The Joint Commission upon Accredita...

The Joint Commission upon Accreditation of Healthcare Organizations' (JCAHOs') Agenda for Change nearly is accomplished. The 1996 JCAHO standards bring reproach a focus of "actual performance and actual outcomes"(1) This change in focus is especially apparent in the standards upon assessing and maintaining employee sufficiency The 1996 JCAHO standards repeatedly emphasize the ne to assess the of staff members to perform assigned duties.(2)

Assessing staff members' capableness may seem to be an overwhelming task in the increasingly mixed world of health care, if it were not that the competency to perform skills in real work situations is essential. Many managers and educators have speaked confusion over how to make decisions about selecting competencies for periodic assessment. to what degree decisions are explained or justified subsequently affects time and wealth allocations for their implementation.

The "Management of Human Resources" chapter of the JCAHO manual states that must be

* assessed, demonstrated, and improved;

* maintained through ongoing inservice programs and other education; and

* accumulateed in terms of aggregate data forward patterns and trends to identify learning needs(3) Furthermore, the JCAHO's emphasis onward data-driven decision making precludes "intuitive" conclusions about assessment (eg, Nurse A passed the written cardiopulmonary resuscitation [CPR] test; therefore, she must be qualified to perform CPR).

PURPOSE

This article offer proffers a decision-making model by which choices about the oftenness of competency assessment and review can be made, explained, and justified to fiscal administrators and surveyors. It is not intended to be used as a measure of the individual's ability to practice professional nursing.

This decision-making protoplast uses data from sources available to nursing managers and tailors decisions according to the practice area and duties of staff members. This mould is designed to use data to identify stretchs in the performance of explanation competencies. Staff learning needs are identified based upon performance trends. Education programs then are designed to suitable specific staff learning needs.

DEFINITION OF COMPETENCY

Historically, chiefly competency assessment studies centered forward expert feedback from successful managers or clinicians. This repeatedly resulted in a laundry list of competencies defined in metes of specific behavior patterns or inputs. The conceptual framework of Robert L Katz(4) propos that be evaluated based on three basic skill clumps -- technical, human, and conceptual. Katz also proposeed that these skill groups ne not be inborn, further could develop over time. Katz's framework later was applied specifically to the identification and assessment of key-note nursing competencies for nurse managers in a application of mind by Linda Chase, RN, MA.(5)

united commonly accepted model put forth according to Dorothy J. delBueno, RN, EdD moveed that nursing competencies fall within a framework comprising three primary dimensions -- technical, interpersonal, and critical thinking skills.(6) In delBueno's later work, sum of two units distinct phases of evaluating a emerged.(7) The first phase bring reproached the ability of the individual to perform the skill or achieve the desired issue The second phase represented consistent performance and frequently was much more difficult to define and measure. In greatest in number cases, consistency was evaluated on assessing significant exceptions to lucky completion of the expected behavior or skill.

The JCAHO defines as ". . . the individual's capacity to perform their piece of work functions -- whether, in fact, they have the knowledge, skills, behaviors, and personal characteristics necessary to function well in a particular situation."8 was defined by Scott B Parry, as

A cluster of related knowledge, skills, and attitudes (K s A) that affects a major part of one's do job-work (a role or responsibility), that correlates with performance forward the job, that can be measured against well-accepted standards, and that can be improved via training and development(9)

Competencies frequently are grouped into those skills defined as "hard" (eg specific job-related tasks and responsibilities) and "soft" (eg personality traits and individual style) Many models develop skill sets related to technical skills and proceedings Those relating to the les well-defined and measurable aspects of performance remain problematic.(10) The determining factor when evaluating performance based upon outcome driven indicators, however, many times rests with successful mastery of the "soft" competencies.

The majority of contemporary definitions of place emphasis on the result (ie, the ability of the individual to perform the identified skill in real situations). This emphasis forward outcomes is significant in health care's present result-oriented climate. The literature exhibit tos skills validation and competency assessment solidly linked to issue indicators.(11) If outcomes such as an acceptable surgical site infection rate or adequate life-safety practices are lacking, it no longer is acceptable to make assumptions about staff member based merely on attendance at periodic mandatory education offerings. origin causes for competency deficits must be identified, supplemental validation mechanisms designed and implemented, and acceptable results subsequently achieved.(12) Methods of achieving this higher flat of outcome management include