When creating a training plan for healthcare, it is important to not just consider course completion. Nurses, Allied Health Professionals, Clinical Support staff and Administrators all need to have the skills to do their job safely and consistently. A good workforce development plan begins with identifying the roles individuals have, their current capability and how they will demonstrate improvements.
Identifying a skills gap in healthcare means understanding how the service requires you to have skills that your staff currently lack. By identifying what skills gaps exist, managers can ensure they prioritise training time to focus on the most impactful areas for patients.
Begin by identifying what skills individuals have. Education leads, clinical leads and service managers can identify what skills individuals have by looking at their competency records, supervisory notes, learning assessments and quality issues. Asking individuals what they feel confident with and what they need support with will also help. However, be sure to also look at what they are doing in practice to get a clear picture of what skills they actually have available throughout shifts, teams and locations.
Once identified what skills they have, look at what skills they will need in the coming months. If they are implementing a new electronic health record, staff may need practice recording information accurately, handing over relevant details and accessing patient records appropriately. If they are seeing increased complex patients on their ward they may need extra supervised practice around identifying deterioration. Administrative staff may also need training in handling confidential information and managing appointments.
Once you have identified what skills they have and what they will need, identify the gap that needs to be addressed. Try to identify why there is a gap in skills. Is it due to patient safety, a new process, ensuring continuity of service or an identified quality issue? This will also ensure you aren’t wasting your training budget on popular courses that don’t address the key skills required. Take into consideration local professional standards, organisational policies and how much each individual can legally do.
Avoid vague goals such as ‘improve communication’ or ‘be more confident’. Your healthcare competency framework should highlight specific behaviours, when they should be completed and who should be assessing them. Attendance can be used to show they have attended.
Be specific with your goals. For example, if they are completing a clinical handover they should be able to communicate relevant observations, actions and escalation using the agreed format for handover. If they are completing a task as a healthcare administrator they should be able to update the record accurately and follow the correct pathway for a confidentiality issue. Ensure you are setting the correct standard for each role.
Define the level of proficiency they should achieve. This can help differentiate between observing, practicing under supervision, practicing consistently within their authorised role and being able to support others. You don’t necessarily need to set them to reach the last level but if they are doing something that impacts patient safety they should be confirmed competent by an appropriately qualified assessor to meet the relevant local requirements.
Having a shared understanding will help you know the difference between upskilling and reskilling. Upskilling would be improving an experienced nurses use of a new documentation system whereas reskilling would be providing them with the skills to undertake a different role that may require formal education, registration or additional authorisation. Work with clinical educators, line managers and relevant practitioners to create definitions. They will know where they are making mistakes in practice and what standards they need to maintain consistently even when their department is busy.
Often different departments have different names for the same skill. One team may have training on patient handover under communication whilst another may have it listed as transferring care. This can make it hard to see if they have been tested on the same core skill.
A skills taxonomy will help provide a standardised list. This allows common skills to be grouped together such as infection control, documentation and escalation. However, you can also have skills that are specific to certain clinical practices. Ensure each skill includes what role it should be completed by, the expected standard, evidence of competency and the assessment method. Just because they have the same name doesn’t mean they have the same requirements for each role.
Before creating training activities, ensure you have clearly defined the workforce skills required. This will help avoid departments having similar skills with different names.
Start with a short list. Identify the most relevant skills to regular practice, clinical governance and service priorities. Ask educators and frontline managers to review the wording. Add alternative terms they use but keep one main term to use for recording. Review the taxonomy when there are changes to processes, equipment or professional requirements. Having a defined competency will help teams identify who needs additional support.
As a healthcare team you won’t have time to address all learning needs. It is important to prioritise what you are going to focus on especially when education may conflict with cover, clinical supervision and appointments. Ensure you are identifying the most essential skills and those that are nice to have.
Prioritise based on how it impacts patient safety, how often the skill is required, how exposed staff are and the impact of poor performance. If they are regularly struggling to identify specimens or escalate an abnormal observation this may be more important to address than a new reporting feature. Consider what risk there is to continuity of care if only one or two individuals can complete an essential skill. Work with clinical governance and training leads to identify what should be prioritised.
Sometimes there may be a need for urgent training due to changes in technology. If they are implementing electronic prescribing or record systems individuals will need to practice using it with guidance and validation. Any new processes should have clear escalation pathways in place in case there is missing information or the device fails. Essential training should ensure they understand the organisations safety processes and professional requirements. Once the most high risk gaps have been addressed you can start to focus on elective skills.
Using a simple impact and urgency matrix will help you identify what you want to focus on. High impact and urgent skills will have dedicated teaching time, supervised practice and formal assessment. Low risk goals may use peer learning and self directed resources. This shouldn’t replace professional judgement. Any mandatory competencies or regulatory requirements should still be met even if they don’t score highly.
Whilst education and e-learning can build knowledge, you need to ensure they can apply it safely. Build a process that includes teaching, practice (simulated or supervised), feedback and recording. Ensure it is supervised at the right level.
This is often used to encourage a balance between learning through experience, peers and education. It isn’t a validated model for how much you should teach individuals based on their competency but can help to ensure you don’t have a fully course based plan. For high risk procedures you may need to provide them with structured teaching, simulation and formal sign off before allowing them to complete independently. Use the model to help rather than having strict percentages.
For example, if they are learning a new process for recording patient information they may complete a short module, observe an experienced colleague and practice using test records. If they are a clinical practitioner learning a new process, they may need simulation-based practice followed by observed and documented assessment. Feedback should help them understand what they did and what they need to demonstrate.
Ensure they are practicing the right skills with the correct supervision. Provide them with scenarios that will challenge them, such as interruptions, handover and uncertainty around escalation. If they don’t need real patient information use simulation or anonymised examples. Use peer learning to help them reflect on their decisions. Supervisors should record their observations and help them with errors but shouldn’t make them feel like they are being blamed. Staff learning a new clinical procedure should not perform it independently with patients until they have been appropriately assessed and authorised.
You need to have an owner for the healthcare development plan. This could be an education lead, learning and development manager or nominated service lead. This will ensure they keep the skills register up to date, schedule reviews and ensure training is prioritised in line with clinical governance and staffing.
Line managers and qualified clinical supervisors will complete the work. They will ensure they are practicing the right skills, provide feedback, schedule assessment and ensure they have time to learn if possible. Mentors can be used from experienced colleagues but shouldn’t be confused with authorisation. This will clearly outline who is responsible for what to avoid important decisions getting lost between HR, education and clinical.
Make development meaningful. If individuals can see a realistic path forward it will make it more meaningful. Individual plans can link new skills to specialist roles, leadership opportunities or other roles. Be clear if they need additional qualifications, registration or employer approval. Demonstrating competency does not authorise staff to work beyond their professional scope or enter a regulated role without the required qualifications and registration.
Consider time. If possible include education, supervised practice and review in their rota. Be clear why the learning goals are important to patient care and their role. Celebrate milestones such as passing their supervised assessment or improving handover accuracy. Continue to monitor their performance.
Just because they complete a course and score well on quizzes doesn’t mean they are competent. For each of your priority skills ensure you have a measure to observe, assess or audit. Look at any changes in service.
Managers may wish to audit a sample of records to ensure they are complete to an agreed standard and how they are managing common omissions. If they are completing a handover programme they may wish to audit they are communicating critical information in line with local policy. Ensure you are using aggregated data and ensuring patient and employee confidentiality. Ensure your measurements are appropriate, helpful and relevant to what they are trying to develop.
If you are looking to understand how long it takes individuals to become competent it can help managers. Ensure your assessments are consistent and they have had similar opportunities to practice. If they are becoming competent quicker it may not be a good thing if the assessment is easier or they are being supervised less. Consider the conditions of your staff, experience of the learner and feedback from assessors before altering their training pathway.
Create a regular review process. Compare their initial skills assessment with any observations, any relevant audits, learning from incidents and ask supervisors if they can apply their learning. If there have been any changes to equipment, pathways or local processes reassess. If the evidence shows they still have a gap in their skills consider changing the practice opportunities or support they are receiving. Don’t automatically put them on another e-learning course.
Healthcare services can change meaning the skills your teams need will also change. By creating a development plan that links specific standards, supervision and meaningful assessment you can improve safety and consistency whilst giving individuals a clear path to grow professionally.
MBTpg/ARC