Competency assessments: Handling them effectively
How to be prepared when JCAHO calls
Competency is a many-faceted area of hospital surveillance. There are a lot of areas a surveyor might probe.
Are your employees specifically up to speed in the areas where they work? Have your staff been provided with age-specific training? What about float and agency nurses? Are they being assigned appropriately?
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in Oakbrook Terrace, IL, is expected to focus on competency with age-specific needs, good documentation, planning and priorities, competency of float and agency staff, and training and records.
There have been suggestions that the JCAHO surveyors will actually pull resumes and match them to job descriptions, but Donna Larkin, a JCAHO spokeswoman, says there are no plans for that type of surveillance.
But it doesn’t hurt to be prepared. "We take our job descriptions and the posted requirements for the job very seriously," says Janice Blankenship, SPHR, director of personnel at Boulder (CO) Community Hospital and a member of the board of directors for the American Society for Healthcare Human Resources Administrators (ASHHRA).
"If I say it’s required, I make sure those requirements are met. At this point," she adds, "the Joint Commission says everyone with regular patient contact must pass the competency scrutiny."
This can mean maintenance workers and housekeeping staff, as well as the clinical professionals who are caring for patients each day. "In different jobs, these competencies mean different things," she says.
Do the cleaning people understand they can’t leave potentially dangerous chemicals lying unattended on a pediatric floor? Do the maintenance people know the precautions to take in an ICU unit when the air conditioning stops working? Do the rehab staff understand the use of treatment and education with small children or delicate geriatric patients? Are transporters trained to handle patients with a wide variety of accompanying infusions?
And what about nurses and aides? Can they communicate effectively with all age groups and those with cultural differences? Are they trained to spot signs of abuse in children and older people?
"It’s quite challenging to meet the standards for the Joint Commission because they’re so very specific," says Cindy Harrison, director of Human Resources at Chelsea (MI) Community Hospital and president-elect for ASHHRA, "Depending on the surveyor, the focus changes, and you’re not sure what to be prepared for."
One of the challenges, of course, is defining competence. Often, it can be determined from a supervisor evaluation and performance review. Sometimes it becomes an issue when a family or patient issues a complaint.
"One of the big things the Joint Commission focuses on," says Harrison, "is age-specific competency. We write them into our evaluation and performance review materials. Competencies are very clearly outlined." And how does a hospital test for competency? "Some of it is [by] written test," she says, "and some of it is peer review. When we bring in new hires there is, of course,
a complete orientation. Each new hire is paired with a mentor who’s responsible for monitoring and directing the employee in the new position. Nurse managers are expected to observe new employees very carefully."
All of this, of course, must be carefully documented to be of any use in a survey.
There are a number of ways to assess competency. Some recommendations are conducting paper and pencil tests, asking a technician to explain a complicated procedure using simple language, staging mock disasters, and implementing competency-based job descriptions.
"We have a nurse education day where we go over competencies," says Harrison. "And any time there’s an incident or a complaint by a patient, visitor, or doctor, we look into it immediately and retrain where necessary."
She says that maintenance and housekeeping staff go through competency procedures just
as specific as those for nurses and technicians. "They’re assessed for their job. For instance,
we need to know that if they’re working in a patient’s room, they are able to communicate effectively and appropriately."
Assuring competency for float and agency staff is another challenge, says Blankenship. "We stipulate to the agencies that provide temporary help that it’s up to them to do competency evaluations, which we then review. We also audit health care agencies to see if they’re doing the appropriate assessments."
Cultural differences are also addressed in Chelsea Community Hospital’s human resources department. "We’re doing an inservice soon for all staff working with patients that specifically aims at working with diverse patients," says Harrison.
"In a nutshell, we’ll be looking at cultural differences, customs, and being sure the patient understands the physician and nurse treatments and assessments," she says.
Harrison also wants the staff to understand that there’s more to diversity than country of origin or color of skin. "Age, gender, etc. play a role here too," she explains.
"It’s always a challenge to be able to assure the competencies acceptable to the Joint Commission," says Harrison. "But on the other hand, it makes us provide better care and pay more attention to these matters which are important."
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