Separate Estates: A Case Study Analysis of Competency Assessment Processes among Clinicians in a Canadian Academic Hospital

This study examined competence and competency assessment of regulated health professionals (RHPs) through a case study approach that utilized the Boyatzis model of effective performance. In order to explore how competency assessment was enacted and understood, and how RHPs perceived and experienced competency assessment in a large Canadian academic hospital, the study used three sources of data: key informant interviews (n=19), focus group interviews (n=32), and a review of organizational documents. Participants included RHPs, managers, directors, executives, and other non-health participants, such as human resources professionals. Data were analyzed inductively using Braun and Clark’s (2006) theoretical thematic analysis, and deductively using Hsieh and Shannon’s (2005) directed content analysis, all in NVivo Version 11 for Windows. Data revealed the absence of common language for competence across the hospital’s RHP participants. Participants referred to regulatory concepts and competency frameworks when asked to define and describe competence or competency assessment in the hospital setting. At the same time, a strong organizational rhetoric around excellence was evident, as was frequent commentary on incompetence. There was little discussion on RHPs who fell between excellence and incompetence. When describing organizational competency assessment processes, participants were equivocal about what was assessed and whether this assessment focused on organizational values or practice competencies. Fundamental differences in competency assessment processes exist for unionized RHP employees, non-unionized RHP employees and appointed physicians who were not employees, creating a situation of “separate estates”. These estates made interprofessional collaboration difficult by reinforcing uniprofessional perspectives, preventing organizational level discussions of competence and limiting the organization’s ability to harmonize processes across RHPs. Competence did not feature as a prominent concern for most participants who expressed the view that as long as the individual remained in good standing with their regulatory body, competency was not a matter of organizational concern. Recommendations call for healthcare organizations to implement best practice approaches to competency assessment across all RHPs; to establish congruence between organizational and regulatory assessments of competence; and to align assessment language between healthcare workplaces and regulatory bodies in order to facilitate meaningful discussions concerning competence in the practice setting and address the issue of “separate estates”.

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