CBPPSIT MEETING MINUTES

April 18, 2000

Present: JoAnn Appleyard, Diane Brown, Andrea Hannon, Judith Papenhousen, Arlene Sargent, Polly Walker

The meeting was called to order by Polly Walker. March 3, 2000 minutes were approved.

Diane Brown from CalNoc joined us for the first part of the meeting. This time was devoted to discussing with Diane questions the committee had on the process of implementing a descriptive study, documenting the relationship between competencies in the service setting and identifying correlations between competencies in the service setting and educational outcomes. We also discussed possible links between CBPPSIT and CalNoc.

Following is Diane’s summary of the discussion:

"Based on a prior conference call with Polly, Nancy Donaldson, and myself on 3/2/00 and a workgroup meeting on 3/3/00, the project plan had evolved to something like this:

Phase I:

A descriptive study using numerous sites of care and locations of care across the continuum, would answer the following questions:

• Do CSPCN competencies exist in the service setting?
• Are nurses practicing in a role that allows them to demonstrate those competencies?
• Does the institution evaluate the nurses using the competencies? (OR, can the competencies be measured and are they valid?)
• Do the service competencies compare to outcome objectives of education?

Process: Ask service sites to share competency and evaluation tools for evaluation. Allocate resources for this analysis to be completed.

Phase II:

A descriptive study, using CalNoc sites (? limited to med/surg or to CC?), to answer the following questions:

• Can competencies be linked to outcome data collected by CalNoc? (This may be the purpose)
• Can we say the competency levels affect patient outcomes? (This may be the analyses)

Today, the CSPCN workgroup was going to look at what the Phase I competency evaluation might look like and discuss ways of competency quantification in order to look at Phase II questions. Until the analysis is complete, it is difficult to begin discussions on the study design for Phase II. We all discussed the need to keep the study small and well defined in order to begin the work (fund it) and be successful, even if it does not answer ALL the questions they have on the topic. For example, measuring "competency" on a unit may be measuring what structural components are actually in place, or degree of implementation, or level of individual nurse competencies. Each level has implications for next steps with Phase II design.

I saw opportunities for the projects to collaborate in Phase II as CalNoc sites would be gathering the following data that might be beneficial to examine the questions posed.

• Context of care at the unit level: hours of care, skill mix, registry, and education/certification/experience.
• Process/patient outcomes: fall rates, PU prevalence, risk assessment rates for falls and PU, restraint use, patient satisfaction.
• CSPCN may want to add vacancy rates in addition to the context of care.

Some of the future work would need to focus on issues such as the following:

• If CalNoc sites were going to be used for understanding the link with competency, both CalNoc Steering Committee and the sites would need to closely examine the confidentiality statements that are signed for CalNoc and what would additionally be required in order to consent to release data for another type of analysis (to be defined).
• CalNoc would need to determine what resources would be required for the additional analyses (to be defined).
• CSPCN would need to determine how to measure "competency" on these units in order to investigate the "link".
• Selected CalNoc sites would also have to be willing to collect all the indicators desired during a defined time period (RN education survey, Picker participation, and prevalence studies as an example).
• It seems very logical that the two projects would continue to collaborate on the outcome measurement (design of phase II). CSPCN would not need to re-invent outcome measurement. CalNoc may want to have "competency" as a variable by the time it is ready -- to help explain outcome variation in addition to our current context variables. CalNoc will not want to re-invent competency measurement. It also seems logical that the same sites that are interested in competency measurement may be the same hospitals that desire to participate in CalNoc (the movers & shakers).

I left the meeting with the following understanding of next steps:

To ask CalNoc if CSPCN can have a copy of the CalNoc site list. They would be interested in seeing if the Nurse Exec. of CalNoc sites might be interested in participating in the Phase I assessment of competency (sending job descriptions, evaluations, etc. for review). I have called Pat to pose the question. I'm not sure what level of discussion this would require on our part.

CSPCN will work on Phase I and quantification of competency (a huge task in itself).

We will wait until their Phase I analysis is complete before trying to have further discussion on possibilities for Phase II. The analysis will drive further discussion on possible opportunities for collaboration."

The following correspondence took place with Dana Rutledge, whom we hope to have assist us with our job descriptions and EII competencies.

"In terms of the job descriptions, the committee would appreciate your correlation of the job descriptions we have received with the competencies document. We have over twenty of them in various shapes and forms!

The committee would appreciate your addressing the following in your review:

1. Are there competencies that are present in the majority of the position descriptions? If so, which ones?
2. What data from the position descriptions can be used to quantify the information in the future?
3. We would appreciate having the data separated by type of health care agency, i.e. public health setting, hospital, etc.
4. What 2-3 competencies are present in most, or all, of the job descriptions?
5. How can we assure reliability among interpretation of position descriptions?
6. Is there a distinguishable characteristic (i.e. behavior) that can be used in measurement in the future? Is this quantifiable?

The committee would like to invite you to be present at our June 8th meeting in Southern Cal. We view this meeting as a working session whereby we would like you to have a draft of a matrix or categories for the position descriptions available for us to review. Together we could react/ discuss the components to determine consensus on how items are categorized. We are open to your input on this and how we might structure the meeting to make it productive for all. We see this as an opportunity for you to use the committee for any questions you might have and for us to buy into how the job descriptions are categorized into the compentencies. How does this sound to you? Is this a reasonable timeframe for you to have a draft completed? We are open to your input. Let me know."

The meeting adjourned at 2:00 P.M.