As long-term care facilities implement the Centers for Medicare and Medicaid (CMS) Final Rule - Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities, they should be taking a closer look at their competency programs for some potential traps that could prevent success:
If it's the latter, that's a problem for the simple reason that various staff members have very different jobs, and they cannot be expected to achieve the same levels of success across all duties and functions within a facility.
Each job role has unique responsibilities, points out Tracey Cooley, RN, BSN, a master trainer and surveyor and Vice President of Training at HealthStream. We definitely have to tailor training and competency programs so that staff can be successful in those roles. Not only does a competency affect the quality of care and services delivered to residents, it also has a huge role in staff satisfaction. Make training engaging, capture staff's attention. Make it more interactive, make it more effective and more dynamic, and the key to that is defining the competencies by the roles of our staff members.
As an example, consider emergency preparedness. Through this program, a facility is supposed to assess the types of emergencies it is vulnerable to. Every department, each staff member, has different responsibilities when responding to a crisis situation, and they need to be confident and competent in their job roles during that high-stress period. Yet their roles will be different and complementary to each other vs. each person trying to do the same one or two things. So, competency around emergency duties is very different for each team member.
"Take a look at the roles that folks have and customize the plan," explains Patrick Campbell, a master trainer and surveyor, and Senior National Account Services Director with HealthStream. Don't assess competency in things they're not responsible for, but make sure [the plan] is comprehensive so that you don't miss anything.
“Assessing through observation of staff members in action is one of the strongest verification methods for determining competency,” Cooley says. “Observe people when they request it, and also observe them in action to make sure they are competent.”
And, she adds, “For some staff members, training and competency is not just limited to technical skills. For example, when you look at the job description of a director of nursing, you see they wear many, many hats. There's definitely more to consider than just the technical skills of the nurse. There are the regulations in addition to many administrative duties. Competencies need to be tailored to the director of nursing's specific responsibilities.”
For a team or overall facility competency plan, including philosophies can also help establish benchmarks. For instance, if employee feedback is part of the overall culture, it can be woven into a competency verification strategy. Other types of documentation can include observation of daily work, says Campbell.
“How do you know how a staff member relates to residents outside of a classroom setting? Well, we should be looking at what they're doing every day,” he says. “That's one way to determine competency or identify problems quietly. Case studies also are always good. Those will tell you things that work and didn't work and may help formulate a plan as far as what a competency is, how to tell when someone is competent, and what kind of training methods do or don't work.”
Lastly, it's key to engage employees in the competency and facility assessment plans, both from a macro and micro perspective. They will have thoughts on how the entire enterprise should perform, as well as their individual roles in achieving facility-wide goals and expectations.
“Sometimes they might not be good test takers and that's OK,” says Ellen Kuebrich, a Senior Director of Business Development at HealthStream. “You can find other ways to verify competencies. Definitely make sure you're identifying what a pass is ahead of time. If it's using a skills checklist when you're observing or grading a test. If they're at a certain percentage, make sure all of those criteria are identified ahead of time. Make this process dynamic. Understand that this is a feedback loop—your facility assessment should inform your competency program, and vice versa, on an ongoing basis.”
Nursing homes and skilled care facilities that continue to excel are those that treat residents as people worthy of respect, regardless of medical condition or funding source—and regardless of the pressures felt by staff. HealthStream works with skilled nursing and LTC facilities to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream for workforce development solutions, long-term care organizations and others across the care continuum are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care.
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