Posted by John Kleeman
In the world of health care, from pathology labs to medical practitioners to pharmaceutical manufacturers, a mistake can mean much more than a regulatory fine or losing money – people’s lives and health are at stake. Hospitals, laboratories and other medical organizations have large numbers of people and need effective systems to make them work well together.
I’ve been learning about how assessments are used in the health care sector. Here is the first of a series of blog articles in the theme of “learning from health care”.
In this article, I’d like to share some of what I’ve learned about how pathology and other health care laboratories approach competency assessment. Laboratory personnel have to work tirelessly and in an error-free way to give good quality, reliable pathology results. And mistakes cost – as the US College of American Pathologists (CAP) state in their trademarked motto “Every number is a life”. I think there is a lot we can all learn from how they do competency testing.
A good place to start is with the World Health Organization (WHO). Their training on personnel management reminds us that “personnel are the most important laboratory resource” and they promote competency assessment based on a job description and task-specific training as shown in the diagram on the right.
WHO advise that competency assessments should be conducted regularly (usually once or twice a year) and they recommend observational assessments for many areas of competence: “Observation is the most time-consuming way to assess employee competence, but this method is advised when assessing the areas that may have a higher impact on patient care.” Their key steps for conducting observational assessments are:
- Assessor arranges with employee a pre-arranged time for the assessment
- The assessment is done on routine work tasks
- To avoid subjectivity, the assessment should be recorded on a fixed check-list with everyone assessed the same way, to avoid bias
- The results of the assessment are recorded, kept confidential but shared with the employee
- If remediation is needed, an action plan involving retraining is defined and agreed with the employee
WHO’s guidance is international. Here is some additional guidance from the US, from a 2012 presentation in the US by CAP’s inspections team lead on competency assessment for pathology labs. This advice seems to make sense in a wider context:
- If it’s not documented, it didn’t happen!
- You need to do competency assessment on every person on every important system they work with
- If employees who are not in your department or organization, contribute significantly to the work product, you need to assess their competence too. Otherwise the quality of your work product is impacted
- Competency assessment often contains quizzes/tests, observational assessments, review of records, demonstration of taking corrective action and troubleshooting
- If people fail competency assessment, you need to re-train, re-assess and document that
If your organization relies on employees working accurately, I hope this provides value and interest to you. I will share more of what I’m learning in future articles.