Put a group of health care-based speech-language pathologists in a room, and you'll have a hard time finding one who serves solely in an administrative role (supervisor, manager, or director). According to ASHA's year-end membership counts, in 2007 only 10.7% of ASHA-certified SLPs reported an administrative role as their primary employment function. When you subtract the 0.4% who chair an educational or research program, we're left with 10.3% who work in an administrative role—and we don't know how many of those are in health care.
In many health care settings, nurses have access to a clinical ladder model that facilitates their development and prepares them to move into management roles. Clinical ladder programs are based on Patricia Benner's research (1984) that describes five levels of expertise in nursing practice based on experiential learning—novice, advanced beginner, competent, proficient, and expert nurse. Although the model is based on enhancing clinical skills, facilities that implement a clinical ladder for nursing often list as program goals developing and recognizing excellence in leadership, encouraging professional development, and facilitating career development. In a review of its nursing clinical ladder program, the Medical College of Virginia Hospitals found that "advancement on the ladder led the nurse into behaviors and activities that were more focused on management practice than clinical bedside nursing" (Goodloe et al.,1996).
The Speech-Language Pathologist: From Novice to Expert (Guilford, Graham, & Scheurle, eds., 2006) explores the development of skills by the SLP along a similar continuum, novice to expert. Most of the information focuses on the development of clinical skills, but many of the chapter authors also highlight the development of management skills needed in specific settings. Without the benefit of formal clinical ladder programs, SLPs were following a path similar to the clinical ladder for nurses.
Making the Transition
Although many hospitals have clinical ladders, far fewer facilities have a similar model for allied health professionals. Some have a clinical ladder program for a single group, such as Ohio State University's program for respiratory therapists. This ladder focuses on the development of clinical rather than management skills. Other facilities, such as the Rehabilitation Institute of Chicago and Baylor Health Care Systems, have clinical ladders for a broader range of allied health professionals. Some of these clinical ladders help a clinician move only as far as a senior clinician level, but not into a management role.
Despite the fact that few formal programs help allied health professionals move into management roles, many clinicians have the skills that would make them good managers. Good communication and decision-making skills help a clinician transition into a nonclinical role. In fact, clinicians "could make significant contributions to nonclinical areas such as risk management, quality improvement, utilization review" (Bender, 2005) and other areas in health care.
Pilling and Slattery (2004) conducted a descriptive study in Australia to investigate the perceived competencies specifically related to SLPs that facilitate career transitions. Many competencies identified as important in making the transition to management seem common to many SLPs: effective communication skills, problem-solving ability, evidence-based practice focus, and teamwork skills.
Moving Up: Success Stories
Most SLPs who assume roles managing/supervising other SLPs do so by moving up in the ranks. Kathy Roberts, corporate compliance and privacy officer with Baptist Health in Little Rock, Ark., said that her transition to management started with being asked to perform "duties as assigned, such as documentation review, policy and procedure development, intradepartmental program development, review of code assignment and billing guidelines" before she moved into her first managerial role, managing a small speech-language pathology department within an inpatient rehabilitation facility. A common path to the first formal leadership position, as Roberts found, begins with assuming informal leadership roles within the department.
Of the small percentage of SLPs who hold management positions, some hold management positions outside the discipline. Because ASHA's database doesn't gather this information, one can only speculate on the number for SLPs who have moved into such roles.
Many who have moved to management positions outside the discipline first managed a speech-language pathology department or unit, as Roberts did. Another clinician who followed that path is Gwen Reeves, director of rehabilitation services for Cascade Health Services, LLC, in Dallas, Texas. "While I was working as a director of speech services in an inpatient unit of a hospital, other opportunities were presented to me that included management," she said.
On the other hand, Sara McDonald, program representative for Timber Ridge Ranch NeuroRestorative Services in Benton, Ark., moved from providing direct clinical services to other nonclinical roles before assuming her first managerial position. She served as an instructor/clinical supervisor at a nearby university and as the speech-language pathology consultant for the public schools in Arkansas before managing a transdisciplinary outreach team at a pediatric facility.
Becky Cornett, director of fiscal integrity at The Ohio State University Medical Center, used a dual-track approach to advance her management career outside the discipline. During the four years she spent managing a speech-language pathology department, she also taught graduate classes at the university. Skills she developed in these roles (e.g., managing budgets and personnel, instructional techniques) helped prepare her to become the director of inpatient rehabilitation services before assuming her current role in finance administration.
Managing Outside the Discipline
When managing a speech-language pathology department—whether or not you also provide some clinical services—you are still most clearly identified with the profession of speech-language pathology. Moving to a role outside the profession, which might be described as a career shift, may cause an ideological conflict between this primary professional identity and a management identity (Reedy & Learmonth, 2000).
Some SLPs who manage outside the discipline also continue to manage SLPs, as Reeves does and Roberts did for many years. This combined role presents less of an ideological challenge, because one is still closely associated with speech-language pathology. Others, like Cornett, Roberts, and McDonald, have moved into areas not directly related to "rehabilitation"—hospital finance, corporate compliance, and marketing. For them, the ideological challenge may be more apparent. When Cornett is asked, "What do you do?" she no longer says she's an SLP, adding, "I still identify with speech-language pathology, and believe that my clinical and management background enhances my current role in hospital finance."
When assuming management responsibilities outside the discipline, each of these clinicians faced challenges in learning about the other disciplines they would manage and/or the content area for their new role. Their challenges differed, perhaps related to the body of knowledge and skill set each possessed when she took on her new role.
Roberts found that "becoming conversant in other practice areas, gaining respect, and maintaining objectivity" were particular challenges when she began managing teams with physical therapists, occupational therapists, and respiratory therapists. Reeves agreed, noting she found it important "to learn more about the roles and clinical expertise of other professionals."
Cornett advises that "some people will be uncomfortable with your entry into their field. Be sure you learn about their knowledge and roles." McDonald, however, found that "learning more about the modalities and content area of other disciplines was fairly easy. Generating budgets, analyzing financial reports, developing business plans, and writing grants were more difficult at first."
Each of these SLPs pursued a different way of learning the new information and skills, including internal training, conferences, observation, and research. Each also found that she already was equipped with skills to help her succeed. McDonald points out that graduate courses that covered topics such as the "logical analysis of information gathered through evaluations and treatment" were most helpful in approaching the financial and business aspects of the job.
Volunteer experiences with ASHA also helped prepare them for their new career challenges. Roberts gained familiarity with legislative and regulatory information in her elected position on the Legislative Council, which she said "was very helpful in having an understanding of the relationship between clinical/quality-of-care issues and compliance with policy." She also served as ASHA's vice president for government relations and public policy, and in that position "learned how to listen actively to varied perspectives, and gained a better understanding of how multiple disciplines interact to resolve problems." Cornett states that her service to ASHA "helped me in my employment far more than I have helped ASHA!"
Those who provide clinical services are the backbone of our profession. However, having SLPs serve in administrative roles outside the discipline can only enhance visibility of and respect for the profession. If offered such opportunities, SLPs should feel confident they can succeed in these new roles.