The right way: staff training and competency assessment

Medical Laboratory Observer, Dec, 1996 by Karen A. George

Competency testing can be painless and tremendously effective if you exercise an organized, comprehensive plan.

Accrediting and regulatory agencies have different requirements for competency assessment. Discussed here are the requirements of the American Association of Blood Banks (AABB), the College of American Pathologists (CAP), the Clinical Laboratory Improvement Act of 1988 (CLIA '88), and the Joint Commission for Accreditation of Healthcare Organizations (JCAHO), as well as ways to meet these requirements through staff training and competency assessment programs.

In general, the effectiveness of orientation, training, and education should be evaluated and reported through a quality improvement (QI) program. Similarly, staff competency should be evaluated and reported regularly so that problems may be identified and solved in a timely way.

It seems everyone is mandating that employees demonstrate competency; however, most guidelines are not specific. So how should this be done? It's pretty much left up to you to decide what is the most efficient yet effective way to proceed.

Some employees may perceive competency assessment as a threat. It is very important to explain to employees exactly what is going to occur and why. You may wish to give employees copies of accreditation regulations, if necessary.

Employees must understand the goal of competency assessment is to improve performance, hence improve patient care. Whenever possible, corrective action should not be punitive. Education should be stressed.

Another problem may occur during actual testing. Some employees may feel someone is looking over their shoulder or checking up on them. This may be true, especially if observation is used by the supervisor to assess competency. Employees may feel their supervisor does not trust them, or worse, is hoping they'll make a mistake.

Once again, continue to emphasize the goal of the program. Inform employees in advance of what skills are to be tested. If possible, let them know when they will be tested so they will feel more prepared. Since everyone should demonstrate competence, don't forget to assess supervisors and support personnel, not just technologists.

Varying requirements

Here's what is required by each agency:

AABB. AABB requires a quality assessment and improvement program to ensure personnel are knowledgeable and skilled in their assigned duties. The Association demands a quality management program that includes periodic evaluation and documentation of competence of personnel to perform assigned duties.

At least annually, the employees must demonstrate their abilities to carry out every test or procedure they may be called upon to perform. The AABB standards suggest use of proficiency testing, written and oral exams, and observance of daily work. Corrective action to improve substandard performance must be documented.

CAP. CAP requires a sufficient work force with adequate documented training and experience to meet the needs of the laboratory. Periodic evaluations are required.

CLIA '88. CLIA '88 requires a mechanism for periodically evaluating the effectiveness of policies and procedures to ensure employee competence (see box, "CLIA's required procedures for evaluating laboratory staff competency"). The procedures for evaluating competency must include those listed in the box. The laboratory director must employ competent personnel to perform and report tests, and the technical supervisor is responsible for evaluating competency. The technical supervisor also is responsible for conducting performance evaluations semiannually for new employees during their first year in the lab and annually thereafter. The technical supervisor may delegate these periodic evaluations to the general supervisor. Corrective action to improve performance must be documented.

JCAHO. JCAHO requires individual competency to perform tests safely and accurately and to prevent transfer of infection. The laboratory director must maintain competency of staff initially and continuously. Proficiency must be demonstrated and documented. JCAHO also requires performance evaluations and suggests appraisals of routine test performance, recording and reporting of results, quality control, proficiency testing, calibration performance, and assessment of problem-solving skills. Blind testing also is suggested by JCAHO.

Measuring competency

There are many ways to demonstrate competence, some more complex and involved than others. Likewise, there are several methods by which competency can be assessed, including the use of blind samples, proficiency testing, written and verbal exams, direct observance, daily reviews of test results, delta checks, and use of physician alert values.

Frequency of assessment. So, how often should an assessment be done? An assessment should occur upon employment and at least annually thereafter. AABB standards require performance assessments semiannually during the first year of employment. One way to comply with this standard is to do a follow-up skills assessment, perhaps at the end of the probationary period three to six months after the date of hire.