What is Competence in Healthcare? (Part I)
By Lynn Howe RN, MS, CEN, CCRN; Executive Director, Competency Solutions, HealthStream
Competence lies at the heart of any talent management effort in healthcare. Competency is a cornerstone on which a successful healthcare organization is built. Defining and understanding competence and competency is the first step in managing it effectively.
What do we mean by “competence” and “competency?”
Competence has four intertwined components—knowledge, skills, behavior, and judgment. Employees must first acquire the knowledge to know how to do their work and why. Employees then must learn the skills that are required to succeed in their given role. Employees also must demonstrate the behavior that is required to effectively manage every situation they are likely to encounter. And then, employees must finally develop and use their own judgment to appropriately address situations where an easy or straightforward response is not apparent.
Competency can be defined as the application and demonstration of appropriate knowledge, skills, behaviors, and judgment in a clinical setting. Competency is not merely the product of completing required courses, nor is it measured simply by successfully passing a test or completing a checklist. Rather, competency is confirmed when knowledge and skills are accurately applied at the bedside, and appropriate behaviors and judgments are consistently displayed in practice.
More than just a simple, one-time evaluation, competency is the consistent demonstration and ongoing development of these components in a real-world work setting. Competency in individual employees enables not only wide-spread compliance with an organization’s standards, but ultimately helps to develop real organizational excellence. Emphasizing, promoting, and rewarding development of these four components in each employee is critical. In addition, the best use of a competence-based philosophy requires an organization to actively engage nurses in the competency assessment process and to demonstrate a direct and strong connection between learning, competency, and patient outcomes.
Competence is a complex concept – especially in health care.
At the very least, competency in a healthcare environment requires evaluation of both an employee’s ability to meet job expectations and subsequently to deliver continuous, effective care for patients. Effectiveness is evidenced by improvements in patients’ health status, positive clinical outcomes, improvement in patient safety, and a positive perception of satisfaction with the care given. In short, competency assessment in a healthcare environment involves much more than a checklist and a test, which is what makes it a challenge for educators and leaders.
Another influencing factor is that new graduate nurses now comprise more than 10% of a typical hospital’s nursing staff, with this number certain to grow, especially given the increasing numbers of entrants to the nurse workforce. Nearly 90% of academic leaders believe their nursing students are fully prepared to provide safe and effective care. Adversely, only 10% of hospital and health system nurse executives believe new graduate nurses are fully prepared to provide safe and effective care.
Unfortunately, straightforward “book knowledge” and technical skills are clearly important factors in developing competency, but not all employees who have the knowledge actually demonstrate and use that knowledge in their every day practice. It has been reported that “there is little or no correlation between undergraduate credentials and competency ability. Almost all RN graduates, regardless of educational preparation, are limited in their ability to meet entry expectations for safe practice.” Although their cognitive knowledge may have been exemplary, one research study found that 50% of new RN graduates did not recognize a patient with classic symptoms of a myocardial infarction.
Competency drives outcomes.
Ultimately, managing competency in a healthcare organization is essential because improvements in employee competencies improve outcomes. Employees are more satisfied when they work with competent peers. Patients are more satisfied when they perceive their care came from well-qualified and competent staff. Clinical outcomes and patient health are improved. And patient safety initiatives are uniformly understood and supported.
Cohen, Michael, What You Accept is What You Teach: Setting Standards of Employee Accountabilty. Creative Health Care Management: Minneapolis, MN 2006
Delbueno, Dorothy; Buyer Beware The Cost of Competence. Nursing Economic: November 2001
Wright, Donna, The Ultimate Guide to Competency Assessments in Health Care. 3rd edition. Creative Health Care Management: Minneapolis MN 2005