Organisational competence

Citation

Gourlay, R. (2001), "Organisational competence", International Journal of Health Care Quality Assurance, Vol. 14 No. 5. https://doi.org/10.1108/ijhcqa.2001.06214eaa.001

Organisational competence

Organisational competence

Introduction

Quite rightly those concerned with quality in health care stress the importance of training and developing staff as a key to continuous quality improvement. Unless staff are competent to do the work assigned to them, there can be no significant drive towards achieving high standards and delivering health care that satisfies the customer/client/patient. In the UK, the National Health Service is adopting an approach defined as clinical governance. Among the many aspects of this strategy are the ideas of lifelong learning and continuous professional development. Great emphasis is being placed on both these, with medical staff, for example, being required to develop and maintain portfolios that demonstrate what they have done in terms of clinical practice, as well as how they have kept themselves up to date professionally. Such portfolios will contribute to decisions about the doctor's future and his/her ability to continue practising. No one can question the importance of this for patient care. However the missing element is what we term "organisational competence". A great deal has been written about the learning organisation but perhaps only a little about what constitutes its goal. In other words if learning is intended to lead to competency, what describes the eventual competencies of a learning organisation.

We would propose that the competencies are to do with how staff behave and work in the setting of an organisation. For example, risk management is of vital concern if a hospital is to avoid litigation and injuring patients and staff. Risk management can mean exposing issues where patient care has been less than adequate. Such exposure can be very threatening to individuals. A state of organisational competency would be where all individuals are willing to share (expose) their mistakes so that action can be taken to avoid similar errors in the future. To enable this to happen, managers and others have to work hard on creating an open and trusting climate. The achievement of this could be defined as a state of organisational competency with respect to risk management.

Organisational competency is, of course, a great deal more than this. Set out below are key features in which organisational competency needs to be encouraged and developed.

Key features of organisational competency

This first key feature is that of co-operation. Organisational competency here is where deliberate efforts are made to discover how what one does impacts on others and the effect of this on their performance.

Barriers between staff in different departments are eradicated; empire building, political intrigue and rivalry over resources do not exist; there is genuine commitment in thought word and deed to producing the best results for the patient.

A second element of organisational competency is linked to that of "co-operation". It is to do with the management of conflict. Conflict can be creative as ideas are thrashed through, or it can be destructive as personalities berate each other and then create a Berlin Wall between themselves.

A state of organisational competency would be one where there are genuine attempts to use conflict creatively and where the outcome is win/win. Organisational incompetence would on the other hand be one where conflicts were resolved in a way that created little commitment from one party or the other to the results of disagreement which could lead to eventual disengagement.

A third element of organisational competency is one of proactivity. By this is meant the taking of initiatives to resolve problems even if those problems are not necessarily in your domain. It is a recognition by all staff that they have a responsibility for highlighting (or better still eradicating) issues which would not necessarily be part of their "job description". At its minimum, proactivity is noting and doing something about for example a light bulb not working; a state of high level organisational competency is about being deliberate in the observation of the daily working of the hospital and, where issues of concern are noted, doing something positive about them.

Organisational incompetency in this domain would be typified by the comment "Nothing to do with me – it's not my problem!"

A fourth element of organisational competency is that of "anticipation". Being organisationally competent in this element, reduces if not obliterates crisis. Anticipation requires staff to have some basic statistical and planning skills, and to be able to use these to recognise potential danger signs.

At a simple level anticipation involves thinking ahead to the next step. If a new Consultant is appointed, competency in anticipation would recognise that such a post would require the tools to do the work rather than have the new employee forage for his or herself.

At a different organisational level, organisational competency would anticipate shortages of specific staff groups. (In the UK an example would be the shortage of histo-pathologists.)

"Anticipation" is one of the more difficult organisational competencies. Staff feel they have enough on their plates to bother about problems around the corner. However having competency in anticipation can reduce the workload that crisis or even small scale problems can create.

A fifth element in organisational competency is that of "getting commitment". Health care does involve many procedures, guidelines, instructions etc. Organisational competency in this area is a state where those aspects of care that can be proceduralised are, and that there is commitment from those who have to operate by them. Such commitment, of course extends beyond mere compliance; it also involves improving procedures and gaining the commitment of others to using the improved version.

A state of incompetence would be where the procedures are ignored or followed slavishly and without thought.

Conclusion

What we have proposed in this editorial is that training and staff development are essential to the delivery of health care. There are, though, some aspects that are traditionally missing.

These are to do with what we have termed "organisational" competency. In our view insufficient attention is paid to developing these organisational competencies in the staff themselves. Technical and managerial competencies are essential – but their value can be negated if staff have little concept of how their behaviour with respect to colleagues and other departments impacts the achievement or otherwise to providing health care.

There are skills to be learned about working in an organisation. Some of these have been described above. Without these skills, there will be no learning organisation and little organisational competency.

Robin Gourlay