Guide to Offering an Administrative Fellowship

An administrative fellowship is a preceptor-directed program designed to nurture independence and experiential learning by an individual who has recently obtained a master’s degree. As such, it represents a way to assist new entrants to the profession in their transition from academically acquired knowledge to the actual management of healthcare organizations. The best fellowships are well structured, typically lasting from one to two years, and involve a mix of rotations in specific departments as well as general assignments and exposure to senior leadership and strategic thinking. While the sponsoring organization may offer the fellow permanent employment, it is not required to, nor is the fellow obliged to accept such an offer.

There are several benefits for organizations offering administrative fellowships. Foremost among those is the value that fellows contribute through their actual work. Postgraduate fellowships attract highly-qualified early careerists. Through their projects they provide concrete benefits, often resulting from work on cross-functional projects that might be difficult to accomplish in another manner.

Second, offering an administrative fellowship can serve as an organizational development strategy, providing the organization with a low-risk opportunity to evaluate the work of a potential addition to the staff.

Third, there is a strong sense of professional fulfillment when contributing to the development of future leaders. This is true not only for the preceptor, but also for the staff members who may mentor fellows during departmental rotations and typically look forward to the teaching/mentoring environment.

Administrative fellowships typically last from 1 -2 years. Most are one year in duration.

Most fellowships include multiple components:

• Exposure to executive leadership and decision-making processes
• Departmental rotations and shadowing
• Responsibility for specific projects (including cross-divisional team projects)
• Professional development (lifelong learning) and professional ethics
• Community and civic activities

Regardless of the specifics, the overall structure of the fellowship opportunity is designed to allow the administrative fellow to observe, learn and do, as well as acculturate into the profession

Some may be rotation-based, where the administrative fellow has concentrated time in each organizational area.  Some may be project-based, where the administrative fellow is assigned to areas based on their project support needs.  Others may be subject-based, for example, population health. In addition to rotations and projects, many include the opportunity to be an "administrator-on-call," paired with the regularly scheduled executive who acts as a shadow administrator.

The preceptor is a coach in a formal relationship with the fellow who coordinates and structures the learning process and provides appropriate resources. Preceptors are senior leaders, such as the chief executive officer or chief operating officer. The effective preceptor will ensure that the fellow is guided by a clear action plan that includes an in-depth orientation, establishes a timeline of activities and rotations, delineates required skills, provides periodic performance appraisals and specifies the nature of the day-to-day supervisory and subordinate relationship. In addition, the plan should address the professional development of a fellow, including participation in continuing education and general dialogue about professional ethics and career development.  ACHE’s Code of Ethics and Ethics toolkits are available as reference.

Administrative fellowships are designed to attract individuals who are prepared to be challenged and learn from diverse assignments, as well as deal with a certain amount of ambiguity. They typically experience rotations across several departments and engage in projects involving cross-functional teams under various degrees of direct supervision. While fellows learn by observing senior management interactions, they also experience how to achieve specific results on concrete projects that contribute to the organization. In the process, guided by their preceptors, fellows are expected to gain new competencies, including interpersonal and managerial skills. Fellows are also expected to develop their identities as members of the healthcare management profession, committed to ongoing continuing education and ethical decision-making.

In addition to specific expectations based on the structure of the fellowship, there are a number of general expectations for fellows. These include but are not limited to:

• Takes part in active, hands-on, substantive projects that foster the development of verbal, interpersonal and analytical skills and the opportunity to translate academic theory into practice
• Demonstrates knowledge and understanding of the healthcare industry and the components of the organization
• Communicates information effectively using the appropriate level of judgment, accuracy, and courtesy with internal and external constituents
• Exhibits accuracy, attention to detail, consistency and ability to meet multiple deadlines in all work efforts
• Demonstrates ability to synthesize information (quantitative/qualitative) and complete components of preliminary and final reports, including spreadsheets and financial analyses (if applicable)
• Demonstrates ability to work independently and to collaborate in group settings.
• Exhibits a willingness to take on leadership and non-leadership roles and responsibilities.
• Possesses effective management skills

Organizations also may want to consider the ACHE Competencies Assessment Tools available.

Some of the key features of fellowships are:

• They are well-planned, with enough flexibility to allow fellows to develop their own learning opportunities consistent with their needs and those of the organization.
• They include a high degree of involvement by the preceptor.
• They offer many ways that the fellow can take part in active, hands-on, substantive projects that foster development of verbal, interpersonal and analytical skills. Exposure to management decision-making processes and board of trustee activities also is important and integral to the fellowship.
• Fellows observe effective leadership and develop leadership skills.
• Fellows learn to work independently as their management skills grow and develop.
• Fellows are treated as professionals and colleagues, not as students or interns.
• Fellows integrate healthcare management theory and application.
• The fellowships offer maximum and effective use of the fellow’s time.
• There are measurable growth and development objectives for fellows, as well as timely, candid, outcome-oriented evaluations by the preceptor and other leaders in the organization.

Organizations typically offer a competitive salary appropriate for a master’s-prepared new entrant to the healthcare management profession and the fellow receives the same benefit package as a full-time employee. Administrative fellows receive support to pursue continuing education through professional association membership dues and registration/travel to local and national professional meetings. A recent compensation study of administrative fellows may be found here.

Typically the administrative fellow's "organizational home" for budgeting and support purposes is the organization's executive office. However, a fellow might be physically located in another department, particularly if there is a secondary preceptor located in that department. While fellows are provided with computers and other office technology, as well as appropriate access to organizational information systems, they typically are expected to produce their own work products rather than rely on executive office support staff.

Before you start recruiting for a fellow, determine how the fellowship fits into your organization and your expectations of the fellow, as well as the basic structure of the fellowship. Once you have defined your fellowship opportunity, post it in ACHE’s online Directory of Administrative Fellowships.

Positions are generally listed by late summer, just before students who will graduate the following spring are returning to campus, with interviewing in the fall. Some positions are also posted on national search sites, such as LinkedIn Jobs.

Typically, an organization requests the following:

• Statement of interest explaining the applicant’s qualifications
• Objectives for the fellowship and how the experience will contribute to career advancement
• Current resume
• Copies of undergraduate transcripts
• Most recent graduate school transcripts
• Letter of recommendation the academic program director
• At least one professional recommendation

Organizations also may request a recorded presentation regarding the applicant’s interest and qualifications for the administrative fellowship role.

Many times the current fellow will organize the search for the next administrative fellow, in conjunction with organizational Human Resources processes.  These are common steps of the application and interview process:

1. Review submitted applications, with ranking of submitted materials.These are typically due mid-late September
2. Initial phone interview of viable candidates
3. On-site interview for finalists, including with executive leadership and the program preceptor. Travel expenses are typically paid by the organization if held in-person. Some choose to have all the finalists interview on the same day, and may also include a group component to the interview (e.g., all the candidates having dinner together the night before with the outgoing fellow).Virtual interviews are becoming more commonplace.
4. Rank finalists shortly after the on-site interviews
5. Extend offer. The selected candidates are typically notified shortly after the on-site interview and are requested to give a timely response.There may be timing elements to the offer that are dependent upon each candidate.

Fellowship begins the following year, typically at the start of July.

As with any new addition to an organization, the onboarding process is important to a successful start. Minimally, administrative fellows should undergo the same orientation program as other new employees, including management-specific orientation. Immediately after, the preceptor should set a communication schedule and discuss fellowship program priorities and objectives. Then during the first two months of the administrative fellowship program, fellows have one-on-one informational interviews with members from senior leadership and other key stakeholders.

The administrative fellow’s role should be included in the organization’s performance management system schedule. In addition, the decision of whether to consider offering a fellow a more permanent management position at the conclusion of the fellowship should be considered prior to the end of the term. Some organizations view administrative fellowships as an opportunity to cultivate future management talent, whereas others view their involvement solely as a commitment to help develop new entrants to the profession and expect the fellow to look elsewhere at the conclusion of the fellowship.

Even if the organization has decided that a fellowship could lead to a more permanent position, this offer would still be based on the performance of the fellow and the availability of an appropriate opening. There never is a promise of a post-fellowship position. For fellows leaving the organization, the preceptor can be expected to provide advice, coaching and contacts, but responsibility for obtaining the next position is on the administrative fellow.

A final consideration is how to celebrate the successful completion of the fellowship. Completion of a fellowship represents an important stage in the individual's development as a healthcare management professional. The individual has transitioned from academic preparation to experiential learning as a fellow and then to readiness to be a full-fledged member of the healthcare management profession. Organizations may use a combination of a capstone project presentation, formal recognition and/or social activities to help celebrate that transition and the end of the fellowship.

The organization's assessment and feedback system begins in the planning stage with the specification of competencies which the fellow is expected to gain through the fellowship experience. Consider the following competencies that fellows are expected to obtain:

• Demonstrates knowledge and understanding of the healthcare industry and the components of the organization
• Communicates information effectively using the appropriate level of judgment, accuracy, and courtesy with internal and external constituents
• Exhibits accuracy, attention to detail, consistency, and ability to meet multiple deadlines in all work efforts
• Demonstrates ability to synthesize information (quantitative/qualitative) and complete components of preliminary and final reports, including spreadsheets and financial analyses (if applicable)
• Demonstrates ability to work independently and to collaborate in group settings
• Exhibits a willingness to take on leadership and non-leadership roles and responsibilities
• Possesses effective management skills
• Demonstrates ability to make timely and effective executive decisions as a project leader

For fellowships involving rotations, the preceptor associated with each rotation is typically responsible for providing feedback to the fellow, both informally during the rotation and through a more formal process at the end of the rotation. Similarly, the internal clients for major project work that crosses departmental boundaries would be involved in the ongoing feedback process.

Just as individual fellows are evaluated, it is important to assess the fellowship program itself. One organization has fellows complete a written evaluation of the program at the end of the training year. The composite results of those evaluations may be shared with the board and other leaders. In addition to evaluations at the end of the fellowship, many organizations include an evaluation of each rotation, as well as other structured aspects of the fellowship experience. A commitment to assessing and improving the fellowship can be an important message to the fellow in terms of reinforcing concepts of continuous improvement.