Creating an Annual Competency Assessment Process that Results in Meaningful Quality Professional Development for Staff in the Ambulatory Setting Using the Quality and Safety Education for Nurses (QSEN) Framework

Experts predict that changes in healthcare will lead to increased volume and acuity of patients in ambulatory settings. This shift has begun to increase the need for more relevant professional development for staff in this changing ambulatory care environment.

As early as 2003, the Institute of Medicine (IOM) published their report, Health Professions Education: A Bridge to Quality, which responded to the need for professional competencies that would be able to appropriately respond to the evolving needs of the healthcare system. The annual competency assessment continues to be an important element of performance. It continues to be a regulatory requirement for The Joint Commission (TJC), and the American Nurses Credentialing Center (ANCC) Magnet recognition that reflects that staff are competent to perform their responsibilities on an ongoing basis beyond orientation. The goal of this work was to improve how the annual competency assessment process in a 66-bed practice site medical group with 1200 multidisciplinary staff could more adequately reflect the changing nature of the job, environment, and organizational strategic direction.

Strategies were employed to influence the organizational culture to make this process more engaging, accountable, and meaningful, while using a design that was outcome focused. An e-learning was designed and a workshop held to engage the senior leaders.

Key to the acceptance was the relationship to the realities of practice that reflect high-risk, problematic, low-volume activities that result in patient and employee safety. Categories were developed, referencing the quality and safety education for nurses (QSEN) competencies, to focus each individual practice sites on identifying at least three practice site specific competencies to improve: patient-centered care, teamwork/collaboration, quality/safety, informatics, and evidence-based practice. The involvement of staff in the design and validation methods encouraged moments of pride. Validation methods for each competency were reflective of the job type and were encouraged, but not limited to mock events, peer review, exemplars, discussion groups, QI monitors, return demonstrations, case studies, and presentations. Teamwork and collaboration were a direct outcome.