Standards and Competencies: Are you using them effectively?

Peggy McElgunn, Esq. Executive Director, Alliance of Cardiovascular Professionals Midlothian, Virginia
Peggy McElgunn, Esq. Executive Director, Alliance of Cardiovascular Professionals Midlothian, Virginia
Standards Necessary to Improve Performance Training to improve performance has always existed. As long as there have been skills, there has been training to prepare the new generation to take over for the old. Initially, it was one-on-one, on-the-job training; however, with the increase in technology and the need to constantly retrain practitioners, assigning new practitioners to the seasoned professional solely was no longer effective without coupling it with documentation and support necessary instruments for accreditation and quality improvement processes. The Alliance of Cardiovascular Professionals (ACVP), in answering members’ pleas for support, has developed Standards and Competencies for staffing various cardiovascular (CV) service delivery specialty labs. The ACVP membership clearly indicated the need for documentation outlining the staffing requirements, technology support, and equipment requirements necessary for minimum service delivery. In response to this request, the ACVP board established a committee for each specialty supported by the membership: invasive, noninvasive, and echocardiography. These committees then spent over 12 months gathering information from across the membership to determine the minimum requirements and elements in labs necessary for quality and success. The result of these labors was the ACVP Standards and Competencies. Given the rate of change in technology and the workplace, and the increased emphasis on performance improvement, the growth of the CV profession has been dynamic. This has had many benefits, one of which has been the ability to integrate change and eliminate what doesn’t work. For example, equipment that was vital a decade ago is, in some cases, no longer required due to technologies that have advanced the field. On the less positive side, however, there have been a proliferation of job titles and an overlap in functions which has hampered communication among the members of the profession, as well as with management. This lack of consensus as to what roles and function define the field, as well as the growing number of personnel assigned performance improvement functions without any preparation as trainers, has been a cause of concern for many in the profession. Professions Have Standards Traditionally, professions are characterized by sets of roles, common language and functions, and the need for specialized preparation. It also includes a means of self-monitoring assuring that practitioners uphold professional standards and perform at a minimum level of competency. ACVP leadership, over a period of years, has evolved a set of standards for the purpose of maintaining and increasing the credibility and accountability of those in the cardiovascular and pulmonary profession, thereby guaranteeing continued employment. Translating Competencies Into Tools and Processes Throughout this article, work standards will refer to the performance expectations that are established by the collection of competencies. Competencies will be taken to mean the skills required. It is important to remember that standards serve the profession only if they are used appropriately. Competencies need to be nurtured and protected, because knowledge fades if it is not used. For example, many years ago, math knowledge was not a focus for competency in the lab it was presumed that this was garnered through schooling. However, with all of the different disciplines now practicing in the lab, all having been trained through different vehicles, math knowledge is quickly becoming a necessary skill that must be measured for success. The ACVP competencies, or behaviors and criteria, can be used to help an educational facility or training department: Evaluate the quality of the training courses it develops; Evaluate the quality of training delivery; Evaluate the effectiveness of the department and its products; Identify the professional development needs of the students or current staff; Develop job descriptions; Evaluate prospective candidates for positions; Develop and/or select appropriate courses or curricula to train the professionals; Develop a systematic approach to developing and implementing and managing training. Although each competency is thoroughly explained in the ACVP document, none are designed to be used by simply retyping them under the headings Job Description or Performance Appraisal Criteria, etc. Rather, they provide the data necessary for an organization to develop its own performance-based professional development system and all of the tools and processes accompanying that system. It is necessary for any organization to adapt the specific competencies to their own culture and goals. The following outlines some strategies that may be used in translating competencies into tools and processes to improve performance. Hiring Competencies can be used as a baseline against which managers can evaluate the training and experience of applicants for positions. Employers could possibly hire more fully competent people if instead of trying to infer confidence and commitment from a projected image in the job interview, they required tangible evidence of success and competencies. Applicants can be given a pre-interview assignment, which might include reading the competencies in preparation for interview questions or writing an essay related to one or more of the competencies. An applicant's critical thinking and problem-solving skills, ability to write with clarity and develop ideas in a logical manner, as well as his/her understanding of the competencies could be evaluated in a pre-interview writing assignment. Interview questions can be structured to gather information regarding an applicant's knowledge and experience related to various competencies. Perhaps best of all, the specific performances, behaviors and criteria that accompany each of the competencies provide a baseline for evaluating responses. Job Expectations To clarify what is expected on the job is essential if that job is to be done well. This is not achieved by simply listing those skills or tasks necessary for the completion of a job, it requires an understanding of what the tasks are designed to accomplish so that the competencies are not ends in themselves, but become means to an end. A customized set of job expectations can be created by breaking down the competencies into their performances and behaviors and identifying/prioritizing those that are most consistent with the needs and culture of the organization. During this process, a common understanding can be arrived at regarding the policies and procedures, available resources, lines of communication, timelines, etc. that characterize your organization. The process also serves as a forum for identifying the end accomplishments that should be the result of the competencies and the criteria by which the professional’s performance and accomplishments will be measured. The result of this process can be viewed as a contract among those involved. In essence, the agreement of each participant indicates his/her understanding of and commitment to the terms of the contract, whether they be in the form of a job description, set of policies and procedures, a performance appraisal or a professional growth plan. Training/Professional Growth Once there is agreement as to the requirements of a particular position, it is necessary to identify the skills or knowledge needed by the person who has to meet these requirements. This is a needs assessment, which identifies any gaps between the current knowledge and skills level of a job holder. The performances associated with each of the competencies provides the information that can be used in conducting such an assessment. Evaluation A good evaluation is objective-based; that is it measures the extent to which the program objectives have been met. The specific objectives provided by a competency-based professional development system provide the criteria against which to measure accomplishments. Commitment and confidence may be inferred from behavior, but competence must be observed directly. Incompetent employees cannot pretend to know what they are doing for long. Competency-based accomplishments can also be documented by means of: Performance checklists Observation by peers and supervisors Degree to which an organization’s employees meet performance-based objectives as a result of participation in courses offered. Succession Planning In the past, the number of years in an organization or a favorable relationship with a supervisor might have influenced raise and promotion practices. Specific competencies make it possible to base salary increase and promotion on performance. Competencies not only make the supervisor’s job easier by providing guidelines and increasing objectivity, they make it easier on the employee as well. If an employee knows that he or she must reach a specified level of attainment to secure a salary increase or an opportunity for promotion, s/he can focus efforts in that direction. Enhancing Professional Credibility One of the first things that begins to define a profession is the language with which its members describe what they do. This enables practitioners to communicate with each other about their roles and functions with some degree of common understanding. It does not, however, mean that they agree regarding roles or functions, and it often excludes those outside the profession who do not know the language. By identifying the minimum tasks that are necessary for training to bring about improvement in productivity or performance, and spelling out who does what by when, competencies reduce the variance with which roles and functions are viewed within the profession. They also make more precise the tasks we engage in and the processes by which these tasks are accomplished. This degree of professional unity we project. It also enables the lay person to better understand the roles, functions and processes involved and the theories that underlie them. Together, these go a long way toward enhancing professional credibility. The ACVP Standards and Competencies were developed by the ACVP leadership over a period of several years and have been fashioned to be successfully utilized by all organizations interested in the training and performance of the cardiovascular specialties. The Standards and Competencies are available to ACVP members upon request. If you would like a copy, please contact the ACVP National Office at (804) 632-0078. Peggy McElgunn can be contacted at peggymcelgunn@comcast.net