Healthcare organizations understand that they need to evaluate the competency of staff. Big changes happening in the healthcare industry continue to sharpen the focus on competency assessment programs. As the industry gets even more serious about delivering patient-centered, value-based care, nurses and other staff members are facing new responsibilities and learning requirements. They must attain higher levels of education and competency in order to meet challenging clinical care and business goals. Along with the constantly changing nature of healthcare delivery, these developments make it an ideal time to review competency programs, competency assessment goals, and create strategies targeted toward building and maintaining an advanced workforce.
What Is Competency for Healthcare?
Competency is the application and demonstration of appropriate knowledge, skills, and behaviors in a clinical setting. Competency is all-encompassing and more than just taking a course, passing a test, or completing a technical checklist. It is how a person processes and acts on information and guarantees an employee can consistently demonstrate desired behaviors whatever the situation. Competency models focus on accountability and empowerment of employees. Methods of validation are used to substantiate the multiple facets of any competency. Organizations are required to not only determine the level of competency, but to document how it was verified. Several methods of validation may be necessary to fully evaluate all three areas of a competence.
Checklists work well for evaluating the technical skills involved in competence, because they document an employee’s ability to complete the correct steps in the right sequence for a particular process, procedure, or skill. Additionally, checklists can be used to ensure safety involved with equipment and procedures. In his book The Checklist Manifesto: How to Get Things Right (2010), surgeon and writer Atul Gawande, MD says: “Good checklists…are precise. They are efficient, to the point, and easy to use even in the most difficult situations… they provide reminders of only the most critical and important steps—the ones that even the highly skilled professional using them could miss.”
Elements of a Successful Competency Assessment Program
As with any new large-scale effort it is important to have buy-in and support throughout an organization. Before starting, project leaders should ensure that all of the organization’s key stakeholders support the program, including senior executives, nurse managers, and staff. It is vital that senior leaders see the strong connection between strategic goals and competency. This involves presenting the program to leaders and team members on an ongoing basis to gain feedback and continued support.
Setting Competency Program Goals
Competency assessment programs should begin based on the organization’s strategic business, clinical, and learning goals. A competency program’s primary goal is to improve care by ensuring the competence of the people who deliver care. Employees must be able to consistently demonstrate competency in a variety of situations. A successful approach will standardize the competency selection process while customizing competency assessment for specific job roles. Incorporating these strategies will transform competency from a compliance requirement to a key driver of clinical and business outcomes.
Joint Commission and Other Competency Standards
Competency assessment is unique to healthcare due to the large amount of regulatory oversight from organizations such as Joint Commission, OSHA, and other bodies. For example, The Joint Commission’s Hospital Accreditation Standards state that “The hospital defines the competencies it requires of its staff who provide patient care, treatment, or services” (The Joint Commission, 2014). Also, the Joint Commission says, “Capacity equals requirement.” This means that competency assessment should “assess on an ongoing basis that you have the right staff abilities to carry out your current organizational goals and objectives.” It is important to keep in mind that the Joint Commission does not provide a prescriptive process, and assessing competency is left up to each organization.
Once an organization has documented their assessment approach, the Joint Commission will hold that organization accountable for that process and policy. Most importantly, be judicious and avoid measuring every competency, even if nurses are specialized in specific areas. Competency assessment is a continuous process, and it is important that competencies measured have meaning and value to employees. Address items that are high risk, low volume, prone to problems, completely new, and time-sensitive.
Competency Assessment and Performance Reviews
A strong competency program should support the larger organizational performance review process. Performance reviews reveal how an employee is developing and how well he or she meets goals. Competencies are an important area of an employee’s overall job responsibilities and weigh heavily during the annual review process. Successfully passing a competency assessment informs managers that an employee is able to perform the minimum job requirements. In turn, competency programs help improve satisfaction and turnover, in part because they ensure that all staff members understand they are being measured and held accountable by the same standards through an objective process.
Gawande, A. (2010). The checklist manifesto: How to get things right (p. 120). Profile Books LTD.
The Joint Commission, “2014 Hospital Accreditation Standards,” Standard HR.01.06.01
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