Health administration faculty diversity in the United States with recommendations to China
Review Article

Health administration faculty diversity in the United States with recommendations to China

Frankline Augustin1, Louis Rubino1, Donghai Wei2

1California State University, Northridge, USA; 2Guangzhou Medical University, Guangzhou 510182, China

Contributions: (I) Conception and design: D Wei; (II) Administrative support: D Wei; (III) Provision of study materials or patients: F Augustin, L Rubino; (IV) Collection and assembly of data: F Augustin, L Rubino; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Donghai Wei. Guangzhou Medical University, Guangzhou 510182, China. Email: weidhai@vip.163.com.

Abstract: Research hospitals/academic medical centers have a threefold mission of patient care, research and education. The meaning of education is to train students with both clinical and administrative personnel in order to better suit themselves in the health care industry. Health administration programs are proliferating in China and the United States due to the influence of their recent health reform movements. In China, health administration programs are staffed with faculty from clinical medicine and management, mostly from their university affiliated medical centers. However, health administration program faculty in the United States have a diverse set of industry backgrounds and bring an invaluable wealth of experience into the classroom. The authors provide a literature background on the often-followed paths that a person in the US might take while pursuing a full time teaching career in higher education. A health administration faculty typology has been well developed, and concentrating on the following professional roles: a healthcare operator, an academic/educational administrator, a consultant, a clinician and a researcher. Thus, the authors discuss anecdotal data that they have collected on the perceived positives and negatives associated for each type. The authors conclude with providing recommendations to both Chinese and American programs to produce a more collegial and collaborative academic environment.

Keywords: Comparative studies; practitioners; faculty; health administration; typology


Received: 04 August 2016; Accepted: 16 August 2016; Published: 08 September 2016.

doi: 10.21037/jrh.2016.08.07


Introduction

Comparative studies are important because they can be learned and applied from knowledge obtained from the other entity. Healthcare in China and the United States are interesting to compare currently due to both countries being in the midst of national health care reform. With changes occurring, the US health system provides lessons and recommendations for China (1,2), and China’s health system can provide the same for the US (3).

Academic medical centers, as research hospitals, have three missions: education, patient care, and research. Under healthcare reform, China and the US both struggle to get qualified and knowledgeable instructors to properly educate our future generations of medical and administrative personnel. New collaborations between universities, higher education and the community are forming due to their respective health care reform initiatives, which will bring a new source of potential faculty (4).

With changes to their healthcare systems comes a critical need for talented individuals to lead the way. Healthcare administration education is proliferating in both countries along with students seeking credentials and competencies. It will help students to prepare themselves better for the careers. In China, more and more graduate programs, as well as an increase in applied programs, propel the surge in health administration education (5). Also China’s healthcare reform is bringing with it a push for strengthening the training of medical personnel including those who will lead their systems (6), as well as manage their hospitals.

In the United States, it has been well known that only former executives have the kind of quality experience that postsecondary students can benefit from. While healthcare executives certainly bring an invaluable wealth of experience into the four walls of the classroom, it is unrealistic to expect that albeit their sage wisdom outranks other important roles that make up the health industry. Doing so could give students a one-sided perspective. As such, the US health administration faculty comes from a diverse set of professional backgrounds that add value to the health administration professional experience. However, at times, the different backgrounds can cause tension and non-collaboration. This analysis of who makes up the faculty for health administration programs in the US, as well as the challenges and opportunities for greater collegiality, can provide techniques to the growing number of Chinese faculty who teach in health administration programs that may turn any division into a more cohesive environment.

Depending on the professional background, the transition to the faculty realm in any country can range from being seamless to challenging. Why do these struggles exist? We will try to answer this question by first providing a literature background on the often-followed path that a practitioner might take as he or she pursues a full time teaching career in higher education in the US. The authors will discuss the anecdotal data that have been collected on the perceived positives, and negatives of moving out of the healthcare management workplace and into the tenure track life of a full-time faculty, concentrating only on the following professional roles: a healthcare operator, an academic/educational administrator, a consultant, a clinician and a researcher. Moreover, it is the authors’ underlying purpose to create a level of understanding of how each of these professional experiences adds value to the health administration curriculum.


Background: from practitioner to faculty

The diversity in professional specialties is typical of health administration faculty in the US (7). In China, health administration faculty has a very similar background: being either physicians or administrators in affiliated medical centers or researchers from the academic area. In the US, the range of experiences various. There are those who were full-time practitioners in the field with no academic exposure before they started teaching (except from their own studies as they pursued their terminal degrees), to faculty whose experience is completely academic and have little to no practical exposure in the field, although their life’s work is revolved around studying the science that make up health administration. Each position brings a different perspective, new knowledge, value and a diversity of thought into the health administration classroom, all of which certainly provides a layer of richness within the traditional course curriculum.

The road to tenure though can be a lonely and challenging one. Menachemi et al. (8) asserts that while health administration faculty generally tends to report high rates of satisfaction, all junior faculty report high levels of stress. Stressors for new faculty include unwieldy workloads, a misunderstanding of the expectations required for tenure, self-imposed pressures, an unfamiliarity of the college culture, not relating to the changing student demographics, time required to develop teaching method, and social isolation (9-11). These stressors are same for new health administration faculty. The majority of new health administration faculty have not been “socialized” into the academic culture as this socialization usually starts in those undergraduate and graduate programs that begin to mold and shape their students for the professoriate (12). The lack of socialization coupled with little direction or mentoring coming from senior faculty can make the transition into academia even more difficult for new health administration faculty. Ginter et al. (7) report that health administration faculty experience demanding pressures in the academic workplace with little time to focus on teaching and research, and more department support is required to better orient new faculty.


Health administration faculty typology

Faculty who teaches in the US for health administration programs have diverse education, professional experiences and research agendas (13,14). Some have operational experience in healthcare practice or university administration. Some are consultants with vast field experiences who have become educators. Others have clinical backgrounds and have worked in a variety of healthcare settings before. While another group, also known as researchers, come directly from their doctoral programs with no real practice experience.

Ginter et al. (7) characterized university-based health administration faculty members in the United States. Vast differences in doctoral degree disciplines, self-identified specialty areas and work settings were identified. This article takes a different approach and examines the previous professional experiences of the health administration faculty in order to apply them on common groupings. The authors reached out to their network and identified five types of health administration faculty, all of whom have completely different experiences. They have been categorized as healthcare operators, academic/educational administrators, consultants, clinicians and researchers. Table 1 includes this information along with examples of prior professional positions.

Table 1
Table 1 Typology of health administration faculty
Full table

The authors requested that their colleagues list personal perceived positives and perceived negatives of leaving their profession and becoming health administration faculty. They were also to list the perceived positives and negatives that their colleagues in the workplace may have about their peers who choose to pursue a teaching career in academia. The authors evaluated and compiled the anecdotal responses to create a typology and an analysis for each position. The typologies were summarized into perceived positives and negatives and put into tables. Tables 2-6 provide typology summaries for the healthcare operator, the academic/educational administrator, the consultant, the clinician and the researcher.

Table 2
Table 2 Healthcare operator: perceived positives or negatives by person and/or colleagues
Full table
Table 3
Table 3 Academic/educational administrator: perceived positives or negatives by person and/or colleagues
Full table
Table 4
Table 4 Consultant: perceived positives or negatives by person and/or colleagues
Full table
Table 5
Table 5 Clinician: perceived positives or negatives by person and/or colleagues
Full table
Table 6
Table 6 Researcher: perceived positives or negatives by person and/or colleagues
Full table

Healthcare operators as faculty

One of the most common types of health administration faculty is the healthcare operator. It does not matter which sector the person has worked (i.e., hospitals, ambulatory care, long term care, insurance industry, etc.), the faculty member brings a wealth of management and/or administrative experiences. Faculty peers outside the discipline might not value this experience since it is not scholarly. Since often times this is the start to a second career, this faculty type is usually more seasoned and mature. The faculty member will usually have good business skills and be able to take the multi-task assignments and projects according to the nature of working in operations. Unfortunately, either the new faculty member or sometimes his peers believe that the person has limitation in teaching because of lacking specific training in education. The competitive nature of being a healthcare operator can sometime cause a style of working with others that may deem to be a bit assertive, if not aggressive. And finally, there is the issue of compensation. The healthcare operator in the US will typically come from having a much higher salary and associated benefits than the other faculty members. Because of this, the operator may be resentful or feel undervalued.

Academic/educational administrators as faculty

The academic/educational administrator has advantage in a university setting before. However, not having worked in the healthcare industry might make the faculty member insecure and feel inadequate compared to those that do have industry background and experience. This type might make additional effort to stay current in the field. But even coming from the same or like work setting does not guarantee someone’s personal style will match the new division style. The management and administration experience that come from these individuals can be an asset when teaching health administration students. Occasionally, the fast-paced environment of an academic/educational administrator is often at odds with the more thoughtful style of educators. Academic/educational administrators may have had a team of staff to help achieve organizational goals. When they transition to faculty the administrative support is much less if any at all. Academic/educational administrators may also struggle with the lack of group dynamics during their tenure track since faculty often work as individuals more than as part of a group. Coming from academia into a faculty role might place expectations on the faculty member that he should consider climbing the faculty affairs administrative ladder or that his previous skills pigeon holes him as the perfect candidate for certain types of committees, sometimes serving as the “token” faculty member. What’s more, the mentality of compensation is certainly different when the academic/educational administrator moves to a teaching position. The “do more with less” culture of this administrator is almost diametrically opposed by the “faculty entitlement” culture that demands extra pay for added work.

Consultants as faculty

A wide variety of consultants have landed in academic positions. For the health administration discipline, management engineers have traditionally been valued. With the global healthcare industry’s fascination with Lean and Six Sigma principles (15,16), consultants looking for a more scholarly life might seek a higher educational degree and working as faculty. Other business consultants might specialize in different processes, like strategic planning, financial management, managed care contracting, and move into an academic position teaching these types of courses within the program. These consultants are usually people who have a more comprehensive perspective of operations due to their familiarity and practical experience in non-healthcare industries. Nevertheless, coming from the practice environment, they have limited scholarly experiences. They are used to focusing on simplifying complex concepts for wider understanding but they may want to do too much and struggle with staying within a department focus. Consultants are natural self-starters, multi-taskers and multi-goal/initiative oriented. This dynamic nature of their way of conducting their practice could be quite different from an academic environment that requires time to think about research, conducting studies and writing results. Consultants are outcome-driven which can be very beneficial in academia. However, the fast paced work level to achieve the deliverables promised to the client may be quite different than the commonly accepted academic pace to get things accomplished. Consultants are usually very good at change management since they must adapt to changing customer needs. Their lack of experience with the academic culture and politics might frustrate them as they see change is necessary but difficult to achieve in academia. Further, consultants are also typically project managers as well as problem solvers and so they may unintentionally without invitation take over facilitation of meetings and activities.

Clinicians as faculty

Clinicians (nurses, imaging technicians, respiratory and physical therapists, and physicians for example), start their careers working in their specific fields and then might decide to pursue teaching. Along with get involved in teaching, research and academic work, they venture into part time and then consider full time academic positions. They bring with them a good solid history of work in healthcare settings and often continue some aspect of their field in an administrative capacity as they conduct research. Generally speaking, these clinicians have a good operational knowledge but this can be truncated by a limited view of overall operations. This operational knowledge gives the clinician faculty member a good understanding of how to improve patient care but they may not necessarily come in with accurate knowledge of how patient care decisions will impact finances. They are aware of how financial decisions made by administration impact patient care, but this is in the context of their own area of work and their understanding of system budgeting is limited. The interaction these faculty members have had in the past with patients gives them a good sense of need, but their new roles away from a healthcare setting provides them little utility to make a direct difference for patients any longer. They do bring good ideas to promote growth and improvements, but these opportunities are usually aligned within their own specialties. The clinician faculty member is well versed on medical terminology and knowledge, but based on their experience and educational background they may lack business acumen.

Researchers as faculty

Health administrators who become faculty typically do not prepare their protégés for academic positions but rather for positions similar with previous ones. The majority of disciplines who have students seeking a career as an academic will advise them to obtain a master’s degree and then go on to a doctoral program. Liberal arts, the humanities, and the sciences, for example, produce higher education faculty this way and have less deviation in hiring people from the field than in health administration. This more direct route has students working with faculty mentors on research and they get help with developing their own research agenda. When this route is taken for health administration, the faculty member has strong quantitative analysis and critical thinking skills. Their experience with research (Institutional Review Board protocols, collecting and analyzing empirical evidence, writing grant proposals, etc.) can be considered as an advantage for a university as the new faculty member can continue his scholarly endeavors. However, because the lack of administrative experience and unfamiliarity with the practical aspects of the healthcare industry, it may cause some internal problems. Researchers are ready to enrich classroom discussions on their studies but this may stray from course-designed curriculum. They are able to engage students in projects thus providing more coaching for academics and supporting the pipeline to future research faculty. These faculty members may not give teaching their full attention and give less importance to administrative tasks wanting to focus only on their research. Finding a balance between their creative work and other teaching responsibilities can be a challenge. They may feel rewarded bringing in grants and publishing papers yet non-research oriented faculty may not value these deliverables in the same way. Finally, the researcher faculty member may become a loner working in his own area of interest and may ignore the importance of collaboration and collegial conduct as he concentrates on his latest study.


The academic-practice gap

Prior studies have demonstrated differences between the academic world and the practice environment (17,18). Even in academia the difference is noted. One recent study showed that faculty members from different sub-disciplines had different journal ranking systems (19). At times though, their alignment is clear. One such study showed an agreement in the academic evaluation of subject matter quality to its practical relevance as measured by practitioners (20). Yet the academic world and practice world continue to perpetuate the gap (21).

The health administration field needs to shrink this gap. In US health administration education there has been a shift from practitioner-based, smaller programs to larger programs having more traditional academic-based faculty (22). During this transformation, people with different backgrounds work together and thus necessitate a sense of inclusiveness, understanding of others, and a strong commitment to teams as faculty strive to have a well-functioning, successful program. The authors offer the following recommendations to bridge the gap between academic and practice, and at the same time provide ways for faculty from diverse backgrounds to bond. Chinese health administration faculty may be able to use some of these recommendations on their home campuses.

Develop a socialization and time management program

The program’s purpose would be to acculturate new health administration faculty to the retention, promotion and tenure process. It could include a faculty mentor program and a lighter teaching load for the first 2–3 years so that new faculty have the time to develop their teaching, research abilities, and student advisement skills.

Senior faculty research partnerships

Senior faculty could offer to include a junior faculty in their research projects. This could help junior faculty who don’t have a strong research background to develop their skills and receive mentoring from seasoned faculty on how to develop a research agenda. The result might include a co-authored publication or co-presenting at a conference, which not only adds to scholarship but it advances junior faculty forward in the retention, tenure and promotion process.

Routine and timely access to pedagogical tools

Many universities house a faculty development program specializing in providing pedagogical training on topics like classroom management and developing a syllabus, to techniques that demonstrate how to integrate technology into the lectures. Junior faculty should be urged to access these resources.

Coffee/tea talks

Health administration programs should routinely meet with their new faculty in an informal and non-threatening setting to check-in with them, answer questions, provide feedbacks, and intervene when necessary. This can also be a time to discuss current events in health care and learn about each other’s research progress.

Hold inter-professional conferences/case study analysis presentations

These extra-curricular activities will allow faculty to demonstrate their particular expertise and skills while providing a learning-centered experience for students.

Organize “Professor for the day/speaker series”

Guests and alumni that represent different practitioner types in the health care industry are invited to share to students. This will increase the exposure of the faculty to these types.

Membership to professional associations

New faculty should be members of their professional association so that they can take advantage of the invaluable resources that their website and conferences offer. In the US, the health administration professional association is called the Association for University Programs in Health Administration (www.aupha.org). The resources, the online forums, the webinars, and meeting with like minds at the annual conferences would provide incredible content and support that will only help to focus and enhance the skills and abilities of the new faculty member.


Conclusions

This article attempts to acknowledge the diverse backgrounds of health administration program faculty in the US. As the industry changes under the health care reform, many nontraditional delivery methods are being initiated. This will produce increased collaboration and new partnerships with the various players who could someday become faculty. We must embrace our differences and remove the negative thoughts associated with academics that are not like us. We need to change the culture of division to one that celebrates our different backgrounds. This will create a much more engaging and enjoyable work environment and a place where students can learn collaboration from our examples. The authors hope that Chinese health administration educators gain insight from this discussion and incorporate many of the suggestions as they apply in their programs.


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

  1. Huang M, Wei D, Rubino L, et al. “Three essential elements” of the primary health care system: a comparison between California in the U.S. and Guangdong in China. Family Medicine and Community Health 2015;3:23-9. [Crossref]
  2. Wei D, Rubino L. Evolving governance during health care reform in the United States and China. Journal of Chinese Research Hospitals 2014;1:60-89.
  3. Blumenthal D, Hsiao W. Lessons from the East--China's rapidly evolving health care system. N Engl J Med 2015;372:1281-5. [Crossref] [PubMed]
  4. Robeznieks A. Herding academic cats; engaging doctors is key to teaching hospital reforms. Modern Healthcare 2015;45:16-8.
  5. Zha Q, Wang C. Is China shifting toward a binary system? March 29, 2014. Available online: https://www.insidehighered.com/blogs/world-view/china-shifting-toward-binary-system#ixzz2xc3FZwWF
  6. National Health and Family Planning Commission of PRC. Health Science, Technology and Education Department work for 2015. 2015. Available online: http://www.chinadaily.com.cn/m/chinahealth/2015-03/18/content_19846699.htm
  7. Ginter PM, Menachemi N, Morrisey MA. Academic health administration: Who are we? what do we do? and what are our views concerning the profession? The Journal of Health Administration Education 2009;26:259-76.
  8. Menachemi N, Morrisey MA, Au D, et al. Job responsibilities and expectations of assistant professors: Does school of employment matter? Journal of Healthcare Management 2009;26:277-91.
  9. Lewallen LP, Crane PB, Letvak S, et al. An innovative strategy to enhance new faculty success. Nursing Education Perspectives 2003;24:257-60. [PubMed]
  10. Sorcinelli MD. Effective approaches to new faculty development. Journal of Counseling & Development 1994;72:474-9. [Crossref]
  11. Sorcinelli MD. New and junior faculty stress: Research and responses. New Directions for Teaching and Learning 1992;1992:27-37.
  12. Tierney WG, Rhoads RA. editors. Faculty socialization as cultural process: A mirror of institutional commitment. Washington, DC: KSHE-ERIC Higher Education Report No. 93-6, 1994:1-123.
  13. Lunn RO. Balancing careers in health management practice and in the academy: issues, synergies, rewards, and pitfalls. Health Care Manage Rev 2002;27:69-75. [Crossref] [PubMed]
  14. Zoller JS. From practice to academia. A successful transition requires new skills and a different perspective. Healthc Exec 2004;19:48, 50.
  15. Zidel T. editor. Lean Done Right: Achieve and Maintain Reform in Your Healthcare Organization. Chicago, IL: Health Administration Press, 2012.
  16. Barry R, Murcko AC, Brubaker CE. editors. The Six Sigma Book for Healthcare: Improving Outcomes and Reducing Errors. Chicago, IL: Health Administration Press, 2002.
  17. Gopinath C, Hoffman RC. The relevance of strategy research: Practitioner and academic viewpoints. Journal of Management Studies 1995;32:575-94. [Crossref]
  18. Santoro N, Snead SL. “I’m not a real academic”: A career from industry to academe. Journal of Further and Higher Education 2013;37:384-96. [Crossref]
  19. Menachemi N, Hogan TH. DelliFraine JL. Journal rankings by health management faculty members: Are there differences by rank, leadership status, or area of expertise? Journal of Healthcare Management 2015;60:17-28. [PubMed]
  20. Baldridge DC, Floyd SW, Markoczy L. Are managers from Mars and academicians from Venus? Toward an understanding of the relationship between academic quality and practical relevance. Strategic Management Journal 2004;25:1063-74. [Crossref]
  21. McNatt BD, Glassman M, Glassman A. The great academic-practitioner divide: A tale of two paradigms. Global Education Journal 2010;2010:6-22.
  22. Weil T. MHA’s are not taught by MHA’s: A call for a more hands-on orientation. The Journal of Health Administration Education 2013;30:137-54.
doi: 10.21037/jrh.2016.08.07
Cite this article as: Augustin F, Rubino L, Wei D. Health administration faculty diversity in the United States with recommendations to China. J Res Hosp 2016;1:8.

Refbacks

  • There are currently no refbacks.