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Healthcare Leadership
Competencies Assessment
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NAME
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LAST 4 OF SSN
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DATE
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I hereby certify that
ALL information I have provided to IMCS Group on this skills checklist and
all other documentation, is true and accurate. I understand and acknowledge
that any misrepresentation or omission may result in disqualification from
employment and/or immediate termination.
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Instructions: This checklist is
meant to serve as a general guideline for our client facilities as to the
level of your skills within your nursing specialty. Please use the scale
below to describe your experience/expertise in each area listed below.
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Proficiency Scale:
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1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
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Rating Stars (Click)
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RELATIONSHIP MANAGEMENT
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1
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2
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3
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4
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Organizational structure
and relationship
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Build collaborative
relationships
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Develop and maintain
medical staff relationships
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Provide internal customer
service
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Practice and value shared
decision making
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Rating Stars
(Click)
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COMMUNICATION SKILLS
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1
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2
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3
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4
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Sensitive to what is
correct behavior when communicating with diverse cultures, internal, and
external
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Communicate organizational
mission, vision, objectives, and priorities
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Prepare and deliver
business communications, including meeting agendas, presentations, business
reports, and project communications plans
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Present results of data
analysis to decision makers
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Provide and receive
constructive feedback
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Rating Stars
(Click)
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FACILITATION AND
NEGOTIATION
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1
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2
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3
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4
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Mediation, negotiation, and
dispute resolution techniques
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Team building
techniques
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Create, participate in, and
lead teams
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Facilitate group dynamics,
process, meetings, and discussions
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Rating Stars
(Click)
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LEADERSHIP
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1
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2
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3
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4
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Leadership
styles/techniques
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Potential impacts and
consequences of decision making
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Establish a compelling
organizational vision and goals
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Hold self and others
accountable for organizational goal attainment
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Promote and manage
change
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Promote continuous
organization learning/improvement
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Rating Stars
(Click)
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HEALTHCARE SYSTEMS AND
ORGANIZATIONS
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1
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2
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3
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4
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Managed care models,
structures, and environment
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Levels of healthcare along
the continuum of care
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Evidence-based management
practice
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The interrelationships
among access, quality, cost, resource allocation, accountability, and
community
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The patient experience
(e.g., cultural differences, expectations)
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Healthcare technological
research and advancements
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Organization and delivery
of healthcare
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Regulatory and
administrative environment in which the organization functions
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Rating Stars
(Click)
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EMR
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1
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2
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3
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4
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Epic
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Cerner
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Eclipsys
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McKesson
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Meditech
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Other Computerized System
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Computerized Physician
Order Entry
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Bar Coding for Medication
Administration
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MY EXPERIENCE IS
PRIMARILY IN:
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Unit
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No. of Years
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Unit
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No. of Years
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BURN
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POST PARTUM
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CRITICAL UNIT
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LABOR & DELIVERY
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PACU
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NEWBORN NURSERY
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NEUROLOGY
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LEVEL II NICU
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TELEMETRY
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LEVEL III NICU
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MEDICAL
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PICU
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SURGICAL
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PEDIATRICS
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ONCOLOGY
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OB/GYN
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ORTHOPEDICS
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PSYCHIATRY
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OPERATING ROOM
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RRT
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EMERGENCY ROOM
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CRT
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TRAUMA CENTER
LEVEL 1
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COMMUNITY ER
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RURAL ER
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Rating Stars
(Click)
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Age Specific Competencies
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1
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2
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3
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4
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Infant (Birth - 1 year)
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Preschooler (ages 2-5
years)
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Childhood (ages 6-12 years)
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Adolescents (ages 13-21
years)
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Young Adults (ages 22-39
years)
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Adults (ages 40-64 years)
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Older Adults (ages 65-79
years)
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Elderly (ages 80+ years)
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Rating Stars
(Click)
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BUSINESS SKILLS AND
KNOWLEDGE
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1
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2
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3
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4
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Ability to analyze and
evaluate information to support a decision or recommendation
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Collect and analyze data
from internal and external sources relevant to each situation
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Techniques for business
plan development, implementation, and assessment
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The functions of
organizational policies and procedures
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Promote and apply
problem-solving philosophies
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Demonstrate critical
thinking and analysis
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Systems thinking
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Facilities planning
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