The competency question

JCAHO mandates "processes that are designed to ensure that the competency of all staff members is assessed, maintained, demonstrated, and improved on an ongoing basis." However, it is difficult to collect aggregate data regarding staff competency patterns and trends. How many facilities have the time or energy to collect aggregate data, let alone statistically analyze it for patterns and trends? Not many in today's environment. I saw the need to create a test to evaluate staff competency at my facility, but soon realized I would have no way of knowing if the results were good or bad. The only way to judge the results would be to have a standardized test that was used by multiple facilities. As president of the Houston X-ray Quality Society, I brought the topic up at a meeting in 1995, and a committee was set up to work on the test. The result is two competency tests--one for staff radiographers and one for mammographers--which are currently used by 35 to 40 facilities, with approximately 1,000 technologists taking the test each year. The tests include practical questions that reflect the knowledge required to perform daily exams. Each test has five sections that assess different areas of competency. The scoring system allows technologists to fail one or more individual sections but still pass the test overall. Twenty to 30 percent of the questions are new each year. That gives us the ability to look for improvement on previous year's questions, and at the same time, avoid producing a static and ineffective test. There are 60 questions on the staff radiographer test and 65 questions on the mammographer test, which also includes clinical images. Facilities must sign an agreement that states that they cannot use the test as a disciplinary tool in the employee's evaluation, or in any other way against the technologist. As a profession, radiology administration not only has regulatory requirements to evaluate competency, but also a moral duty to insure that patients receive the best possible care. We should not cover up or ignore the blemishes that we all know exist. Instead, we should take them on, as professional and personal challenges to improve the competency of our staff.