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Clinical Center Competency Program

Competency - What's that all about?

JCAHO defines it as "a determination of an individual's capability to perform expectations". Think about it like this - competency is how well we use and integrate our knowledge, skills, and abilities in performing our jobs.

The entire issue of competency moved to the CC's front burner of Joint Commission issues because of JCAHO's revised Education, Training, Orientation, and Competency Standards. JCAHO expects each organization to create a shared vision of competence and to assess competency regularly. Some specific standards covering this area are:

HR.3: The leaders ensure that the competence of all staff members is assessed, maintained, demonstrated, and continually improved.

HR 4.2: Ongoing in-service and other education and training maintain and improve staff competence.

HR 4.3: The hospital regularly collects aggregate data on competence patterns and trends to identify and respond to the staff's learning needs.

Why do we need to define competencies in the first place?

To give people a clear idea about what they need to do to prepare themselves to succeed at their jobs. In order to be successful, organizations also must be able to identify what employees will need in the way of competency in the future. It's the only way to make sure that employees are prepared to handle responsibilities dictated by current and evolving organizational objectives.

How are competencies developed? Who's responsible for developing them?

Individual departments define and describe specific competencies for most positions held by Clinical Center employees. It's normally a collaboration among supervisors, employees, department heads and administrative officers, and the staff of the Office of Human Resources Management. These competencies are considered "job or position-specific". Many organizations are also adopting "core or generic" competencies, which would apply to all employees. The "organizational competencies" usually reflect the strategic mission, vision, and guiding principals of the organization.

Does the Clinical Center have core competencies?

We do. There are four. A group of educational specialists from each CC department drafted them. They were then presented to all department heads, the Quality Assurance Team, and the JCAHO Work Group for discussion and feedback. The final draft was approved by the CC Executive Committee in February 1997.

What are they?

All employees are expected to possess a basic level of competency in each of these areas:

Safety and Emergency Preparedness - Engages in proper safety, emergency preparedness, and infection control practices.

Quality (or Performance) Improvement - Provides quality service in all endeavors by supporting initiatives designed to improve individual and organizational performance.

Diversity Appreciation and Communication - Effectively communicates and interacts with patients, their families, and other external and internal customers (including fellow employees) from diverse backgrounds.

Customer Service - Anticipates, assesses, and responds effectively to the needs of diverse customers both internal and external, making excellent customer service the first priority.

How will I know if I'm meeting this basic level of competency in those areas?

The value of the competency is the expression of the behavior. Certain things that you do, certain behaviors, indicate that you are competent. Here's an outline:

Competency: Safety and Emergency Preparedness

Basic Level Behavioral Indicators

  • Emergency Procedures: Demonstrates and/or describes how to respond to an emergency involving a life-threatening medical condition, security incident, failure of a critical building utility, fire or other hazardous materials incident (Procedures outlined in the CC Emergency Handbook).
  • Infection Control: Demonstrates or describes appropriated measures for preventing the spread of infection.

Competency: Quality (or Performance) Improvement

Basic Level Behavioral Indicators

Understands, verbalizes and participates in the quality improvement process especially as it relates to customer service. Demonstrates knowledge of the Clinical Center's strategic mission, vision, and guiding principles.

Competency: Diversity Appreciation and Communication

Basic Level Behavioral Indicators

Listens to others, asks for clarification when needed, and expresses one's own point in an objective and issue oriented manner. Is alert for and constructively challenges inappropriate or offensive behaviors. Encourages diverse opinions and ideas when engaged in work projects or hospital activities. Provides access to translator or translation services when necessary. Utilizes appropriate hospital services designated when needed to communicate with employees and patients with speech and hearing disorders.

Competency: Customer Service

Basic Level Behavioral Indicators

  • Promotes courtesy to customers through the use of verbal amenities.
  • Promptly answers telephone with identification of self and service.
  • Demonstrates active listening by acknowledging and clarifying verbal messages to ensure mutual understanding.
  • Seeks information to better understand customer needs and requests.
  • Proactively keeps customers informed by giving timely and appropriate feedback.
  • Assesses problem situations and initiates effective service interventions that result in customer satisfaction (i.e. informs patients about delays).
  • Diffuses sensitive or difficult customer situations and creates a climate for mutual problem-solving.
  • Explores ways of accommodating different customer requests, cultural practices, and age progression in order to provide sensitive customer service.
  • Demonstrates through daily interactions that all individuals in the CC are our customers.
  • Coordinates role with staff in other departments in order to effectively meet customer service needs.

What type of competency-based training and assessment is required and how should it be documented?

There's no one answer. Competency training and assessment can be done in many different ways. For instance, training can include formal courses, classes and in-services; mandatory reviews; policy and procedure reviews; videos; written materials; supervisory instruction and review; and self-directed learning modules. Common methods of competency assessment include observation; demonstration, verbalization, test or quiz; and documentation review.

What type of training is considered adequate for meeting and maintaining competency in the four areas?

New Employee Orientation:

Any employee who completes it will receive the basic information needed to meet the Safety and Emergency Preparedness Competency. It's the supervisor's responsibility to assess it as he or she deems appropriate.

Fire drill training:

This training, which covers the basics for responding to a fire emergency, is required for all areas of the CC. Drills are done on a regular basis (quarterly per shift for patient care areas and annually for all other areas). To arrange a training session or ask questions, contact Paul Davis (Fire Protection Section, Emergency Management Branch, Division of Public Safety, ORS, OD) at 6-0487.

Emergency Handbook:

JCAHO will expect all employees to know what RACE means for their work areas; where your exits, fire extinguishers and fire alarm pulls are located; and who to call in an emergency. All of this is covered in the Emergency Handbook given to new employees in Phase I Orientation. Employees who need another copy can contact Dr. Michelle Evans at 6-5281. The handbook is on the CC home page under NIH Staff Resources.

Emergencies: General Procedure - RACE

If You Discover a Fire Remember "R.A.C.E. for FIRE"

E=Extinguish or Evacuate

Alert other personnel in the area. Team up with a co-worker and take the following actions:

  • Remove anyone in danger. If you need help, call out to others nearby.
  • If you can do so without endangering yourself, take immediate steps to ensure safety of patients, visitors, and others in danger.
  • Activate the fire alarm. Pull the fire alarm pull station and then dial 911 on any phone and report:
  • Building, floor, wing, and room number.
  • Nature of the emergency.
  • Your name and telephone number
  • Designate someone to meet the NIH Fire Department and direct them to the scene.
  • Confine fire by closing door to the area.
  • Extinguish the fire only if you can do so without endangering yourself or others, only after notifying the NIH Fire Department. When using a fire extinguisher, fight the fire from a position accessible to an exit to avoid entrapment. If in doubt, evacuate the area and wait for the NIH Fire Department to arrive.
  • Do not return to the area until it has been evaluated and deemed safe for occupancy by the fire officer-in-charge.

Universal Precautions/Tuberculosis training:

This may satisfy the requirement for most employees to provide an understanding of the risk of blood-borne pathogens and ongoing training in infection control issues.

Basic Infection Control Instruction:

This is for employees who need an update in basic infection control. It was devised by the Clinical Center, Hospital Epidemiology Service (HES) and is available on their home page. Employees may review the instruction on the computer. It can also be printed and given to employees who prefer to review on paper.

By request:

HES staff are available to give seminars on infection control topics to requesting Clinical Center Departments.

Quality (or Performance) Improvement:

Basic information is provided during New Employee Orientation. Laura Lee, Special Assistant to the Deputy Director for Clinical Care, is available to give a 30-minute slide presentation entitled, Quality Improvement-The Basics for CC Departments.

Diversity Appreciation and Communication:

The NIH Office of Equal Opportunity and Diversity Management provides on-line training education modules.

Customer Service:

A half-day training program entitled "Contact: You Make the Difference" is available for both employees and supervisors.

Once training has been completed does that mean that the competency has been met?

Training is provided to help employees obtain the knowledge, skills, and abilities that are necessary for meeting a competency. But the process doesn't end with training. Assessment is the only way to verify that competency is met and continues to be met.

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