) supports the Department of Defense's (DoD) Joint Medical Executive Skills Development Program Competencies ^8-9, and in particular, the Army Medical Department's (AMEDD) Executive Skills courses.

What elements of academic courses and assignments should be incorporated into the professional development of MTF commanders and leaders? To address these concerns, the U.S. Congress in the Defense Appropriations Act of 1992, mandated that MTF commanders be required to demonstrate professional administrative skills. The Secretary of Defense for Health Affairs convened a Tri-Service Task Force in early 1992 to identify managerial competencies required to successfully command MTFs. The competencies (knowledge, skills, and abilities) identified in the joint medical executive skills development program are accepted in both private and military sectors. The set of competencies identifies basic skills that a potential MTF commander should possess before assuming command. The Surgeons General of the U.S. Army, U.S. Navy, and U.S. Air Force have approved the methods by which competencies may be acquired by departmental officers. Army officers achieve competencies through military education, graduate education, and progressive job experience. Navy and Air Force officers may also attain competencies through professional certification. Because career patterns (assignments, educational opportunities, and contingency operations experience) vary widely within and among the Armed Services, potential MHS leaders may not have fully achieved qualification in all specific competencies. The only academic curriculum addressing all the required federal competencies is the U.S. Army-Baylor HCA program. Baylor program graduates (and other officers selected for senior leadership positions) return to attend the AMEDD Executive Skills courses (for commanders and senior staff) to obtain updates on the current trends and research which draw from the executive competencies studies. Commanders need to stay current in their knowledge and skills about health care trends and developments.

In 1994, the U.S. Army-Baylor University Graduate Program in HCA became part of the newly founded Center for Healthcare Education and Studies at the AMEDD's Academy of Health Sciences (AHS) at Ft. Sam Houston, Texas. In response to the Congressional mandate, an ongoing research initiative was undertaken in late 1992 by the U.S. Army-Baylor program faculty, under the direction of the Dean of AHS, Colonel Paul Brooke, Jr., and the director of Army-Baylor, Colonel Ronald Hudak, to study and examine the executive skills, knowledge, and abilities projected to be required by both military and civilian health care professionals, managers, executives and administrators. To date these Delphi methodology research studies have examined health care executive and administrative job requirements for U.S. Army hospital commanders and deputies for administration, fellows of the American College of Health Care Executives (ACHE), fellows of the American College of Medical Practice Executives (ACMPE) - the professional development and credentialing arm of the Medical Group Management Association (MGMA), members of MGMA's Society of Physician Executives (SPE), the American College of Physician Executives (ACPE), U.S. Army Medical Service Corps officers, U.S. Army nurse administrators, U.S. Navy hospital administrators, U.S. Coast Guard health care executives, U.S. Army and U.S. Navy dentists, and DoD and civilian pharmacists.^10-30 Over the past decade, nearly 3,000 senior civilian and military administrators have participated in the U.S. Army-Baylor executive skills research program. Table 1 summarizes the extent of the research as it has appeared in the professional, scientific and managerial literature of health services administration.

1. Lutes, J.D. (1933). Why the College of Hospital Administrators? Hospital Management; 34-35.

2. Richards, J.T.: A History of the United States Army-Baylor University Program in Health Care Administration. (unpublished manuscript).

3. Krieger, D.A. & Leahy, L.M. (1988). The US Army-Baylor University Graduate Program in Health Care Administration (A Historical Review). Medical Bulletin of the U.S. Army Medical Department; PB 8-88-8: 19-20.

4. Barcus, N. (1984). Fort Sam's Unique Students. Waco, TX: Baylor [Magazine] June-July; 27-28.

5. Ginn, R.V.N. (1997). The History of the U.S. Army Medical Service Corps. Washington, DC Office of The Surgeon General and Center of Military History. (CMH Pub 30-19-1).

6. Neuhauser, D. (1983). Coming of Age: A 50-Year History of the American College of Hospital Administrators and the Profession It Serves 1933-1983. Chicago, Il: Pluribus Press.

7. Neuhauser, D. & Neuhauser, S. (1995). Coming of Age: A 60-Year History of the American College of Healthcare Executives and the Profession It Serves 1933-1993. Ann Arbor, MI: Health Administration Press.

8. Deputy Secretary of Defense (18 Dec 1991). Administrative Skills Qualification for Command of Medical Facilities. Washington, DC: Memorandum.

9. Joint Medical Executive Skills Development Program. Available at http://nshs.med.navy.mil/eme2 Accessed Nov 1, 2001.

10. Hudak, R., Brooke, P., Finstuen, K., & Riley, P. (1993). Health care administration in the year 2000: Practitioner's views of future issues and job requirements. Hospital and Health Services Administration, Summer, 38(2), 181-195.

11. Hudak, R., Brooke, P., & Finstuen, K. (1994). Forecast 2000: A prediction of skills, knowledge and abilities required by senior medical treatment facility leaders into the 21st century. Military Medicine, 159, 494-500.

12. Duperrior, R., & Finstuen, K. (1995, April). Envision 2000: Nursing executive competencies. Paper presented at Health Promotion: The Practical Side, Federal Nurses Meeting, Las Vegas, NV.

13. Mangelsdorff, A.D., Finstuen, K., & Rogers, J.R. (1996, October). Forecast for Success - U.S. Army Medical Service Corps Officers. Proceedings, 38th Annual Conference of the International Military Testing Association, San Antonio, TX.

14. Rogers, J.R., Beaty, S., Hagen, J., Thieschafer, C., Mangelsdorff, A.D., Finstuen, K., Zucker, K., & Twist, P. (1996). Medical Service Corps Vision 21: Behavior for Career Success in the 21st Century. Center for Healthcare Education and Studies, AMEDD C&S (DTIC No. ADA310081).

15. Hudak, R., Brooke, P., & Finstuen, K. (1996, October). Management competencies for medical practice executives: Skills, knowledge and abilities required for the future. Invited paper presentation at the 70th Annual Conference of the Medical Group Management Association, Minneapolis, MN.

16. Hudak, R., Brooke, P., Finstuen, K., & Trounson, J. (1997). Management competencies for medical practice executives: Skills, knowledge, and abilities required for the future. Journal of Health Administration Education, 15(4), 218-239.

17. Mangelsdorff, A., Rogers, J., Zucker, K., Thieschafer, C., Hagen, J., & Finstuen, K. (1997). Vision 21 Delphi panel: Senior Army medical service corps officers' vision of behaviors for success of future medical service corps officers. Military Medicine, 162(7), 450-452.

18. Sentell, J., & Finstuen, K. (1998). Executive skills 21: A forecast of leadership skills and associated competencies required by Naval hospital administrators into the 21st century. Military Medicine, 163(1), 3-8.

19. Hudak, R., Brooke, P., Finstuen, K., & Trounson, J. (1998). Management competencies required in ambulatory care settings. Physician Executive, 24(5), 32-38.

20. Wineman, J., Mangelsdorff, A., & Finstuen, K. (1998). Senior executive behaviors for the Army dental care system of the 21st century. Military Medicine, 163(6), 377-380.

21. Rogers, J., Finstuen, K., Mangelsdorff, A., & Snyder, G. (1999). Executive competencies and skills required by U. S. Coast Guard health care administrators. The AAMA Executive, 38(5) , 10-15.

22. Hudak, R., Brooke, P., & Finstuen, K. (1999, June). Meta-analysis for identifying future management competencies for health care executives. Invited paper presentation, opening plenary session, proceedings of the Annual meeting of the Association of University Programs in Health Administration (AUPHA), Chicago, IL.

23. Hudak, R., Brooke, P., & Finstuen, K. (2000). Identifying management competencies for healthcare executives: Review of a series of Delphi studies. Journal of Health Administration Education - Special Issue, 18(2), Spring, 213-243.

24. Peters, A., Dominguez, D., & Finstuen, K. (2001). Vision 2005: Forecast of executive leadership competencies required by U.S. Navy Dental Corps Officers into the 21st century. Navy Medicine, 92 (4), July-August, 10-15.

25. Hudak, R., Brooke, P., Finstuen, K., & Trounsan, J. (2002). Gaining influence: Physician executives share insights on ways to influence people - Part I. Physician Executive, 28(4), 29-32.

26. Hudak, R., Brooke, P., Finstuen, K., & Trounsan, J. (2002). Gaining influence: Physician executives share insights on ways to influence people - Part II. Physician Executive, 28(5),32-36.

27. Meadows, A., Finstuen, K., & Hudak, R. (2003). Pharmacy executive leadership issues and associated skills, knowledge, and abilities in the Department of Defense. The Journal of the American Pharmacists Association, 43(3), 412-418.

28. Meadows, A., Finstuen, K., Hudak, R., Carillo, J., Lawrence, J., & Wright, K. (2003). Managerial and administrative competencies of professional pharmacists in the Department of Defense. The Journal of the American Pharmacists Association, 43(4), 488-496.

29. Meadows, A., Finstuen, K., & Hudak, R. (2003, March). Executive competencies, skills, knowledge, and abilities for DoD and civilian professional pharmacists. Paper presented at the 151st annual meeting of the American Pharmacists Association, Federal Day, U.S.A.F., New Orleans, LA.

30. Meadows, A., Maine, L., Keyes, E., Pearson, K., & Finstuen, K. (2003). Pharmacy executive leadership issues and associated khills, knowledge, and abilities. Manuscript submitted to The Journal of the American Pharmacists Association.

31. Brown, D., Lee, J., & Mylan, M. (2004). Executive preceptor competencies: Mentoring the next generation. Paper presented at the 2004 Preceptors Conference, San Antonio, TX