A competency is defined as ‘the proven ability to use knowledge, skills and personal, social and/or methodological abilities, in work or study situations and in professional and personal development’ by the European Qualifications Framework recommendation.

Therefore, a competency combines three elements: knowledge, skills and attitudes (including values and behaviours).

Competencies are usually described in a sentence including an action verb, an object of action and a goal for the action and how to achieve it.

Brief overview of existing models

There are various references (models, directories, frameworks) of competencies for leadership and management for healthcare managers.

In the FHME workshop in 2017, two models were presented and debated and received special interest by participants: the Healthcare Leadership Model by the NHS Leadership Academy (UK)  and the Leadership Competencies for Healthcare Services Managers Directory, developed by the Special Interest Group in Healthcare Management of the IHF.

The Leadership Competencies for Healthcare Services Managers Directory by IHF is structured on 5 dimensions: Leadership; Communication and Relationship Management; Professional and Social Responsibility; Health and Healthcare Environment; and Business. Along with the directory, IFH provides an online assessment platform (Healthcare Management and Leadership Assessment platform) that serves as a survey for self-assessment, open to all healthcare professionals in a management position. This platform provides a global benchmark for the identified core competencies across geographical locations, while allowing for peer-to-peer insights/comparison.

FHME is considering these two models as relevant references for defining future competencies of senior managers in healthcare organizations in Europe.

Other models considered in this project:

  • LEADS in a Caring Environment Framework (Canada)
  • NCHL Health Leadership Competency Model (USA)
  • ACHSM Master Competency Framework for health service managers (Australia, New Zealand, Hong Kong)
  • IHM Professional Practice Framework (UK)
  • American College of Healthcare Executives (ACHE)
  • American Organization of Nurse Executives (AONE)
  • Health Services Executive (HSE) competencies in Ireland.

Most existing models have been developed based on an analysis of current roles and functions of managers in healthcare. Also, most of them have been developed to be useful for many levels of healthcare management and describe activities and tasks that can be certified.

FHME proposes a list of new competencies based on new and emerging challenges but not on currently observed functions of managers, to be useful for planning training and career development of senior managers and executives.


Our approach: future-focused competencies

FHME aims to provide a reference of competencies which is compatible and complementary to these existing models by:

  • Targeting healthcare executives and senior managers and not all levels of management in healthcare organizations
  • Scoping competencies to healthcare systems in Europe with the significant relevance of public systems in most EU countries.
  • Focusing on the future role and challenges that imply new needs for competencies
  • Considering new competencies as an opportunity for develop a new role and managerial function in their organizations
  • Defining competencies in a flexible and adaptable way to changes in challenges and the environment
  • Curating and distributing competencies in an open and collaborative way

because the main purpose of FHME competencies is to update training and improve capabilities.

Moreover, in contrast with other models, FHME competencies are not meant to be used for certification of professionals or training activities.


In 2017, FHME focused on discovering new and emerging competencies for healthcare executives and senior managers. The goal is to provide a reference:
  • for healthcare executives and senior managers to plan their career development in accordance with new requirements
  • for faculty (academic directors and professors) of healthcare management programs to improve and update the programs with new materials and learning methods.

FHME focuses on competencies that will be required by executives and senior managers in healthcare organizations.

FHME considers as “healthcare executives and senior managers” as those professionals who plan, organise, direct, control, evaluate and formulate policies of healthcare organizations, such as hospitals, mental health centers, primary care centers, long-term care centers, public health and health system administration institutions.

Examples of positions of healthcare executives are: hospital CEO or division director, senior manager in health system administration, primary care trust director.

In 2017, the activities included discovery of new competencies with an open view of the future healthcare managers’ role, including internal and external stakeholders of healthcare organisations.

Participants of FHME included managing directors, health policy makers, clinical leaders, healthcare departmental managers, health management faculty, medical education professors, healthcare innovators and entrepreneurs and healthcare industry (pharmaceutical and medtech) executives, as well as other healthcare management stakeholders.

The FHME workshop at IESE Barcelona campus involved more than 60 participants, from countries such as France, Italy, Portugal, Sweden, Belgium, Ireland, UK, Spain, Germany, Switzerland, and Iceland, and discussion was organized around 6 selected topics in healthcare: value-based care, Entrepreneurship, Leadership, Digital Transformation, Innovation, and Governance.

Healthcare Management Challenges

As a result of FHME workshop activities in 2017, the following challenges of healthcare executives and senior managers have been identified as the most relevant:

FHME Model

Future-focused competencies are classified into 6 dimensions:

List of FHME competencies (version 2018)

# Competency label Competency description
1 Collaborative network leadership Exemplify collaborative leadership by sharing authority and responsibilities and balancing motivations of stakeholders in the network, and develop clinician leaders that exhibit the same style.
2 Integrative health ecosystem thinking Consider the complex dynamics of the health and care ecosystem and devise actions that integrate all stakeholders in the network of care with special emphasis on leveraging participation of all involved actors.
3 Anticipatory business vision Anticipate and prepare for possible changes that may impact the role of the healthcare organization in the network of care, and understand challenges and opportunities of health reforms, policies and other external pressures that may influence the provision model.
4 Orchestrate sustainable innovation in the ecosystem Orchestrate sustainable initiatives for change and innovation in the network of care and the health and well-being ecosystem, developing awareness of the dynamics in the ecosystem, assessing the capacity and readiness for change and innovation and building ecosystem’s health and resilience.
5 Develop shared organisational vision Develop a shared organizational vision that considers professionals values, beliefs and motivations and aligns units with the plans of the organization and considers the larger network of care and healthcare ecosystem.
6 Foster patient empowerment and health promotion Promote models for empowerment of patients and citizens, fostering interventions for lifestyle counselling and recommendations at all levels of the organization and in the network of care.
7 Develop services adaptability and responsiveness Implement models and approaches to facilitate rapid adaptation of healthcare services in response to advances in knowledge and technologies, and changes in patients’ and community needs.
8 Communicate with the public and engage patients’ associations Communicate with passion and pedagogy with the public and patient and families, and other associations in the health ecosystem and involve them in the co-creation and review of healthcare services.
9 Develop new professional roles Observe changes in the health care needs, current professions and boundaries, facilitate development of new roles in the healthcare organization and influence regulators to accept and sustain new professional arrangements.
10 Apply emergent change management Apply emergent change approaches for less prescriptive transitions where professionals become change leaders towards new models of care, and provide them with guidance, alternatives and support in decision making.
11 Develop models for participatory management Develop models for engaging clinicians at all levels of management that foster their involvement in various activities of management such as planning, directing, organizing, and decision-making as well as in monitoring and control.
12 Unity in top management teams Develop “teamness” in top management teams that exhibit a collaborative behavior, a high level of information exchange and joint-decision making.
13 Empathic and positive leadership Develop active listening and empathy with professionals, and demonstrate coherence through conscious empowering and enabling actions that focus on individuals’ needs for meaning and membership.
14 Multidisciplinary negotiation and compensations systems Manage and control the dynamics of negotiation in a complex organization with multidisciplinary professionals, and implement compensation systems that combine economic incentives, professional recognition and development, and prosocial contribution.
15 Foster clinician intrapreneurship Foster intrapreneurship by sponsoring opportunities for clinicians to develop their professional projects within the organization and developing their sense of control over external variables.
16 Develop transformational leaders Develop leaders that communicate and generate trust in the change, inspiring optimism in the changes and demonstrating honesty and openness in all interactions.
17 Promote digital and human-friendly health care models Understand and leverage digital technologies for adapting care models to improve access and optimize resource utilization, such as telecare and home care, while considering the ‘human’ dimension in all interactions and process activities.
18 Foster collaboration in interdisciplinary and virtual teams Foster collaboration and coordination in virtual teams made from diverse specialties, disciplines, units, and settings for integrated care.
19 Access and adoption of new technologies and health innovations Anticipate benefits and challenges of new technologies such as genomics, biomics, nanotechnologies, robotics, prosthetics implants for precision medicine and for improving clinical processes.
20 Develop capabilities for adopting external innovation Develop capabilities for integrating and scaling external innovations (new drugs, medical technologies, digital and so on), and when planning anticipate their potential impact to people, resources, processes and alliances.
21 Organizational ambidexterity Balance activities for improving operational excellence with activities for exploration of new opportunities for innovation and value creation; to facilitate sustainability, growth, and professional satisfaction.
22 Design patient-centric organizational structures Apply organizational design towards a more patient-centric model according to grouping patient tracks or needs (such as pathology units, thematic lines or clinical directorates) removing silos of knowledge or medical specialties.
23 Agile strategic project management Apply agile iterative models for implementing strategic changes and for process improvement to deliver goals in a system where changes happen with increasing speed.
24 Resilience and flexibility in performance management Maintain focus on goals and persist with efforts in achieving them with a strong need for achievement yet having the capability to adapt and be flexible with new situations that may arise.
25 Lead comprehensive performance management systems Lead the development of models and systems for planning, monitoring, and measuring of outcomes for health, safety, quality and financial, and the implementation at all levels of the organization, with special emphasis at individual and team level and with involvement and consideration of professionals and the link with reward models.
26 Promote responsible and sustainable research and innovation Promote research and innovation to respond to the real needs of society, ensuring that integrity, ethics, and risk analysis are considered with transparency and openness of the methodology and the results.
27 Develop effective and transformational governance Develop effective governance boards and mechanisms that contribute to assurance and improvement of organizational performance such as quality, patient safety and efficiency, while energising initiatives for transformation.
28 Develop contracting models with focus on value and reported outcomes Understand and implement various contracting models with special emphasis on value-based, in combination with capitation, packaged services and traditional reimbursement models, and promote evaluation and measures for patient reported experience and patient reported outcomes.
29 Ensure patients and public involvement Ensure that the voice of patients is consistently heard at every level of the organization and the patients’ needs and preferences are reflected and to including their needs, concerns and experience.
30 Detect and assess opportunities for innovation and growth Identify changes in the ecosystem that would lead to new opportunities for improvement of services and make quick evaluations with risk-taking propensity and need for achievement.