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Journal of the American Academy of Physician Assistants:
doi: 10.1097/01.JAA.0000431509.67454.0b
Commentary

Building the right skills for the healthcare workforce of the future

Cohen, Paul M.

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Paul Cohen is a senior business consultant at Kaiser Permanente in Oakland, California.

For PAs, as for most clinicians, continuing education and professional development are part of the job. But are PAs building the right skills—the competencies that will best serve their patients and their organizations in a time of change?

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With healthcare reform taking hold in 2014—and with the supply of primary care physicians shrinking—the demand for PAs is likely to grow. In fact, PA jobs were already expected to grow by 30% from 2010 to 2020, according to the Bureau of Labor Statistics.1 But the pressure to control costs and improve the quality of care suggests that healthcare professionals will be asked to develop new capabilities in the years ahead. “Soft skills” such as problem solving, collaboration, cultural competence, and team leadership will be as important as technical skills.

Amy Edmondson, Novartis Professor of Leadership and Management at Harvard Business School and an authority on organizational learning and team effectiveness puts it this way: “Performance is increasingly determined by factors that can't be overseen: intelligent experimentation, ingenuity, interpersonal skills, resilience in the face of adversity, for instance. Consider a hospital emergency department. At any moment, a patient with a previously unheard-of set of symptoms might walk in, and specialists from several departments—reception, nursing, medicine, laboratory, surgery, pharmacy—need to coordinate their efforts if the patient is to receive effective care. These people must resolve conflicting priorities and opinions quickly. As in most knowledge organizations, room to maneuver is extraordinarily high. People rely on their own and their colleagues' judgment and expertise, rather than on management direction, to decide what to do. When work is interdependent and in flux, as it is in this situation, interpersonal fear is not only unhelpful, it's downright counterproductive.”2

Leading healthcare organizations are responding to these changes by creating new ways to deliver care, solve problems and engage and develop their people. Kaiser Permanente is a case in point. An integrated, nonprofit health plan and healthcare provider serving more than 9 million members in nine states and the District of Columbia, Kaiser Permanente employs more than 170,000 people, including more than 850 PAs. Most employees work in an innovative, far-reaching labor-management partnership that touches almost every aspect of care delivery and operations.

Partnership brings frontline managers, healthcare workers, and physicians together to make full use of each individual's expertise. This happens mostly in unit-based teams, which include all the members of a natural work group. Unit-based teams focus on improving performance in their areas by finding efficiencies and better ways of doing day-to-day work. They have undertaken more than 20,000 performance improvement projects, including efforts to reduce waste, better manage chronic disease, improve patient service and satisfaction, and improve patient and workplace safety.

To be sure, Kaiser Permanente offers the kinds of clinical and technical training available at most high-performing healthcare organizations. But recognizing the need to engage the whole workforce in continuous learning, and to develop critical thinking and problem-solving skills that benefit all parties means that Kaiser Permanente and its partner unions also provide:

* training in performance improvement, including the Rapid Improvement Model. This model, based on a framework developed by Associates in Process Improvement and popularized by the Institute for Healthcare Improvement, uses iterative cycles of “plan, do, study, act” to conduct small tests of change.

* jointly led workforce development programs to promote career development and mobility within the organization

* two educational trusts that provide career counseling, training, and financial assistance to represented employees seeking to upgrade their skills or career path

* strategies to identify and internally recruit for hard-to-fill positions (including PAs and NPs).

“Our approach to workforce planning and development is unique,” says Laura Long, director of national workforce planning and development for Kaiser Permanente. “We provide comprehensive services that help ensure the success of our programs. You can provide funding for all the training you want, but unless you support the people taking those programs—for example, with career counseling or stipends to offset lost time—a lot of people won't be able to complete the training.”

That was the case for Sylvia Sarin, a PA at Kaiser Permanente's ambulatory surgery center at Tysons Corner, Virginia, who took a 22-hour course in anesthesia assessment with the help of a stipend from a jointly sponsored (union-management) educational trust. “I would not have been able to take off work in order to take this training otherwise,” she said. “It gave me an opportunity to expand and reinforce my skills so we can continue to provide patients with the best care available.”

Mike Riley, a PA in family medicine at Kaiser Permanente's Lakewood, Colorado, medical offices, uses his performance improvement training even when not seeing patients. “We have to solve operational as well as clinical problems that don't always have clear-cut solutions,” he said. “We get physicians, managers, and labor all at the table to solve problems, and that gets better results for our patients.”

Riley is also putting his years of training to additional use, teaching a course on patient communication for incoming physicians. “Teaching MDs is huge,” he says. “It helps keep me sharp.”

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REFERENCES

1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition. http://www.bls.gov/ooh/healthcare/physician-assistants.htm. Accessed April 15, 2013.

2. Edmondson AC. The competitive imperative of learning. Harvard Business Review, July 2008. http://hbr.org/2008/07/the-competitive-imperative-of-learning/ar/1. Accessed April 15, 2013.

© 2013 American Academy of Physician Assistants.

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