A Qualitative Content Analysis Exploring Systems-Based Practice Across Health Professional Competency Standards

Systems-based practice is crucial for health professionals. Our study aimed to explore systems-based practice within health professions competency standards in Australia, Canada and the United Kingdom.

We employed conceptual content analysis to review the extent to which systems-based practice is articulated within competency standards documents across 14 different health professions. Systems-based practice key word searches were undertaken across 38 documents, with frequency of terms counted and compared across professions and countries. The text surrounding the key word was analysed and categorised based on a systems-based practice framework into either knowledge (structural competencies), skills (structural action) or attitudes (social responsibility). Categories across professions were summarised and synthesised across professions for each of knowledge, skills and attitudes.

The most common terms used across the professions and countries were 'quality' and 'system' with most phrases surrounding quality related to safe and effective patient care with only some references to improving care or quality improvement. Text surrounding the term 'system' mainly referred to health professions being able to navigate the systems in which they interact to provide care, with some standards describing competencies to affect systems that affect health, including bias, determinants of health, and access to care. The competency statements mostly focused on knowledge and skills with only some attitudinal capabilities described across the standards. All professions included systems-based practice competencies with some emphasising health system practice (paramedicine, midwifery, medicine, paramedicine, pharmacy, podiatry, radiography) and others including broader social systems (dietetics, nursing, physiotherapy, psychology, sonography, speech pathology, social work).

Systems-based practice is as a key competency for health professionals across Australia, Canada and the United Kingdom with a focus on health care systems and limited focus on competencies that challenge broader systems and prepare graduates to address the determinants of health.