HealthStream Spotlight - Competency Q&A with a Clinical Expert
Lynn Howe RN, MS, CEN, CCRN Director of Competency and Performance Management
(1) What are the major problems we are trying to help people solve with our focus on competency?
The Joint Commission is not prescriptive in defining a competency management standard. Currently there is not a national standard for this measure. The problems this creates are (1) a lack of standardization in healthcare, (2) a lack of prescriptive process for achieving competency, and (3) the absence of any meaningful data on competency to assist in measuring success and quantifying the effort to increase healthcare excellence.
This leaves each healthcare organization to devise its own competency standard. It is widely accepted, however, that patient care organizations much supply evidence of achievement for the standards they establish. They also must produce records indicating employees possess the competence necessary to perform their job responsibilities, but must also demonstrate the organization’s competency management process results in a culture of patient safety and staff empowerment.
(2) What is competency?
Competence is defined by four intertwined components - knowledge, skills, behavior and judgment – it is the assessment, demonstration, and ongoing development of these components in the real work setting that enables not only compliance with standards, but ultimately real organizational excellence. We also believe this framework enables an organization to actively engage nurses in the competency assessment process and demonstrate a connection between learning, competency, and patient outcomes. Increased patient safety is one of the most important goals in healthcare.The key to patient safety is competency.
We define competency as the application and demonstration of adequate and appropriate knowledge in a clinical setting. Competency is not merely the product of completing assigned courseware, nor is it measured simply by successfully passed testing. Rather, it is confirmed when appropriate judgment and behaviors are displayed in practice on the job. Competence is determined by how knowledge is applied and how critical thinking is used at the bedside.
(3) What is competency management?
Competency management is the process of determining the current level of competence of an individual staff member, unit and organization on a competency. Assessment can focus on a single competency or multiple competencies at once and may be conducted using a variety of tools and at a range of times in the staff member’s career and employment with an organization. Competency assessment from pre-hire initial entry through continued employment is essential to ensure that a single high standard of competency for the entire organization is clearly articulated and achieved.
Competency management has three components:
- Competency assessment – determining the current level of competency of an individual 1. staff member
- Competency development – acquiring the necessary competencies to move up the career ladder2
- Competency demonstration – practical application of knowledge and skills at every level in the 3. career ladder, in an actual or simulated clinical setting
(4) What’s the impetus for competency management in healthcare?
When competency is based on accountability and focused on patient outcomes, the competency assessment process shapes the culture of the organization. Application of knowledge combined with an effective validation process enables an organization to achieve its desirable patient outcomes and strategic goals.
(5) What is unique about our approach?
We believe no single provider offers a solution that is comprehensive. For true organizational excellence, linking multiple providers and their different assessment tools allows for a more thorough measurement of competency, taking into account its complexity.
(6) What solutions does HealthStream offer?
At HealthStream we are dedicated to developing the core solutions for competency management and building a network of partners providing a comprehensive range of solutions for the assessment, demonstration, and maintenance of competence.
We call this the HealthStream Competency Network, centered on the HealthStream Competency Center, which enables assessment and the measurement of critical behaviors in the real-world work setting. This comprehensive solution intertwines all competency assessment tools to support the process of engaging nurses in the assessment process and demonstrating the connection between learning, competency, and patient outcomes.
It also includes the HealthStream Competency Dictionary, which contains 1,400 customizable statements for all clinical, ancillary, and facility support employees. It is designed to standardize and clearly articulate essential behaviors for all hospital employees.
The HealthStream competency center also offers the ability to create comprehensive performance appraisals. These appraisals not only address the needs of an organization’s human resource needs but also incorporate competency assessment with performance appraisals.
(7) How are customers implementing HealthStream’s competency solutions and gaining benefits from them?
HealthStream’s Competency Center and Competency Network allow customers to take their assessment of competency to the next level. They now know the relative competency of each staff member. Customers using the competency center are able to place the accountability of competency assessment in the hands of the employees. The staff becomes accountable for achieving their individual competency goals as well as the strategic goals of the organization. Pulling data about each employee’s degree of competency enables a more accurate needs assessment. Customers are better able to allocate resources for attaining competency and quickly and easily identify who needs reassessment and additional training. Just because one person made a mistake, not everyone needs training. Customers are able to finally draw a clear distinction between competency issues and compliance issues. Best of all, rankings and ratings allow an organization to move employees more efficiently along the novice to expert continuum.
(8) Key considerations when evaluating solutions
For competency recommendations to increase the impact of your healthcare organization’s competency program. look for solutions that: (1) use professional standards instead of skills checklist to assess competency, (2) produce reports showing who is more competent than whom and provide evidence of staff effectiveness, (3) embody a peer review process, and (4) are able to incorporate competency assessment as part of performance appraisals.
These recommendations are not assumed to be exhaustive; they merely represent a productive pathway toward organizational excellence. It is always insightful to remain cognizant of the high-level vision to create a culture of safety where patient outcomes are optimized. By ensuring that all members of the healthcare team are empowered and professionally supported through your competency and quality programs, you enable employees to lead your organization in creating an open, honest, and responsive culture of patient safety end employee satisfaction.