Objective Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method. Methods A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework. Results Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism. Conclusion This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context.

IntroductionClinical governance as an approach to improving the quality and safety of clinical care has been run in all Iranian hospitals since 2009. This study aimed to provide a comprehensive overview of the processes and challenges faced in implementing clinical governance (CG) in acute-care hospitals in Iran.MethodsWe conducted an in-depth, qualitative, multi-case study using semi-structured interviews with a range of key stakeholders and review of relevant documents. This study was conducted in 2011–2012 in six governmental hospitals affiliated with Tehran University of Medical Sciences. The data were analyzed using framework analysis.ResultsThe interviewees, predominantly senior managers and nurses, expressed generally positive attitudes towards the benefits of CG. Four out of the six hospitals had a formal strategic plan to implement and execute CG. The emergent barriers to the implementation of CG included insufficient resources, the absence of clear supporting structures, a lack of supportive cultures, and inadequate support from senior management. The main facilitating factors were the reverse of the barriers noted above in addition to developing good relationships with key stakeholders, raising the awareness of CG among staff, and well-designed incentives.ConclusionsThere is a positive sense towards CG, but its successful implementation in Iran will require raising the awareness of CG among staff and key stakeholders and the successful collaboration of internal staff and external agencies.

PurposeHospitals need highly trained and competent managers to be responsible for the strategic development, overall operation and service provision. The identification and confirmation of core management competency requirements is a fundamental first step towards developing the competent management workforce for sustainable hospital service provision. This paper reports on the finding of a recent study focusing on identifying managerial competencies required by middle and senior-level managers in the public hospitals in Iran.Design/methodology/approachThe qualitative research design included position description analysis and focus group discussions with middle and senior-level public hospital managers in Iran. When analysing the identified knowledge, skills and attitudes, the validated MCAP framework was used to guide the grouping of them into associating management competencies.FindingsThe study identified 11 to 13 key tasks required by middle and senior-level managers and confirmed that the position descriptions used by current Iranian hospitals might not truly reflect the actual core responsibilities of the management positions. The study also confirmed seven core managerial competencies required to perform these tasks effectively. These core competencies included evidence-informed decision-making; operations, administration and resource management; knowledge of healthcare environment and the organisation; interpersonal, communication qualities and relationship management; leading people and organisation; enabling and managing change and professionalism.Research limitations/implicationsCompetencies were identified based on managers' perceptions. Views and experiences of other stakeholders were not captured.Practical implicationsThe seven core management competency identified in the current study provides a clear direction of competency development among senior and middle-level managers working at the Iranian public hospitals. The study also confirms that position descriptions do not reflect the actual responsibilities of current hospital managers, which are in need to urgent review.Originality/valueThis is the first study that has identified the core managerial competencies required by middle and senior-level hospital managers in Iran.

Background Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system including hospitals. The purpose of this study is to synthesize the evidence related competency to management and leadership in healthcare organizations including hospitals through the Best Fit Method. Methods A systematic literature review was performed to identify studies focusing on confirming and/or assessing the competency requirements of health service managers in particular hospital managers. The following electronic databases were searched from January 2000 and December 2018: ISI/Web of Sciences, PubMed, Scopus, Emerald, and the Scientific Information Database. Applying the Best Fit Framework Synthesis Method, we mapped all of the competency and associating behavioral items against the validated MCAP management competency framework which includes 6 core competencies, 18 subthemes and 83 associating behavioural items. Results Eleven studies were identified for inclusion in the review. The mapping of the competencies and relevant items identified in these studies with the validated MCAP management competency framework and associating items confirm that the MCAP framework has vastly represented findings of all recent studies. Although the MCAP framework incorporated behavioral items associating with the competency of Professionalism into the six core competencies, the study found the necessity of treating Professionalism as an independent competency to be included in the global management competency framework for health service managers, in particular hospital managers. As a result, the proposed Global Management Competency Framework includes the following 7 competencies: evidence-informed decision making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism. Conclusions This review and the mapping of the competencies identified in previous studies with the validated MCAP framework resulted in the recommendation of Global Management Competency Framework for health service managers. It provides useful guidance to the formulation of training and development direction for the health service management workforce. However, since management competencies are context sensitive, in order to developing a more targeted approach or target curriculum for the development managers from different sectors, management levels, validation is recommended.

Background:The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs.Objectives:This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist.Patients and Methods:An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%).Results:The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r = 0.38, P < 0.001) and perceived behavioral control (r = 0.43, P < 0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior.Conclusions:The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by family physicians and are of great value in developing interventions to reduce the variation in referral rate of patients to medical specialists at primary care health centers.