Throughout the pandemic many healthcare professionals have expanded work functions and taken responsibility for new tasks. This role expansion put a spotlight on the need for digital tools that help staff quickly and efficiently convey information and guidelines to large numbers of employees.
We recently spoke with Eddy Mikkelsen, advisor in the Department for Subjects and Education. Ms. Mikkelsen manages the Dossier competence portal at Haukeland University Hospital in Bergen. We discussed how Haukeland University Hospital has used Dossier during the pandemic.
“Competence plans help us get things in order. We all know what is needed, and if staff need to be relocated, we have requirements for competence and competence plans, which they must implement before they can be included in the operation,” Mikkelsen said.
At the request of the clinical professional environment and the top management at Haukeland University Hospital, Mikkelsen and her colleagues prepared several new COVID-19 focused competency plans, including plans that cover undressing and dressing, as well as guidelines for patient cleaning and hygiene.
The Department of Subjects and Education worked closely with the e-learning team and produced short videos about the use of CPAP and respirators. This content was then distributed via Dossier’s competency platform, which pushed information to the right groups quickly and allowed for easy follow up on implementation status and competency progress.
“It is an advantage that employees know what is expected of them at all times. This means that both managers and employees have good insight into competence requirements. It benefits us all,” Mikkelsen said.
“We use competency plans to ensure employees are current on competency and in possession of the right competencies at the right times and places. In addition, we freed up a lot of time by avoiding manual review, updates and follow up. Employees automatically receive a notification when a competence requirement expires, and we have much better oversight.”
When COVID-19 entered Norway, having Dossier in place proved to be a great advantage as staff were already familiar with structured competence management, and thus, also with effective procedures for competence development and quality assurance.
“Everything has gone a little faster, and the need for new competence plans has been great. Fortunately, we work closely with those responsible for infection prevention, with directors and with those who have the professional responsibility for content. When we had to push plans for undressing and dressing throughout Helse Bergen and Haukeland, we used Dossier’s platform to immediately push those updates to 16,000 employees and students,” Mikkelsen said.
Today, Dossier is used by most of Norway’s healthcare system, as well as in Region Zealand in Denmark and Region Skaane in Sweden. Haukeland University Hospital in Bergen has been a pioneer in competence management. They were some of the first to use Dossier in 2014 when Dossier launched its new technology targeting healthcare competence management. The project was developed in collaboration with Norway, Dossier and Eddy Mikkelsen, as well as the Department for Subjects and Education at Haukeland Hospital.
The digital competency solution replaces many manual processes in a sector where there is a great need for training and competencies to be updated frequently. And during a time when complexity and documentation requirements have increased going digital makes sense and minimizes opportunities for error.
For many years, managing employee competence has been in physical and electronic folders, where it has been difficult to get a comprehensive look at competencies and competency gaps. With Dossier’s competence solution, competence development and certification can be managed and followed up within the digital competence portal, providing both managers and employees with an overview.
When exploring the healthcare sector as a market opportunity, the team agreed there needed to be a strong focus on change management, especially in relation to getting employees and managers to see the usefulness of digital competence management.
One approach to address concerns was to share stories about how shifting from paper to digital would improve efficiency and staff job satisfaction. As a result, those metrics were monitored.
The Dossier team knew they needed to select committed, ambitious partners, so they intentionally sought health systems with numerous competence requirements and documentation (e.g. in relation to introductory programs and medical equipment).
The collaboration with Helse Vest resulted in a powerful, robust platform that meets the needs of healthcare systems around the world. When you join the staff at Helse Vest today, you are automatically assigned a competency plan, which includes competency plans for hygiene, information security, fire and rescue, and first aid. The plan is valid for one to two years, and employees are notified by the Dossier system when plans expire.
To verify critical competence, digital signatures from skill assessments, return demonstrations and preceptor-based training sessions were crucial to gather evidence that satisfied regulatory requirements from auditing authorities.
The COVID-19 crisis provided Mikkelsen with new opportunities for the competency portal, “Users are more positive. We have worked systematically since the beginning, and we were able to stay one step ahead during the pandemic. Some of the doctors have previously been difficult to motivate due to busy lives, but they quickly saw the benefits of working with digital competency plans. Those who previously had reservations, now see the value.”
A CFO asks a CEO: “What happens if we invest in developing our people and then they leave us?”
The CEO responds: “What happens if we do not and they stay?”
We are often asked, “What is competence and how do leading organizations develop it?” The answer is dependent on the organization and the situation. Competence occurs when people demonstrate expertise in their roles. Competence development, then, is the ongoing assessment and improvement of the knowledge, skills, judgement and behaviors that roles require to build and sustain expertise. For organizations to excel, leaders must be strategic in their approaches to competence development, as it is essential for continuous improvement.
The strain of the pandemic has been felt at both the individual and organizational level. Many executives have used the pandemic as an opportunity to identify and close competence gaps. Evaluating employees, tasks, behaviors, processes, etc. to create standards for competence and, then, identifying individual performance gaps helps to ensure the organization and staff are on the path to excellence. This requires executives to view professional development as an investment in the organization’s future.
An organization’s competence plan should be operational and not so overarching that it only becomes words without real content. The plan should define the guidelines necessary to to mobilize, further develop, or acquire competencies. It should also be operationalized through an action plan with specific activities and an implementation timeline.
Standardizing competence helps organizations, especially those in healthcare, ensure the right people have the right skills for the tasks they are responsible for. While industry standardization is the goal, organizations can standardize competence to ensure staff knowledge while identifying and closing performance gaps. Staff appreciate the investment in professional development, which helps to boost morale. As well, organizations are rewarded with higher-quality performance.
The competence strategy, established at the organizational level, defines the vision. When creating a competence strategy, a good starting point is for executives to answer the following:
In addition to building the competence strategy, executives should also assess the environment and capture anything (internal or external) that could influence competence development and desired outcomes. This level of scenario planning can help identify budget needs and help ensure the company is adequately prepared for possible disruptions. This critical step helps to identify opportunities for changes and ongoing improvement. It may be necessary to document re-evaluation periods, times when changes to plans may be needed at the strategic level based on changes to the environment.
Establishing a clear vision for organizational competence is only part of the strategy and should be included with other goal and management documents.
Once the organization has clearly defined its vision for competence, it’s time to assess performance against that vision. Identifying gaps is a critical step in developing the action plan and a timeline for measuring improvement. Once gaps are identified, competence development can occur. Competence plans are built, implemented and monitored at various levels within the organization.
Competence development takes place in many different forms, from comprehensive formal education to more informal side-by-side instruction. Plans should use a blended learning method.
In some cases, all employees may need to be trained when, for example, an organization introduces new digital systems. In other cases, a select few may need new skills in connection with the work they perform. The starting point for prioritization should be the organization’s current situation, then future needs.
Competence development is an essential investment by the organization and needs to be viewed as such by leadership. Just as upgrading technology is regarded as an organizational priority, competence development should be, too.
Once the training needs for staff have been identified, a budget should be built. Protecting the budget from being reduced or removed, especially during recessions, is highly recommended.
When operationally mapping which competencies should be developed, involve key people in the organization in workshops designed to discuss current issues and scenarios. To be sure you have come up with the most relevant competencies, have discussions with individuals at different levels and within different departments. Systematically review each work area, department and facility. Assess instructions, procedures and requirements for the different roles. Then you can use goal and development interviews as a basis for preparing and updating competence profiles for each individual employee.
The next step is to document and educate staff about the expectations and their competency plans. Be clear about the measurable outcomes of demonstrating competence. Each action plan should be as specific as possible, but not so extensive that staff get stuck. Plans should contain the following:
Competence development should always be adapted to the organization’s ambition level and access to resources. The goal should be to make your plan thorough, but simple. Good luck in your work with strategic competence development!
The Great Resignation is a sad and sobering reality and one we will likely be dealing with for years to come. Our healthcare system has been hit particularly hard. While the U.S experienced nursing shortages prior to the beginning of the pandemic in 2019, they were exacerbated when the pandemic hit. In the U.S., about 1 in 5 healthcare workers have left their jobs since the pandemic began. With the pandemic entering its third year, questions continue about the stability of our healthcare system when frontline workers are experiencing extreme burnout.
Nearly 400,000 healthcare workers have left their jobs since the start of the pandemic, according to the U.S. Bureau of Labor Statistics. In January 2022, hospitals in 18 states reported critical staff shortages, including Kentucky. 60 Minutes recently shared a segment highlighting the challenges felt by three hospital CEOs in Kentucky, which was cause for concern. Is our healthcare system teetering on the brink of collapse? It could be if actions aren’t taken to address frontline worker recruitment and retention.
In a recent survey by the American College of Healthcare Executives, hospital CEOs ranked personnel shortages among their leading concerns, outpacing financial challenges for the first time since 2004. Overwhelmed clinical AND non-clinical staff are leaving for better pay, more benefits, and less stress. In light of this, hospital executives are forced to make retention and recruitment their top priorities.
Healthcare workers chose to work in healthcare because of their passion to help others. They are continuously learning and growing so they can provide better care to patients. With the staff shortage, these essential workers are left with just enough time to put out fires. They don’t have the luxury to spend the time they want with patients. They don’t have the luxury to spend time looking after themselves. They are overwhelmed, overworked, and burned out.
How are hospital executives trying to solve this? Becker’s Healthcare interviewed 22 executives asking what changes are needed to improve retention.
To no surprise, mental health and wellness was cited as one of the most important factors to reduce and manage burnout. A strategy could be as simple as an executive walking the halls and wards thanking the staff. This is effective in a crisis (such as the pandemic) but is not sustainable or scalable. Hospitals should also look for simple-to-implement, innovative methods to help staff free up time, and allow them to take that critical mental break.
Another critical and effective strategy to improve retention is staff engagement. During times of high-stress, it’s easy to lose sight of one’s sense of purpose and deprioritize individual growth. Hospital executives can help staff keep purpose and growth top of mind.
An effective onboarding process helps to set employees up for success — helping new hires acclimate to the culture of the hospital should be part of the onboarding process. Hospital executives that include recognition and professional growth as part of staff orientation can help to keep staff engaged — which affects retention through job satisfaction. In a recent Becker’s Healthcare article, two statements, in particular, support this need for staff engagement as a retention strategy:
“Providing managers and leaders with tools through focused education and training is imperative to a successful engagement culture.”
Director of Employee Relations
Marshfield Clinic Health System
“In addition to all our efforts and successes in retaining what staff we have, we will have to continue to recruit new healthcare workers.”
Chief Human Resources Officer
Lakeland Regional Health
For existing employees, gaining new knowledge through upskilling and career laddering helps them feel valued by the organization and reinforces that their careers are moving forward. Staff feel valued by their organizations when they experience professional growth and career advancement. And that translates to increased job satisfaction.
Millennials are now the largest generation in the workforce. They value diversity, equality, empowerment, involvement (a respected voice in what is going on), flexibility (real flexibility, not just bid shifts), formal professional development with planned (guaranteed) career advancement, all things technology and mobile, and organic cultures with much less structure. Hospital cultures need to evolve with the wants and needs of this modern workforce. Hospital executives can support that evolution by focusing on these values and incorporating them into the organization’s culture.
As an industry, our goal should first be to help our current workforce regain their personal time and focus on their wellness. This will help to address burnout and increase attrition. Then, focus on professional growth. Career advancement is important; it helps establish value between employer and employee. We also need to look for new, creative ways to onboard and train new staff so we can easily and quickly ensure their competence and continue to deliver high-quality patient care.
Through the heroic efforts of our healthcare leaders, clinicians and other essential workers, we have kept up with the demands placed on healthcare—in many cases, just barely. But this is not sustainable unless things change. Healthcare is feeling the pressures of digital transformation. Historically, it’s been slow to invest and evolve. But now, we are at an inflection point. We MUST embrace technology if we are to sustain the level of healthcare quality and safety that is expected today.
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