Considering Competence

Transcription

1 Page 1 of 7

2 Considering Competence Introduction The College of Physiotherapists and the physiotherapy community promote and support the high performance of physiotherapists/ physical therapists in their practice. Integral to this is the requirement that each and every registered practitioner has the competence to perform safely and with quality outcomes. Competence is central to the College mandate as entry to practice, professional conduct and quality management are all based upon the assumption that physiotherapists/physical therapists will maintain, or exceed, a level of essential proficiency in any practice situation. In other words, it is what physiotherapists/ physical therapists actually do in a patient encounter that is what is important, not what they know or think they can do. Applied competence in day to day circumstances is what is important to the physiotherapist, to the public and to other health care providers. Describing Competence The term competence is used broadly in all areas of the College and within the profession. Competence is central to the concept of self regulation and is directly connected to the protection of the titles of physiotherapist and physical therapist. In general, competence refers to a therapist s knowledge, skills and abilities and application of judgement in the delivery of safe, quality physiotherapy care. Competence is individual in nature, and while any individual s competence resides within the general scope of practice of the profession as a whole, competence speaks also to a specific practice setting, specific clientele/patients, and specific practice experience. Competence spans a career, and in physiotherapy in Canada, is based on the essential competencies 1 needed to practice in all circumstances. Using the term competence and understanding what it means and how it is applied is key to understanding and improving individual performance. Aiming for Conscious Competence The term consciousness, when connected with competence means that an individual deliberately considers all the relevant factors in making decisions or taking action. This interpretation also applies when considering clinical decisions, professional behaviours and practice processes. 1 Essential Competence Profile for Physiotherapists in Canada October 2009 Page 2 of 7

3 To be competent and act consciously means to act beyond habit or routine or previous success and be able to explain with ease to others, particularly patients or their representatives, why certain interventions or choices have been made. Consciousness is not the same as innovation rather it is fundamentally about risk in performance and assuring an evidence informed approach. It is knowing when you know what to do, knowing when you need to know more, and knowing when not to act. Framing Conscious Competence 2 If conscious competence is the aim for daily practice, to what it is compared and contrasted is equally important. Unconscious Competence Conscious Competence Unconscious Incompetence Conscious Incompetence The descriptions of other competence concepts in relation to conscious competence are described as follows: Unconscious Incompetence An individual who is unconsciously incompetent does not realize that she/he does not know how to do the task or does not understand that she/he does not have the authority to perform the procedure. For example, a physiotherapist/ physical therapist may perform a legally restricted activity without appropriate delegation because she/he is unaware that it is an activity not authorized to physiotherapists/ physical therapists. This is unconscious incompetence. Conscious Incompetence A consciously incompetent practitioner is aware that she/he does not know how to perform the task and performs it regardless. For example, the physiotherapist/ physical therapist is covering for a colleague and provides an intervention that is part of the patient s plan but with which this physiotherapist/physical therapist is unfamiliar. 2 Adapted from the College of Occupational Therapists of Ontario Page 3 of 7

4 Unconscious Competence A person who is unconsciously competent does a task well, but likely could not explain how to perform the task to others. It may be an approach from routine. If the individual s current approach were to become less successful, she/he may not be able to correct the situation. For example, a physiotherapist/ physical therapist may intuitively develop a particular approach over a period of time. In many situations the approach is successful, but sometimes it works less well. Unless the physiotherapist/ physical therapist understands each component of the approach and self corrects by identifying what is not working, the patient outcomes will be less successful. Conscious Competence A consciously competent practitioner can perform a task well and understands the skill behind the task. This individual can explain what works and why. She or he can deliberately change course when needed because she/he understands the skills required and the risk context. For example, the consciously competent physiotherapist/ physical therapist will approach each assessment and intervention with the opportunity for questioning, the opportunity for shift and the ability to explain why in all circumstances. A consciously competent practitioner is one who: knows her/his strengths and limits (what he/she does); knows the guidelines and rules (the legislation, the standards, the policies); makes good choices consciously and deliberately (evidence informed); and is able to explain why she/he took a particular course of action. Unbundling Conscious Competence Conscious competence as a concept speaks to both risk and performance. This analysis, when conducted in a conscious manner, happens in a four-stage sequence. Page 4 of 7

5 Conscious competence links to: Opportunity Ability Judgement Delivery of Quality Care Opportunity which with Ability which with Judgement equals Delivery of Quality Care (outcome) Opportunity + Ability + Judgement = Delivery of Care Each stage speaks to a different level of risk evaluation in relation to competence. Understanding the stages or components within conscious competence supports safe, quality and ethical care. It enables physiotherapists/physical therapists to ask the tough questions and to do only what they know how to do and where the action is supported by patient consent and the available evidence. Each stage is described below with primary questions identified. An answer of No to any one demands a consciously competent therapist to stop a course of action. This halt in progress may terminate proceeding at all, may require further demonstrated evidence, information or materials to proceed, or may offer a different solution to better assist a safe quality outcome. Stage 1 -Opportunity Is this activity within the scope of practice of physiotherapy? Do I know this area? Is there any applicable law(s) that requires consideration prior to proceeding? If so what and what is the implication to my practice? Do the College standards permit my choices? Is my choice(s) ethical? Does it meet the profession s code of ethics? Page 5 of 7

6 Plus Stage 2 - Ability Does my practice context support my decision options? Is my individual sphere of competence (skill) sufficient? What can I do? Do the resources of my practice context support my practice options? Are the patient s goals consistent with my care options? How can the patient s goals be best achieved? by me, by other providers, by an assistant, other? Plus Stage 3 - Judgement Do I have consent of the patient or decision maker to proceed? Do I have the specific competencies to carry out the plan? Are they current? In other words I do do what I recommend. Does the evidence, where available, support my considered options? Page 6 of 7

7 Equals Stage 4 - Delivery of Quality Care Do I know the evaluation tools to use to measure care outcomes? Have I initiated their use? What are the outcomes of the care delivered? What are the learnings of this care interaction? How will I change my practice in future? Summary Competence, more specifically the ability to be consciously competent, is key to the safe quality physiotherapy care. Competent physiotherapists will easily shift between intuitive practice (unconscious competence) and deliberate practice (conscious competence), yet performing, understanding and explaining what drives the shift of mode remains essential. This model serves as a cornerstone to exploring and explaining competence in the public interest. Page 7 of 7