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The Code of Good Practice was first adopted in 2015 by NCAF members, who are leading graduate health management programs and administrative fellowship programs. NCAF members work collaboratively to advance the role, availability, and quality of fellowships and the fellowships process. The Code was established to support better coordination for all stakeholders involved.

2019 Code of Good Practice: Statement of the Issue

Post-graduate administrative fellowships in Healthcare Management (hereafter referred to as “fellowships”) are a critical stepping stone for many early careerists who will ultimately aspire to senior leadership roles. They contrast with other post-graduate positions in at least two important ways:

(1) Fellowships are time-limited, typically lasting between 12 to 24 months
(2) Fellowships emphasize structured learning and leadership development in addition to completion of work

There are also some graduate health management programs that require a residency that spans between 9 to12 months for graduation. Those students also may compete for and participate in the Fellowships described here, however, come Fellowships require completion of a degree to apply.

The American College of Healthcare Executives’ Policy on Appropriate Preparation for Healthcare Executive Management Positions for All New Entrants to the Field (November 2014) notes, “It is preferred that graduate students complete a postgraduate fellowship or residency.” The Policy goes on to say:

Healthcare executives and employers contribute to the success and development of future leaders by providing postgraduate fellowship experiences. Fellowships help transition a young professional from the world of academic learning to real-world experiences. Fellows can make a meaningful contribution to the organization when the fellow is assigned real projects that cross organizational lines. Employers are encouraged to offer these opportunities to assist the entry of students to the field of healthcare management. Employers must also be aware of the rigor of accredited programs, such as those accredited by CAHME, and the advantages of hiring accredited programs' graduates Healthcare executives share responsibility to elevate both students and stakeholders on the best pathway for success.

Although many fellows report having positive experiences with their fellowship experience, historically, the absence of uniform approaches to these Fellowships has resulted in practices that can undermine fairness, including burdensome application, interview, and acceptance practices, which can limit the ability of students to assess the program’s quality and choose a fellowship program that is a best fit for their career goals.

Graduate programs are supportive of Fellowships as an effective entrée into the field of practice; however, there are increasing inefficiencies in the system that create substantial work on the part of faculty and administrative members who are tasked to write countless letters of recommendations on a less than optimal timeline in the student’s education.

Similarly, while fellowship program directors are committed to the success of the fellowships, the pipeline development opportunity within the current system creates an equally challenging application and recruitment environment. These hospital/health system Fellowships are faced with increasingly competitive forces to accelerate their recruitment process, in turn limiting their ability to adequately assess and consider the applicant pool and recruit candidates that are a best fit for their particular program.

To address some of the aforementioned challenges the following guidelines were developed by the National Council on Administrative Fellowships (NCAF). NCAF is a voluntary membership organization of leading graduate health management programs and administrative fellowship siteswho work collaboratively to advance the role, availability, and quality of Fellowships and the fellowships process.

Policy Position

NCAF believes that (1) the development of early careerist healthcare leaders and managers can be greatly enhanced by the completion of a high-quality post-graduate fellowship, (2) organizations sponsoring Fellowships derive a large benefit from the contributions of high-potential, early careerists to operating and transforming healthcare systems, and (3) graduate programs, employers, and students will benefit from better coordination across the field in the development and operation of fellowship sites.

The following guidelines were established to support better coordination for all stakeholders involved:

Graduate Program Directors and Advisors

Graduate program directors and advisors should take an active role in supporting the fellowship process by:

  • Communicating their support of NCAF fellowship sites and the value of standardized processes, deadlines, and Code of Good Practice requirements to students
  • Preparing students with the requisite skills for success in fellowships
  • Developing an understanding of the role of fellowships to future career development
  • Promoting the value of fellowships to graduate students
  • Promoting the value of fellowships to alumni who may be in a position to develop fellowship sites
  • Connecting with healthcare organizations that currently offer fellowships so that students gain increased exposure to potential fellowship opportunities
  • Seeking feedback from recent program graduates about their experiences with specific fellowship sites
  • Assisting current students in considering whether, how, and which specific fellowship placements may benefit their career goals, align with their interests, and meet their geographic preferences
  • Supporting students in putting together competitive applications for appropriate fellowships
  • Ensuring that faculty members and program directors provide letters of recommendation that quickly and clearly distinguish and differentiate the top and best students, and are submitted in a timely manner, to expediate a student’s application verification
  • Assisting students in navigating the offer process with both NCAF and Non-NCAF fellowship sites, including but not limited to requesting offer extensions until the NCAF initial offer date to ensure students are able to make the best decision for their career and have all of their options available prior to making a final decision
  • By agreeing to participate in NCAF, understand that the graduate program is required to respond to the annual benchmarking survey and provide data on their fellowship and recruitment experience, allowing for the proper collection of fellowship trend data
  • Informing NCAF of any ‘soft offers’ the student recives from NCAF member sites to help maintain the deadline and to ensure there is not a misuse of soft offers


Students should take an active role in considering whether a fellowship placement may benefit them by:

  • Discussing fellowship opportunities with their program advisors
  • Investing a sufficient amount of time researching fellowship sites before applying, to ensure they are a good fit for their background as well as career interests
  • Investing an adequate amount of time preparing fellowship application materials (personal essay, resume, etc.)

Students who apply for fellowships should exemplify a professional approach to the application, interview, and offer process by:

  • Only applying to and interviewing at fellowship sites where they are genuinely interested in accepting an offer
  • Properly preparing for each specific interview
  • After the interview process, prioritizing fellowship site preferences to expedite the offer process
  • Holding only one offer at any point during the offer process, whether the offer is made by direct communication, email, voicemail, or text
  • Providing a response to an offer within the time frames specified by the fellowship site. If it is an NCAF site this cannot be less than 24 hours
  • Understand that hospitals generally have defined budgets for fellow salaries and benefits
  • Thoughtfully considering options and accepting a fellowship offer only with the full intention to serve as a Fellow at that organization
  • Understanding that if an offer is received from a fellowship site that is not a member of NCAF prior to the initial offer date, and it is not his/her first choice, the student can and should: (1) Ask the fellowship site to provide more time (until the initial offer date) for the student to make his/her decision. This allows for the student to know all of the possible options available. (2) Meet with their graduate program director to discuss their options
  • Upon acceptance of a fellowship offer, notifying any other fellowship sites that have extended offers or interviews that a position has been accepted elsewhere and withdrawing their applications
  • Understand that hospitals generally have defined budgets for fellow salaries and benefits and these are often non-negotiable

Fellowship Site Administrators

Fellowship site administrators should adopt good recruiting practices by:

  • Providing applicants with an accurate description of their fellowship, including both its strengths and limitations
  • Providing constructive feedback to graduate program directors regarding the quality of their applicants, when appropriate or requested
  • To the greatest extent possible, refrain from making ‘soft offers’ (i.e., informal indications of interest in making an offer), as they create risks of misunderstanding and can jeopardize NCAF’s efforts to create a climate of fair and balanced decision-making
  • Working collaboratively with other fellowship site administrators to provide a coordinated approach to the fellowship recruiting process

This includes:

  • Adhering to the uniform application deadline, which is designed to allow fellowship applicants an adequate opportunity to clarify their post-graduate career interests. The uniform application deadline is the first Monday of October. For Fall of 2019, the uniform application deadline will be no sooner than Wednesday October 2, 2019.
  • Adhering to the uniform offer date by refraining from making any formal or informal offers, which will allow students and fellowship sites adequate time for the interview process. There is a 6-week period between the application deadline and the offer date. For Fall of 2019, the uniform, initial offer period begins no sooner than Wednesday, November 13, 2019.
  • Complying with the uniform offer acceptance time period of no less than 24 hours from time of the offer.

During the fellowship engagement, fellowship site administrators should adopt good development practices by:

  • Providing a high-quality program and experience for the fellows they recruit and work with
  • Providing performance feedback to fellows on a regular basis
  • Taking the initiative to discuss post-fellowship employment opportunities no less than three months prior to the scheduled conclusion of the fellowship

Ensuring that your fellowship program includes the following:

  • Provides opportunities to work with high-level executives and insight on the decision-making process within the organization
  • Provides opportunities to work on all levels of the healthcare organization
  • Provides opportunities to engage with multiple departments in a meaningful way
  • Provides opportunities to take initiative and ownership to create and/or improve processes or programs
  • Provides opportunities to work on and complete well-structured assignments and/or projects
  • Note: Fellows are required to complete the annual NCAF benchmarking survey, about these five program areas

As a follow up to the fellowship experience, fellowship program administrators should conduct post-fellowship evaluations that provide the organization with accurate and timely feedback of their program’s strengths and weaknesses for continuous improvement purposes.

Fellowship site administrators should strive to build the reputation and value of all administrative fellowships for the healthcare management profession by:

  • Supporting and adhering to efforts to standardize application and acceptance processes and deadlines
  • Supporting applicants’ ability to determine which site is the best fit for their interests and needs
  • Striving to create learning and development opportunities that exceed the expectations of the field of practice for young careerists

By agreeing to participate in NCAF, understand that the fellowship site is required to respond to the annual benchmarking survey and provide data on their fellowship and recruitment experience, allowing for the proper collection of fellowship trend data

National Council on Administrative Fellowships

NCAF should adopt good management practices by:

  • Promoting the value of Fellowships to the field
  • Supporting the activities of the NCAF Steering Committee and Subcommittees in their efforts to strategically set the direction of NCAF
  • Supporting data collection and benchmarking research that can be used to analyze and evaluate trends and outcomes of Fellowships
  • Providing relevant and updated resources for graduate health management programs and administrative fellowship sites to meet the needs of the membership
  • Work in concert with the Association for University Programs in Health Adminsitration, the Commission on the Accreditation of Healthcare Management, and other interested stakeholders, to benefit the growth and success of Fellowships and the health management profession
  • Being good stewards of NCAF membership fees

NCAF should adopt good member support services by:

  • Responding to all member inquiries and concerns in a timely manner
  • Maintaining an updated list of NCAF members and contacts to facilitate member communications and collaboration, a prospective members list for broader outreach to the field, and apublic-facing directory of NCAF Fellowshipsto assist student applicants in locating NCAF Fellowships
  • Overseeing and coordinating the work of Liaison International for NCAF members for a successful implementation of the National Administrative Fellowship Centralized Application Service (NAFCAS)

The combination of these activities will help ensure that students can attain and are adequately prepared for positions that lead to future leadership roles in the field.

For additional information about the National Council on Administrative Fellowships, please contact

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