Competence assessment in the ambulatory setting

Essentially, assessing competence in the ambulatory setting does not differ from the processes used in the acute care setting. The same requirements and expectations are applied to the ambulatory setting as well. It does not matter what terms the medical staff and organization use to describe the competence assessment function, the process will be the same.

If the accrediting body is the same for the acute care and ambulatory settings, the competence assessment processes should be the same—just modified to the site of care. The facility may choose to apply some measurement indicators and benchmark rates to all settings, such as those reflecting professionalism, communication skills, or patient satisfaction. Others will be different and reflect the specific skills needed and procedures performed in the various settings.

For example, the inpatient facility may assess a practitioner’s competence using mortality, blood usage, and patient length of stay as competence indicators. In the office-based setting, the organization may choose to monitor immunization rates, blood sugar monitoring for diabetic patients, and colon cancer screening for patients older than age 50. The indicators for measurement may be different in the ambulatory setting and the acute care setting, but the process should essentially mirror the medical staff process as outlined within the medical staff bylaws, policies and procedures, and performance improvement plan.

Physician indicators of performance that apply to the ambulatory setting can be adapted from the Six General Competencies from the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties joint initiative to serve as the framework for categorizing the measurement indicator.

The measurements may also include benchmark targets (acceptable and excellent). Setting two targets allows the medical staff and practitioner to have a clear understanding of performance that is below expectation, performance that meets expectation, and performance that exceeds the expectation. Using two targets for benchmarking avoids the “pass/fail” concept inherent when only one target is established.

For example, set the “average” benchmark rate for performing diabetic screening at 75%. To be considered “excellent,” set the benchmark at 100%. If only one target is used (e.g., 75%), practitioners either pass or fail this standard. Setting two targets promotes “raising the bar,” since “average” is considered acceptable, and for most practitioners being rated as “average” is not sufficient. Therefore, most practitioners would strive to improve their compliance with the practice standard. This effort then raises the overall standard of care.

Further, falling below the target of 75% clearly notifies the practitioner that his or her performance is below the acceptable standard. These data would also be evaluated by medical staff leadership to determine whether there were performance issues that needed to be addressed.

Source: The Medical Staff's Guide to Overcoming Competence Assessment Challenges