Competence and Flow

[A Former User]

This is a bit of a tenuous connection.

I heard a talk by Dr Zubin Austin a few days ago and took notes. His topic was the way we evaluate professionals, and he felt that cempetence was a poor measure .

It was interesting for 2 reasons - The first was that I had not thought about health care professionals and measurement standards and the second was the description of flow, which I have felt as a patient involved with heathcare when all of the things I have learned fit together coherently.

Here are the notes I made about the talk - it was delivered to a group of health professionals.

Dr Zubin Austin on Professional Competency

If "Competence" is the Answer Have We Asked the Right Question?

A lot of the things that keep us awake at night are not problems we can solve on our own - for many issues we rely on professionals.

What do we want from them? We want them to care and be interested in us personally.

In the 1980's the CPSO had some unpleasant issue - this led them to ‘circle the wagons' and esulted in the government saying that half of the members on the councils of the Colleges of Regulated Health Professionals had to be members of the public.

We as patients trust professionals to be careful and wise in the relationship. Where evidence is fragmented we look at only a slice.

We want the 3 A's - Affability, Accessibility and Acknowledgement.

When people complain about professionals usually impoliteness plays a big part. Even though all of the regulations call for competency it accounts for under 2% of the complaints. It is actually a low burden, and means "interpersonal savvy"

If we downgrade professions to jobs, if professionals are employees of large corporations and subject to bureaucracy we create new problems. Some have called this ‘competency drift' and the professinals most at risk of this are 25 years out of school and /or practicing alone.

In fact though, under 1% are ever found incompetent and sanctioned. The bureaucratization of competency means people are just ‘doing a job' rather than acting as professionals.

A prime example of the effects this can have on a health system is Mid Staffordshire, the subject of searching enquiries after a major scandal. Dr Austin describes an atmosphere of "it's not my job" playing into the Mid Staffs scandal. Pushing throughput and cost savings is not necessarily best for patients. He suggested that we need to work with employers and regulators

He describes engagement as a psychological state of connection, of caring about what you do, rather than doing the least bad thing or the least-worst alternative.

His description of ‘flow' which occurs when you are at one with what you are doing was quite inspiring to me even as a non-professional in the true sense. When things are clicking into place as I work on various aspects of being a patent advisor it is immensely satisfying.

[A Former User]

When I think of flow, I think of the experience patients and their families have as they "flow" through the system -- or not!

I have often felt like a football turfed over the wall to the next specialist or point of care. I am usually the primary glue that holds the process together.

So tackling the flow from hospital outward seems oddly an easy place to start and I have been on the Discharge Planning group at my local hospital. We are trying to push into helping to make connections with home care, rehab and long term care rather than handing off to the patient and family and washing our hands.

I think the biggest challenge is the primary care - specialist - hospital etc. flow. Thoughts?