Enhancing Professional Role Based Competency
By Roxane Spitzer, PhD, MBA, RN, FAAN and Enderson Miranda, MBA, CPHQ
The American health care system has undergone several reforms and is likely to undertake another reformation soon, given the sociopolitical landscape. Shifts from fee-for-service (FFS) to value-based reimbursement (VBR) models continue to transfer a significant percentage of clinical and financial risk from payers to providers. Value-based models aim to reduce potentially unnecessary health care costs, improve the quality of care provided, and increase efficiency. This aim cannot be attained unless all health care providers are completely clear about their accountabilities and competent in their professional roles.
Professional role competency demands that nurses work to the full extent of their licensure, education, and training. Registered nurses must be clear about their professional accountabilities, responsibilities, and licensure expectations by adhering to the standards and regulatory requirements from state boards of nursing and the American Nurses Association. Lack of role clarity creates variation in practice, which leads to avoidable errors.
Many of the Institute of Medicine's reports over the last several years continue to recommend that we must remove unwanted variation in health care practice through the clarification of professional role accountabilities and the promotion of evidence-based practice. In fact, evidence-based practice requires full professional role competency.
Professional competency involves practice to the full extent of professional licensure and scope of practice. Autonomous decision-making and critical thinking are essential components of the RN scope of practice. Nurse leaders must acknowledge that nurses can only be fully engaged in their profession and scope of practice in an environment that supports autonomy. However, even if the environment is perfectly conducive for full professional practice, nurses cannot be expected to practice what they don't know, nor can they be completely engaged in their work if they are not role competent and clear about their professional obligations. Therefore, role competency cannot exist without full engagement, and full engagement cannot exist without professional role clarity.
Accordingly, nurses and other health care professionals cannot fulfill their legal and ethical obligations if they are not fully engaged. Gallup's State of the Global Workplace study reported that only 30% of US workers are engaged in their work, and international figures are even worse. This is a major concern. We need nurses to be fully engaged in their practice as acuity and the aging population increases. Furthermore, ensuring efficient population management across the care continuum is essential to our future and the well being of our patients. There are many different definitions and varying opinions regarding employee engagement. A widely accepted description states that employee engagement is “a desired outcome that occurs when workers feel a heightened mental and emotional connection to their jobs, their manager, their coworkers, and/or their organization and its mission.” As a result, they are more dedicated and more willing to apply discretionary effort to their work above and beyond the norm to help their organization succeed. The multidisciplinary teamwork required to meet the total needs of our patients reinforces the demand for an engaged and role competent workforce. All members of the health care team must be engaged and fully aware of their unique roles in this collaborative and yet fast-paced environment. Fortunately, modern health care organizations can provide innovative ways to ensure their teams remain engaged in their own personal development.
Evidence-based professional development
There are different ways in which organizations can act to ensure the continued development of their nurses. Three factors are the most important when considering an effective solution to address gaps in role competency: timing, convenience, and relevance of content.
1- Timing. The learning activity must take place in a timely manner. Health care workers, especially nurses, are very busy professionals. It is guaranteed that other tasks and obligations will fill their schedule if too much time passes. Educational content needs to be available to them immediately.
2- Convenience. Our society has seen substantial advances in technology within the last few years. From smartphones, to smart TVs, to smart cars, we are used to on-demand, on-the-go, real-time access in almost all aspects of life. The acceptance of advanced technology has been embraced by all generations, from Millennials to Baby Boomers. Therefore, it is imperative that remediation be available online via computers and mobile devices.
3- Relevance of Content. The Internet has revolutionized the speed in which content becomes available, and the amount of educational resources obtainable online is amazing. However, this abundance of information can present a serious challenge. Professionals need to cut through the noise and information overload to focus their time on tailored, meaningful education resources created from evidence-based content.
Fortunately, advances in technology are providing us with resources that fit all these criteria. Evidence-based adaptive learning solutions are revolutionizing the continuing education industry. For instance, these solutions can use algorithms to create millions of crosswalks that connect specific evidence-based content to each person's unique behaviors, competencies, or area of opportunity, automatically recommending tailored on-demand educational content at their fingertips. Furthermore, adaptive learning solutions use adult learning principles that encourage the user to choose educational content based on their interests, thus creating pathways of professional development that are most meaningful to that individual. New content crosswalks are then created spontaneously by the algorithms based on the learner's choices, ensuring a personalized development experience. Additionally, adaptive algorithms automatically update every time the learner satisfactorily completes his or her assigned educational activity and corresponding knowledge checks, generating newly curated and personalized recommendations for ongoing learning based on the most up-to-date results.
David Sackett, the founder of the Center for Evidence-Based Medicine at the University of Oxford, UK, is widely considered the father of evidence-based medicine. He created many invaluable resources to enhance evidence-based practice, including the Cochrane Collaboration global research community, with the goal of ensuring that clinicians use the best available research to treat their patients. According to Sackett and his colleagues, evidence-based practice is “the integration of the best research evidence with clinical expertise and patient values."
Figure 1. The 3 Pillars of Evidence-Based Practice (EBP)
Evidence-based adaptive learning solutions are not exclusive to direct-care nurses. They also provide tailored education and data analytics to management and executive leadership, providing key insights into areas of strength and opportunity. These solutions support concepts of life-long learning and continued improvement. Management insights are often used for leadership development and frequently include expanded 360-degree variables such as input from direct-reports.
Data analytics and organizational insights
From an organizational perspective, these professional development activities produce an enormous amount of useful data that can provide valuable insights. The education department can organize training workshops based on areas of common need across the organization, directors can analyze areas of opportunities within their departments, managers can engage in data-driven shift allocation based on actual competencies, mentors can be assigned to individuals based on paired competencies, hospital systems can compare results from different hospitals and analyze development trends, and so on. The possibilities are truly limitless.
Clive Humby said in 2006 that “data is the new oil.”He was correct then, and his assessment continues to prove true today. Much like oil, data are valuable in their crude form, but they are astronomically more precious when refined into insightful information. It is imperative that organizations leverage the right tools to mine their oil wells.
A 2014 Oxford Economics study reported that 53% of executives indicate that workforce data are a key competitive differentiator, yet only 38% of these executives believe they have ample workforce data to understand their organization's talent strengths and vulnerabilities.
The adaptation of solutions to offer optimal value does not stop at the individual level. Assessment and data analytics solutions need to be customizable to allow each organization to measure the behaviors and competencies most applicable to their own professional practice models. These solutions often reduce countless hours in laborious and antiquated legacy assessment systems, provided that managers and leaders are properly trained for their efficient and effective utilization.
The bottom line
As health care leaders, we must create an environment that ensures a committed and engaged workforce that gives its best each day. We should pursue opportunities to leverage data-driven and evidence-based solutions that can add value to our employees, our patients, and the overall organization we serve. Professional role competency and evidence-based practice together can promote behaviors that meet the challenges of today and tomorrow. Health care changes and reforms will always be a variable in our industry, so we must be prepared to deal with whatever challenges come our way. Our work is to evaluate, educate, empower, and engage our employees to reach their highest potential. This will improve morale, retention, patient care, and promote a positive bottom line. Evidence-based adaptive learning solutions are a remarkable advantage to support and advocate for lifelong learning: a professional necessity.