Carolyn St.Charles, RN, BSN, MBA Regional Chief Clinical Officer, HealthTechS3

Transcription

1 May/June 2017 CLINICAL CONNECTION Carolyn St.Charles, RN, BSN, MBA Regional Chief Clinical Officer, HealthTechS3 UNDERSTANDING AND MEASURING COMPETENCY PART 1: DEVELOPING A FRAMEWORK FOR COMPETENCY ASSESSMENTS Welcome to our two part summer series on Competency. Part 1, May/June will focus on a framework for measuring competency. Part 2, July/August will focus on examples of competency including cultural competency. Introduction As healthcare providers we often struggle with how to measure competency effectively and to ensure that we are providing safe, effective, and culturally appropriate patient care to the populations we serve. In their article, Measuring the Competence of Healthcare Providers, Kak, Burkhalter, and Cooper define competency as, the ability to perform a specific task in a manner that yields desirable outcomes. Binkski, in the newsletter, Developing a Competency Framework, defines competency as, the integrated knowledge, skills, judgment, and other attributes that people need to perform a job effectively. Unfortunately, we sometimes confuse formal or informal education and/or years of experience with competency. Although both education and experience may have a positive impact they are not in and of themselves reliable indicators of competency. Patricia Benner in her 1984 book, From Novice to Expert, describes five levels of skill: Novice Advanced Beginner Competent Proficient Expert Although written for nursing, Benner s levels can apply to any discipline. Adding information to the competency assessment regarding the level of skill can help establish realistic expectations. It can also help us think about competencies as a continuum and not a set point in time. HTS3 May/June 2017 Page 1

2 Competency Framework Developing a model for measuring competency that is effective and also not cost-prohibitive can be difficult, especially with the multiple skills required in healthcare today. We have outlined a 5-step framework for developing and implementing a competency program. We hope you find it useful. STEP 1: IDENTIFY A STANDARDIZED TEMPLATE There are a wide variety of templates available for documenting competency. It s important to have a standardized template for the organization so that competency is consistently assessed and documented, regardless of the department or manager. The Senior Leadership Team including Human Resources should be actively involved in both developing and implementing a standardized template, as well as holding managers accountable for measuring and documenting competency of their staff. NAME: POSITION: DEPARTMENT: HIRE DATE: PURPOSE OF EVALUATION (CIRCLE ONE): NEW EMPLOYEE - ANNUAL COMPETENCY - NEW SKILL OR PROCEDURE Goal We will provide Exceptional Customer Service to Every Patient and Every Visitor Every Time We will provide safe and effective IV Therapy Competency Use of AIDET to communicate with patients & families Acknowledge Introduce Duration Explanation Thank You Example 5 Rights Medication 2 Pt. Identifiers Correct skin prep technique Correct insertion technique Correct barrier IV site References Learning Activities Policy ADM42 Patient Handbook Policy NSG42 Policy NSG43 Method Computer Test # of Observations Minimum of 5 that meet standard # of Observations # Meeting Standard Minimum of 3 that meet standard # of Observations # Meeting Standard Person Assessing Proficiency (Circle one) Novice Advanced Beginner Competent Proficient Expert Novice Advanced Beginner Competent Proficient Expert Recommendations for FU Required for Novice or Advanced Beginner HTS3 May/June 2017 Page 2

3 STEP 2: IDENTIFY METHODS FOR ASSESSING COMPETENCY In the article, Measuring the Competence of Healthcare Providers, Kak, Burkhalter, and Cooper provide an illustration reflecting the extent to which different assessment methodologies approximate actual job performance. As can be seen by the illustration, a written test has the least congruence with actual job performance and job sampling and job simulation have the most. LEAST Congruence with Actual Job Performance MOST WRITTEN TEST COMPUTER TEST RECORDS REVIEW ANATOMIC MODEL JOB SIMULATION JOB SAMPLE (OBSERVATION) However, they also state in the article that when choosing an assessment methodology, consideration should be given to the methods and resources available, who will be responsible for evaluating competence, and the actual competency being assessed. Intranet systems that include written information that staff must read and then pass a test are becoming more common. Facilities often see these systems as a way to decrease costs and provide better tracking. Some tests can measure critical thinking skills while others may only test recall. An important step in your competency framework is to carefully define which competencies are appropriate for which method of assessment. STEP 3: IDENTIFY AND VALIDATE COMPETENCIES THAT MAKE A DIFFERENCE Many facilities take the approach that more is better when developing competencies. It may be easier to have a long list but it s important to carefully evaluate those that are really needed. Here are some tips for identifying the critical few. 1. Complete an Annual Learning Needs Assessment Complete an annual learning needs assessment that solicits manager and staff input. This is an important tool for planning education as well as completing competency assessments throughout the year. 2. Develop Competencies that are in Alignment with Organizational Goals Determine the competencies that are needed to align staff performance with the organization s Mission, Vision, Values, and Strategic Goals. Although skill-based competency is of course crucial, you also want alignment with what you are trying to accomplish as an organization. The example on the next page is an illustration of alignment with the organizational goal of providing exceptional customer service. 3 HTS3 May/June 2017 Page 3

4 Organizational Mission, Vision, Values Specific Competency References Learning Activities Applicable Staff Frequency Method Assessment Responsibility We will provide Exceptional Customer Service to Every Patient and Every Visitor Every Time Use of AIDET to communicate with patients & families Acknowledge Introduce Duration Explanation Thank You Review Policy ADM42 Patient Handbook 100% of Staff including Senior Management Travelers Contract Staff At Orientation or prior to 1 st day of work Within first 90 days of hire Annually Written Test Simulation Job Observation Job Observation Department designee designee 3. Review Regulatory Requirements The Conditions of Participation for Hospitals (Appendix A), The Conditions of Participation for Critical Access Hospitals, (Appendix W), The Joint Commission and other accrediting agencies require assessment and documentation of competency. In some instances, the requirements are very specific and in others more general, referring only to the fact that staff are competent to perform their job duties. Include a review of regulatory requirements as part of your process of developing competencies. 4. Identify Department Competencies Department specific competencies are usually only applicable to a single department, although in some cases they may apply to multiple departments, such as administration of medications. You may want to consider thinking about department-based competencies in three groups: Frequently Used Skills or Procedures Focus on those that impact Patient Safety Low-Volume / High-Risk New or Anticipated Skills or Procedures Examples might include medication administration or blood administration for frequently used skills and restraints for a low-volume / high risk procedure. 4 HTS3 May/June 2017 Page 4

5 Whenever multiple departments require competency for the same skill, it is important to ensure that the same methods and processes are used for the assessment as illustrated in the example below. EXAMPLE - MEDICATION MANAGEMENT Specific Competency References / Learning Activities Applicable Staff Frequency Method of Competency Assessment Assessment Responsibility Demonstrate Five Rights when administering medications Policy NSG13 Policy RT03 Policy PT01 RN LPN/LVN Respiratory Therapist Medical Assistants (Clinic) Within 1 st 90 days but prior to administering medications independently Annually Computer Test with a score of at least Minimum of 5 that meet standard Minimum of 5 that meet standard Designee Designee Correctly calculate medication doses Review Learning Module RN LPN/LVN Respiratory Therapist Within 1 st 90 days but prior to administering medications independently Computer Test with a score of at least s Minimum of 5 that meet standard Designee Medical Assistants (Clinic) Annually Computer Test with a score of at least 5. Identify Separate Competencies for New Employees You typically want to measure more competencies for new staff than you do for staff who have worked for a longer period of time in the organization. Your goal is to validate competencies and to determine if the new staff person can function independently or within the scope of their job. This is especially important, as you know, for new graduates who may take longer to become independent. STEP 4: IDENTIFY FREQUENCY OF ASSESSING COMPETENCY There s no one right answer for when or how often competency assessments need to be completed, with the exception of new employees who should complete a competency assessment within the first 90 days. Scheduling competency evaluations over the course of a year generally has greater impact than trying to assess competencies over 1 2 days, once a year. Having said that, Skills Fairs can be very effective if they concentrate on a few targeted skills and allow time for demonstration and feedback. Just-In-Time education and competency assessment is ideal when there is a new procedure or when there have been identified practice issues or for low-volume procedures. 5 HTS3 May/June 2017 Page 5

6 STEP 5: DEFINE WHO CAN ASSESS COMPETENCY The basic rule of who can assess competency is the person who is completing the competency assessment must be proficient or an expert at the skill they are assessing. The Joint Commission standard HR EP3 states, An individual with the educational background, experience, or knowledge related to the skills being reviewed assesses competence. The basic rules for identifying who can assess competency is to choose individuals that: Are proficient at the skill or have been trained to review a specific element Understand the standard to be assessed Have the time to accurately observe the skill Have the communication skills to provide constructive feedback to improve the skill if it is needed There are times when there is not another individual in the same discipline to review competence, such as a dietitian or a social worker. In those instances, you may need to consider someone in the community who doesn t work at your facility to complete the assessment. You may also consider proxy methods of assessment such as a nationally recognized test. Conclusion I would like to end with a quote from Margaret Fite, SPHR, SHRM-SCP, Managing Consultant at 5mile Consulting, LLC. She described the importance of competency this way, A hospital that is serving its Mission is an organization where leaders continuously ensure that those who come into contact with patients are competent to do their jobs. 6 HTS3 May/June 2017 Page 6

7 1 Kak N, Burkhalter B., Cooper, M Measuring the Competence of Healthcare Providers. Operations Research Issue Paper 2(1). Bethesda, MD: Published for the U.S. Agency for International Development (USAID) by the Quality Assurance (QA) Project. 2 Blinkski, V. Developing a Competency Framework, Linking Company Objectives and Personal Performance. Published by MindTools.com. Kak N, Burkhalter B., Cooper, M Measuring the Competence of Healthcare Providers. Operations Research Issue Paper 2(1). Bethesda, MD: Published for the U.S. Agency for International Development (USAID) by the Quality Assurance (QA) Project. 3 Kak N, Burkhalter B., Cooper, M Measuring the Competence of Healthcare Providers. Operations Research Issue Paper 2(1). Bethesda, MD: Published for the U.S. Agency for International Development (USAID) by the Quality Assurance (QA) Project. For more information, please contact Carolyn St.Charles: Call: Office: Cell: carolyn.stcharles@healthtechs3.com Website: HealthTechS3 hopes the information contained herein will be informative and helpful on industry topics. However, please note this information is not intended to be definitive. HealthTechS3 and its affiliates expressly disclaim any and all liability, whatsoever, for any such information and for any use made thereof. Recipients of this information should consult original source materials and qualified healthcare regulatory counsel for specific guidance in healthcare reimbursement and regulatory matters. HealthTechS3 is an award-winning healthcare consulting and hospital management firm based in Brentwood, Tennessee with clients across the United States. We are dedicated to the goal of improving performance, achieving compliance, reducing costs, and ultimately improving patient care. Leveraging consultants with deep healthcare industry experience, HealthTechS3 provides actionable insights and guidance that supports informed decision making and drives efficiency in operational performance. Building Leaders Transforming Hospitals Improving Care 7 HTS3 May/June 2017 Page 7