Clinical Notes
ED Leadership Competency Matrix:
An Administrative Management Tool
DOUGLAS A. PROPP, MD, MS,* SETH GLICKMAN, MD,†
AND DENNIS T. UEHARA, MD, MS‡
A successful ED relies on its leaders to master and demonstrate core
competencies to be effective in the many arenas in which they interact
and are responsible. A unique matrix model for the assessment of an ED
leadership’s key administrative skill sets is presented. The model incor-
porates capabilities related to the individual’s cognitive aptitude, expe-
rience, acquired technical skills, behavioral characteristics, as well as
the ability to manage relationships effectively. Based on the personnel
inventory using the matrix, focused evaluation, development, and re-
cruitment of ED key leaders occurs. This dynamic tool has provided a
unique perspective for the evaluation and enhancement of overall ED
leadership performance. It is hoped that incorporation of such a model
will similarly improve the accomplishments of EDs at other institutions.
(Am J Emerg Med 2003;21:483-488. © 2003 Elsevier Inc. All rights re-
served.)
The administrative medicine literature is replete with
articles recognizing the scarcity of clinician leaders ready to
assume their role in the evolution of health care during these
turbulent times of change.1-10 Training is required to pro-
vide leaders with the ability to deal with issues such as
clinical standardization, site efficiency, outcomes manage-
ment, value enhancement, data management, patient and
customer satisfaction, informatics, as well as change and
human resource management. These issues are all pertinent
to the effective running of the ED.
Experts recognize that the appreciating resource of hu-
man capital (people’s individual and collective learning and
knowledge, skills and expertise, creativity and innovation,
competencies and capabilities) within the organization pro-
vides its core opportunity for sustained competitiveness.11
Given the industry-wide pressure within health care to pro-
vide a positive financial return to support implementation of
new technology and provide capital to service and replace
the aging infrastructure of healthcare organizations within
this country, the need to enhance the performance of lead-
From *Advocate Lutheran General Hospital, Park Ridge, Illinois;
the †University of Chicago Emergency Medicine Residency, Chi-
cago, Illinois; and ‡Rockford Health System, Rockford, Illinois.
Received September 18, 2002; accepted September 28, 2002.
Address reprint requests to Douglas A. Propp, MD, MS, Chair,
Department of Emergency Medicine, Advocate Lutheran General
Hospital, 1775 Dempster Street, Park Ridge, IL 60068. E-mail:
douglas.propp-md@advocatehealth.com
Key Words: Competencies, administrative medicine, leadership.
© 2003 Elsevier Inc. All rights reserved.
0735-6757/03/2106-0009$30.00/0
doi:10.1016/S0735-6757(03)00164-5
ership is paramount. In addition, the increasing competition
among providers requires that unique core competencies of
organizations that allow them to distinguish themselves
from their competitors must be developed.2 A unique model
was created to assist the Chair of a nonuniversity-based
teaching, suburban ED evaluating over 51,000 patients per
year to enhance the performance of its clinical leadership.
LEADERSHIP CORE COMPETENCIES
In examining the expansive skill set required of medical
leaders, we have stratified them into those relating to the
individual’s (1) cognitive aptitude, (2) acquired technical
skills, (3) experience, (4) behavioral characteristics, and
finally, (5) ability to manage relationships effectively.4 The
first 2 categories are entry-level threshold capabilities, the
fourth category is difficult to modify, whereas the last group
of attributes deals with higher level performance.
The ability to successfully complete the advanced educa-
tion and training required to be a clinician suggests that ED
leaders have at least an acceptable overall cognitive apti-
tude. However, the ability to effectively render EM care and
advocate for an individual patient is very different from the
competencies required to perform as a proficient adminis-
trative leader. For example, the ability to interact success-
fully with multiple stakeholders, including nonclinician
peers, to understand the nuances of organizational behavior,
and to enact organizational strategies requires very different
skills than those required for clinical practice.
A healthcare leader can acquire the technical skills of
management through readings, continuing education, or for-
mal advanced education such as that obtained through com-
pletion of an advanced degree program (for example, MBA,
MMM, MPH, MHA).12 The multitude of acquired skills can
be categorized into those that are related to, for example,
measurement, interpersonal interactions, business acumen,
clinical quality, productivity, as well as industry dynamics
and healthcare policy (Table 1).
Probably the most critical and challenging competencies
relate to the clinician leader’s personality-driven behavior.
These are the hard-wired, functional responses to environ-
mental stimuli that must be internally managed to avoid
behavior that could be counterproductive to exemplary lead-
ership performance.9 These behaviors might include those
that deal with credibility, productivity, power and influence,
leverage, and interpersonal interactions (Table 2).
483
484 AMERICAN JOURNAL OF EMERGENCY MEDICINE ■ Volume 21, Number 6 ■ October 2003

TABLE 1. Acquired Leadership Skills An adaptable leader will quickly and appropriately disen-
gage from the past, recognize how the current proposed
Quantitative/measurement
Manage and analyze data changes fit into the long-term perspective for the organiza-
Use informatics and decision support tion, participate in the “design” of the latest view of the
Demonstrate financial expertise future, and position the ED so that its influence is enhanced
Communication/ interpersonal interactions in the new environment.
Communicate effectively in multiple mediums and in multiple
directions ED LEADERSHIP’S COMPETENCY MATRIX
Sensitivity to patient, payor, and customer satisfaction
Recruitment, mentoring, and evaluation of personnel The primary focus of our model of organizational excel-
Ability to transmit information to facilitate cascading lence relates to the creation and continuous modification of
knowledge within the organization a competency-resource template to inventory key skills sup-
Negotiation skills portive of departmental objectives, strategies, and tactics
Team-building and performance
that incorporate the previously described core competencies
Conflict management and resolution
Persuasiveness in leading others (Table 3). The ED leadership matrix is an evolving docu-
Business acumen ment that is continuously updated acknowledging current
Ability to identify, support, and excel at business expansion and anticipated future leadership requirements for our
opportunities department to thrive. Clearly, other EDs might identify
Strategic thinking and planning different elements of their matrix based on their unique
Business planning organizational needs. Our matrix currently includes compe-
Systems orientation tencies in clinical credibility (peer-benchmarked quality
Visionary
Clinical quality
Manage the cost/quality interface TABLE 2. Behavioral Characteristics
Identify and accomplish optimal quality and healthcare
outcomes Credibility
Productivity Honesty
Management of change and successful adaptation Integrity
Optimal management of time Trustworthiness
Healthcare policy and industry dynamics Compassion
Awareness of external regulatory/accreditation requirements Fairness
Awareness of healthcare policy Consistency
Awareness of marketplace/industry dynamics Congeniality
Kindness
Accountability
Productivity
The term “emotional intelligence” describes the ability to Self-starter
manage oneself and relationships effectively.4 For example, Creative
the ability to recognize and understand your moods, emo- Results oriented
tions, and drivers and their effects on others with their own Responsible risk-taker
emotive makeups is one component. At the extreme, the Early adopter
Flexible
ability to control or redirect disruptive impulses or moods,
Adaptable
realizing how such behavior would undermine collaborative Thirst for continual self-improvement and learning
effectiveness given the multitude of complex relationships Assimilator of new information
within an organization, is descriptive. The personal effec- Recognition of patterns and connections
tiveness elements of emotional intelligence are exemplified Innovative
by the pursuit of goals with persistence, a realistic self- Imaginative
evaluation of dynamic strengths and limitations, drive to Power and influence
meet an internal standard of excellence, as well as readiness Organizational diplomacy
to seize new promising opportunities for growth and devel- Networking
opment.5 Clearly, the effective ED leader must have high Acknowledgment of informal organizational structure
Publicly advocate for the organization
emotional intelligence.
Strategic systems thinker to envision how the pieces fit
Adaptability refers to the ability of leaders to be flexible together
and to quickly adjust to change, frequently not within their Function comfortably within an ambiguous environment
control. Although change is expected, it often occurs with- Leverage
out warning, sometimes even appearing capricious in na- Willing to set an overall positive tone
ture. Common scenarios are those associated with changes Ability to collaborate, recognize others and create an
in organizational structure, philosophy, or senior leadership. atmosphere of empowerment
Any of these changes could result in the ED leader finding Mentoring of colleagues
their authority and tenure vulnerable. The organizational Referent power to influence, inspire, motivate, and lead others
leaders and values previously relied on for sponsorship and Interpersonal interactions
Collaborative relationship building and maintenance
direction might no longer pertain to the new reality. The
Clinician friendly
successful leader will anticipate the change if possible and Receptive to feedback
develop strategies to mitigate any potential negative impact.
PROPP ET AL ■ ED COMPETENCY MATRIX 485

measures), informatics (being astute in incorporating com-

Scholarly Individual
Totals
puter tools), patient and customer satisfaction (peer-bench-

53
46
46
42
39
36
marked patient satisfaction scores and medical staff com-
plaints/compliments), quality (the ability to enhance quality
Academic/

Skill Sets Credibility Informatics Satisfaction Quality EMS Outreach Thinking Leadership Politics Visionary Awareness Diplomacy Networking Innovation Adaptability Activity
care by analyzing care from a systems perspective), EMS,

3
2
1
1
0
5
12
community outreach, strategic thinking, change leadership,
politics (understanding the dynamics of power and influ-
ence), vision (anticipating future trends and moving forward
to embrace them), industry awareness, diplomacy (ability to
2
1
4
3
5
3
18
interact with others in a pleasing nature), networking, cre-
ativity/innovation, adaptability, and academics/scholarly ac-
tivities.
Creativity/

The ED physician and nurse leaders are identified on the

3
5
3
2
4
2
19
vertical axis of the matrix. In the absence of objective
measures (for example, benchmarked measures, specific job
description and duties, individual’s focused expertise and
interest, number of publications, and so on) the department
3
3
4
2
2
4
18

Chair scores each, from a low of 0 to a maximum of 5,

within the relevant cell. As one fills in the cells of the
matrix, a unique perspective on individual and overall staff
4
4
2
2
1
3
16

capabilities evolves elucidating strengths, weaknesses, and

gap opportunities.
When considering a row, one is able to evaluate an
Industry

individual, identifying strengths and opportunities for fur-

4
1
2
3
0
0
10

ther focused development. The evaluation could be per-

formed unilaterally by the person to whom the individual
reports or by other informed ED or institutional leaders.
Although it is acknowledged that few leaders will excel at
4
4
1
2
2
2
15

all of the skills identified, the matrix provides focused

opportunities for training, development, and ongoing per-
formance reviews. In reviewing the ED leadership matrix
4
3
5
4
5
2
23

(Table 3), one can easily appreciate the difference in skills

possessed by leader A (score ⫽ 53) compared with leader F
Community Strategic Change

(score ⫽ 36). The tool can also be used to identify unique

3
4
3
3
2
2
17

competency profiles that would be desirable to add to the

department in its recruitment and selection efforts. One
might even enlist focused reference checks to include the
4
3
3
5
4
2
21

candidate’s strengths and weaknesses relating to the re-

quired departmental skill set opportunity.
Consideration of a column identifies the capabilities of
the ED leadership as a whole for that specific attribute.
3
3
3
0
1
0
10

When reviewing the matrix (Table 3), one can appreciate

differences in departmental capabilities. For example,
whereas the department performs well in clinical credibility
0
1
4
0
1
0
6

and politics (score ⫽ 23), it appears that there is an oppor-

tunity for improvement in EMS (score ⫽ 6). Although not
4
3
2
5
3
2
19
ED Leadership’s Competency Matrix

done in Table 3, the leadership could weight each individual

category, reflecting their appreciation of the relative impor-
Patient/Customer

tance of each category in contributing to the department’s

4
3
3
3
1
2
16

overall effectiveness. The ongoing review to add, subtract,

or reweight categories as well as scoring of each individual
leader should occur on a regular basis, depending on chang-
ing departmental needs. One can appreciate how the matrix
3
5
3
2
4
2
19

provides a unique, useful tool in managing the effectiveness

of key ED leaders in optimizing organizational objec-
tives.13,14
Clinical

5
1
3
5
4
5
23

CONCLUSION
Personnel

ED totals
TABLE 3.

A unique perspective of the ED leadership’s strengths

and needs evolved during the development and implemen-
tation of the competency matrix. Although the ED Chair
C
D
B
A

E
F
486 AMERICAN JOURNAL OF EMERGENCY MEDICINE ■ Volume 21, Number 6 ■ October 2003
initially scored the tool, it was reevaluated by the nonphy-
sician administrative director to challenge some of the as-
sumptions of the physician leader, which was felt to be a
valuable exercise. Given the dynamic nature of many of its
elements such as changes in the healthcare environment,
overall organizational vision and strategies, the personnel
being scored, changing capabilities of individuals, and the
relative importance of the multitude of categories, one can
see how the tool will remain a work in progress. We
envision the tool to be used as a self-evaluation instrument
for the ED leadership in the near future. One could easily
imagine the tool being tied to some at-risk portion of com-
pensation to better align individual performance with de-
partmental goals. In summary, we envision the competency
matrix to continue to enhance the leadership evaluation and
performance in our thriving ED.
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