Institute of Medicine Core Competencies

In the Quality Chasm report developed by the Institute of Medicine (IOM) in 2001, the committee recommended the following vision for all institutions offering education and training to health practitioners: “all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics” (Institute of Medicine, 2003). Based on the above vision, five competencies were set to help the country’s health care system meet the needs of the 21st-century. The competencies include the provision of patient-centered care, the offering of care as interdisciplinary teams, the use of evidence-based practice, constant quality improvement, and the use of informatics (Institute of Medicine, 2003). Below is a detailed discussion of these core competencies and the challenges faced when implementing them and their solutions.

Institute of Medicine Core Competencies

The first core competency is the provision of patient-centered care.  Patient-centered care can be defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (Kuipers, Cramm, & Nieboer, 2019). Based on this competency, health care providers need to identify, respect, and care about the diverse need of their patients. Patients and health care providers share power and responsibility. caregivers also communicate with patients openly and involve them in the decision-making process (Institute of Medicine, 2003). One of the major obstacles when it comes to the provision of patient-centered care is the lack of enough staff. Nursing shortages affect an institution’s ability to offer patient-centered care. One way to solve this challenge is to offer accommodative schedules that allow nurses to meet their personal and professional needs. Institutions that do this excel in nurse recruitment and retention.

The next competency recommended in the report is the provision of care by interdisciplinary teams. Health care providers in different practices should collaborate and integrate care to ensure patients receive continuous and reliable care (Institute of Medicine, 2003). Working in teams helps health care providers come up with solutions to complex health issues. It also makes it easier to respond to multiple patient needs, especially when dealing with a patient who needs chronic care. One of the major obstacles to the success of interdisciplinary teams is poor communication. Lack of proper communication among the different care providers results in the breakdown of the provision of care. One way to solve this problem is to ensure caregivers receive constant teamwork training (White, 2016). Training helps caregivers communicate with each other helping eliminate miscommunication.

According to the IOM, caregivers also need to ensure they use evidence-based practice. This is the use of best evidence gathered from well-designed research studies together with the caregiver’s clinical expertise and patient values to make health care decisions. The evidence used needs to be relevant to the situation being solved. One of the major obstacles that prevent the use of evidence-based practices is the failure to use rigorous quantitative research designs when carrying out studies (Institute of Medicine, 2003). As a result, most studies are descriptive or qualitative. Such studies do not provide sufficient evidence. The solution to this problem is standardizing evidence and combining it with findings from other related fields to ensure the best outcomes are achieved.

Another key competency is quality improvement. It revolves around the identification of errors and hazards likely to be witnessed during the provision of care. Once the errors and hazards have been identified, safety measures are put in place to ensure they do not occur again. Health systems also have inefficiencies such as duplication of services, delays in the provision of care, and wastage of resources. Quality improvement helps to get rid of these inefficiencies. However, the lack of a proper information structure to support the process poses a significant challenge to quality improvement. One possible solution is the development of policies that will act as guidelines on how information should be stored and utilized to improve health care. The policies should also dictate the information that needs to be collected, stored, and analyzed.

The final key competency is the utilization of informatics. Health care informatics involves the use of information technology systems to solve health problems (Institute of Medicine, 2003). It can be used to facilitate patient-centered care as it ensures important information is readily available. The information can then be used to make decisions. A good example of an information system used to facilitate the provision of care is an electronic health record (EHR) system. EHR systems contain information that facilitates patient safety and timeliness and efficiency of care. Informatic systems are often faced with legal and regulatory issues such as the right to privacy. Regulatory requirements and acts need to be designed to address such issues.

References

Buchan, J., & Aiken, L. (2008). Solving nursing shortages: a common priority. Journal of clinical nursing17(24), 3262–3268. https://doi.org/10.1111/j.1365-2702.2008.02636.x

Colduvell, K. (2017). Nurse Bullying: Stand Up and Speak Out. Nurse.org. Retrieved from https://nurse.org/articles/how-to-deal-with-nurse-bullying/

Edmonson, C. (2019). Our Own Worst Enemies: The Nurse Bullying Pandemic. Nursing Administration Quarterly, 43(3), 274-279. DOI: 10.1097/NAQ.0000000000000353

Haddad, L.M., Annamaraju, P., & Toney-Butler, T.J. (2020). Nursing Shortage. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493175/

Institute of Medicine (US). (2003). Chapter 3, The Core Competencies Needed for Health Care Professionals. Washington (DC): National Academies Press (US). Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK221519/

Kuipers, S.J., Cramm, J.M. & Nieboer, A.P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and the physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Serv Res 19(13). https://doi.org/10.1186/s12913-018-3818-y

McGhee, M.K. (2019). Top 5 Ethical Issues in Nursing in 2019. American Mobile. Retrieved from https://www.americanmobile.com/nursezone/nursing-news/top-five-ethical-issues-in-nursing-in-2019/

Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday ethics: ethical issues and stress in nursing practice. Journal of advanced nursing66(11), 2510–2519. https://doi.org/10.1111/j.1365-2648.2010.05425.x

White, J. (2016). How Communication Problems Put Patients, Hospitals in Jeopardy. Healthcare Business & Technology. Retrieved from https://www.healthcarebusinesstech.com/communication-patient-harm/

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