50 Years of Scholarship in Action

A. David Mangelsdorff, Ph.D., M.P.H., Kenn Finstuen, M.Sc., M.Ed., Ph.D., and Rene Pryor
U.S. Army-Baylor University Graduate Program in Health Care Administration

Introduction

Commanders of military treatment facilities (MTFs) and leaders of the Military Health System (MHS) face major challenges balancing financial uncertainty, organizational reform, readiness requirements, deployment operations, delivery of health services, and maintaining the quality of, and access to, health care for military beneficiaries and their dependents. The field of health care and the academic programs designed to prepare health care administrators recognize and deal with the demands of continual change.1 The U.S. Army-Baylor University Graduate Program in Health Care Administration has evolved over 50 years, meeting those challenges, and educating current and future leaders in the Federal sector.2-7 This article reviews the program's history, outlines current admission requirements, examines the Joint Medical Executive Skills competencies and associated executive skills research, summarizes demographic characteristics of program students, describes student research, examines program outcomes, and projects future directions.

Program History

The U.S. Army-Baylor University Graduate Program in Health Care Administration started in 1947 as a three month course in the Department of Administration at the Medical Field Service School (MFSS) at Fort Sam Houston, Texas which awarded Certificates of Training in Hospital Administration. The first class consisted of 40 students and a faculty of eight officers and one civilian. The course curriculum was designed by Lieutenant Colonel James T. Richards who had completed a master's degree in hospital administration at Northwestern University under Malcolm MacEachern. Richards became the first program director at the MFSS. The course was expanded to twenty weeks in 1949, and in 1951 the MFSS hospital training program became affiliated with the Graduate School of Baylor University in Waco, Texas, making it the 11th graduate hospital administration program in the country. The course was lengthened to 39 weeks, and in 1952, the program became accredited as a member of the Association of University Programs in Hospital Administration (AUPHA). The first graduates of the affiliated program received Master's degrees in May 1953. In 1969, the name was changed to the U.S. Army-Baylor University Graduate Health Care Administration Program, awarding the master's of health care administration (MHA) degree through Baylor and the Army Medical Department\rquote s (AMEDD) Academy of Health Sciences at Fort Sam Houston. In 1983, the curriculum was lengthened to twelve months (four semesters) consisting of sixty graduate hours, maintaining the one-year administrative residency requirement. 2-7 While subject to numerous curricula and name changes, the program has always maintained the spirit of the program's motto "Scholarship in Action."

The U.S. Army-Baylor University Graduate Program in Health Care Administration (HCA) is fully credentialed by AUPHA and the Accrediting Commission of Education for Health Services Administration (ACEHSA) since the late 1960s, as well as being accredited as part of the Graduate School of Baylor University through the Southern Association of Colleges and Universities. Though there are numerous training programs in health services, it is the only graduate program for health care administration in the Federal system. Students have included officers (active duty and reservists) from the Army, Navy, Air Force, Coast Guard, and civilian personnel from the Department of the Army and the Department of Veterans Affairs. The current curriculum consists of 60 academic graduate hours over 12 months followed by a 12- month residency at a medical treatment facility. A typical class has physicians, nurses, administrators, and other allied health professionals in attendance. The academic program is funded by the U.S. government. Since 1988, all students are issued a laptop computer for use during the didactic year. For over 50 years the U.S. Army Baylor program has provided professional hospital and healthcare leadership around the globe for peace and wartime missions that have involved patient and casualty care from the Korean and Viet Nam conflicts to the Gulf wars, and humanitarian efforts around the world.

Current Admission Requirements

Candidates must: 1) be employed by the Federal government and demonstrate leadership potential; 2) have completed a Baccalaureate degree or first professional degree from an accredited educational institution; 3) achieve a composite verbal and quantitative Graduate Record Examination (GRE) score of 1000 or a score of 500 on the Graduate Management Admission Test (GMAT) within the past five years; and 4) have earned a cumulative 2.7 undergraduate grade point average (GPA) on a 4.0 scale.

Joint Medical Executive Skills Development Program Competencies

 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." 8-9 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 Army, Navy, and Air Force have approved the methods by which competencies may be acquired. 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 U.S. Army-Baylor University HCA program addresses all the required federal competencies. 10

Executive Skills Research

In support of the Joint Medical Executive Skills Development Program an ongoing research initiative was undertaken by the U.S. Army-Baylor program faculty in late 1992 to study and examine the executive skills, knowledge, and abilities projected to be required by both civilian and military health care professionals, managers, executives and administrators. According to Delbeq, Van De Ven, and Gustafson, the Delphi method is an iterative feedback technique used to structure a group communication process for collecting and analyzing information from a group of experts. 11  To date, Delphi research studies have examined health care executive and administrative job requirements in both the civilian and federal sectors. Civilian studies have included 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), fellows of the American College of Physician Executives (ACPE), and American Pharmaceutical Association (APhA) graduates of the GlaxoSmithKline Executive Management Program for Pharmacy Leaders at the Wharton School, University of Pennsylvania. 12-18 Federal health care executive studies have included U.S. Army hospital commanders and deputies for administration (DCAs), U.S. Army nurse administrators, U.S. Army Medical Service Corps officers, U.S. Navy hospital administrators, U.S. Coast Guard health care executives, U.S. Army and U.S. Navy dentists, and DoD pharmacy executives.15, 19-29  Commanders need to stay current in their knowledge and skills about health care trends and developments. 30-31

Application of Healthcare Executive Competency Research to Program Curricula

 Results from executive skills research have been, and continue to be, used to validate current U.S. Army-Baylor University HCA graduate program objectives and curricula. Other civilian agencies, such as ACHE headquarters in Chicago, MGMA's Center for Research in Ambulatory Health Care Administration (CRAHCA) in Denver, the ACPE's Journal of Medical Management administrative offices in Tampa, and most recently the APhA in Washington DC have used results from the Army-Baylor Delphi studies to determine needs and topics for continuing health care administration education, executive development and professional conferences. 12-18 

Demographic Characteristics of Students

 There have been 2,234 students in the HCA program between 1951 to 2001. The distribution includes 112 foreign military officers and 27 civilians. The U.S. military students (n=2100) have the following demographics: 82.1% male, 17.9% female; Branch of Service: 83.0% Army, 9.7% Air Force, 7.0% Navy and Marine Corps, 0.3% Coast Guard; 77.4% Medical Service Corps, 13.6% Nurse Corps, 6.6% Medical Corps, 3.2% Specialist Corp, 2.0% Dental Corps, and 0.2% Veterinary Corps. The average student age is: 34.9 years old (SD 5.0), with an undergraduate grade point average of 3.1 (SD 0.3), a composite GRE (verbal and math) average of 1105 (SD 124.2), and has at least 10.6 (SD 4.0) years of experience. The graduation rate is shown in Table 1. Program statistics are available on the Army-Baylor Alumni Club web page.

Student Research

 The HCA research program focuses on scholarship in action by both students and faculty. Student research is conducted in numerous courses and in a capstone course in the fourth semester. Individual courses emphasize the direct involvement of students with management and consultative projects. In the Research Methods course (HCA 5311), students work in small groups examining problems of interest in health care settings. From the separate research sections, the best projects compete at the student research conference named in honor of J. Dewey Lutes (first Director General of the American College of Hospital Administrators - ACHA: now ACHE 6-7). Students vote on the most professional and creative projects. Winners are recognized by the McGaw Scholarship award. In the Consulting Practicum course (HCA 5390) in the fourth semester, students integrate the knowledge, skills, and tools learned in previous courses to help address management problems in local hospitals and commands. This capstone course permits students to integrate their knowledge into applied settings. The academic phase serves to assist students in developing their scholarship and problem solving abilities. In the residency phase (12 months), students conduct a graduate management project (GMP) to answer problems of concern to the institution. Faculty readers nominate the best GMP for consideration for the Boone Powell Award for Academic Excellence (named for Boone Powell, an early Army-Baylor program lecturer and advocate, past chairman of the ACHA, past administrator for the Baptist Medical Hospital System, and advocate of administrative residencies 6-7. The criteria for the Boone Powell award are: excellence in scholarship, intellect, and professionalism. Student research projects, J. Dewey Lutes winners, and selected GMPs can be viewed through the Army-Baylor Alumni Club page. In addition, many of the faculty executive skills research studies cited above have involved graduate student co-investigators. 12-29 Student GMPs are available in Stimson library at the AMEDD Center and School or through the Defense Technical Information Center.

Program Outcomes

The impact of Army-Baylor HCA on the Military Health System was examined on some evidence-based educational outcomes for the Individual (student), the Society (all Army MTFs), on the MHS, and other health care programs. Individual student outcomes track career development of classes from 1951 to 2001. Measures include: graduation, promotion rates, promotion rates to senior executive level (O5, lieutenant colonel), professional certification, advancement within professional organizations such as American College for Healthcare Executives (ACHE), American Academy of Medical Administrators (AAMA), Medical Group Management Association (MGMA), and obtaining additional education degrees. Individual results are shown in Table 2.

The Society frame of reference was operationally defined as all of the 38 Army MTFs, where the dependent variables are: the JCAHO outcomes scores and the monthly DoD patient satisfaction scores in all Army MTFs. Army MTFs have similar constraints and resources; external assessments of evidence-based outcomes are standard practices. All the Army Deputy Commander for Administration (DCAs) had earned master's degrees, so educational levels were considered comparable. The independent variables examined were: DCA's education (Baylor vs. non-Baylor), MTF size (Clinic, Medical Activity, or Medical Center), and the Year of inspection (between 1994 to 2001). MTFS with DCAs educated through the Army-Baylor HCA program showed significantly higher JCAHO and patient satisfaction scores; Baylor DCAs were more likely to be assigned at Medical Centers. Comparable results were found for the monthly DoD patient satisfaction scores, that MTFS with Baylor trained DCAs had higher levels of satisfaction. 32 The impact of Army-Baylor alums and faculty on the MHS and other health care programs is most significant (see Table 3). Graduates have distinguished themselves at all levels of the MHS, in corps leadership roles, professional associations, and in international settings. In addition, the program has produced at least 68 graduates who went on to earn doctorates. Many of the doctoral prepared graduates returned to serve as Army-Baylor program directors (17 of 23) and faculty, then went on to hold senior leadership positions as deans, program directors, and/or faculty at other health care education programs in the United States and around the world.

Future Directions

Future directions include seeking partnerships to increase the value of the HCA program. New ventures include: a joint MBA/MHA with the University of Texas San Antonio, an international MBA, an executive management level program, communities of practice modules, and increased distance learning opportunities. The intent is to stimulate and sustain a passion for life long learning, leveraging information technology, to provide excellence in teaching, scholarship, research, and community service to the Federal health care system.

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