Project Status

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SOLVING A PUZZLE CONTINUING COMPETENCE
COMPETENCY
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Terminology

• The difference between continuing competence and
  competency is subtle.
• The difference explains why there are multiple
  stakeholders with different roles.

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Stakeholders

• OTs OTAs
• Employers
• Clients
• State Licensure Boards
• NBCOT
• AOTA
• State Associations
• Universities/Educators
• Third Party Payers
• JCHO, CARF
• State Federal Government

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Stakeholder Interest

• Some stakeholders are interested primarily in
  competency (e.g., licensure boards).
• Some stakeholders are interested primarily in
  continuing competence (e.g., professional
  associations).
• Some stakeholders are equally interested in both
  (e.g., employers).

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Understanding Competency and Continuing Competence
COMPETENCY
COMPETENCE

• competence refers to an individual's capacity
  to perform job professional responsibilities"

• competency focuses on an individual's actual
  performance in a particular situation

CURRENT PERFORMANCE AGAINST STANDARDS
BUILDING CAPACITY
McConnell, 2001, p. 14)
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COMPENTENCY FOCUSES ON - -WHAT A PROFESSION WAS
OR WHAT IT IS - - NOT ON WHAT IT CAN BE.
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What a Profession Can Be is Dependent upon
Continuing Competence
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Stakeholders -State Regulatory Boards

• Requirements
• Evidence of passing initial NBCOT certification
• Diploma from an accredited OT education program
• Payment of state fees
• 42 states DC continuing education
• AOTAS Model Continuing Competence Guidelines for
  OT and OTA A resource for state Regulatory
  Boards (AOTA 2002)

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Stakeholders -

• Private credentialing with self-selected board
• Mission Protect the Public
• Initial certification examination

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NBCOT Certification Renewal

• Three-year voluntary renewal
• 36 Professional Development Units
• Self-Assessment (5 point scale) six categories
• Determine needs and priorities for intervention
• Identify and design evidence-based intervention
• Implement intervention based on current practices
  and emerging knowledge
• Report and evaluate effectiveness of
  interventions
• Provide OT services for populations
• Provision of OT services

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Why is Competency and Continuing Competence
Important?
Its not what you know, but how you apply what
you know.
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Professions Exist to Serve Society
"Failing to keep abreast of change or failing to
prepare for change can lead to an inability to
fulfill professional and organizational
expectations" and thus ultimately leads to
problems of competency in the future (Alsop,
2001, p. 128)
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Client Harm - Incompetence

• Obvious Harm
• Fail to avoid life threatening situations
• Fail to prevent a condition from getting worse
• Fail to prevent secondary complications

• Evidence-based
• Ineffective interventions
• Interventions not as effective when compared with
  an alternative intervention

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Evidence-Based Practice

• Knowledge
• Latest evidence
• Most effective assessment
• Most effective intervention methods
• Outcome measures

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No Involvement in Continuing Competence

• Job dissatisfaction
• Loss of business
• No promotion
• Client harm

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All occupational therapists and assistants have
unique competency characteristics and sets of
competencies that qualify them to practice
occupational therapy.
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How do general competencies developed in OT
school translate into practice?
INSTITUTIONAL POLICIES
PHYSICAL ENVIRONMENT
CUSTOMER EXPECTATIONS
ROLE RESPONSIBILITIES
ACCREDITING BODIES
WORK CONTEXT
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CHALLENGES
Many challenges they the professions face are
similar - - challenges brought about by advanced
technology, practice that expands across
jurisdictional boundaries, economic pressures of
regional, national, and global markets, and the
need for accountability to the public.
Hayden, 1997
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All occupational therapists and assistants have
unique competency characteristics and sets of
competencies that qualify them to practice
occupational therapy.
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Competency Characteristics

• The underlying requirements upon which
  competencies are based are referred to as
  competency characteristics.
• Expert knowledge,
• Skills,
• Motivation to change performance,
• Positive self-concept or self-image,
• Conducive attitudes or values.
• (Decker,1999)

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All occupational therapists and assistants have
unique competency characteristics and sets of
competencies that qualify them to practice
occupational therapy.
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Competencies

• Competencies are explicit statements that define
  specific areas of expertise or competency.
• Competencies are causally related to effective
  job performance.
• Competencies enable meeting and exceeding
  customer outcome expectations.
• Decker (1999)

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Types of Competencies

• Four types of competencies
• those that are generic across all jobs in an
  organization,
• those that are related to management or
  supervision roles,
• those that are threshold or that are the minimum
  requirements of a job, and
• those that are specific to a job.

Decker Strader, 1997
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Generic Competencies in Healthcare

• Health-care organizations with a focus on
  outcomes generate competencies related to
• Practicing a customer focus (client-centered
  practice)
• Practicing information management
• Participating in performance improvement

Phillip Strader, 1997
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Generic Competencies

• Controlling costs
• Protecting the rights of clients
• Satisfying clients and other customers
• Practicing infection control
• Practicing safety management.

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IOM Competencies

• Client-centered care
• Working in teams
• Informatics
• Quality improvement
• Evidence-based practice

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What does it mean to be competent?
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Measuring Competency

• complex
• time consuming
• expensive
• labor intensive

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Code of Ethics    Competency
Characteristics Competencies
Knowledge Explicit
statements Critical Reasoning
Interpersonal Abilities
Define areas of expertise. Task
Competence Causally related
to Performance Skills
effective performance
Ethical Reasoning Ranges from
Novice to Expert Functioning
    Abilities Virtues Cognitive Integ
rity Emotional Caring Relational Prudenc
e  
Triangular Model of Competence
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Measuring Competency

• Determining competency is complicated by several
  factors
• Which competencies to develop and to measure,
• The criterion on which competency should be
  judged,
• A cut-off point between being competent and
  incompetent,
• Which competency characteristics are most likely
  to influence competency, and
• How best to address other parameters of
  competency.

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PARAMETERS OF COMPETENCY

• Many factors influence competency.
• Competency is not always located solely in the
  person.
• Competency may arise as an interaction between
  the persons competency characteristics and a
  combination of factors within the environment or
  the organization in which one works.

Batalden, 2001
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CHALLENGES
All professions struggle with the question of
what constitutes competency, who should set the
standards for continuing competence, and how
professionals can maintain up-to-date expertise.
Hayden, 1997
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RECERTIFICATION

• Who has the right to determine competency or
  continuing competence?
• What research supports recertification?
• What are the possible effects on the Profession?

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REQUIREMENTS OF A VIABLE APPROACH TO COMPETENCY
AND CONTINUING COMPETENCE

• Administratively feasible
• Publicly credible
• Professionally acceptable
• Legally defensible
• Economically feasible

National Council of State Boards of Nursing, 1997
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AMERICAN OCCUPATIONAL THERAPY ASSOCIATION
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AOTAS GOALS

• Practitioners to
• Assess
• Maintain
• Document Competence

Strategies to support practitioners continuing
competence in the variety of responsibilities
that they assume in their daily professional
lives.
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COMMISSION ON CONTINUING COMPETENCE AND
PROFESSIONAL DEVELOPMENT
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Continuing Competence Plan for Professional
Development

• Examining responsibilities
• Triggers
• Perform a self-assessment
• Identify needs in light of the Standards for
  Continuing Competence
• Develop a plan for continuing competence
• Implement continuing competence plan
• Document
• Implement changes and demonstrate continuing
  competence

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STANDARDS FOR CONTINUING COMPETENCE

• Knowledge
• Critical Reasoning
• Interpersonal Abilities
• Performance Skills
• Ethical Reasoning

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SPECIALTY CERTIFICATION
Defined set of skills, techniques, interventions.
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BOARD CERTIFICATION
Major domain of practice with established
knowledge base in occupational therapy
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2003-2004

• Review and Revise the Standards For Continuing
  Competence
• Specialty Certification
• Board Certification
• Model Continuing Competence Guidelines

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QUESTIONS