MEASURE WHAT. Ensuring an Effective Healthcare Competency Program

Transcription

1 MEASURE WHAT MATTERS: Ensuring an Effective Healthcare Competency Program WHITE PAPER Dorothy Duncan, Product Manager, HealthStream Gwen Wright, Product Manager, HealthStream Healthcare s Leader in Workforce Development

2 Healthcare organizations understand that they need to evaluate the competency of their staff. Big changes happening in the healthcare industry continue to sharpen the focus on competency 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. These developments, along with the constantly changing nature of healthcare delivery, make it an ideal time to review competency programs, competency assessment goals, and create strategies targeted toward building and maintaining an advanced workforce. What are the elements of a powerful competency program? The most successful healthcare organizations seek to standardize competencies across entire units, facilities, and systems while remaining flexible enough to design competencies that drill down to specific job roles. Successful programs also enable managers to create turnkey processes to monitor competencies, extract meaningful data, and produce valuable reports to effectively validate clinical competency and measure quality outcomes. Having a defined competency assessment is one of the most important components in a competency program. According to education expert Donna Wright (2005), it is important to select competencies critical to an organization s goals and to select the right validation techniques. Moreover, Wright supports a close collaboration with staff members, saying it is important to establish accountability between the manager and the employee, as well as enable employees to choose validation methods. Finally, Wright says organizations must seek to understand when an issue is a true competency problem and to address those issues right away. A successful competency program includes multiple appropriate methods of validation. There are several effective validation methods to consider when assessing the various competencies. One such method is the checklist. Widely used across healthcare, the checklist is effective for testing technical skills and validating skills proficiency. Checklists, just like tests, don t evaluate competence or competency alone (Whelam, 2006). When used strategically, however, checklists are an exceptional tool for educating, training, and coaching employees. COMPETENCE VS. COMPETENCY An innovative and well-managed competency program benefits the organization as a whole. As evaluating and improving upon employee competency advances, so do clinical and business outcomes. The culture of an organization and employee engagement can also significantly improve. Employees are more satisfied when they work with competent peers, and patients are happier when they perceive their care came from well-qualified and competent staff. When we think about the concept of competence, it is important to distinguish between competence and competency. Both play an important role in the overall development of the learner. 4 HealthStream White Paper: Measure What Matters

3 WHAT IS COMPETENCE? Competence has three main domains knowledge, skills, and behavior. Employees acquire knowledge and skills to perform their work roles successfully. At the same time, they must demonstrate specific behaviors to effectively manage any situation. A common misconception is that checklists validate competency. However, it is important to understand that checklists only validate a person s technical skills and proficiency, but not areas like critical thinking and interpersonal skills, which are vital parts of the competency process. WHAT IS COMPETENCY? Competency, on the other hand, is the application and demonstration of appropriate knowledge, skills, and behaviors in a clinical setting. Competency is all encompassing. It is not just taking a course, passing a test, or completing a technical checklist. It is how a person processes and acts on information. Competency means an employee can consistently demonstrate the desired behaviors in a variety of situations. Competency models, such as Wright s, focus on accountability and empowerment of employees and their ability to demonstrate a skill. Methods of validation are used to substantiate the multiple facets of a competency. Organizations are required to not only determine the level of competency, but to also document how it was verified. These verification methods are used to measure knowledge, skills, judgments, and behaviors. It can take several methods of validation to fully evaluate all three areas of a competence. Checklists are one method that works well for evaluating the technical skills aspect of 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 insure safety when it comes to 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 program or initiative it is important to have buy-in and support throughout the organization. Before starting any competency program, it is crucial to ensure that all of the organization s key stakeholders support the program, including senior leaders, nurse managers, and staff. To that end, it is important that senior leaders see the strong connection between strategic goals and competency. This involves presenting the program to leaders and team members initially, as well as on an ongoing basis, to gain feedback and continued support. HealthStream.com contact@healthstream.com 5

4 SETTING COMPETENCY PROGRAM GOALS Competency assessment programs should start with a clear understanding of the organization s strategic business, clinical, and learning goals. A competency program s primary goal is to improve care by assessing and developing the people who deliver care. Employees must be able to consistently demonstrate competency in a variety of situations. A successful approach strives to standardize the competency selection process while customizing the 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. 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 related to competency state that The hospital defines the competencies it requires of its staff who provide patient care, treatment, or services (The Joint Commission, 2014). According to Wright, the Joint Commission says, Capacity equals requirement. This means, says Wright, 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. A strong competency program should support the larger performance review process. Performance reviews reveal how an employee is developing and how well he or she meets their 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. Three Reasons Competency Assessments Matter In addition to meeting regulatory requirements, competency assessments strengthen healthcare organizations in multiple ways. 1. Help employees reach their potential. Competency evaluation is a tool for developing clinical and non-clinical staff. Competency assessment helps to reveal an employee s learning needs and develop his or her potential. The competency assessment also holds employees accountable for meeting organizational expectations. 2. Identify strengths and risks. Competency evaluation promotes awareness of organizational goals and helps the organization identify strengths and gaps. 3. Boost employee engagement. An effective competency evaluation process improves employee engagement and job satisfaction. Engaged employees perform more consistently, effectively, and efficiently than equally qualified, non-engaged employees. 6 HealthStream White Paper: Measure What Matters

5 CREATING DEVELOPMENT PLANS Reflective development plans complete the learning and competency assessment process. A well-designed development plan will identify experts and their potential, as well as involve performing a deep assessment of expected behaviors and performance gaps. When developing competency assessments, programs should include initial and ongoing assessments, as evaluating a staff member s competency does not end after orientation. Once there is standardization of the process for defining appropriate competencies across the organization in regard to which competencies should be measured and when they should be measured, then managers and their employees can customize competencies to specific job roles (Wright, 2005). ESTABLISH A RIGOROUS VALIDATION PROCESS Not all validation methods are equal when assessing critical thinking, technical, and interpersonal skills. For example, when it comes to critical thinking, competency assessments should use multiple verification methods, including guided reflective practice, measuring approaches, outcome measurements of daily work, and verification methods that can actually develop critical thinking skills, Wright notes (2005). Validation for interpersonal skills could include validation techniques that incorporate peer reviews. Validating technical skills requires a different approach, such as checklists. Today, virtually all healthcare organizations use checklists and assessments in some form throughout their normal course of business. When it comes to validation, checklists are powerful tools that can be used in multiple areas, including routine laboratory processes and cleaning procedures, or for a rare patient procedure. A set of validation methods should accompany each of the three competency areas: 1. Critical thinking skills. According to critical thinking expert Peter Facione, (as cited in Wright & Hanlon, 2013), self-regulation is a core cognitive skill involved in critical thinking. It involves the ability to think about how we arrived at certain conclusions, to evaluate our own cognitive activities by self-examining, and then correcting our thoughts, actions, and perceptions based on information being filtered through the higher reasoning centers in the brain. The only way to effectively do this is to use the skill of reflection. Many techniques Matching Validation Methods to Competencies Critical Thinking Domain Evidence of daily work Exemplars Mock events/surveys Peer reviews Quality improvement measures Technical Domain Return demonstrations Tests/exams Presentations Checklists Interpersonal Domain Case studies Peer reviews Self-assessments Discussion/reflection groups for competency assessment are focused on technical skills. However, critical thinking skills require other validation methods. Education experts suggest using evidence of daily work, exemplars, and mock events/surveys. HealthStream.com contact@healthstream.com 7

6 2. Technical skills. The healthcare worker must be able to perform tasks, procedures, and processes assigned to his or her job role. These are technical skills. Validation methods include return demonstrations, tests/exams, presentations, and quality improvement measures. Checklists can be used to verify proficiency of technical psychometric skills. Ideal for this purpose, checklists should be simple and quick, with clearly listed steps. Moreover, checklists are ideal in ensuring consistency among preceptors. They provide preceptors and managers another method to validate technical skill proficiency. Checklists are highly individualized to specific procedures and equipment. Because checklists teach skills in specific steps, instructors can quickly determine areas in which learners need the most help. While checklists help to validate technical skill proficiency, it s important to remember that they don t assist with critical thinking and can t measure competency. Also, checklists have some limitations. For example, those healthcare organizations that have not migrated their checklists from paper onto an electronic learning platform will have challenges in tracking and reporting results. 3. Interpersonal skills. Interpersonal skills are the other component of the accepted competency model. In healthcare settings, staff members must be able to communicate safely, effectively, and respectfully with patients, physicians, colleagues, and managers through verbal and nonverbal means. They must also be adept at the softer skills, such as listening, interpreting, negotiating, and collaborating. Interpersonal skills drive employee engagement and satisfaction, communication, and a healthy work environment. Consider the following methods for validating interpersonal competencies: case studies, peer review, self-assessment and discussion/ reflection groups. Adopting Checklists Enterprise-Wide Healthcare organizations typically use checklists for training, coaching, and validating technical skill proficiency in the following areas: Equipment training Compliance-focused learning events Required information Orientation/residency programs with new employees Training of experienced staff during transitions in practice Training on new or changing organizational policies Training on new or changing clinical and nonclinical procedures Does your organization overuse checklists? The key to maximizing their effectiveness is the ability to recognize when to use a checklist tool and when to use a competency assessment tool. Ideally healthcare organizations will have a clearly defined process determining when to use checklists and when to use more in-depth competency assessment tools. Challenges are introduced when checklist task items are mixed with competency assessment statements and vice versa. This often occurs when creating a documentation form that contains a combination of technical skill items with competency assessment statements. As organizations evaluate competency programs, it is a good exercise to separate checklists which are step-by-step practices from competency assessment statements and place them on separate documentation forms. 8 HealthStream White Paper: Measure What Matters

7 SUCCESSFUL ROLLOUTS AND FOLLOW THROUGH Launching a competency program is just the start. Creating and staying on track with a competency assessment program is a dynamic process that involves consistent changes and updating. As requirements change, new technology emerges and the healthcare environment evolves, so too must a competency program. Healthcare organizations must make it a priority to validate employee competencies each year in order to ensure that the workforce is able to meet patient care and organizational goals. In healthcare, advanced organizations understand that competency requirements are shifting and demanding more attention from the highest levels of leadership. As the government, payers, and patients/consumers place more requirements on the healthcare system to improve care, HEALTHSTREAM S COMPETENCY CENTER The HealthStream Competency Center is an online management tool that allows you to capture initial and ongoing competency assessments. It allows you to measure real-world application of technical, critical thinking, and interpersonal skills of the staff, therefore identifying competency in all areas of healthcare. The Competency Center is designed to truly improve clinical outcomes competency assessment programs must be aligned with the strategic goals of healthcare organizations. An effective competency program answers critical questions, such as: how competent and engaged are your staff members? How well are they performing? Are you hiring the right people, and can you identify those with high and low potential? These answers are derived in part through an effective validation process that incorporates multiple techniques. Checklists are one such method offering an enterprisewide solution as a tool for achieving task-oriented technical skills and for validation of staff. A successful competency program, however, presents multiple methods of validation without over utilizing checklists a problem commonly seen in existing competency programs today. through deeper assessment of expected behaviors. Prebuilt, customizable reports make it easier to manage risk and provide data to regulatory and accrediting bodies. With its flexibility and a library of more than 3,400 clinical and non-clinical competencies (with 1,200 of those specific to post-acute care), this tool sets the standard for the management of competency in healthcare. CHECKLIST MANAGEMENT Checklists are straightforward tools that support any situation from the simplest to the most complex faced in healthcare on a daily basis. HealthStream has automated this important process with Checklist Management, allowing you to move from a cumbersome manual process to a simple online solution. With pre-built reporting and the ability to assign approved evaluators, Checklist Management allows you to standardize and assure consistency across your organization. HealthStream.com contact@healthstream.com 9

8 ABOUT THE AUTHORS Dorothy Duncan Dorothy is a product manager for HealthStream, where she manages the Talent Management platform solutions. With many years of healthcare and HR experience, she has previously worked in HR consulting, supply chain, healthcare insurance, and benefits. She received her MBA from Vanderbilt University and her Bachelors from the University of California, Santa Barbara. Gwen Wright Gwen is a product manager for HealthStream, where she manages the Professional Portfolio and Checklist Management products. Gwen has a combination of clinical, academic, product development, and operational experience in a variety of healthcare settings. She received her MS in Clinical Nutrition from Rosalind Franklin University and her Bachelors of Science in Public Health Nutrition from the University of North Carolina, Chapel Hill. 10 HealthStream White Paper: Measure What Matters

9 209 10th Avenue South - Suite 450 Nashville, TN HEALTHSTREAM (NASDAQ: HSTM) HealthStream is a leading provider of workforce development and research solutions for providers throughout the continuum of care. We are dedicated to improving patient and resident outcomes through the development of healthcare organizations greatest asset: their people the professionals on the frontlines of care delivery every day. REFERENCES CITED: Gawande, A. (2010). The checklist factory. The checklist manifesto: How to get things right (p. 120). Profile Books LTD. The Joint Commission, 2014 Hospital Accreditation Standards, Standard HR Levine, J. (2014). An Organizational Competency Validation Strategy for Registered Nurses. Journal for Nurses in Professional Development, 30(2), Wright, D. (2005). The ultimate guide to competency assessment (third edition, pp. xii-xiv, 2-11). In R. Smith (Ed.), Minneapolis: Creative Health Care Management. Wright, D., & Hanlon, T. (2013). Top 3 tools to assess critical thinking competencies for healthcare. Accessed September 2014: healthstream.com/blog/bid/114769/top-3-tools-to-assess-critical- Thinking-Competencies-for-Healthcare. Whelam, L. (2006) Competency assessment of nursing staff. Orthopedic Nursing, 25(3), WP14COMP