Training hones therapists’ skills in all clinical areas
3-pronged approach promotes better patient care
At DeKalb Medical Center in suburban Atlanta, a therapist who normally works the acute care setting can easily flex to the aquatics program or work hardening, if the need arises.Through a three-pronged cross-training program, therapists are increasing their skills by becoming familiar with all areas of the hospital.
"Since we have so many different teams, we need for our therapists to be cross-trained so they can be shifted to other program areas when the case load goes up, or someone is sick or on maternity leave," explains Gayle Lindsay, OTR/L, clinical development manager.
DeKalb Medical Center provides therapy for the acute care unit, the inpatient rehab unit, outpatient facilities, work hardening, the arthritis care program, the aquatics program, the pediatric unit, and at each of the hospital’s minor emergency clinics.
A clinical competency program, begun in October 1996, has three parts:
• Core competency.
This segment requires all therapists to pass core competency for their disciplines in all eight areas of the hospital.
• Intermediate competency.
This competency requires all therapists who have not worked in more than one area of the hospital to be cross-trained in another area of their choice.
• Optional specialty competency.
This optional competency allows therapists to pursue a specialty on their own to increase their education and training.
"The competency training gives us a way we can flex the staff and have them feel comfortable going over to a new area. By having all the therapists familiar with all areas of the hospital, we ensure that the patients get better care," says Rachele Branson, OTR/L, rehab specialist and co-chairwoman of the competency project.
After-hours retreat
The competency program grew out of a clinical development retreat held after work at the hospital in October 1995. About one-third of the rehab staff chose to participate.They were asked to brainstorm ways to improve the rehab program. The competency program was one of several clinical development projects selected, Lindsay says.
To develop the competencies, a committee of volunteers interviewed each treatment team to determine what therapists needed to know to provide care for patients in that area.
They listed all the skills needed by these therapists and broke them down into core competency skills, intermediate skills, and advanced skills, Branson says. (For details of the three areas of competency, see related story, p. 68.)
The committee compiled a competency-based needs assessment form for every area and every discipline. For example, one form lists the competencies for outpatient occupational therapy, and a separate form lists those for acute care occupational therapy.
Developing the competencies for the therapy staff took about eight months. The competency assessments began last October.
The committee is working on competency and cross-training for aides and transporters, then will come up with a similar plan for the secretarial staff, Branson says.
Every therapist in the hospital must pass the core competencies for his or her discipline in all areas of the hospital. (For details on the core competency assessment, see related story, p. 67.)
Competency in intermediate skills or cross-training is required of all therapists who have been employed at DeKalb for at least a year and have worked only in their one assigned area of the hospital.
Therapists are paired with a mentor in the area of choice and have three months to complete the competency standards. (For details on the cross-training program, see related story, p. 68.)
"Schools do teach the therapists the basics, but the competency training enhances their skills and makes them more efficient and effective," Lindsay says.
And when therapists have been out of school for a while and have specialized in one area, switching to pediatrics after ten years in outpatient services may be scary, she adds.
The key to a successful competency program is to give staff an active role in the development process, help them understand the need for it, and answer their concerns, Branson says. Staff at first complained they were not going to have the time to fulfill the cross-training component.
Management, however, reassured them that their supervisors all know that cross-training is a requirement, and staff will be given the flexibility to spend time in their cross-training area.
Giving staff the opportunity to pick the area in which they wanted to be cross-trained overcame other objections, she adds.
Therapists concerned about training
Some staff were concerned that if they went through the cross-training they would be the only ones called to help in a particular area, but Branson assured them that would not happen."If I need someone in the outpatient occupational therapy department for an hour, I can call on anyone in the hospital because everyone has been through the core competencies. But if we need long-term coverage, such as for a vacation, we would call on the person who was cross-trained," Branson says.
Although the cross-training is required, the hospital has no formal policies in effect that delineate what will happen if a therapist does not comply, Lindsay says.
"We have stated that it is required, and we have buy-in from staff so we don’t think we will have to force the issue. The year won’t be up until this fall, and if some therapists aren’t complying, we may write a policy that raises will be withheld until the requirements are met," she adds.
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