11 February 2014

A journey of a thousand small steps: Thinking about competence in a different way

Last week, a year to the day after the Francis Report on Mid Staffordshire was published, we hosted a seminar to continue our discussions on professionalism and to launch the next stage of our research (1). The seminar was led by Professor Zubin Austin from the University of Toronto, who has a particular expertise around competence and how we understand it in a health and care context (2). We were particularly pleased to welcome so many representatives from professional bodies, employers, educators and other regulators to this forum.

Professor Zubin Austin’s work in Ontario illustrates a number of important themes highly relevant to the collective desire to see improvement in health and social care in the aftermath of Mid Staffordshire.

First, that patients and service users are likely to have different expectations of professional competence from professionals. Service users and patients want professionals to be ‘accessible’, and ‘affable’. Technical know-how is important, but not more important than clear communication and authentic respect.

Second, the evidence suggests that professionals who are competent have several characteristics in common: they are professionally networked, and express satisfation with their career choice and with their personal lives. The key factor in what Zubin calls ‘competency drift’ is isolation. Zubin suggested that disengagement in one’s workplace is often linked to disatisfaction more widely, and that the ‘firewall’ that existed for previous generations between the personal and the professional world no longer exists. The core problem with competency has very little to do with technical skills alone and everything to do with the individual.

During the discussions, there was agreement that competency is multifactorial and is influenced by the environment as well as the individual. There was an appetite for exploring this new discourse on disengagement further, and encouraging people in health and social care to talk about how and why it occurs. Some were concerned about how this could be measured, whilst others proposed that it was the conversations themselves that were key to change. The evidence from Ontario is encouraging. Where interventions along these lines have been introduced, complaints to regulators have reduced.

There was an acknowledgement that all the agencies have a role to play in this discourse. If we can recognise and address personal and professional isolation before it becomes the trigger for poor practice, we may have an influence on the number and nature of complaints that are made.  

Professor Zubin Austin called it a journey of a thousand small steps. For service users, patients and professionals, it is surely a journey  worth making.

Anna van der Gaag

Anna, Zubin and colleagues feed back on the event

Dr Anna van der Gaag in conversation with Professor Zubin Austin


(1) HCPC is commissioning research to look at the factors which can lead to poor practise, why things go wrong when they do using a qualitative study of fitness to practise cases. This work will be published in January 2015.

(2) Austin Z. (2013) How competent are we at assessing competency?
Keynote, CLEAR Congress on Professional and Occupational Regulation, Edinburgh, June 27-28,  2013 www.clearhq.org.

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