DOI: 10.2478/orga-2013-0004 The Impact of The Intellectual Charm of Physicians on the Healthcare Organizations Elena Marulc1, Gabrijel Devetak2 1The Tourism and Marketing Institute, Ljubljanska 11, 3000 Celje, elena.marulc@siol.net 2Faculty of Organizational Sciencies, University of Maribor, Kidričeva 55 a, 4000 Kranj, mandrija@siol.net The recession has greatly affected the business operations of every undertaking, including healthcare organizations. Change is required. This also concerns the relationship towards employees in terms of their influence on the successful business operations of an organization. Among employees, physicians possess a special, now already traditional status; therefore, their influence needs to be taken advantage of. In the empiric part of the study, we have identified twelve key physician competencies, based on the rankings of physicians, which, in their mind, influence successful business operations of their respective healthcare organizations during an economic recession. The comparison of the collected results to the findings on intellectual charm of managers has indicated that the collected key competencies, that are creativity, quality, education and personal development, attitude towards others, team work and cooperation, communication skills, problem management, business integrity, motivation and stimulation, multidisciplinary thinking, attitude towards culture and ethics, and acceptance of differences, form a whole which is named the intellectual charm of physicians. Key words: intellectual charm, physician competencies, successful business operations, healthcare organizations, factor analysis 1 Introduction The recession has affected different countries and businesses to a different extent. The pressures on organizations are growing stronger, and demand even better knowledge of consumers (Klemencic et al, 2012). In this period of recession, where managers are faced with complex business-related issues, only those managers will prove successful who, besides expert knowledge, also possess intellectual charm, which is the sum of communication skills and attitude towards speaking partners, attitude towards teamwork, attitude towards culture and ethics, creativity, encouraging motivation and stimulation, professionalism and correctness, multidisciplinary thinking, and solving problems. In this period, genius and charisma, or apparently beneficial personal characteristics of leadership, are no longer enough (Devetak, 2012). During an recession, the enhancing of leadership is especially important. The situation is the same in the field of healthcare (Gregoric Rogelj, 2010), as financing in the public domain is tightly interwoven with the economic situation. A solution will have to be found not only in financial abstinence, but also efficient leadership and management. The hierarchy of healthcare organizations is headed by physicians who are content with their posts, which they wish to retain (Marulc, 2011). This has proven problematic to leaders who wish to introduce adjustments aimed at more successful business operations during an economic recession. Healthcare organizations will not be changed overnight. This is why, in the current period of crisis, the situation in healthcare would most easily be resolved by considering the said hierarchy and using the existing organizational culture in order to enhance business operations. Therefore, unexploited competencies of physicians, which are unrelated to formal education (medical, economic), as well as the physicians' desire to reach the top of the healthcare hierarchy, must be taken advantage of with a view to improving the operations of healthcare organizations. The article only deals with physicians who are part of the medical staff. The purpose of this study was to examine the key competencies of Slovenian physicians, which are unrelated to formal education (medical or economic) and which influence suc- Received: 20th September 2012; revised: 18th December 2012; accepted 9th January 2013 cessful business operations of healthcare organizations during an recession. The objectives of the article are as follows: to collect the competencies of physicians, which are unrelated to formal education (medical or economic) and which influence successful business operations of healthcare organizations during an recession, to identify key physician competencies from the collected competences, based on the physicians' rankings, which influence successful business operations of the physicians' healthcare organizations during an economic recession, and to propose a model of key physician competencies which will assist their healthcare organizations in more successful business operations during an economic recession. 2 Overview of the literature Various researchers (Calhoun et al., 2008; Stoller, 2008; Scott Derue et al., 2011; Qitaku et al., 2012;) have proposed ideas for successful organization management. Trying to more accurately define management and leadership is a difficult task, as first, a detailed list of the valuable characteristics of leaders must be prepared (Wagner et al., 2011). Here, competencies may be applied. A competency is an underlying characteristic of a person in that it may be motives, traits, skills, self-image, social role and knowledge (Boyatzis, 1982; Spencer & Spencer, 1993). Economists have been trying to explain the connection between key employee competencies and the successful operations of an organization. It should be emphasized that the results of studies on key competencies may differ, since the activity, country, level of technological development, and the organizational culture may significantly affect the results (Levy & Murnane, 2001). Therefore, in practice, key competencies for each individual case must be defined separately. 2.1 Competencies in healthcare Although physicians have a great influence within healthcare organizations, there have been few studies conducted on the matter (Hamilton et al., 2008). Studies have mainly concentrated on managers, or physician managers, in healthcare (Smith, 1990; Decker, 1999; Stefl, 2008; Garman & Scribner, 2011). The emphasis on measurable outcomes and competencies did not happen overnight (Stefl, 2008). Defining competencies and measurement criteria is a lengthy process, which results in a model of competencies for a specific employment, profession, or organization. Today, there are several healthcare competency models available, with a different number of competencies. Models (Chafee & Mills 2001; Decker, 1999; Dye & Garman, 2006; Garman et al., 2004; Garman & Scribner, 2011; Healthcare Leadership Alliance, 2005; National Center for Healthcare Leadership, 2006; Ross et al., 2002; Shewchuk et al., 2005; Smith, 1990; Wagner et al., 2011; Wallick & Stager, 2002;) based on studies of the US healthcare provide structures comprised of a varied number of competences. The scope of models is dependant on the decision of authors on how many organisational aspects to include in the model. The review of the literature, the purpose of which was to find non-US healthcare competency models, has yielded modest results in terms of quantity and content. In the United Kingdom, based on the assumption that today, physicians must possess more than just the ability to practice medicine, the Medical Leadership Competency Framework has been developed (NHS Institute for Innovation and Improvement, 2010). The review of Slovenian literature on healthcare competencies has indicated that researchers have mainly concentrated on nurses, health technicians, junior nurses, and qualified midwives (Zeleznik et al., 2008; Kvas & Seljak, 2011). The greatest examination of competencies of physicians is conducted by the Slovene Family Medicine Society (2008). In the past, physicians were not concerned with the problems of successful operations of healthcare organizations. Most studies connected to the issue at hand were conducted before the current period of recession. Therefore, their findings cannot be applied to the current period. A new study must be conducted. In view of all above findings we set basic research hypothesis: Hypothesis: Among the competencies of Slovenian physicians that contribute to successful operations of healthcare organizations also belong the characteristics of intellectual charm (communication skills and attitude towards interlocutors, attitude towards teamwork, attitude towards culture and ethics, creativity, fostering motivation and stimulation, professionalism and integrity, multidisciplinary thinking, and problem management). 3 Research methodology After reviewing the literature, we have decided to elaborate a list of competencies based on the most extensive foreign study on healthcare competencies (Healthcare Leadership Alliance, 2005) comprising 802 competencies, and the most extensive Slovenian study on physician competencies (Slovene Family Medicine Society, 2008) with 319 competences. The elaborated list contained 1,121 competencies. It was not our purpose to encourage physicians to abandon their medical activities, but rather to inform them that they can contribute to the successful business operations of organizations while performing their duties. This is why business competencies, along with medical ones, were removed from the list. A list of 376 competencies was obtained. The empirical part of this article is composed of the qualitative and quantitative studies. 3.1 Qualitative Study The qualitative study was conducted among employees in healthcare organizations selected from the list of 1,626 organizations obtained from the Agency of the Republic of Slovenia for Public Legal Records and Related Services, the principal activity of which, according to standard classification, are hospital activities, general medical practice activities, and specialist medical practice activities. 20 organizations were randomly selected and requested to participate in small focus groups, each of which was composed of 4 individuals from the same organization, namely 2 physicians, 1 employee concerned with human resources, and 1 member of top management. Five organizations responded to our invitation. In May 2012 participants in each focus group selected the influence of individual physician competencies on the successful operations of healthcare organizations during a recession, with the use of printed list of 376 physician competences and a projector. All participants also received 376 competences cards, which they sorted into 3 equivalent groups: most influential, influential and less influential competences. Once individuals completed their classification independently, a comparison of decisions and coordination of various grades followed among them (Gruban, 2004). Since in groups they could not decide on elimination of precisely 2/3 of the competences, but a few less (difference of 2 to 3 competences less per group), we also retained these competences. Duplicated competencies were only listed once. Participants were requested to give 5 additional different suggestions, which were in turn included in the list. The obtained list contained 141 physician competencies. The quantitative part of research followed. 3.2 Two Quantitative Studies First study. From the list of all 5,300 physicians registered with the Medical Chamber of Slovenia (2012), we initially randomly selected 5 physicians for testing the pilot questionnaire. We then additionally selected another 100 physicians from the list for the survey at random. The survey was conducted between 4 and 29 June 2012 across Slovenia; anonymity was guaranteed, the questionnaires were sent and delivered in envelopes. The questionnaire included demographic data (gender, age, level of medical education, ownership structure and number of employees of the healthcare organization), a list of 141 physician competencies and 141 competence cards with instructions for use (classify in 3 equivalent groups: most influential, influential and less influential competences; following classification, circle the 47 most influential physician competences on the list). 29 respondents returned the questionnaires. In total, they selected 60 different competences (Figure 1). Second study. From the main list of physicians, we excluded the names of participating physicians, and 10% (526) of the remaining physicians were randomly selected. The second survey was conducted between 2 and 27 July 2012. The selected physicians were sent a questionnaire with a list of 60 physician competencies selected in the pilot study and competence cards with instructions: first divide the cards in half; one pile with influential competences, the other with less influential physician competences; then, the selected 30 cards with influential physician competences are to be classified based on a drag and drop system, i.e. card by card picked from the left pile, and then on the right, so they are classified by order (Blasius, 2012) of influence from 1 to 30, where 1 is the most influential and 30 the least influential physician competence. Key physician competencies were established through a factor analysis. Several assumptions were made: the list of physicians of the Medical Chamber of Slovenia was accurate; participants in focus groups and the selected physicians ranked competencies in accordance with their beliefs and opinions; the ques- tionnaires were completed by physicians to whom they were addressed. Also, limitations were defined: the possibility of dishonest answers and rankings, and missing answers; time and cost of implementation of the study borne solely by the study authors; possibility of unreal results due to missing physician competencies. The guideline for sample size in factor analysis is according to the number of variables, i.e. a minimum 100 studied persons for factor analysis (Kline, 1979; Gorsuch, 1983; MacCallum, Widaman, Zhang and Hong, 1999) or at least 51 cases more than the number of variables (Lawley and Maxwell, 1971). With 116 respondent physicians we exceed both criteria. The study is only missing values for five variables. The overall summary of missing values indicates that for 5 variables there is at least one missing value, i.e. 2.6% missing data of variable No04, 2.6% of variable No03, 0.9% of variable No05, 0.9% of variable No02, and 0.9% of variable No01. 3.3 Results of the Quantitative Study 3.3.1 Sample 116 or 22.1% of the distributed questionnaires were properly filled out and returned. The collected results were statistically processed through SPSS 20. The majority of the respondents were female (71.6%). Most respondents, who completed the questionnaire, were between 46 and 55 years of age (42.2%). The majority of the remaining respondents were older physicians aged above 55 (30.2%); there were fewer younger physicians aged 35 to 45 (18.1%), and the fewest physicians aged below 35 (9.5%). The majority of the respondents had a university education (91.3%), while a small share had a master's (5.2%) or a doctor's degree (3.5%). Most of the respondents were employed by public healthcare organizations (81.0%). Almost half of the physicians were employed by healthcare organizations with 50-249 employees (48.3%), fewer by organizations with 10-49 employees (35.3%), and the fewest by organizations with 250 or more employees (12.9%), or fewer than 9 employees (3.5%). With regard to gender, age, education, the ownership structure and number of employees of the healthcare organization, the sample was unbalanced. 3.3.2 Questionnaire reliability In studies, questionnaire reliability is extremely important, as it must be known to what extent identical or similar results can be expected if the same questionnaire was applied to future studies. Cronbach's alpha amounts to 0.808. Based on this, it can be assumed that the reliability of the applied scale is satisfactory. 3.3.3 Factor Analysis A correlation matrix was made prior to the factor analysis. It indicated that the problem of multicollinearity does not exist, since not a single correlation reaches 0.9. No01:Facilitate group discussions and meetings. No02:Provide and receive constructive feedback. No03:Provide effective communication linkages within the organization and to its external environment. No04:Recognize and use non-verbal forms of communication. No05:Speak clearly and effectively before individuals and groups in formal and informal settings. No06:Build collaborative relationships. No07:Demonstrate effective interpersonal relations. No08:Develop external relationships. No09:Network with colleagues. No10:Participation in professional associations and networks. No11:Build effective teams. No12:Creates a climate that encourages teamwork and trust. No13:Facilitate group dynamics, process, meetings and discussions. No14:Foster teamwork between clinical and administrative staff. No15:Participate in community service. No16:Create an organizational climate that facilitates individual motivation. No17:Keeping all colleagues motivated to achieve better business results with the health organization. No18:Keeping patients motivated to be active, which lead to a faster recovery. No19:Encourages the motivation of the environment for donations to healthcare. No20:Motivating all employees for better collaboration. No21:Anticipate and plan strategies for overcoming obstacles. No22:Resolve and manage conflict. No23:Share views in a non-judgmental, non-threatening way. No24:Understand and manage expectations. No25:Use effective negotiation skills. No26:Create an environment which recognizes and values differences in staff, physicians, patients, and communities. No27:Establish an organizational culture that values and supports diversity. No28:Represent the organization to non-healthcare to non health care constituents within the community. No29:Synthesize and integrate divergent viewpoints for the good of the organization. No30:Cooperating with other experts and services at the level of primary public health. No31:Create an environment that facilitates the team to initiate actions that produce results. No32:Provide visionary thinking on issues that impact the healthcare organization. No33:Recognize one's own reaction to change and strive to remain open to new ideas and approaches. No34:Support and mentor high-potential talent within the organization. No35:Support innovation and creativity. No36:Follow through on promises and concerns. No37:Foster an environment of mutual trust. No38:Professional roles, responsibility and accountability. No39:Use factual data to produce and deliver credible and understandable reports. No40:Hold self and others accountable for actions and outcomes. No41:Adheres to ethical business and professional standards. No42:Integrate high ethical standards and core values into everyday work activities. No43:Organizational business and personal ethics. No44:Serve as the ethical guide for the organization. No45:Respect the four principles of medical ethics. No46:Demonstrate and promote cultural sensitivity. No47:Cultural and spiritual diversity for patients and staff as they relate to healthcare needs. No48:Confront inappropriate behaviors and attitudes toward diverse groups. No49:Analyze population data to identify cultural clusters. No50:Recognize one's own method of decision making and the role of beliefs, values and inferences. No51:Acquire information and skills from a variety of sources to stay current with market and industry trends. No52:Promote continual organizational learning and improvement. No53:Create an environment wherein professional and personal growth is an expectation. No54:Learn from setbacks and failures as well as successes. No55:Develop effective interpersonal skills. No56:To provide quality and accreditation of the departments. No57:That it is necessary to care for quality improvements on the basis of quality indicator monitoring. No58:That it is necessary to include patient opinions into the system for improving the quality of work. No59:The importance of constant quality improvement on the basis of monitoring of the quality indicators. No60:Foster all employees to meet quality standards. Figure 1: List of 60 physician competences; items marked No01 through No60 represent the competences selected for the second study. We checked with the KMO and Bartlett's test if the dataset is suitable for a factor analysis. The results show that the Kaiser-Meyer-Olkin measure of sampling adequacy is 0.9 and the Bartlett's test of sphericity value is statistically relevant. Values of KMO testing between 0.8 and 0.9 are great. Our value is in this interval; thus, we can say we obtained a great value. It can therefore be derived that the factor analysis with our dataset is viable. First, the decision on the selection of the appropriate number of factors to be used in a factor analysis must be made. The Guttman-Kaiser criterion is the cut-off criterion most frequently used. The popularity of this criterion, as against other criteria, is its ease of use, its minimal judgemental element and its intuitively acceptable justification (Yeomans and Golder, 1982). The results of factor elimination through principal component analysis (Table 1) have indicated that, according to the Guttman-Kaiser criterion, only 12 components meet the conditions for preservation and that they explain 84.89% of the total variance. The first component bears the highest eigenvalue of 7.170 and explains 11.95% of the total variance. The twelfth component has the lowest eigenvalue of 1.875 and explains 3.13% of the total variance. In some cases, the Guttman-Kaiser criterion can exclude too many factors; therefore, the factor structure was also examined graphically. From Figure 2, it is apparent that the slope of the curve after the twelfth principal component is smaller, which indicates the inclusion of the first twelve components. This corresponds to the previous finding. A final solution is obtained with a rotation of factors, particularly by orthogonal varimax rotation, the advantage of which is its ease of understanding and interpretation (Brown, 2009). Due to better visibility, all factor loadings not considered significant, e.g. factors between -0.3 and 0.3 (Kline, 2002) are erased from Table 2. The correlations between factors and the input variables show that the first factor has the highest factor loading for variable No. 15, and a high factor loading for variables No. 13, 12, 11 and 14. The first factor has a strong positive correlation with the compe- tencies related to teamwork, attitude towards teamwork, and cooperation, therefore, it has been titled teamwork and cooperation. The latent variable was obtained by adding the values of variables from which the factor is composed. The obtained sum is then divided by their total number. A latent variable obtained in such a way is named after the variables of which it is composed. In a similar manner in this chapter we obtain another 11 groups of variables, which are defined by one factor: variables No. 36, 37, 38, 39 and 40 have a strong positive correlation with factor 2, entitled business integrity; variables No. 21, 22, 23, 24 and 25 have a strong positive correlation with factor 3, entitled problem management; variables No. 26, 27, 28, 29 and 30 have a strong positive correlation with factor 4, entitled multidisciplinary thinking; variables No. 46, 47, 48, 49 and 50 have a strong positive correlation with factor 5, entitled acceptance of differences; variables No. 6, 7, 8, 9 and 10 have a strong positive correlation with factor 6, entitled attitude towards others; variables No. 41, 42, 43, 44 and 45 have a strong positive correlation with factor 7, entitled attitude towards culture and ethics; variables No. 31, 32, 33, 34 and 35 have a strong positive correlation with factor 8, entitled creativity; variables No. 51, 52, 53, 54 and 55 have a strong positive correlation with factor 9, entitled education and personal development; variables No. 01, 02, 03, 04 and 05 have a strong positive correlation with factor 10, entitled communication skills; variables No. 16, 17, 18, 19 and 20 have a strong positive correlation with factor 11, entitled motivation and stimulation. The final factor No. 12 has a strong positive correlation with competencies No. 56, 57, 58, 59 and 60, whose factor loadings range between 0.918 and 0.633 and deal with quality. Factor 12 is therefore entitled quality. 3.3.4 Variability and normality of the obtained factors The Results of Kolmogorov-Smirnov test, which is exact test for testing normality (Table 3) indicate that the distribution of all factors is not normal. Component Eigenvalue Percentage of total variance Cumulative percentage of total variance 1 7,170 11,950 11,950 2 5,921 9,868 21,817 3 5,441 9,068 30,885 4 4,824 8,041 38,926 5 4,533 7,555 46,481 6 4,211 7,018 53,499 7 4,055 6,759 60,258 8 3,820 6,366 66,624 9 3,273 5,454 72,079 10 3,147 5,245 77,324 11 2,667 4,445 81,769 12 1,875 3,125 84,894 Table 1: Results of factor elimination through principal component analysis Component Number Figure 2: Scree plot of eigenvalues of 60 physician competencies. Thus, distribution will be assessed with the aid of skew-ness and kurtosis (Table 4). The variability (CV=29.01) has indicated that the group is homogeneous in the teamwork and cooperation factor. The distribution (skewness= -0.509, kurtosis= -1.040) is left-skewed and restricted, not normal. The business integrity factor has low variability (0.24); consequently, the group is homogeneous. The distribution is left-skewed (-0.992) and flat (2.000), not normal. The variability of the problem management factor is low (14.75) and the group is homogeneous. The distribution is right-skewed (2.618) and flat (12.224), not normal. With the multidisciplinary thinking factor, it is evident (CV= 18.50) that the group is homogeneous. The distribution is left-skewed (-0.544) and flat (0.988), not normal. The acceptance of differences factor has a low arithmetic mean (only 1.338). The variation coefficient amounts to 46.39 and therefore the group is heterogeneous. The distribution is right-skewed (1.869) and flat (2.220), not normal. The attitude towards others factor group is homogeneous (CV=18.26). The distribution is left-skewed (-1.190) and flat (0.650), therefore not normal. The attitude towards culture and ethics factor group is homogeneous (CV=20.94). The distribution is left-skewed (-0.348) and flat (3.181), not normal. The variability of the creativity factor is low (7.56) and the group is homogeneous. The distribution is left-skewed (-3.206) and flat (11.113), not normal. The education and personal development factor has low variability (CV=8.95) and the group is homogeneous. The distribution is left-skewed (-2.493) and flat (6.341), not normal. The variability of the communication skills factor is low (CV=17.16) and the group is homogeneous. The distribution (skewness = -0.040, kurtosis= -1.178) is left-skewed and restricted, not normal. In the motivation and stimulation factor, a low standard deviation and variability coefficient (6.86) indicate that the group is homogeneous. The distribution is left-skewed (-4.480) and flat (24.444), not normal. The quality factor has the highest arithmetic mean (4.874). The arithmetic mean, median value, and mode are very similar. The group is homogeneous (CV=6.26). The distribution is left-skewed (-3.333) and flat (13.522), not normal. 3.3.5 Differences between the factors according to socio-demographic variables Since the variable distribution is abnormal in all the factors, we applied non-parametric tests in order to examine the characteristics of the groups. The results of the Mann-Whitney test for gender indicate that p-values are between 0.266 and 0.961. Therefore there are no statistically relevant differences for any of the twelve factors when dealing with gender. As is evident, men and women rank the importance of individual factors for successful business operations of a healthcare organization during economic recession in an identical manner. The Kruskal-Wallis test has indicated (p-values are between 0.100 and 0.850) no difference in the ranking of factors, regardless of the education of the responding physicians. Thus, there is no deviation in the ranking of the importance Table 2: Factor loadings of excluded two factors (varimax raw factor rotation) ____ Factor Factor Factor Factor Factor Factor Factor Factor Factor Factor Factor Factor Factor Competency 1 2 3 4 5 6 7 8 9 10 11 12 No15 ,986 No13 ,983 No12 ,982 Noll ,973 No14 ,972 No36 ,962 No37 ,952 No38 ,951 No39 ,949 No40 ,941 No21 ,989 No22 ,989 No23 ,976 No24 ,971 No25 ,959 No28 ,957 No29 ,946 No27 ,937 No30 ,928 No26 ,846 No47 ,970 No46 ,970 No48 ,935 No49 ,918 No50 ,912 No06 ,973 No08 ,967 No10 ,918 No07 ,904 No09 ,885 No42 ,944 No41 ,943 No45 ,931 No44 ,918 No43 ,915 No35 ,965 No33 ,897 No34 ,890 No31 ,860 No32 ,824 No54 ,931 No51 ,924 No53 ,876 No52 ,847 No55 ,768 No05 ,865 No04 ,854 No03 ,842 No02 ,826 No01 ,771 No18 ,897 No16 ,818 No20 ,777 No17 ,736 No19 ,715 No56 ,918 No60 ,760 No59 ,745 No58 ,700 No57 ,633 Table 3: Results Of The Kolmogorov-Smirnov Test For The Obtained Factors Factor communication skills attitude towards others teamwork and cooperation motivation and stimulation problem management multidisciplinary thinking N 116 116 116 116 116 116 Normal Parameters Mean 4,029 4,388 3,864 3,916 3,034 2,814 Std. Deviation ,6953 ,8010 1,1242 ,2692 ,4478 ,5214 Kolmogorov-Smirnov Z 1,259 3,454 2,311 5,134 5,159 4,010 Asymp. Sig. (2-tailed) ,084 ,000 ,000 ,000 ,000 ,000 Factor creativity business propriety attitude towards culture and ethics accepting the difference education and personal development quality N 116 116 116 116 116 116 Normal Parameters Mean 4,850 2,736 2,966 1,338 4,802 4,874 Std. Deviation ,3672 ,6815 ,6243 ,6177 ,4338 ,3059 Kolmogorov-Smirnov Z 4,307 4,594 3,858 3,737 4,776 4,597 Asymp. Sig. (2-tailed) ,000 ,000 ,000 ,000 ,000 ,000 of factors for successful business operations in of a healthcare organization during the recession. Also, the Kruskal-Wallis test has shown (p-values are between 0.068 and 0.851) that respondents of different ages bear no statistically relevant differences in terms of ranking the importance of individual physician competencies for the successful operations of a health organization during the recession. We have also examined the differences in ranking between physicians employed by public and by private healthcare organizations. The Mann-Whitney test has shown that the creativity factor is the only statistically relevant result (p-value =0.047). This means that the views on the importance of the creativity factor for successful operations of a healthcare organization during the recession, of physicians employed by public and private sector organizations, differ. P-values of other factors are between 0.196 and 0.851 and therefore there are no statistically relevant differences for any other eleven factors when dealing with ownership structure of the organization. Physicians employed in the public sector have a higher mean rank (60.80) than those employed in the private sector (48.66). Physicians employed in the public sector have ranked the creativity factor as more important for successful operations of a healthcare organization during the recession compared to private sector physicians. No differences have been established in other eleven factors. In regard to the correlation between the number of employees in healthcare organizations, which employ the respondents and the results obtained, the Kruskal-Wallis test has shown no statistically relevant results for any of the factors. This means that physicians employed by healthcare organizations with a different number of employees, rank the importance of factors for successful operations of a healthcare organization during the recession in an identical manner. 3.3.6 Ranking We were also concerned with establishing the importance of individual physician competencies for successful operations of a healthcare organization during an economic recession. For this purpose, we used the method of ranking. The results (Table 5) indicate that, according to physicians' ratings, the most important competencies for successful operations of a healthcare organization during the recession are as follows: "provide visionary thinking on issues that impact the healthcare organization" (No. 32), "support innovation and creativity" (No. 35), "create an environment that facilitates the team to initiate actions that produce results," (No. 31) and "support and mentor high-potential talent with the organization" (No. 34). The following competency was considered the least influential: "recognize one's own method of decision making and the role of beliefs, values and inferences" (No. 50). Next, we have added together the ranks of individual competencies, which were then ranked according to the sum to obtain 12 ranking factors (Table 6). According to the respondents, creativity is considered the most important factor for successful operations of a healthcare organization during an economic recession. It is followed by quality, and education and personal development. Acceptance of differences was considered the least influential factor. Table 4: Central Tendencies And The Variability Of The Obtained Factors Factor communication skills attitude towards others teamwork and cooperation motivation and stimulation problem management multidisciplinary thinking Mean 4,029 4,388 3,864 3,916 3,034 2,814 Median 4,000 5,000 4,000 4,000 3,000 3,000 Mode 5,0 5,0 5,0 4,0 3,0 3,0 Std. Deviation ,6953 ,8010 1,1242 ,2692 ,4478 ,5214 Variance ,483 ,642 1,264 ,072 ,201 ,272 Skewness -,040 -1,190 -,509 -4,480 2,618 -,544 Std. Error of Skewness ,225 ,225 ,225 ,225 ,225 ,225 Kurtosis -1,178 ,650 -1,040 24,444 12,224 ,988 Std. Error of Kurtosis ,446 ,446 ,446 ,446 ,446 ,446 Coeff. of variation (%) 17,16 18,26 29,01 6,86 14,75 18,50 Factor creativity business propriety attitude towards culture and ethics accepting the difference education and personal development quality Mean 4,850 2,736 2,966 1,338 4,802 4,874 Median 5,000 3,000 3,000 1,000 5,000 5,000 Mode 5,0 3,0 3,0 1,0 5,0 5,0 Std. Deviation ,3672 ,6815 ,6243 ,6177 ,4338 ,3059 Variance ,135 ,464 ,390 ,382 ,188 ,094 Skewness -3,206 -,992 -,348 1,869 -2,493 -3,333 Std. Error of Skewness ,225 ,225 ,225 ,225 ,225 ,225 Kurtosis 11,113 2,000 3,181 2,220 6,341 13,522 Std. Error of Kurtosis ,446 ,446 ,446 ,446 ,446 ,446 Coeff. of variation (%) 7,56 0,24 20,94 46,39 8,95 6,26 4 Discussion Despite the unbalanced sample, the examination of differences between factors according to control variables has indicated that male and female physicians, differently educated respondents, respondents of different ages, employees in public and private healthcare organizations, with different numbers of employees, rate the importance of individual factors for successful operations of a healthcare organization during the recession in a similar fashion. The only exception is the ranking of the importance of the creativity factor, when comparing rankings by physicians from public and private organizations: the latter, in comparison to the former, believe the said factor has a smaller influence on successful operations of a healthcare organization during the recession. Through factor analysis, we have isolated 12 components, which explain 84.89% of the total variance. The comparison of factors and input variables has indicated a strong correlation between certain variables. Based on these variables, the factors can be defined as follows: teamwork and cooperation, business integrity, problem management, multidisciplinary thinking, acceptance of differences, attitude towards others, attitude towards culture and ethics, attitude towards creativity, attitude Table 5: Average or Mean Rank of Variables Competencies Valid Median Mode Mean Rank Competencies Valid Median Mode Mean Rank No32 96 2,00 1 1 No24 91 21,00 21 15 No35 91 2,00 1 1 No23 75 21,00 22 15 No31 70 2,00 2 1 No20 34 25,00 22 16 No33 65 3,00 3 2 No39 40 23,00 23 17 No34 84 3,00 3 2 No30 37 26,00 24 20 No56 83 5,00 5 3 No36 56 24,00 24 18 No59 82 5,00 5 3 No40 94 24,00 24 18 No58 72 6,00 5 4 No17 63 25,00 25 19 No60 50 6,00 6 4 No18 29 26,00 26 20 No57 56 6,00 7 4 No38 82 23,00 26 17 No53 91 8,00 8 5 No27 31 27,00 26 21 No51 69 9,00 8 6 No19 37 25,00 27 16 No54 42 9,00 9 6 No28 66 27,00 27 21 No52 79 9,00 9 6 No26 18 28,00 28 22 No55 38 9,50 10 7 No42 20 28,50 28 23 No06 81 10,00 10 8 No44 24 28,00 28 22 No10 46 12,00 11 9 No41 12 28,50 29 23 No08 99 12,00 12 9 No43 65 29,00 29 24 No09 68 12,00 13 9 No45 21 29,00 29 24 Noll 63 14,00 13 10 No47 39 29,00 29 24 No12 45 15,00 13 11 No46 16 30,00 30 25 No14 97 14,00 13 10 No48 43 30,00 30 25 No13 88 14,00 14 10 No49 28 30,00 30 25 No15 37 14,00 14 10 No50 12 30,00 30 25 No03 91 16,00 16 12 No07 49 12,00 10a 9 No04 47 17,00 16 13 No02 70 17,00 16a 13 No01 55 17,00 17 13 No22 62 20,00 17a 14 No05 80 17,00 17 13 No37 43 20,00 21a 14 No25 58 20,00 18 14 No16 62 25,00 25a 19 No21 77 20,00 20 14 No29 61 27,00 27a 21 Note: a Multiple modes exist. The smallest value is shown. It is evident from the frequency table that the modes are No07: 10 and 12, No02: 16 and 19, No22: 17 and 19, No37: 21 and 25, Nol6: 25 and 27, No29: 27 and 29. towards education and personal development, communication skills, motivation and stimulation, and quality. The reliability of the questionnaire, which served as the basis for the study, as well as the gathered results was considered acceptable according to Cronbach's alpha. The examination of variability and variable normality has indicated that all factor groups, excluding the group of acceptance of differences, are homogeneous and that the variable distribution is abnormal. The ranking of physician competencies in regard to their influence on the successful operations of a healthcare organization during an economic recession, and the calculations of individual factor rankings have indicated that according to the responding physicians, creativity is the most important factor. Following creativity, factors ranging from most to least important are quality, education and personal development, attitude towards others, team work and cooperation, communication skills, problem management, business integrity, motivation and stimulation, multidisciplinary thinking, attitude towards culture and ethics, and acceptance of differences. The results of the study comply with the findings on intellectual charm, which is required by present day managers, along with professional know-how, for successful business operations of their organizations during an economic recession. The comparison has shown that every constituent of the intellectual charm of a successful manager during a recession, i.e. communication skills and attitude towards interlocutors, attitude towards teamwork, attitude towards culture and ethics, creativity, fostering motivation and stimulation, professionalism and integrity, multidisciplinary thinking, and solving problems (Devetak 2012 a), is essential for present day physicians, as they help physicians contribute to successful operations of their healthcare organizations during the recession. Table 6: Ranking of obtained factors Factor Factor competencies Sum of competence ranks Mean rank creativity No31, No32, No33, No34, No35 7 1 quality No56, No57, No58, No59, No60 18 2 education and personal development No51, No52, No53, No54, No55 30 3 attitude towards others No06, No07, No08, No09, No10 35 4 teamwork and cooperation No11, No12, No13, No14, No15 51 5 communication skills No01, No02, No03, No04, No05 64 6 problem management No21, No22, No23, No24, No25 72 7 business propriety No36, No37, No38, No39, No40 84 8 motivation and stimulation No16, No17, No18, No19, No20 90 9 multidisciplinary thinking No26, No27, No28, No29, No30 105 10 attitude towards culture and ethics No41, No42, No43, No44, No45 116 11 accepting the distinctive No46, No47, No48, No49, No50 124 12 Based on all these findings we confirm the hypothesis "Among the competencies of Slovenian physicians that contribute to successful operations of healthcare organizations also belong the characteristics of intellectual charm (communication skills and attitude towards interlocutors, attitude towards teamwork, attitude towards culture and ethics, creativity, fostering motivation and stimulation, professionalism and integrity, multidisciplinary thinking, and problem management)." The physicians' attitude towards quality, education and personal development, and towards differences, is important as well. Consequently, these characteristics can be considered specific for the intellectual charm of physicians. Based on these findings, we have proposed a model of a physician's intellectual charm (Figure 3). Physicians with such charm can contribute to successful business operations of their healthcare organizations during the recession. The most important characteristics are the physician's creativity and his attitude Figure 3: Model of a physician's intellectual charm (model of key physician competencies which will assist in more successful operations of his organization during the recession) towards creativity. In the order of decreasing importance they are followed by quality, education and personal development, attitude towards others, teamwork and cooperation, communication skills, problem management, business integrity, motivation and stimulation, multidisciplinary thinking, attitude towards culture and ethics, and acceptance of differences. 5 Conclusion The study performed among randomly selected Slovenian physicians has shown that according to their ratings, a physician's creativity, quality, education and personal development, attitude towards others, teamwork and cooperation, communication skills, problem management, business integrity, motivation and stimulation, multidisciplinary thinking, attitude towards culture and ethics, and acceptance of differences are of key importance for successful business operations of their healthcare organizations during an economic recession. All of these key competencies comprise a whole defined as a physician's intellectual charm. Despite several studies on competencies, there has never been a study which would examine physician competencies positively affecting the operations of a healthcare organization during an economic recession, in a comprehensive manner. The expression "intellectual charm" is also considered a novelty in healthcare. In the recession, the results of the study can be applied to benefit everyday practices. Physicians and other healthcare employees must be informed of these findings on physician competencies which benefit the business operations of their organizations; they must be reminded of their implementation, while physicians lacking in certain competencies should work to develop them to a sufficient degree. In the future, the competencies and intellectual charm of other healthcare employees will have to be examined as well, and strive for maximizing the beneficial impact of every healthcare employee on the business operations of their organizations during an economic recession. 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She is currently finishing her PhD studies. Gabrijel Devetak is an associate professor of marketing and innovations. In his long career, he has given lectures at all four Slovenian universities. He engages in innovation and marketing and holds marketing lectures at various Slovenian faculties. He has published nine scientific titles. His work consists of 1,125 bibliographic units. He is an expert in the fields of innovation and marketing. Vpliv intelektualnega šarma zdravnikov na zdravstvene organizacije Recesija močno vpliva na poslovanje vseh organizacij, med njimi tudi zdravstvenih organizacij. Potrebne so spremembe in novi pogledi na zaposlene v teh organizacijah z vidika možnosti njihovega vplivanja na uspešnost poslovanja organizacije. Med zaposlenimi imajo zdravniki že tradicionalno poseben status, zato je potrebno izkoristiti njihov vpliv. V empiričnem delu smo na osnovi ocen zdravnikov izluščili 12 ključnih kompetenc zdravnika, ki po mnenju zdravnikov vplivajo na uspešnost poslovanja njegove zdravstvene organizacije v času recesije. Primerjava naših rezultatov z intelektualnim šarmom managerjev je pokazala, da dobljene ključne kompetence, ki so ustvarjalnost, kakovost, izobraževanje in osebni razvoj, odnos do drugih, timsko delo in sodelovanje, komunikacijske veščine, obvladovanje problemov, poslovna korektnost, motivacija in stimulacija, multidisciplinarnst v razmišljanju, odnos do kulture in etike ter sprejemanje drugačnosti, predstavljajo celoto imenovano intelektualni šarm zdravnika. Ključne besede: intelektualni šarm, kompetence zdravnika, uspešnost poslovanja, zdravstvene organizacije, faktorska analiza