Ann & Robert H. Lurie Children's Hospital of Chicago used to rely on paper competency checklists in its nursing professional development.
THE CHALLENGE
Using paper checklists was challenging and inefficient to track and maintain documentation related to orientation progression. New hires were responsible for the paper checklists, which often were forgotten in lockers, left at home or lost. Transparency of orientation progress was minimal and only visible when a new hire shared the paper checklist with their preceptors and leadership team.
Communication of skill progression, areas for continued practice and goal setting was limited and often did not occur between multiple preceptors as the paper checklists were not updated frequently.
Documentation on paper checklists often was incomplete or needed correction as it did not meet requirements of accreditation agencies. Much time was spent working with new hires and preceptors to complete and correct documentation.
"In addition to the lack of orientation transparency and documentation inefficiencies, the competencies on the checklists were not consistent and there were multiple versions of each competency," said Lisa Tieman, RN, nursing professional development specialist, competency management, at Lurie Children's Hospital. "The competencies evolved over time to become a reminder to the preceptors of what to teach, rather than measuring competence of the new hire.
"The education department, which maintained the checklists, did not have an established process for developing or reviewing the competencies," she added. "This resulted in multiple versions of the same competency and duplication of content within the competencies."
PROPOSAL
The application that housed the competencies was nearing end-of-life and a new system was needed to create and maintain the competencies. Moving to a digital platform was the ideal situation as the hospital was seeking ways to move away from paper documentation for improved record keeping. Paper checklists were proven to be inefficient and time-consuming, and it was decided a digital system was needed.
"Several skills and competency management technologies were evaluated for features, transparency and functionality," Tieman recalled. "The staff in the education department needed a competency management platform to decrease the amount of time spent locating paper checklists, ensuring documentation was complete and ensuring the checklists were in the employee's file.
"Much time was spent on these tasks, and the goal was to improve efficiencies for the new hire, preceptor and leadership team," she continued. "Improving documentation and streamlining the process of employee file reviews for accreditation agencies and surveyors was a desired outcome."
Technology was needed to house and maintain both initial and annual competencies. The initial competencies for the paper checklists were housed in an application that did not allow for the export of the competencies. Annual competencies were developed individually and kept with the author of the competency rather than in a centralized location. This process led to duplication of work and proved challenging to locate competencies when surveyors were on site.
"The implementation of a skills and competency management platform from Kahuna Workforce Solutions provided the education department an opportunity to evaluate the current initial and annual competency process," she explained. "A competency template, which could be used across departments, was created, and guidelines were established on how competencies would be created and used within the organization.
"A full review of all initial competencies was completed – duplications and gaps were identified, and over the course of a year, all initial competencies for nursing and respiratory were rewritten to align with the new template and guidelines," she continued. "The competency management technology allowed for the standardization of competencies, which promoted a more standardized approach to orientation and patient care."
MEETING THE CHALLENGE
The skills and competency management technology now is being used to track initial and annual competencies, education/in-services, cross training documentation, preceptor competencies, class attendance and agendas, department meeting attendance, and requirements for committee members.
"This technology is currently being used with all nurses, medical and nursing assistants, advanced practice providers, respiratory therapy, facilities services, neurodiagnostics, procedural areas, ECMO, and dialysis teams," Tieman said. "All point-of-care testing throughout the organization is documented in the system and monitored by the point-of-care team. Pharmacy, sterile processing, medical imaging and rehab services are in the process of being added into the system over the next year.
"To improve tracking of committee involvement, the Nursing Professional Governance Board asked to track committee membership and involvement in the platform," she continued. "This will improve tracking and data required for Magnet. This allows for staff to share their involvement in the organization with their leader and demonstrate professional development throughout their career."
Leaders can easily identify which staff members are involved in nursing professional governance and are working toward advancement, she added.
"Currently there is a manual, one-direction integration with the Workday system," she explained. "This allows for the transfer of HR information and Workday Learning information to be pulled into the competency management technology.
"Work toward automated integration is planned for the coming year," she continued. "The point-of-care team presented a request for an integration with our RALS system and has been scoped and is planned for implementation this fall. Requests for integration with Rounds+ and Red Cap are currently being explored to allow for improved transparency and access to data collected by each system. Adding the platform app to our Voalte phones used by staff also is being explored."
Lurie Children's Hospital's use of competency management technology has promoted transparency to staff and leaders regarding professional practice and development. Ownership of competency attainment is no longer kept with the education department – it now is visible to staff and leaders. It also has streamlined the process for employee file reviews for surveyors. All current and historical information is kept in one place and allows for a streamlined file review process.
RESULTS
When the technology was first implemented, the main goals were for competency standardization, improved transparency into orientation and competency attainment, and reduced time spent following up with staff to complete checklists. Everything would be kept in one system and reduce the challenges associated with paper documentation.
"A process for annual competency identification has been created and implemented," Tieman reported. "Much work has been done within the organization to identify the differences between competency and education, both of which are easily tracked within the competency management technology.
"Since implementation, there has been a push to explore additional uses of the technology," she continued. "Now departments are tracking annual requirements for staff including staff meetings and required in-services, attestations of receiving information. Staff can view requirements for their roles and know if they met the identified goals."
Work is being done to shift the ownership of professional practice to the staff. Prior to the implementation of the competency management technology, this was a challenge, as completion of required items was kept with the education department.
Staff would have to ask or be told if they were approaching expiration dates or they were due for annual competencies. Now there is full transparency to staff and leaders of progression toward annual requirements.
"Over the next several months, we'll also be introducing a dedicated digital clinical ladder platform to complement our existing skills and competency management technology," Tieman said. "The clinical ladder platform will leverage the user information and competency completion in the competency management technology.
"The validations of competency completion will transfer from the main platform to the ladder platform and eliminate the need for leaders to write letters validating practice," she continued. "The ladder platform will allow staff and leaders to have clear insight into if requirements for promotion have been met."
Given the amount of data captured by competency management technology, staff are starting to evaluate time to competence for new hires or staff moving into new roles.
"We are exploring methods to better capture skill attainment for nursing assistants transitioning into the nurse role and how this can improve confidence and decrease time to competence," Tieman reported. "We are exploring more opportunities for cross-training staff to additional roles and to promote professional practice growth.
"Competency management technology allows for quick identification of staff by role and by competency or skill," she added. "It has assisted in promoting practice alignment between the different departments."
ADVICE FOR OTHERS
When considering using skills and competency management technology, there are several key factors to consider, Tieman advises.
"It is important to have a structure in place that identifies who will be responsible for maintaining the platform and who will have access to add items to the platform," she said. "A strong structure is important to maintaining the integrity of the system and to ensure a systematic approach to skills and competencies.
"Additionally, identification of who will be responsible for identifying and/or creating skills and competencies that will be used within the competency management technology is necessary," she continued. "When transitioning to skills and competency management technology, there is quite a bit of work to be done to transition existing items into the technology platform."
Before work is done to implement the system with staff, it is important to involve leaders from the departments where the technology will be used, she went on.
"Strong leadership involvement and understanding of why the system is being implemented, how to use the system, and how the system will improve their workflows and role as a leader is important," she stated. "They then will be able to help share expectations with staff and hold staff accountable.
"Once an organization is ready to implement competency technology with staff, having multiple methods for teaching how to use the system is vital," she added. "Time does need to be spent educating staff and leaders on how to use the system expectations regarding what information is required to be kept in the system. When creating an education plan, ensure multiple methods of education are used and all education, tip sheets and videos are kept in a central location accessible to staff for further reference."
Having strong change management processes in place is essential, Tieman insisted.
"Do not underestimate the challenges that come with implementing new technology and associated processes," she said. "Digital technology adoption does not come easily to everyone, and it takes patience and continued reinforcement with staff to drive adoption. After the initial implementation, it is important to have leaders continually share information about the system and to have staff update information into the system.
"The more staff interact with the competency management technology will drive adoption and compliance with the system," she continued. "Adoption of the system has been driven by annual campaigns to ensure staff have met identified requirements within the system. Partnering with HR for monthly file reviews has promoted engagement with leaders and staff to ensure documentation is up to date within the technology."
Finally, after the initial implementation, identify processes to maintain and review the items within the competency management technology platform, she added.
"The healthcare landscape and requirements frequently change, and having a process in place to address changes is vital," she advised. "Identify staff members who will be involved in this process and when it will be conducted. Having a clear process in place has proven to be helpful with ensuring staff and the organization are meeting survey and accreditation requirements.
"Using skill and competency management technology has promoted a change in organizational approach to competency attainment and management, standardized competencies across departments and the organization, and improved transparency into competency attainment and professional development of staff," she added.
Lurie Children's Hospital has been able to streamline the process for employee file reviews and is working to improve sharing data between different systems.
"While driving adoption can be challenging at times, having strong processes and expectations in place helps to promote use and incorporation of the competency management technology into professional practice," she concluded.
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
WATCH NOW: Helpful tips on smart rooms from OhioHealth
