What Do We Mean By “Competency”?

Patients, employers, and practitioners themselves expect health care providers to demonstrate and maintain professional competency throughout their careers.

In school, at entry-to-practice, and as a necessary condition for annual renewal of registration, practitioners are required to show they are competent. Of importance, recent evidence suggests that “competence” may mean different things to different stakeholders: understanding these differences is critical for practitioners.

Arguably, the most important perspective on competency comes from patients who receive the care and services of health care providers. Most of the literature in this area suggests that patients give practitioners the “benefit of the doubt” and generally trust them to provide safe and effective care. When asked, most patients equate competency with “the Three As”: accessibility, affability, and acknowledgement.


Competency

The Three A's of Competency

  1. Accessibility. Patients want practitioners they can actually see when they need to—having access to practitioners in a timely manner is crucial for their understanding of “competency”.

  2. Affability. Similarly, patients expect their practitioners to be warm, caring, considerate and demonstrate appropriate interpersonal skills—to be likable.

  3. Acknowledgement. Finally, patients need practitioners to demonstrate understanding and empathy particularly in a medical context.

It is important to recognize that less than 1% of practitioners within most professions are the focus of a complaint or discipline process; those who are frequently have demonstrated an interpersonal or communication problem rather than a technical or professional skill issue.

For practitioners, competency is complicated and directly connected to the workplace and practice conditions. They tend to equate competency with technical errors, some of which are the result of random, workplace-specific features (e.g. excess workload, insufficient support etc) rather than a personal deficiency.

As the complexity of daily practice increases, so too do fears of error and competency breach, some of which practitioners feel may be beyond their direct control.

For employers, competency is frequently seen as fitness-for-purpose and alignment with standard operating procedures. Competency is a form of risk-mitigation in large organizations, and tends to be reduced to proceduralized checklists that may not fully acknowledge the importance and complexity of professional work.

The use of managerial control systems (like performance evaluations) to monitor competence may not always recognize the patient or practitioner perspectives, but instead focus on other factors such as efficiency or productivity.

Ultimately, we all have an interest in coming to a common understanding about competency. Professional work is complex but important. Society—and patients—need individuals who can apply scientific knowledge in ambiguous situations using judgment and compassion.

No Obvious "Right Answer"

Algorithms and treatment guidelines are crucial tools, but cannot replace professional wisdom and care. The essence of professionalism is the ability to function in circumstances where there is no obvious “right answer” but only a series of “least worst alternatives” that must be balanced.  Patients’ focus on the Three A’s, practitioners’ focus on workplace context and employers’ focus on SOPs all emphasize different facets of competence that are important.

Recognizing that each focus—on its own—is necessary but insufficient to truly recognizing what competency means is an important role for practitioners—and their regulators—to ensure safe and high quality professional practice.