Healthcare Workforce Transitioning

Competency Conversations through World Café

Dr. Anne Drabczyk

• Publisher: Productivity Press
• Year: 2019
• ISBN:
  9780429680663
• Edition: 1
• Topic: Médecine
• Subtopic: Santé publique, administration et soins

Healthcare Workforce Transitioning shares with educators and healthcare professionals alike the awareness, integration, and partnership that results from a successful process of framing a Healthcare Management Program around core competencies. To transition toward a successful healthcare career requires proficiencies in communication, leadership, professionalism, knowledge of the healthcare environment, and business skills. Competencies provide context to curriculum construction and build awareness of the role this standard plays in a career-ready workforce. Integrating professional development and service learning into co-curricular activities further strengthens outcomes. Partnering with healthcare professionals through ongoing World Café conversations, contributes a touchstone about expectations and accountabilities to be successful in a career.

This book draws on the World Café methodology, guidelines, and vignettes in developing performance assessment, coaching, training, and performance reviews. The author provides lessons learned throughout the text to illustrate the points made in the chapters. It also provides a proven participatory methodology applied to competency exploration, application, and authentication.

Chapter 1

Healthcare Competencies: Framework for a Program

Origin of the Competency Conversation

Advancing healthcare workforce transitioning is not a new idea. For the last couple of decades it has been a component of healthcare reform. Indeed, the healthcare workforce is in as much transition as the healthcare system. In order for the restructuring agenda to progress, we must support a focus on the very personnel and teams that will make an optimal healthcare system a reality. One component of such a focus rests with sustaining a healthcare competencies conversation, and we will examine the origin of that dialogue.

The Institute of Medicine Reports

In order to give context to this chapter, a little history will be helpful. The Institute of Medicine seminal report, To Err Is Human: Building a Safer Health System, revealed the shocking state of healthcare in the United States, and focused on the need for patient safety and reduction of errors (Institute of Medicine 1999). The foundational report was followed by Crossing the Quality Chasm: A New Health System for the 21st Century, and highlighted “what we know to be good quality healthcare and what the system actually provides.” The Chasm report set forth “an ambitious agenda redesign of the broken health care system to achieve six national quality aims; safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity” (Institute of Medicine 2001).

The emerging healthcare paradigm is going to be a challenging goal, and of particular interest is the need to prepare the workforce. As stated in the Chasm report: “therefore, the importance of adequately preparing the workforce to make a smooth transition into a thoroughly revamped healthcare system cannot be underestimated” (Institute of Medicine 2001). To meet this objective would require a redesign of the way health professionals are trained to emphasize the six aims for improvement.

The next major publication, Health Professions Education: A Bridge to Quality concentrated on the healthcare workforce. The recommendation of the report was that “all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics” (Institute of Medicine 2003b).

The foundational work of the Institute of Medicine occurred long before the Patient Protection and Affordable Care Act of 2010, which added many more previously uninsured Americans to an already burdened system, and so the conversation about competency is indeed timely. One example of how healthcare is experiencing a paradigm shift is as fundamental as how business is conducted, moving from a fee-for-service approach to a value-based one. “In value-based models, healthcare providers are paid on the basis of keeping healthy patients healthy while caring for and improving the health of those suffering from acute and chronic illnesses with cost-effective and evidence-based treatments” (Lipstein et al. 2016, p. 6).

A burgeoning patient pool and major system changes underscore just how timely a healthcare reform conversation really is. Thompson (2018) noted “in the last quarter, for the first time in history, healthcare surpassed manufacturing and retail, the most significant job engines of the 20th century, to become the largest source of jobs in the U.S. The entire healthcare sector is projected to account for a third of all new employment.”

Implications for Healthcare Workforce Transitioning

Certainly it stands to sense that as the healthcare system is under scrutiny to change, so too there are implications for the healthcare workforce in transition. Healthcare News (2018) reported “a low supply of healthcare workers is quickly becoming the biggest challenge to meeting patient care demand. This challenge is exacerbated by other important issues, such as changing reimbursement formulas, increasing competition, complex regulatory mandates, technology demands, and uncertain and disparate public policies.” If the healthcare workforce resource is left undeveloped, the repercussions could literally mean the difference between life and death.

A survey of healthcare executives identified core competencies of a successful healthcare executive of the future. “These competencies include management skills across hospitals, ancillary providers, physician practices, ambulatory settings, as well as skills and risk management and quality. Results suggested how the curricula of healthcare administration programs can be revamped” (Love and Ayadi 2015, p. 4). The American Hospital Association website details Bridging Worlds; the Future Role of the Health Care Strategist (2017), and “the report is a comprehensive roadmap for skill development, self-assessments, and targeted educational activities to grow individual and team skill sets.” Emphasis on multidisciplinary teams seems to be a model for tackling healthcare reform challenges.

The healthcare field is dynamic and changing now more than ever. To keep pace with healthcare reform will require a skilled workforce that can transition as the system does. The healthcare worker of today and tomorrow will have to have a broad array of competencies in their arsenal to successfully manage patient-centered and evidence-based practice, all while being a member of an interdisciplinary team. It is apparent that America’s top thought leaders are concerned and focused on the healthcare workforce. Exploring the potential that healthcare competencies offer in preparing the workforce of the 21st century is one way to ensure a career-ready workforce up for the task.

Healthcare Competency Potential

The case for healthcare reform was brought into sharp focus by groundbreaking Institute of Medicine reporting, and the urgency to train a 21st century healthcare workforce has been acknowledged. Perhaps the current phase of this journey toward an optimal healthcare system is embracing the potential of healthcare competencies. If our path forward is made possible through the workforce in transition, then connecting competency with performance to improve systems may just be our guiding light.

Given the complexity of healthcare disciplines, it is understandable that a varied list of competencies would ascend throughout the system. So, what are the essential skills germane to healthcare? Many associations and agencies have attempted to answer this question.

The Healthcare Leadership Alliance (HLA), an association of leading healthcare member organizations defined competencies as “clusters that transcend unique organizational settings and are applicable across the environment” (Stefl 2008, p. 360). HLA identified five core competencies: communication and relationship management, professionalism, leadership, knowledge of healthcare systems, and business skills and knowledge.

Englander et al. (2013, p. 1090) conducted a meta-analysis of existing competencies in the healthcare system “in order to work toward a common taxonomy. Although there were core similarities across disciplines, there was a need to add, conflate, and eliminate duplications.” A sample tweak that evolved from advanced analysis was “broadening the title of one domain from Medical Knowledge to Knowledge of Practice.” This adjustment may not seem to be a big one, but it served to expand the application of the competency beyond just a clinical interpretation to a more inclusive one of healthcare professions across the general practice of healthcare.

The National Academy of Medicine “identified 8 emerging areas in need of competency development: informatics, communications, competency-based participatory research, global health, ethics, genomics, cultural competency, and public health and law. While the list of competencies and training needs is robust, it is without clear prioritization. This remains a critical gap in workforce development” (Sellers et al. 2015, S14).

Even if we can imagine one day when a universal set of competencies is established for healthcare; what happens then? The competency is only as effective as it is exercised and assessed to improve performance, and this is where an accrediting body plays a role. The healthcare discipline is only too familiar with certifications and licensing. But, according to the Institute of Medicine (2003a), “accrediting organizations vary in their approach to the core competencies, ranging from assessing such competencies in their standards, to requiring related curricula and education experiences, to encouraging educational institutions to include the competencies.”

While working at the National Association of County and City Health Officials, I had an opportunity to liaise with the Public Health Foundation (PHF). The PHF Council on Linkages Between Academia and Public Health Practice worked to develop a consensus set of skills for the broad practice of public health, as defined by the 10 Essential Public Health Services. In June 2014, a set of Core Competencies were adopted around eight domains, reflecting skill areas within public health, and three tiers, representing career stages for public health professionals (Council on Linkages Between Academia and Public Health Practice 2014).

Associating competencies with job descriptions (Public Health Foundation...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• List of Tables
• Preface
• Author
• 1. Healthcare Competencies: Framework for a Program
• 2. Professional Development Portfolios
• 3. World Café
• 4. Healthcare Communication Competency
• 5. Healthcare Leadership Competency
• 6. Healthcare Professionalism Competency
• 7. Healthcare Environment Competency
• 8. Business Skills Competency
• 9. Healthcare Workforce Transitioning
• Index