The Code of Good Practice



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.


2020 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 is pipeline development opportunity 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 for both NCAF and Non-NCAF fellowship sites, by encouraging student’s to behave in a professional manner and advising on how to handle multiple offer situations, to ensure students are able to make the best decision for their career
      • 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


      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
      • The following options are available as formal written offers are received prior to the uniform offer acceptance date:
        • Students may receive offers anytime after the application deadline of Thursday, October 1, 2020.
        • If an offer is received, students are not required to accept an offer until the uniform offer acceptance date. Offers may be accepted, declined, or put on-hold until Thursday, November 12, 2020 Noon CT.
          • Should an offer be accepted, students must withdraw themselves from the applicant pool
          • Should an offer be put on hold, students may continue to interview and prospect all available options
        • Only ONE offer can be on hold at any given time. If a second offer (or subsequent offer) is received, students will have 24-hours from the time of the second offer to decide which offer to accept or hold AND which offer to decline
        • Any offer on-hold should be accepted or declined by Noon CT onThursday, November 12, 2020. Fellowship sites may elect to extend offers to other alternate candidates for positions that have not been accepted by this time
        • Should students not be interested in an offer, they are asked to decline in a timely manner, allowing fellowship sites to then move to their next choice. If a student declines an offer, they may continue to interview and prospect all available options until a fellowship is accepted
      • Understanding that if an offer is received from a fellowship site that is not a member of NCAF and it is not his/her first choice, the student can and should:
        • Ask the fellowship site to provide more time (until the initial acceptance date) for the student to make his/her decision. This allows for the student to know all of the possible options available
        • Contact their first choice, if an NCAF site, for an update on the status of their application
        • Meet with their graduate program director to discuss their options
      • Thoughtfully considering options and accepting a fellowship offer only with the full intention to serve as a Fellow at that organization
      • 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

      Students applying via NAFCAS should note that the centralized application service will open on June 10, 2020, and will remain open until October 1, 2020, 11:59:59 PM EST

      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
      • 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. For Fall of 2020, the uniform application deadline will be no sooner than Thursday October 1, 2020
        • Adhering to the uniform offer acceptance date, which is designed to allow fellowship sites and applicants more control and transparency. For Fall 2020, the uniform offer acceptance date will be no sooner than November 12, 2020, Noon CT
        • Ensuring all formal, written offers made are after the uniform application deadline AND do not require fellowship applicants to accept prior to the uniform offer acceptance date. For Fall of 2020, formal written offers can be made anytime after Thursday, October 1, 2020
        • Fellowship sites may elect to extend offers to other alternate candidates for positions that have not been accepted by Noon CT on Thursday, November 12, 2020
      • Acting professionally and in good faith to not formally or informally pressure students to accept an offer prior to Thursday, November 12, 2020
      • Providing constructive feedback to graduate program directors regarding the quality of their applicants, when appropriate or requested
      • If offers are made on the offer acceptance date of Thursday, November 12, 2020, applicants must be given at lease at least a 24 hour offer acceptance period from the 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
      • 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
      • 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

      As a follow up to the fellowship experience, fellowship site 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