Age, gender, culture are key competencies

Assess management skills as well

(Editor's note: This is the second of a two-part series that examines the components for a successful competency assessment program in outpatient surgery. Last month, we looked at the essential components of a program, and this month we look at some of the components that outpatient surgery programs routinely neglect to address in their competency assessments.)

Does your competency assessment program address age-, cultural-, and gender-specific competencies? Does your program address management and administrative issues? A good competency assessment program goes beyond regulatory and accreditation requirements, but these additional areas pose challenges for outpatient surgery programs, say competency experts interviewed by Same-Day Surgery.

A cultural or diversity competency assessment must apply to all employees and managers within the program, says Dawn Q. McLane, RN, MSA, CASC, CNOR, chief development officer of the Nikitis Resource Group, a consulting firm based in Broomfield, CO. Not only do individual employees need to be aware of the different values, beliefs, or practices of the different cultures the program serves as they provide one-on-one care, but also managers or administrators need to be aware of the effect their actions may have on the community.

"I was a consultant to a new surgery center that developed a problem with woodpeckers that kept pecking holes in the building," McLane says. "The cost to spray the building to keep the birds away was high, so the administrative team opted to put statues of owls on top of the building to scare the birds away."

What managers did not take into account was the fact that the large American Indian population in the area viewed owls as a sign of death, which is not the best advertising for a surgery center, she admits. "We had to remove the owls and arrange for a medicine man to bless the building to rid it of evil spirits to reassure community members that it was safe to come to the facility," McLane adds.

While a manager needs to ensure that staff members are able to respect cultural and diversity differences in the patient population, showing respectful behavior toward co-workers also is important. Assess your staff's ability to avoid sexual harassment in the workplace, suggests Marcy Grow-Dorman, RN, BSN, ambulatory surgery center director at Orthopedic Sports Medicine Center in Elkhart, IN. One way to approach this issue is to talk about communication between co-workers and how the intent of different messages can be perceived, she says. Observing staff members interacting with each other and asking staff members about the appropriateness of certain jokes or comments can be used to evaluate the staff member's comprehension, she says.

Gender differences in your patient population also must be addressed in your competency assessment, says Grow-Dorman. "Women are physically more sensitive to pain, so we cannot expect reported pain levels to be the same in men and women,"1 she says. Nursing assessments that recognize the physical differences enable the staff to help women better control pain after surgery, she adds.

Age-specific competencies also must be included in your program, says McLane. If your program treats all ages of patients you should develop competencies for pediatric, adult, and geriatric patients, she says. For example, nurses should be able to start an intravenous line in pediatric patients using appropriate pediatric supplies as well as geriatric patients with fragile skin, she says.

Be sure to check your pharmacy and nursing staff's knowledge of medication differences for different ages within your competencies, says Grow-Dorman. "We don't treat a lot of children, but we do see some during the year, so it is important that we know how to determine a pediatric dose," she says.

Another area of competency assessment that is frequently overlooked is management, says McLane.

"This is one area that is important to freestanding centers because they do have limited resources for management to call upon for help, so we have to make sure that managers do know how to lead a team, perform a cost analysis, and evaluate personnel," she explains.

Hospital-based program managers do have other departments for assistance, but freestanding centers are on their own, McLane says. "Typically, a good staff nurse is promoted into a management position for which he or she is totally unprepared," she says. A thorough competency assessment will help identify areas of knowledge needed for the job so that the new manager can get the education or training needed, McLane adds.

Ask staff to identify competencies

Although oversight of a competency assessment program ultimately must be the responsibility of the manager, it is important to involve staff members, says McLane. "I think it is critical to involve the staff in developing the program from the ground up and helping maintain the program," she says. "In all roles, they should actively participate in identifying what department- and role-specific competencies they believe need to be practiced and documented regularly in order to demonstrate competency."

Competencies that are included in an assessment program may be:

  • high-volume procedures such as performance of an accurate glucometer test;
  • low-volume but high-risk procedures such as response to a code blue, malignant hyperthermia, or scope to open procedure for scrub techs;
  • items identified in the quality or risk management program of the organization that require extra education and training for the staff.

If you do identify items related to your quality or risk management program, you may want to include them only for one to two years or until you are satisfied that you've addressed the issue, says McLane.

Because every successful competency assessment program is designed to meet the specific and unique needs of your outpatient surgery program, there is no "one-size-fits-all" program, McLane says. "I believe that the most effective program is one where the employees are charged with the responsibility of participating in the creation and maintenance of the program so that they buy into it and understand their individual responsibilities to document their professional competencies on an annual basis," she says.


  1. Mowlavi A, Cooney D, Febus L, et al. Increased cutaneous nerve fibers in female specimens. Plast Reconstr Surg 2005; 116:1,407-1,410.


For more information on developing competency programs, contact:

  • Marcy Grow-Dorman, RN, BSN, Ambulatory Surgery Center Director, Orthopedic Sports Medicine Center, 2310 California Road, Suite B, Elkhart, IN 46514. Phone: (574) 970-4454. E-mail: