Appendix 2: Competencies
Domains of knowledge
(Batalden, Berwick et al. 1998)
Domain
Knowledge
1
Customer/Beneficiary
knowledge
Identifying customers internal and external to the
organisation, describing methods to identify customer
needs
2
Health care as a
process/system
Understanding work as a process and analysing data as a
process of work
3
Variation and
measurement
Collect and analyse data on outcomes of care, interpret
qualitative and quantitative data and differentiate common
and special cause variation; use data to make changes that
decrease unwanted variation
4
Leading, following, making
changes
Displays skill in active listening, gives and receives
constructive feedback
5
Collaboration
Work collaboratively with health professionals from other
disciplines, work effectively in multi-disciplinary teams,
appreciate the importance of multi-disciplinary
establishment of organisation-wide quality goals, and know
why an interdisciplinary approach is necessary for quality
improvement and safety in health care
6
Developing new locally
useful knowledge
Conduct serial experiments of improvement, ie, PDSA and
apply continuous improvement to personal learning and
change
7
Social context and
accountability
Understand the linkage of quality and cost in health care
and apply continuous improvement
8
Professional subject
matter
Gain all the specialist knowledge and skills that equips for
competency in quality improvement
Quality improvement domains
Adapted by the Health Foundation from Batalden & Davidoff 2007 JAMA, cited in Quality
Improvement training for health care professionals (The Health Foundation 2012 ).
1
2
3
4
5
Components
Examples of topic areas
The wider context

How the health system is structured and how it works

Historical, social and political context within which health
systems develop and operate

Health policy

Accountability

Professionalism

Psychology of change

Learning styles

Leadership

Teamwork and collaboration

Management

Multidisciplinary working

Reflection and learning from mistakes

Seeing health care from then user’s perspective

Identifying and targeting the needs and preferences of
different subgroups of users

Acquiring tools to asses and respond to users

Systems thinking

Complexity theory and interdependencies

Spread

Sustainability

Planning and predicting

Understanding risk and risk management

Different forms of evidence

The philosophy of science

Variation

Measurement

Local versus generalisable knowledge

Small versus large scale change

Collecting, analysing and interpreting data
Human behaviour
Needs and preferences
of people who use health
services
Health care as a process
The nature of knowledge

Reporting and displaying information

Process mapping
Leadership for quality
(Garman 2011)
1
2
3
4
5
6
Domain
Competencies
Fosters positive change

Advocates and adapts to change

‘Partners’ for change

Cultivated a quality-supportive climate

Drives for results

Verbal communication skills

Written communication skills

Listening and receiving feedback

Educating

Strategic planning

Strategic thinking and alignment

Financial acumen

Systems thinking

Professional ethics

Manages personal limits

Resilience and self-restraint

Consumer advocacy

Future focus

Lifelong learning

Managing data

Analyst thinking/knowledge-based decision-making

Develops a knowledge-rich environment
Communicating
Organisational
awareness
Self-management
Professionalism and
professional values
Performance
improvement
Team competencies
(Baker, Day et al. 2006)
1
2
3
Teamwork
Definition
Behavioural examples
Team
leadership
Ability to direct and coordinate
the activities of other team
member , assess team
performance, assign tasks,
develop team KSAs, motivate
team member, plan and organise
and establish a positive
atmosphere.

Facilitate team problemsolving

Provide performance
expectations and acceptable
interaction patterns

Synchronise and combine
individual team member
contributions

Seek and evaluate
information that impacts team
functioning

Engage in preparatory
meeting and feedback
session with the team

Identifying mistakes and
lapses in other team members
actions

Providing feedback regarding
team actions in order to
facilitate self-correction

Recognition by potential
backup providers that there is
a workload distribution
problem in their team

Shifting of work
responsibilities to underutilised team members

Completion of the whole task
or parts of tasks by other
team members

Identify cues that a change
has occurred, assign meaning
to the change and develop a
new plan to deal with changes

Identify opportunities for
improvement and innovation
for habitual or routine
practices
Mutual
performance
monitoring
(situation
monitoring)
Backup
behaviour
The ability to develop common
understanding of the team
environment and apply
appropriate task strategies tin
order to accurately monitor
teammate performance
Ability to anticipant other team
member’s needs through
accurate knowledge about their
responsibilities
The ability to shift workload
among members to achieve
balance during high periods of
workload pressure
4
Adaptability
Ability to adjust strategies based
on information gathered from the
environment through the use of
compensatory behaviour and
reallocation of intra-team
resources. Altering a course of
action or team repertoire in
response to changing conditions
5
6
7
8
Shared mental
models
Communication
(Internal or external

Remain vigilance to changes
in the internal and external
environment of the team.
An organising knowledge
structure of the relationships
between the task the team is
engaged in and how the team
members will interact

Anticipating and predicting
each other’s needs

Identify changes in the team,
task or teammates and
implicitly adjust strategies as
needed
Exchange of information between
a sender and a receiver
irrespective of the medium

Following up with team
members to ensure message
was received

Acknowledging a message as
received

Clarifying with the sender that
the message received is the
same as the intended
message sent.

Taking into account
alternative solutions provided
by teammates and appraising
that input to determine what is
most correct

Increase task involvement,
information sharing,
strategizing and participatory
goal setting

Information sharing

Willingness to admit mistakes
and accept feedback
Team/Collective Propensity to take others’
orientation
behaviour into account during the
group interactions and the belief
in the importance of team goals
over individual members’ goals
Mutual trust
The shared belief that team
members will perform their roles
and protect the interests of their
teammates.
Capabilities for individuals
(National Advisory Group on the Safety of Patients in England 2013)
Berwick’s recommendations for improvement in the NHS link knowledge and skills to specific
organisational roles.
1
2
3
4
Domain
Competencies
Front line staff

Setting goals and measures

Identifying problems

Mapping processes

Testing changes

Simple waste reduction

Simple standardisation

Team behaviours

Setting goals and measures

Identifying problems

Mapping processes

Sequencing tests of change

Simple understanding variation

Implementation and spread

Simple waste reduction and standardisation

Understands systems thinking

Leads microsystem

Setting goals and measures

Identifying problems

Implementation of portfolio and management

Simple understanding variation

Managing spread

Simple waste reduction and standardisation

Understands microsystems

Systems thinking

Setting directions and big goals

Execution leadership

Portfolio selection and management

Oversight of improvement
Clinical leaders
Operational leaders
Executives
5
Experts

Being a champion and sponsor

Understanding variation to lead

Analysis, prioritisation of portfolios

Deep statistical process control

Deep Improvement methods

Leadership team advisory re portfolio selection

Effective plans to implementation and spread
Quality improvement and patient safety skills
(The Health Foundation 2014)
The most extensive list of knowledge and skills was published in the Building Capability
document, Health Foundation. It was gathered from scans of existing quality
improvement/safety curricula and programmes. Asterisks (*) indicate safety specific skills.
Domains
1
2
Technical safety
improvement skills

Cause and effect diagrams

Process mapping/analysis
Identifying where and
why improvement is
needed; analysing safety
risk and
measuring/evaluating
data, change and
outcomes

Driver diagrams

Swim lane mapping

Understanding clinical variation

Understanding clinical risk*

Proactive risk analysis tools (eg, failure mode and effects
analysis)*

Model for improvement

Identifying error and harm*

High reliability systems*

Human factors*

Root cause analysis

Safety-critical work (eg, invasive procedures, infection
control, medicines safety, emergencies)*

Plan-Do-Study-Act (PDSA) rapid improvement cycles

Value stream mapping

Spaghetti diagrams

Fishbone analysis

Five whys

Recognising, reporting and managing adverse events
and near misses*

Patient stories
Measurement skills

Measurement for improvement
Designing measures and
evaluating data, change
and outcomes

Setting baselines

Excel, Pareto, Run, SPC, Win Charts

Balanced scorecards

Quality measurement

Collecting data/audit
3
4

Data sampling

Analysing data

Safety culture measures (eg, safety culture interaction)*

Measurement of reliability

Mortality measures*

Harm measures*

Patient experience measures

Evaluating improvement
Engagement and
implementation skills

Leading change/improvement

Understanding others’ perspectives
Influencing and engaging
colleagues in patient
safety work; involving
staff, patients and
partners; motivating
those involved to
change/enhance practice
and sustain change over
time

Creativity and innovation

Sustainability

Organising for quality

Staff engagement

Group facilitation skills

Creating a culture for improvement/safety*

Working in partnership

Patient and carer engagement

Coaching principles and practice

OD cycle and skills (contracting, data collection, data
feedback, implementation)

Effective teams

Team diagnostic tools (e.g. Aston organisation
development)

Motivation theory

Communicating about risk, safety and errors*

Learning and changing practice from errors*

Manchester Patient Safety Framework (MPSF)*

S-BAR handover tool

Handling conflict effectively

Respectful and non-respectful behaviours
Research and learning
skills

Qualitative research methods

Quantitative research methods
Extending and
deepening knowledge
and understanding about
safety improvement;
sharing learning;

Research findings into practice

Peer reviewed publishing
5
applying and transferring
research into practice
across wider contexts

Conducting patient safety research*

Action research
Systems leadership
skills

Whole systems theory

Social movement theory
Creating a culture of
values and behaviours
which nurture and
promote safety
improvement across a
meso- or macro-system

Understanding complex systems

Leading change across organisational boundaries

Developing shared purpose and values

Latent conditions for safety

Peer leadership across systems
Patient safety competencies
(The Safety Competencies Steering Committee 2008)
Canadian patient Safety Institute (The Safety Competencies Steering Committee 2008)
identified six competencies required for ensuring patient safety: Each Domain is further
specified by key competencies and enabling competencies. This table will include only the
key competencies for each domain.
1
2
3
4
5
Domain
Description
Contribute to a culture of
patient safety

Commit to patient and provide safety through safe,
competent high quality daily practice

Describe the fundamental elements of patient safety

Maintain and enhance patient safety practice through
ongoing learning

Demonstrate a questioning attitude as a fundamental
aspect of professional practice and patient care

Participate effectively and appropriately in an interprofessional health care team to optimise patient safety

Meaningfully engage patients as the central
participants in their health care teams

Appropriately share authority, leadership and decisionmaking

Work effectively with other health care professionals to
manage inter-professional conflict

Demonstrate effective verbal and non-verbal
communication abilities to prevent adverse events

Communicate effectively in special high risk situations
to ensure the safety of patients

Use effective written communications for patient safety

Apply communication technologies appropriately and
effectively to provide safe patient care

Recognise routine situations and settings in which
safety problems may arise

Systematically identify, implement and evaluate
context-specific safety solutions

Anticipate, identify and manage high risk situations

Describe the individual and environmental factors that
can affect human performance

Apply techniques in critical thinking to make decisions
safely

Appreciate the impact of human/technology interface in
Working in teams for
patient safety
Communicating effectively
for patient safety
Managing safety risks
Optimising human and
environmental factors
safer care
6
Recognise, respond to and
disclose adverse events

Recognise the occurrence of and adverse event or
close call

Mitigate harm and address immediate risks for patients
and others affected by adverse events and close calls.

Disclose the occurrence of an adverse event to the
patient and/or their whānau/family as appropriate and
in keeping with relevant legislation

Report the occurrence of an adverse event or close call

Participate in timely event analysis, reflective practice
and planning for the prevention of recurrence