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Date Updated: November 9, 2011

Health System Reform Policies Appendix

Health Professionals' Competencies

Contemporary patients expect a greater role in their own care than may have been the case in the past. Clinicians must have the skills to practice in a patient-centered manner: eliciting patient preferences, respecting patient choices, coaching patients in making decisions in their own best interest, communicating clearly with patients and families, and engaging with patients and their families in the relevant cultural context. These behaviors require advanced knowledge and skills in empathy, cultural awareness, and communication.

Historically the focus of health education has been on the preparation of practitioners to treat disease. Less attention has been paid to prevention of disease. However, the appearance of clinical signs or symptoms as markers of illness often occurs late in the disease process. Therefore, it is important that healthcare practitioners understand and demonstrate the ability to promote health and prevent the occurrence and progression of disease whenever possible. Health promotion and disease prevention activities occur at the individual patient level as well as at the population level. Healthcare practitioners should be able to demonstrate proficiency in communicating to patients about health promotion and disease prevention strategies including diet, exercise, and sleep; and to potentiate these behaviors. At the population level, practitioners should recognize and actively influence factors that contribute to disease occurrence, including environmental and social factors.

In the past, health professions' education primarily has emphasized the acquisition of knowledge. However, providing quality healthcare in a changing environment requires competencies related to evidence-based healthcare such as health promotion advice, diagnostic and therapeutic choices, understanding positive/negative aspects of study methodologies, translation of data from studies to bedside, understanding costs/benefits/risks of diagnostic and therapeutic choices, and competencies that culminate in patient safety. Provision of healthcare involves advising patients regarding choices about diagnostic and therapeutic alternatives. Yet, when healthcare practitioners fail to base this advice on an understanding of clinical effectiveness, outcomes suffer and aggregate costs increase. This competency involves understanding the positive and negative aspects of various study methodologies utilized to determine the clinical effectiveness of alternative strategies and the ability to apply clinical effectiveness data within one's own practice. Practitioners who possess this competency will be able to function optimally within a redesigned healthcare system where the benefits and costs of alternative diagnostic and therapeutic strategies are clearly understood.

An understanding of clinical effectiveness is one component of the practice of evidence-based patient care. This competency requires healthcare practitioners to be able to apply the results of research to the care of patients at the bedside. Choice of diagnostic modality and therapeutic regimen is then based upon the results of well-designed research studies where such studies are available, and, when such evidence is not available, based upon the highest quality evidence. Practitioners are able to help their patients choose a course of action that is specific to each patient and does not consume resources in an inefficient manner. Increasingly, patients are demanding that their care be targeted to their specific situation. It is important that healthcare practitioners understand that resource utilization involves choices among competing alternatives. Resources consumed in an inefficient manner are no longer available to be used to optimize care for other patients.

Efficient resource utilization requires practitioners to understand the costs as well as the benefits of alternative diagnostic and therapeutic choices. Patients should receive care that has not only been proven to be effective but which represents the most efficient utilization of healthcare resources. This skill is particularly relevant in caring for patients at the end of life. Improved patient care outcomes and decreased healthcare costs are directly linked to healthcare practitioner competency in promoting efficient resource utilization. Further, efficient care is only possible when care is coordinated effectively among the practitioners and institutions involved in caring for an individual patient. Efficient practice requires that the clinician possess competence to play an appropriate role in such coordination of care.

Recently, healthcare has begun to apply lessons learned from other industries. The airline industry provides a model for patient safety, which is increasingly being incorporated into the healthcare delivery system. This model includes the use of checklists, timeouts, formal methods of communication and handoffs, and team training. It is increasingly recognized that enhanced attention to patient care processes can enhance the safety of the care delivered to patients. The ability to evaluate and modify patient care processes to promote optimal patient safety is a critically important competency for healthcare practitioners in a reformed healthcare system. Practitioners who possess this competency can positively impact patient care outcomes and reduce the costs associated with patient injury.

Healthcare is increasingly being provided in a multidisciplinary framework which takes full advantage of the skills of multiple health professionals and institutions. It is increasingly recognized that each of the health professions brings unique competencies to the care of patients, and the application of these combined competencies can produce optimal patient outcomes. The ability to work effectively as a member of a multidisciplinary team and to help guide patients through the complex system of institutions and professionals engaged in their care is a critical competency for all healthcare professionals. Enhanced collaboration among healthcare professionals is essential for the delivery of high-quality, efficient patient care.

Professional behavior encompasses a wide range of competencies that are critical for optimal patient care. These include the ability to recognize the limitations in one's own knowledge and skills, altruism, integrity, compassion, and the willingness to uphold the ethical foundations of medical practice. During the last decade, health professions schools and postgraduate training programs have increasingly incorporated professionalism education into the curriculum. This has occurred because of the recognition of the importance of professional behavior to the provision of healthcare as well as increased public scrutiny of the healthcare profession.

Medical knowledge is increasing at such a rate that it is impossible for healthcare practitioners to keep up with all the new discoveries. Lifelong learning or learning across the continuum of a practitioner's career therefore becomes critically important. This competency requires that healthcare practitioners be able to recognize the gap between the knowledge and skills they need to provide optimal care for patients and their current level of knowledge and skill. It also requires that practitioners possess the capability to seek out new knowledge from a variety of sources, to critically evaluate this knowledge, and to apply it to the care of their patients. In particular, individual clinicians must have skills for and a commitment to learning from their own practices and improving the care provided.


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