Peer Review Monthly: Improving physician-nurse relations by following the six general competencies

Dear Medical Staff Leader,

As I recently prepared a quality and peer review educational program for a medical staff, the hospital I was working with asked me to cover physician-nurse relations as well. As I thought about how to approach this, I realized that discussing it in the context of the six general competencies might make the most sense.

By now, I hope you are familiar with the six competency categories that The Joint Commission (formerly known as JCAHO) adopted from the Accreditation Council for Graduate Medical Education (ACGME) for resident evaluation. Just to be sure, here is the list of the categories and the question each one raises:

• Patient care: How do we use our specific clinical privileges and general medical skills?
• Medical/clinical knowledge: What must we know?
• Interpersonal and communication skills: What must we say?
• Professionalism: How must we behave?
• Systems-based practice: Who do we depend on and who depends on us?
• Practice-based learning and improvement: How have we improved?

The general competences expand the definition of physician competency beyond technical knowledge and skills to areas that have a direct impact on nursing, most notably interpersonal and communication skills, professionalism, and systems-based practice.

So where do physician-nurse relations fit into peer review? Obviously, professionalism deals with disruptive behavior, which can affect physician-nurse relations, but I would like to focus on interpersonal and communication skills and systems-based practice because I feel these competencies can have an ever greater impact.

The general competency categories defined by the ACGME include a set of specific expectations that The Joint Commission’s version lacks. Setting clear expectations is an essential step in The Greeley Company’s physician performance pyramid, which separates medical staff leadership responsibilities into layers. Just as they have done using the Greeley framework in the past, medical staffs that want to use the general competencies are now in the process of defining specific behavioral expectations that make this framework useful when evaluating and improving physician competency.

Once you define expectations for each category, the impact of the general competencies on physician-nurse relations becomes clearer. For example, under interpersonal and communication skills, the ACGME defined an expectation that residents “work effectively with others as a member or leader of a healthcare team.” Many medical staffs feel that this expectation applies to attending physicians as well.

The systems-based practice competency also affects physician-nurse relations because of physicians’ influence over the hospital’s resource use and patient safety. For example, setting the expectation that physicians will support hospital patient safety practices as a physician competency, rather than simply a nice thing to do, can drive significant change in physician performance.

How does this help physician-nurse relations? When the medical staff recognizes that physicians need to be competent team members and follow the same safety rules that nurses depend on daily, it makes a strong statement to the nursing staff that physicians care. It will go a long way to help define areas in need of improvement and spark dialog on how to improve.

Robert Marder, MD
Vice president
The Greeley Company
http://www.greeley.com/consulting.cfm