Exploring Leadership Competencies and Professional Experience Level of Health Administrators in Haiti

Posted: January 4th, 2023

Exploring Leadership Competencies and Professional Experience Level of Health Administrators in Haiti

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Exploring Leadership Competencies and Professional Experience Level of Health Administrators in Haiti

Many poor countries struggle to provide quality healthcare to their populations due to resource and personnel scarcity. These countries often suffer from disease epidemics and natural catastrophes that overwhelm their healthcare systems and facilities. With the rising costs of healthcare across the world, health services in such countries are expected to encounter more challenging times in future. Haiti is one of the poor countries that are languishing in a troubled healthcare system (The World Bank, 2017). The country spends $13 per person on public health compared to $180 and $781 in the neighboring Dominican Republic and Cuba, making it one of the lowest healthcare expenditures in the world (The World Bank, 2017). The hospital sector takes up 38% of the total health expenditure in the country, which is much higher than that in equality poor countries such as Tanzania (26%) and Burundi (23%) (The World Bank, 2017). Although the country has numerous hospitals built using donor funding, the care provided in them is either substandard or inexistent due to lack of healthcare professionals and medical supplies. Moreover, the administrative staff in public hospitals comprises about half the workforce, which is significantly higher than in comparable low-income countries, yet the country experiences rates of infant and maternal mortalities that are 4-5 times higher than those in Caribbean and South American countries (The World Bank, 2017). The dismal health outcomes raise doubts about the quality of hospital administrators in the country. Besides, these hospitals do not provide adequate primary healthcare, going by the high fatalities from diseases such as cholera, tuberculosis and Zika (The World Bank, 2017). Therefore, the high investment in hospitals did not translate to improvement in healthcare services, which implicated poor hospital administration (The World Bank, 2017). This state of healthcare in Haiti was because expenditure was directed more towards curative instead of preventative health care. While the administrative staff is overrepresented in the healthcare workforce in Haiti’s hospitals, information on their level of leadership competence and professional experience was lacking. Such information can help in assessing whether the poor health outcomes in the country is attributed to the quality of hospital administrators.

Purpose of the study

The purpose of this study is to determine the level of leadership competencies and professional experiences among healthcare administrators in Haiti, considering that they are overrepresented in the healthcare workforce in the country. Already, the administrative staff lacks data to facilitate the proper monitoring, evaluating and supervising of the quality of challenging (The World Bank, 2017). Therefore, it is likely that the hospitals lack leadership and professional expertise to utilize the available facilities and resolve the basic health issues afflicting many Haitians today. If this study unearths inadequacies in leadership and professional competencies among hospital administrators, improvements in professional training can be made. This would help Haitian hospitals provide quality and effective healthcare services with the meager resources available.     

Importance and applicability of leadership competencies and professional experience level to health administration

The importance of leadership and continuous professional development in healthcare has administration been discussed extensively in literature. Thakre & Thakre (2015) reiterated the significance of the leadership and management role of healthcare professionals in navigating the contemporary global healthcare environment that was characterised by globalisation forces, digital technology advancements, high demand for health as a human right and the usefulness of evidence-based practice. They noted that governments should champion a comprehensive approach in strengthening healthcare professional skills for organisational effectiveness. Similarly, Sonnino (2016) emphasized the need to undertake leadership training throughout the career of a healthcare professional.  He also reiterated the importance of early career leadership training in maintaining a continuous pipeline of future healthcare leaders. Moreover, he insisted that leadership training should be interdisciplinary, incorporating individual and institutional projects that allowed healthcare professionals to practice their newly-acquired knowledge. Figueroa et al. (2019) provided an overall perspective when they observed that the changing and expanding role of health managers required capacity enhancement to meet the priorities in change, human resource management, cost-saving and efficiency. These changes were required at the international, national and individual levels of healthcare management.   

However, Dolvo (2016) observed that the heavy reliance on donors and partners by the healthcare systems in resource-deprived settings distracted the healthcare priorities due to the poor understanding of the local contexts, thus hindering management effectiveness. As such, healthcare management was often overlooked because it did not consider the working environment of healthcare professionals, the size of the healthcare workforce and the healthcare support systems and value chains. In the same vein, Sammut and Ngony (2019) observed that although Africa was experiencing a significant shortage of competent healthcare professionals, its physicians were unprepared for the leadership roles in healthcare systems and facilities despite being promoted to such positions. Prolong supremacy squabbles fomented internal crises among the healthcare workforce and demonstrated poor healthcare administration, which was the cause of the health sector crisis in Nigeria (Adeloye, et al. 2017).

Hudspeth et al. (2015) observed that continuous professional development of healthcare practitioners in low-resource settings was poor because it did not influence medical licensure. Health professionals in such settings were permanently licensed to practice, and therefore not obliged to engage in professional development after completing their college training. Besides, educational materials were adopted for high-resource systems, and therefore did not address the health realities in poor countries. Battat et al. (2016) identified numerous areas that were missing in the Continuing Medical Education (CME) programs in Haiti, which fell short of the competencies recommended by the College of Family Physicians Canada (CFPC) and the American Academy of Family Practitioners (AAFP), despite the longstanding medical education tradition in the country. From different perspective, Fils-Aimé et al. (2018) noted that mobile health clinics could help supplement hospital services in the rural areas of resource-strapped countries such as Haiti, although their success required a comprehensive community-based strategy.

Research questions

The research questions that this study will seek to answer are:

1. What are the leadership competencies possessed by the healthcare administrators in Haitian hospitals?
2. What are the professional experience levels of healthcare administrators in Haitian hospitals?
3. What challenges do healthcare administrators in Haitian hospitals experience in their hospital managerial duties?

Methodology

A qualitative research will be conducted using a survey designed by the researcher. This approach is chosen because it can provide demographic data, which can be backed up by qualitative information, therefore providing a comprehensive outlook on the state of healthcare administration in Haitian hospitals. 

Data collection

A survey of the hospital administrators and archived documents will be used to collect data. Primary and secondary data will be obtained from the survey. The primary data will be collected using a questionnaire that will be administered to administrators in 2 hospitals in Haiti by the researcher. After purposive sampling of the two hospitals, ten hospital administrators will be selected to participate in the study. After that, 4 hospital administrators, two in each hospital, will be selected for in-depth interviews. The interviews will augment and clarify the data obtained from the questionnaires by providing insights into the leadership and professional issues identified in the questionnaires and unearth any other related issues that may not have been captures in the questionnaires. The questionnaire will comprise of questions that capture the demographics of the administrators, such as their age, gender, department, education level, professional training, and years of experience among other details. It will also comprise of items that capture the perspectives of the healthcare administrators related to their leadership duties and professional experiences. Perceptions about the leadership and professional challenges will also be captured by the questionnaire and expounded in the interviews. Moreover, the hospital administrators will offer recommendations that could help improve their leadership and professional competencies. 

After obtaining permission from the hospitals’ management, administrators in different levels and departments at the hospitals will be invited to participate in the survey. The purpose of the study and expected use of the collected data will be communicated to the participants and their informed consent sought. The privacy of personal information and confidentiality of the data will be assured to endear participants’ confidence and truthfulness.    

Secondary data will be obtained from hospital records and other archived documents to supplement the primary data. Hospital records will provide data on hospital administrators in the last 10 years. This data is expected to yield information about the performance of the hospitals in the last decade, which will reflect the effectiveness of the leadership during this period.

Data analysis

Data from the questionnaires and interview transcripts will be cleaned, coded and fed into a statistical computer program (SPSS). Descriptive data will be analyzed and presented in frequencies, percentages, means and other statistics. For the explanations and textual data, a thematic analysis will be performed to unearth the common ideas and patterns of meanings in the statements made by the participants related to their leadership and professional experiences. Cross tabulations and correlation coefficients will be used to determine the relationships between different data and variables. The results will be presented in text, tables, and graphs.     

References

Adeloye, D., David, R. A., Olaogun, A. A., Auta, A., Adesokan, A., Gadanya, M., … & Iseolorunkanmi, A. (2017). Health workforce and governance: the crisis in Nigeria. Human Resources for Health, 15(1), 32-40. doi:10.1186/s12960-017-0205-4.

Battat, R., Jhonson, M., Wiseblatt, L., Renard, C., Habib, L., Normil, M., … & Sacajiu, G. (2016). The Haiti Medical Education Project: Development and analysis of a competency based continuing medical education course in Haiti through distance learning. BMC Medical Education, 16(1), 275-282. doi: 10.1186/s12909-016-0795-x.

Dovlo, D. (2016). Does management really matter? and if so, to who?: Comment on” Management matters: A leverage point for health systems strengthening in global health”. International Journal of Health Policy and Management, 5(2), 141-143. doi:10.15171/ijhpm.2015.204

Downing, J. (2016). Implementing a palliative care nurse leadership fellowship program in Uganda. Oncology Nursing Forum, 43(3), 395-398. doi: 10.1188/16.ONF.395-398.

Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: A rapid review. BMC Health Services Research, 19(1), 239-250. doi:10.1186/s12913-019-4080-7.

Fils-Aimé, J. R., Grelotti, D. J., Thérosmé, T., Kaiser, B. N., Raviola, G., Alcindor, Y., … & Daimyo, S. (2018). A mobile clinic approach to the delivery of community-based mental health services in rural Haiti. PloS One, 13(6), e0199313. Doi: 10.1371/journal.pone.0199313.

Hudspeth, J., Curry, C. L., Sacks, Z., & Surena, C. (2015). Continuing professional development in low-resource settings: Haiti as example. ANN Glob Health, 81(2), 255-259. doi:10.1016/j.aogh.2015.03.004.

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Sonnino, R. E. (2016). Health care leadership development and training: progress and pitfalls. Journal of Healthcare Leadership, 8, 19-29. doi:10.2147/JHL.S68068

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