Competency Structures Pt.1

Competency Structures
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Hi, my name is Torrye Metoyer, and thank you for joining us today. We are now on our fourth episode in our series, You Have to do Competencies, Now What? Today’s episode will focus on competency structures and our speakers are Catherine Kovar, Kahuna’s Principal Advisor of Customer Adoption, and Brie Dance, Product Manager at Intermountain Healthcare, a partner and customer of Kahuna. Brie, why don’t you tell us a little bit about yourself?

Brie Dance

Hey, thanks so much, Torrye. Thanks for having me, Catherine. First and foremost, I’m a nurse through and through. I started at Intermountain Healthcare as a new graduate RN and over the years through the various opportunities I’ve had in patient-facing roles, I was invited to help Intermountain as they started their competency framework journey in 2010. With my participation as one of the subject matter experts along the way and shepherding the growth of this fantastic framework, I’ve now become the Product Manager of the Intermountain Healthcare competency framework. Which, as you know, we are not only your customers, but we are also partners with you in bringing the Intermountain competency framework to healthcare institutions across the United States.

Torrye Metoyer

Awesome. Thanks, Brie. Now I will hand it over to Catherine Kovar Kahuna’s Principal Advisor of Customer Adoption.

Catherine Kovar

Thanks, Torrye. Thanks again Brie for joining us today to talk about the different competency structures that you’ve implemented. In this series, we’ve been talking about how to do the competency structures and the different components that you need in order to do this in-house to accompany. And so, the structure that we’ve got here is one that I’ve implemented in a couple of different areas. You’ve got a company, values, and safety structure for your safety competencies. And we did it in engineering. This one was for an X company. And so then we broke it down into the different areas of connectors, wellheads, manifold, trees, and systems. And then we went into further down to locations, and what this allowed us to do is to assign the engineers the appropriate area that they need to focus on for their competencies, but then also had the flexibility of assigning the other areas as they needed to develop in that structure. So, this is just one type of designing and manufacturing structure that I’ve implemented.

This is where I wanted to get your expertise in and how you saw your competency structures coming up. This next one is an example is also an operator structure, company B an engineering Corp. You have reservoir facilities, production, completions, and drilling the same type of structure. This is for field operations, but your area is a completely unique one to me and I thought it would be best if we move on it and talk about the different competency structures. The last one that I had was just the development model, which is a heavy operations type of structure. This allowed us a lot of flexibility to move people and assign the things, as I said, the rules, as it was pertinent to the job that they were doing out in the field. Now, your competency structure holy cow! This is really interesting to me. So, I’m going to let you take it over from here.

Brie Dance

Thanks so much. You’ve really hit several of the nails right on the head that drove our development process. One of the first and foremost and most critical is the safety in healthcare. Healthcare and  oil and gas have some very similar parallels within our verticals and safety is critical. When we deviate from safe practices and follow-through of technique, people can get hurt. In healthcare, it’s not just the operator or the caregiver that may be injured, it is also the patient on the other side receiving the care. So, the first thing that drove us, or our North star, was the safety and the care delivery to our patients. 

But aside from that, there were really a couple of critical components. And one is that you have to understand who your audiences are and in our organization, our audiences are our different caregivers; whether that’s nurses, nursing assistants, respiratory therapists, you heard a lot about them in this COVID-19 pandemic. You may have pharmacists, environmental service, specialists, the people that honestly keep our hospitals moving by turning over rooms and making sure that there are no infectious materials that are remained between patients. How critical are they? A lot of people don’t even realize how critical and highly skilled they have to be. So, you have to understand the audience and then you also need to understand the business model for why you’re going through the effort to create this framework and the groupings. I mean, because if there’s not a business need to do things safer, more efficient and at a lower cost, then go ahead and keep using your checklist, right? That each individual, quote-unquote, the educator can have. comp

Each nurse in any organization – let’s just use nursing as our keyword here – this could be applicable again to a number of different types of caregivers that we talked about just a second ago, it’s hired into a specialty area or into a grouping called a float pool that services multiple specialties. But, you’re typically going to focus on an area of training initially, and then you may have career development and it’s better business for the hospital to try and organize what you need in your day to day role, rather than training you to all of the nursing skills across an entire facility. And so we’ve, we organized all of the competencies and our library has about 6,000 different competencies, another approximate 8,000 performance-based checklist, and several thousand learning resources and then mapping to all of the evidence-based vended content that’s available on the market. And we organize them into care areas. So behavioral health, critical care, medical-surgical, oncology, et cetera. And what you see here are the representations of core work areas. And within each of those core work areas, even if you’re a women’s labor and delivery nurse, you are going to have similarities in some of your role, even to that of behavioral health or a psychiatric nurse, you may be seeing completely different types of patients, but there are some fundamental areas to your core behaviors that align no matter where you go.

Catherine Kovar

I mean, to interrupt you. That’s one of those things that when you’re looking at this, you have to, you have the opportunity when you’re looking at each one of these areas to identify those things that are, you would consider core, right?

Brie Dance

Absolutely.

Catherine Kovar

And most of the things that are transferable across any area that you go into, correct?

Brie Dance

Yeah. And those are when you can identify those and then appropriately placed them in your framework and then digitally deliver and assess them, that is what drives the business ROI, right? It’s being able to capitalize on my name’s Brie, I was hired into the float pool at Primary Children’s in 2006 and if I decided to go back to the bedside next month to one of our ICUs, to help take care of our surgeon COVID patients, I have applicable training that’s already been assessed and is documented that they can avoid retraining me to. They can see my initial training verification that’s stored wonderfully in your digital platform and then the ability to capture the recency of which I’ve been able to practice those applicable skills in the new area.

It’s really been a huge savings driver in our organization to come with this curated approach. Not only does it drive the business savings for our operation channels and our orientation budgets, but the other area that we found savings in, and we’ve actually been able to salvage FTEs because of this is letting our educators work to the top of their skill level instead of building checklists either on their own or trying to piece together lots of skills from other vended solutions that are just basic data dumps the PDF. You may get 2000 different skill-based checklists from a vendor, but then you’ve still got to put them into meaningful use. By delivering them a standardized role that they then can customize if needed, we’ve just freed up the educator from really being kind of the grand Poohbah of paper, orientation management and let him or her really get back to what we need them doing and that’s assessing the learning needs of our caregivers in our organization.

Catherine Kovar

Gotcha. So,  one of those things too is that, when you said it resonated with some of the different implementations that I’ve done, is the fact that I can see everything about you, and then I can quickly ramp you to where I need to. But I also know that we have consistency across the area. We’ve all interpreted things the same way because when you’re walking into some of these different companies, they’ve been acting in their own way in what we call stove pipes. And what would happen is, you want it to move Sally over to a different area and it was like, well, no, Sally can’t come over here because she doesn’t know anything about our business or how we do things. Whereas now, you’ve got that consistency across the entire company so your workforce planning is so much richer because now those people that typically wouldn’t be maybe seen they’re so specialized in an area really can be utilized and another area because your roles have identified that. And when you looked at your structure, that’s one thing that we start talking about when we look at the structure, are the updates and how to make your structure so it’s flexible and you can it can grow in it. If you get too into the micro, right, to intimate into the minutia, then it causes more difficulty. Did you struggle with some of those things when you were trying to structure it?

Brie Dance

Yeah, absolutely. And again, this is where we’ve got some really deep parallels and to be completely honest, I haven’t become an expert in the oil and gas competency structures or what has driven that your development and the specific challenges in that vertical, but what I can say in healthcare is one of the challenges and barriers for healthcare systems or educators to trust adopting another vendor solution is that they get too far into the weeds. They are not a living, breathing healthcare organization, that one, and again, most critical delivers, patient care,  two they steward and are shepherds of the real live nurses that are having to maintain accreditation certifications and licensure to deliver the care, and three go through regular accreditation and risk analysis themselves as it helps your organization you know that fine balance of where too far into the weeds is, but where the evidence-based practice has to lie. And there’s a very, very fine balance there that no other non-healthcare system vended offering can really provide you. And so, you’re absolutely right and that really finding that delicate balance, maintaining the evidence-based core focus of our clinical practice teams, and also understanding that we don’t want to put too much legal liability on a caregiver or the organization yet ensuring safety is paramount of the patient was a two and a half year journey and two and a half million dollars for our organization to find that sweet spot and even since that development at initial investment within ourselves, it takes us three full FTEs and a myriad of consultants in legal, risk, and practice to help us maintain that sweet spot so that we can provide the best structure and framework continually to our caregivers as they go out and initially trained. And then as you said, redeploy to critical areas and we’re seeing a surge in that right now where we may not be running our operating rooms full steam ahead because our ICUs are overflowing with patients needing respiratory care related to COVID and so we’re trying to rapidly redeploy and real we re-skill, or real skills, our caregivers into areas where they’re most needed. That sweet spot is not getting too far into the weeds and having just the right structure is really what enables you to do that as you’ve discovered through your years of experience leading this.

Catherine Kovar

The biggest thing that we also had challenges with is when you have individuals, the subject matter experts. You have a multi-pronged approach, while the other industries have the safety and they have the certification and those types of components; a lot of them are self-policing whereas your industry is not a self-policing industry.

Brie Dance

No, not at all.

Catherine Kovar

And so, you’ve got that whole other level to it. And so you have those components that had to be structured into yours, versus the other industries they’re more self-policing and we had to establish more credibility, not credibility, but accountability on those sides to say you’re accountable for doing this and we’re going to be accountable for assessing you and doing all these items. So, you’ve definitely got an even higher level of criteria in your system.

Brie Dance

So, yeah and you’re spot on there. I think we, like a lot of healthcare organizations, like to champion our caregivers to continually be self-aware and assessing where they feel like they’re at. But at the end of the day, you’re right. There’s not a single competency that we would allow a caregiver to be practicing independently without somebody that has more experience watching over them and assessing that it was done correctly first.

Catherine Kovar

Most definitely. So, in the challenges when you looked at your structure and how you’re going to do it, and what areas that you determined. I see the three circles, right, and I love the circles because they intersect and that’s where we had different groups that we helped develop their structures it was the things that cut across all of you that are the overlap as we call it a lot of times the core, right? Or the foundational items. And when you built that, did you find that each area was like, no, no, no, we do it very special and that they actually had to come to an agreement on no this is a standard? Or was that driven by your industry certifications?

Brie Dance

You hit a hot button, my friend. Nurse educators, and maybe it’s educators in every vertical.

Catherine Kovar

It’s everything. I want to know if you got the same thing I did.

Brie Dance

Well, they are passionate creatures. I mean, just really passionate about where they work, the patients they’re serving, and the specialty that they’re employed in. Initially, everybody felt like we’re pretty special, we do pretty special work, and the checklists that I’ve worked so hard on over the last five years or my tenure here is the best so I don’t really know why we need to align here. And, what really helped us, and Torrye, you need to have all the credit for this lingo here is the competency compromise. That’s what I think you’ve got to call it. We had to do a thorough intake and part of that two and a half years and two and a half million dollars was the resources it took to inventory a system that at the time was about 20 facilities and now we’ve just mushroomed well past that and 40,000 employees. And again, much bigger than that now, to really go through all our essentials. The IP on each unit to say what are you doing? What are the skills you’re training to? What are your standards? And to really pull them together and we had to build this, quite frankly, we had to build the database to analyze it and get some data architects to help us evaluate it. This was no small feat. So when hospital organizations say I’ve got content, well, every hospital organization in America has a checklist or multiple checklists. You can think that you standardized it, but until you put that microscope on a macro level product and really invest in yourself to evaluate it, you don’t really have content that can drive value.

It was tough and it was a culture shift in our organization to go, you know what; we get to base camp. Do you want to climb Everest? That’s great. Let’s climb Everest. We’ve got to get to base camp first. You can’t run to the top without the rep. You have to get to base camp, re-charge, re-center, re-focus, and set the next goal. Tammy Richards, our AVP of clinical operations, really deserves all the credit there because she got us to base camp. I won’t say that there weren’t times that there were frustrations and exasperation with people feeling like they gave up what they developed, but what we’ve realized is you didn’t give it up. You gave it to a better product and we took the best of what everybody had done and we aligned and evaluated that against the evidence-based practice and any issue that we had run into with an accreditation visit or risk analysis or legal proceeding and we identified the best. We made the alignment with all of our policies and procedures as well. You can’t just align your competencies, your processes have to be aligned too or you’re really not standardized and aligned in your care anyway.

Catherine Kovar

Right. That I think this whole program when you go to do this, it drives other occurrences to happen. Which is, oh we need to have this aligned. We need to have this other area aligned. Because if you don’t, then this is where you start to see when you’re trying to bring things together, that’s when you see, oh we’ve got a divergence over here. A lot of times what we found is it was out of our scope of what we were supposed to be doing, but we ended up having to take that on and then people were like, great, we’ve been trying to do this for years. To bring that alignment between this procedure or this process and what you’re doing because you definitely have the opportunity to see how things are out of sync.

Brie Dance

Absolutely. Absolutely. And in healthcare, the exact same thing happened where one can’t go without the other. And because educators are not always practice experts, that became muddy and so we had to draw a really clear line in the sand to say, hey, I’m not the practice expert so if we don’t have the appropriate practice expert, we’re going to have to identify and fill that need in order to really drive this ship. Maybe not ship if we’re going to base camp, climbing and not on the water, but you get what I’m saying. They both were activities that had to happen. And we had that commitment to that investment in our organization. And again, that is what makes the Intermountain and Kahuna offering so far different and above what you can find out there in the marketplace. It’s so hard to develop you.

You’ve been there, Catherine. This is no small feat and then to maintain it, takes another investment in yourself and it’s continual. And I think that’s why we’re so passionate to bring this forward to healthcare systems across the country. We’re making that investment in ourselves and we understand what healthcare systems are up against every day and how the profit margins, even not-for-profit organization, the revenue margins are so laser thin, that we want to bring what we know and we’re investing ourselves in ourselves already to help other organizations be able to do the same at a lower cost. Finding that sweet spot in that partnership with you guys is really a dream come true and helping us really reduce the cost of care delivery and improve the quality of care to our patients across the country.

Catherine Kovar

Oh, I agree. I think from the actual roles, one thing that I heard loud and clear is now people can actually see everything that it takes to do what we do and be it in the nursing industry, in the energy industry, manufacturing; all of a sudden it really sheds a light on yes, you have your education, but now this is how we practice. This is how we continue to develop these individuals and really what it takes. It’s not as easy to see, you can’t see it. That’s the joy that I’ve taken in. Obviously, I work for Kahuna and the joy that I take is that I visually can see it. I can provide people with the capability of seeing what path they need to do and how they need to do it. It’s not just a question. It’s not I did it one way, you did it another way. So, from that standpoint, your structure gives a whole lot of enlightenment to people to see how these things are structured and what they need to do when they’re looking at this. Sometimes putting it into the system, I say this, is probably the easier part. It’s all the upfront work and these structures and how you’re going to design it, that is the heavy lifting as I would see it.

Brie Dance

Yeah. And very truthfully, you’re exactly right. There is an incredible lift on the front end and then there’s an incredible commitment to maintenance following that. You cannot do it without substantial resources in the beginning or over the course of a long period of time unless you want to license it from another organization or another vendor. Throwing our own little plug for Intermountain there, but I just think it’s an incredible opportunity for like-minded organizations to come together, and as Torrye said, you don’t really have to compromise on competency to come together with another organization and use their content. 

This is the quality of the training we are sending and vice versa upon return. That is in a nutshell, the Intermountain Healthcare competency framework paired with the Kahuna competency management system.​ I think it’s so exciting. Learning and development isn’t typically revenue-generating and so it’s the first area that people go, what can you cut? I’m going to take from learning and development or we’re going to going to license that because I can’t afford to keep these people on and I can buy it cheaper. It’s so exciting that we’re in a time, and in 2020 has been an accelerator for it, to really come out there and make a difference in people’s lives. I’m speaking really with a healthcare focus right now and I don’t want to detract from any other verticals in their learning and development arms, but we’re making a difference together and we are improving lives and we are making it more affordable through the competency structures like this, for people to get care and to admit to having confidence in the quality of the training that the person providing that care has.

Catherine Kovar

Well, I appreciate your joining me today and going through your competency structure.

Brie Dance

I’ve always looked up to you ever since I met you at Kahuna. So thanks for inviting me.

No, I appreciate it. It goes back to, this is exactly spot-on for people to be able to understand what they need to do in the competency structures. So again, thanks again for joining me. You have a good rest of your day.

Brie Dance

Hey, thanks, Catherine. Have a great day.

If you missed the last episode in this series, Skills and Program Infrastructure, check it out here.

Be sure to subscribe to the #REALskilling podcast to stay up to date and access the latest trends, best practices, industry news, and insights to help you kick-start your competency program.

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