OBJECTIVE AND COMPETENCE-BASED APPROACHES IN A SYSTEMATIC WORK WITH HEALTHCARE STAFF

I.Naida, N. Bovtruk, N. Guts

 Due to combining the objective and competence-based approaches we will have synergy in effect (effect of integrity) for passing the way of leading world countries in a shorter period of time!

We are all witnesses to a complicated system of relationships in our country; we were captured by intermediate and present objectives.

Only few people thought strategically. Under these conditions human energy and considerable resources are wasted without achieving goals. This phenomenon is taking place in the healthcare services nowadays.

Many organizations and institutions of national, regional and local levels carry out specific duties which are focused on the current tasks, without strategic planning. Their functions majority of the times are not coordinated with other subjects at which activities are aimed at achieving the main goals of the state – to preserve and strengthen health, to reproduce and multiply human potential at the state and satisfy peoples’ needs in high levels of medical care.

The majority of healthcare organizations are still living with their own interests and do not meet the main goal; therefore,  organizations of self-preservation often become a goal, defending the usefulness of creating new bodies, increasing unproductive competition for resources. 

What we have in this case? In this case, there are conflicts, closure of management systems of healthcare services that leads to a system of destabilization. As results show that this leads to a transformation towards the opposite direction from the main goal.

Focusing on a single goal (the main goal) creates the ideal conditions for achieving the required (certain) results. While focusing on the ultimate (the main target) goal we need to realize that:

a) A specified goal is not a dogma and can be revised (changes must be done according to all social, economic and other characteristics);

b) Long-term goals and ways to achieve them should be clearly defined;

c) The attention required to all current activities should not be lost. The activities should be done in accordance with the ultimate goal (the main) with the help of intermediate goals.

Thus objective-based approach as a system of methods and techniques ensures permanent management orientation which allows us to consider the hierarchy of the objectives. It also helps to identify goals that "are working" to achieve results, to form a system of priorities and goal based performance. In general this approach enables to manage the process of development and achieve goals in any field and any organization.

“Management by objectives, says J. Morrisey. – requires a clear definition of the objectives or desired outcomes of work, forming a real program of their achievement and clear parameters of work “[2].

Pyramid of productivity and a system of management by objectives.

We need to emphasize at the level of goals and results management. The first level is the leader’s and all staff’s skills to aware organization's mission and values which allow employees to feel the uniqueness and social significance of their organization. Employees need to understand what to expect from the organization and how organization is reliable for cooperation.

There are also goals and strategies. Organizational goal is a particular image of the desired (expected) result which organization can actually reach in a certain period of time.

Organizational str

ategy – it is the path which organization is moving on, the basic direction of movement.

On the other hand, goals, strategy and action can be presented in integrated form by mission of the organization (pic.1).

Pic. 1. Pyramid of productivity

Practical implementation of objective-based approach is caused by the necessity of proving these principles to each performer. This problem is often solved by using the "management by objectives" [2].

Therefore, at this stage of development of a country, the chairman O. Musiy decided to clarify understanding of how we want to see our national healthcare system. It can be executed by forming a new national healthcare system concept which is an important component of practical implementation of established ideas.

The concept defines the ultimate (main) goal. Action plans should form the strategic and tactical goals whilst achieving the ultimate (main) goal [3].

We can admit that even a perfectly formed, logically written goal is only an intention which can be realized by people with appropriate qualification.

Therefore, the idea of forming managers and performers whom are able  to execute intermediate and strategic goals in a short period of time are becoming more of value.

The Management by objectives structure can be presented by three main stages (pic. 2).

Рic. 2. Stages of objective-based system

Competence-based approach in details

Competence-based approach has an important role in the policy and practice of management as one of the key factors in achieving goals. Nowadays, all successful organizations (business, public sector) use a similar approach in their activities: in some organizations a set of competencies are used in specific order, in others – it is becoming determinant in HR.

Nowadays competence-based approach seems to be more declared than a practical use in our country, although there are already some developed documents such as the “National framework of qualifications”, approved by the Cabinet of Ministers dated 23 November 2011, №  1341.

The National Qualifications Framework is necessary to the executive bodies, institutions and organizations which are implementing the public policies in education, employment and industrial relations, educational institutions, employers and other businesses and individuals to design, identify, plan and develop qualifications.

Our task is to implement competence-based approach in the government structure, hospitals, educational and research institutions and all business which activities are related to staff training and management. It has to become the property of the new educational programs, textbooks and teaching materials, including professional trainings for: doctors, nurses, pharmacists and others.

There are two main important definitions in competence-based approach: competence and expert capacity.

Competence – is the ability on reflecting the required standards of behavior. It describes the requirements for personal, professional and other qualities necessary to perform a particular activity [4].

Expert capacity- is the ability required to solve business tasks and produce the required results (proved ability to apply knowledge, skills, and defined competences) [4]. Expert capacity – is a high, standard or low – is determined by a level of implementing a competence.

There are three main groups of competencies: core (general corporate); professional (for a particular activity) and managerial.

Competence can and should be developed owing to proper management and development. The highest level of professional competence will always be the possession of competency "effectiveness.” In this case we mean the ability to set up difficult but achievable goals, to focus efforts on achieving them.

Competency-based approach allows carrying out recruitment, adaptation and development of personnel whom are capable to perform professional duties and achieve goals more efficiently [5]; to perform faster and more efficiently.

To understand what model of competencies looks like, there is a following model of civil servants in Ukraine, which consists of 9 competencies grouped into "clusters" (competences which belong to the same group of properties). Each competence has a description of expected behavior which indicates that person has these qualities (knowledge and skills).

Table 1. Competence model of civil servants in Ukraine

	DECENCY
Personality	A person is guided by ethical norms (honesty, moral rules of public and professional communities) in everyday life. A person generates respect and credibility Fulfills promises and obligations.
	SELF DEVELOPMENT
	Strives to new knowledge and experience Provides consistent steps to realize own life Generates the terms and conditions for development, taking into account the public interest.
	PURPOSEFULNESS
	Is able to identify goals and mechanisms for achieving them Believes in his opportunities. Is able to achieve results.
Corporative	Professionalism
	Has professional knowledge and skills according to the occupied position. Deeply understands and analyzes core questions. Is able to manage professional processes effectively.
	Communicativeness
	Is able to establish and maintain effective relationships. Is able to hear and understand other people and resolve issues according to public interests.
	Involvement
	Considers being on his own duty to contribute to the prosperity of the state and industry. Is worried about goals and tasks. Initiates constructive actions
Statehood	Patriotism
	Self-identifies himself with Ukrainian political stance Deliberately relates personal, corporate and government interests. Knows and is proud  of Ukrainian culture and traditions ADHERENCE TO PRINCIPLES Consistently adheres and supports certain  Government guidelines. Is stable to own moral and political principles. Is inclined to abandon his own interests for the public’s sake.
	Statehood Adheres to principles of the rule of law Acknowledges and respects the diversity of political,  ethnic, social and cultural communities in Ukraine Fulfills the applicable laws and legislative acts of Ukraine.

  

System of competence – is based on an evaluation

Competence-based approach suggests that we can work out the quality required to worker or a manager to perform their professional duties according to a clear system of evaluation activities, criteria and competencies.

Let’s consider the possibilities of medical environment.  Independent classification commissions and structures should evaluate the doctor’s work directly .There is a firmly defined criteria and methods of evaluation.

Firstly, the worker evaluates himself. Secondly, he is evaluated by their colleagues he is working with. Thirdly, worker’s managers do this. Fourthly, the patients serve to give their assessment. In other words, it is so-called “method of 360 °” or method of an "objective subjectivity" is used.

The most popular is the criteria-based approach on competence. Is consists of a five-level scale.

We should know not only competences which are needed to perform certain work but we need to evaluate people according to defined criteria.

  

Table 2. Criteria-based approach to competence evaluation

Rating	How competence is showed
5 {+2; 12}	Competence  which is reproduced to other	Leadership level	An excellent level, much higher  from the expected	Master’s level. The quality is  brightly expressed, skills are developed and executed automatically
4 {+1; 10}	High competence	Strong level	Good level, a little higher from the required	Quality is evident and can be developed independently,  skills are  developed well
3 {0; 7}	Competence	Basic level	Below the desired level	Quality is evident in typical situations and can be developed independently or with the appropriate training, skills are satisfactorily developed
2 {-1; 4}	Competence which is being formed	Level of understanding	Lower than expected	Quality appears occasionally and requires development; skills are poorly formed, requires appropriate training, lack of practical skills
1 {-2; 2}	Incompetence	Negative level	Inappropriate display of competence (unsatisfactory rate)	The quality is not evident at all, lack of practical skills, great difficulties in its training

In practice it is difficult to achieve perfection but we are striving to take into account views of all members of healthcare: doctors, professionals, communities and management. Thus everybody from the list may raise the question about removal of one or another doctor from the work because of failures.

 We consider to be undeniable the benefits from evaluation of activity and remuneration based on competencies using criteria approach and method of 360°:

1.     To ensure transparency and openness taking into account the whole group’s point of view (subjective objectivism).

2.     To educate motivated, qualified and dedicated employee.

3.     To define approaches in planning of individual development, training programs aimed to increase human potential and achieve goals.

4.     To form clear criteria for recognition and rewards through measuring employee’s performance.

Competence-based approach is indispensable in the process of preparing mature pupils, students, employees, managers. The significance of this approach is extremely important to today and will increase in the future.

Due to combining the objective and competence-based approaches we will have synergy in effect (effect of integrity) for passing the way of leading world countries in a shorter period of time.

 Literature

[1] Morrisey J. Management by objectives , 1979. - 74.
[2] Richard C. Kearney Evan M. Berman Public Sector Performance: Management, Motivation, and Measurement, Westview Press, 1999. - 235

[3] Walsh  К. KPI. – М,  2001.- 363.

[4] Hollyford, Management by competences, Hippo, 2003.- 228.

[5] Sink. Productivity management, - М.: Progress, 1989. – 528