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Staff Competence

Every care provider knows that they have a legal responsibility to ensure that their staff team are competent to undertake the work expected of them. Yet, often little thought is given to some key questions relating to competence. These questions are:-

• What is competence?

• How does training relate to competence?

• Why should competency be evidenced?

• How can competency be assessed?

• What if the assessment reveals that the staff member is not competent?

The following article looks at these key questions and provides some suggestions that may help providers and managers to answer the above.

What is competence?

Competence may be defined as:- “The ability to undertake responsibilities and perform activities to a recognised standard on a regular basis. It is a combination of skills, experience and knowledge.”


How does training relate to competence?

Put simply, training provides underpinning knowledge and that knowledge when embedded into practice leads to competence. Many care providers think that it is sufficient just to provide staff with training. This is far from the case, in fact this can be a dangerous assumption to make. A certificate of attendance provides evidence of only one thing – that the person attended the training. It certainly does not provide any evidence that learning occurred or that the person has improved their skills as a result of the training.


How can competency be assessed?

If we accept that competency has two components; (i) knowledge and skill, and (ii) the ability to use that knowledge and skill, then any assessment of competency should encompass both of these. It is therefore clear that competency is more than having attended a training session. It is the ability to use the knowledge gained to improve skills and to apply those skills consciously to the tasks involved in the undertaking of the role. A competency assessment should therefore cover both of these aspects and any staff development programme should be designed with this in mind.

A competency assessment framework should also be designed from the perspective of the task to be performed rather than from the perspective of the knowledge base. For example, a manual handling competency assessment should have as its core objective the ability of the person to perform a range of manual handling techniques. This ability should be underpinned by a thorough understanding of the knowledge of physiology and manual handling theory. In many cases, manual handling training consists solely of training in

Underpinning knowledge followed by a practical demonstration of techniques. Records of such training are merely evidence that staff attended a training session, they do not evidence competency.

Competency should be evidenced by a workplace-based assessment of knowledge base, the ability to apply that knowledge in a range of scenarios and an assessment of the demonstration of the application of skills in the workplace.

It is essential that the person carrying out the competency assessment is also competent. In order to be competent to carry out a competency assessment the assessor must have subject knowledge of both the task and of the assessment process. They must also have the ability to carry out the task correctly and to carry out the competency assessment. At some stage, their competency will need to have been assessed, in many cases this will be carried out by an external organisation.

The diagram left illustrates the competency assessment process. The knowledge base underpins the skills required to apply that knowledge to the task. The competency assessment assesses this application of knowledge into skills in a range of situations. This leads to increased competence. Corrective actions as illustrated by the yellow arrows are; to improve skills, knowledge or both in order to achieve competence.


What if they fail the competency assessment?

It is tempting to avoid competency assessments as they carry the risk that the staff member fails the assessment and is therefore not competent to carry out their role. This can have consequential effects on staffing levels, morale and resources. The solution is twofold; firstly, to design a competency assessment system that includes a system to address areas of incompetence in a planned manner, and secondly to embed competency assessments into the organisations quality assessment programme. The assessor explaining theory or demonstrating techniques can easily address some areas of incompetence at the time of the competency assessment. Others may require refresher training, re-assessment or possibly performance management.

A key part of the competency assessment is the action plan; this details the area where action is required to achieve competence, the person(s) responsible for these actions and the date by which this should be achieved. This can then be “signed-off” via a repeated competency assessment when the actions have been completed. Providers should implement a series of competency assessments on their staff team in key tasks i.e. medication administration, manual handling etc. If these competency assessments reveal that staff lack competence in similar aspects of the task then this information can be used to design a refresher training programme.


Maintaining competence

Maintaining competence is a continuous process of assessment against developments in legislation, best practice and techniques. Information from a range of sources can be used to inform this process, this includes; serious care reviews, investigations, reports, newsgroups etc. What is for certain is that if the organisation maintains the same level of competence it will soon be incompetent as the required competence level is continuously increasing. Regular competence assessments enable action to be taken to identify and address deficiencies in competence and thus ensures that the staff team and hence the organisation maintains the ability to carry out the required tasks in accordance with current requirements. This is illustrated by the figure below.

Conclusion

Competency assessments can be used to evidence compliance with appropriate legislation and standards, to demonstrate due diligence and to contribute to a continuous assessment of quality of service provision. Competency assessments are not tests designed to catch people out or to punish them if they fail. If you carry out or take part in a competency assessment the worst thing that can happen is that actions are required to achieve competence. The alternative i.e. not carrying out a competency assessment could lead to the death of a staff member, service user or another person.

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