Continuous improvement means improving quality and reducing costs by enhancing the efficiency of care delivery processes. These processes involve all cardiovascular specialties and have a substantial impact on how a department or hospital operates. In this article, we look at how best to utilize standards and competencies, and how their use can aid in each cath lab s ongoing quest for continuous improvement.

Using Standards to Improve Job Performance
Training to improve performance has always existed. As long as there have been skills, there has been training to prepare the new generation to take over for the old. Initially, it was one-on-one, on-the-job training; however, with the increase in technology and the need to constantly retrain practitioners, simply assigning new practitioners to the seasoned professional is no longer as effective.
Considering the rate of change in technology and the increased emphasis on performance improvement, the growth of the invasive cardiology profession has been a dynamic one. It has had many benefits, one of which has been the ability to integrate change and eliminate what doesn t work. On the less positive side, however, there has been a proliferation of job titles and an overlap in functions which has hampered communication among the members of the profession, as well as with management. The lack of consensus as to what roles and function define the field, as well as the growing number of personnel assigned performance improvement functions without any preparation as trainers, has been a cause of concern for many.

Professions, By Definition, Have Standards
Traditionally, professions are characterized by sets of roles, common language and functions, and the need for specialized preparation. There is also a means of self-monitoring of assuring that the practitioners uphold professional standards and perform at a minimum level of competency. The ACVP Standards and Competencies have evolved from the ACVP leadership over a period of years for the purpose of maintaining and increasing the credibility and accountability of those in the cardiovascular and pulmonary profession, thereby guaranteeing continued employment.

Application: Translating Competencies into Tools and Processes
Throughout this article, competencies refers to the skills required for a profession. Standards refers to the performance expectations established by the collection of competencies. It is important to remember that standards serve the profession only if they are used appropriately. We must also pay close attention to competencies, which need to be nurtured and protected, because knowledge can fade away if it is not used.
The ACVP Standards & Competencies include behaviors and developed criteria which can help an educational facility or training department:
Evaluate the quality of training courses under development;
Evaluate the quality of training delivery;
Evaluate the effectiveness of the department and its products;
Identify the professional development needs of students or current staff;
Develop job descriptions;
Evaluate prospective candidates for positions;
Develop and/or select appropriate courses or curricula to train professionals;
Develop a systematic approach to developing, implementing and managing training.

Although each ACVP competency is thoroughly explained, none are designed to be used by simply retyping them under the headings Job Description or Performance Appraisal Criteria. Rather, each competency should provide the necessary springboard, from which an organization can develop its own performance-based professional development system as well as all of the tools and processes necessary to support it. Each organization must adapt the competencies to fit their own culture and goals. In the following text, we outline some strategies to help translate the ACVP competencies into tools and processes to improve performance.

Improving the Hiring Process
Competencies can be used as a baseline against which to evaluate the training and experience of applicants. Employers could potentially hire more fully competent people if, instead of trying to infer confidence and commitment from a projected image in the job interview, they required tangible evidence of success and competencies. Here are a few suggestions:
Applicants can be given a pre-interview assignment, which might include reading the competencies in preparation for interview questions or for writing an essay related to one or more of the competencies. An applicant s critical thinking and problem-solving skills, ability to communicate with clarity and develop ideas in a logical manner, as well as his/her understanding of the competencies could be evaluated in a pre-interview writing assignment.
Interview questions can be structured to gather information regarding an applicant s knowledge and experience as it relates to various competencies. Perhaps best of all, the specific performances, behaviors and criteria that accompany each of the competencies provide a baseline for evaluating responses.

Clarifying Job Expectations
To clarify what is expected on the job is essential if that job is to be done well. It cannot be achieved by simply listing the skills or tasks necessary to complete a job. It requires an understanding of what the tasks are designed to accomplish. Thus, the competencies are not ends in themselves, but can be understood as the means to an end.
A customized set of job expectations can be created by breaking down the competencies into their performances and behaviors. Identify and prioritize those most consistent with the needs and culture of your organization. This type of decision-making process can help clarify the policies and procedures, available resources, lines of communication, timelines, etc., that characterize your organization. The process can also serve as a forum for identifying end accomplishments and the criteria by which each professional s performance and accomplishments will be measured.
The agreed-upon information resulting from this process can be presented to each staff member as a contract of sorts. In essence, the agreement of each participant indicates his/her understanding of and commitment to the terms of the contract, whether it is in the form of a job description, set of policies and procedures, a performance appraisal or a professional growth plan.

Training/Professional Growth
Once there is agreement as to the requirements of a particular position, identify the skills or knowledge needed to meet these requirements. A needs assessment can identify any gaps between an employee s current knowledge and skills level required for their position.

Evaluations
A good evaluation is objective-based; that is, it measures the extent to which certain objectives have been met. The specific objectives provided by a competency-based professional development system provide the criteria against which to measure employee accomplishments. Commitment and confidence may be inferred from behavior, but competence must be observed directly. Incompetent employees cannot pretend to know what they re doing for long.

Competency-based accomplishments can also be documented by means of:
Performance checklists;
Observation by peers and supervisors;
The degree to which an organization s employees meet performance-based objectives as a result of participation in offered courses.

Succession Planning
In the past, the number of years in an organization or a favorable relationship with a supervisor might have influenced raise and promotion practices. Specific competencies make it possible to base salary increase and promotion on performance.
Competencies not only make the supervisor s job easier by providing guidelines and increasing objectivity, they make it easier on the employee as well. If an employee knows that he or she must reach a specified level of attainment to secure a salary increase or an opportunity for promotion, they can focus their efforts in that direction.

Competencies Enhance Professional Credibility
One of the first things to define a profession is the language members use to describe what they do. Having a common language enables practitioners to quickly communicate with each other about their roles and functions with a good degree of understanding. It does not, however, mean that they agree regarding roles or functions, and it often excludes those outside the profession who do not know this language.
Competencies help in identifying the minimum tasks necessary for training in order to bring about improvement in productivity or performance. They can also help just by clearly spelling out who does what by when. Competencies reduce the variance with which roles and functions are viewed within the profession. Competencies also make the tasks and processes we engage in more precise. The degree of unity projected by our profession is strengthened. Finally, the use of competencies allow the lay person to better understand the roles, functions and processes involved in our profession and the theories that underlie them, helping to enhance our professional credibility.

This article was reprinted with permission from Cath Lab Digest 2007;15(9):50-51.