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The Art and Science of Competency Development

March 8, 2024
March 8, 2024

Developing, assessing, and validating clinical staff competency is complex. Further complicating the issue is the fact that many of the clinical skills, interpersonal skills, clinical judgement skills, and decision-making abilities are difficult to quantify. Creating a comprehensive competency development program can seem daunting, but a recent HealthStream webinar provided clear recommendations on how to do just that while leveraging artificial intelligence (AI) to individualize and maximize competency development.

The webinar was moderated by Dan Pawlus, HealthStream’s Senior Manager of Digital Events and featured Trisha Coady, Senior Vice President, Workforce Development Solutions for HealthStream.


The Case for Improving Competency Development

In addition to her passion for being a lifelong learner and healthcare educator, Coady also shared her experience as a mother of a child on the spectrum that had a complex diagnoses bundle. As Coady worked with her child to overcome these issues, she came to understand the importance of focusing on the foundational ability to receive information, categorize that information, and then respond to that information. It was then that she began to see progress as her child began to feel safe in the learning environment and then moved on to building confidence in certain skills. This journey led Coady to reflect on how to apply this learning to the development of confident nurses.


Focus On What Matters

Coady’s journey led her to question traditional education and competency programs. Typically, these programs had focused on the delivery of information whether it be in school or in practice. Instead, Coady encourages leaders to focus on how learners receive information versus how it is delivered. She reminded leaders to ask questions about what each learner needs in that moment and whether or not we are really teaching nurses how to process information and connect the dots in a meaningful way. She also shared that learners need context, which is developed when a learner receives information, makes use of the information, and repeats it within the appropriate context.


Knowledge vs. Judgement

An abundance of research suggests that there is a substantial variance between knowledge and judgement, but the size of that gap might surprise you. The national benchmark shows that knowledge scores are 20 points higher than clinical judgement scores with some meaningful variations by specialty and setting. Coady pointed out that this means that a significant number of nurses are struggling to consistently make safe decisions. The good news is that the data also demonstrated improvement when nurses were reassessed after development. While knowledge improvements did peak with an improvement of 5.9 points at the 2–3-month mark, it was most notable that the clinical judgement improvement at the 6–7-month mark was 7.5 points further making the case for a solid foundation in the development of clinical reasoning skills.


Personalized Development – The Challenges

Traditionally structured educational programs that assume that learners arrive with little to no knowledge and rely on a handful of educators to educate thousands of nurses make it impossible to personalize instruction. These programs can be particularly problematic for younger learners and digital natives that have little tolerance for meaningless repetition, particularly relating to material that has already been mastered. Current financial and staffing issues in healthcare have created an urgent need for education that helps nurses practice at the top of their licenses and cross-trains them in an efficient means without compromising on personal confidence or quality outcomes. However, assessments that lead to personalized development plans for individual learners are simply not feasible without a solution that is supported by technology.


Personalized Development – The Solutions

Coady believes that the solution to these challenges lies in our ability to leverage technology and HealthStream has developed a tech-enabled system that is able to assess and personalize competency development for each learner, and perhaps even more importantly, to do that at scale. HealthStream’s jane AI™ uses the power of artificial intelligence to focus on developing a solution that is progressive and personalized:

  • It can assess what the nurse already knows.
  • It can determine which skills have already been mastered.
  • It can evaluate a nurse’s ability to reason and how nurses synthesize information.
  • It can measure judgement and whether or not nurses are able to make informed decisions.

Clinical judgement assessments combined with virtual simulations are able to assess a number of competencies within each specialty and setting that cover knowledge and clinical judgement. Using objective, unbiased measurement, jane is then able to provide a recommended path for development that may also include bedside preceptor engagement. “Our system is not focused on competency assessment or meant to associate a nurse with a score. It’s a competency development system; so, our goal is to identify individual strengths versus gaps and provide an individualized plan to close those gaps,” said Coady.


Yes, But Does It Work?

Coady addressed the improvement seen in both knowledge and clinical judgement skills while reducing seat time and the associated costs, but she also shared some results that point to broader gains. This kind of personalized education can also impact outcomes. Interestingly, for every 1-point increase in the average knowledge score, there is a corresponding 0.1202 increase in the organization’s CMS star rating. Also, for every 1-point increase in the jane AI clinical judgement MI scenario, there is a 3.6% decrease in mortality rate. The data indicates that creating real clinical competency can result in better outcomes and improved financial performance as quality and outcomes measures are tied to reimbursement.