Integrating competency analysis into national rehabilitation workforce evaluation: a case study – Human Resources for … – Human Resources for Health

Analysis of the data from the key informant interviews and project officer debrief revealed several themes related to the perceived value of the competency analysis, as well as of the evaluation more broadly. Themes also emerged around challenges experienced with data collection and quality, and several experts offered suggestions for strengthening future implementation of the evaluation. The main themes are elaborated below. Note that key informants and the project officer are referred to as “experts”.

Working with the concept of a rehabilitation workforce

GRoWE was designed as a resource for the rehabilitation workforce collectively, rather than for any specific occupation. This was reflected in the competency analysis in particular, which presented rehabilitation assessments and interventions targeting a range of areas of functioning (e.g., mobility, communication, respiration, mental health.). Experts reported that participating in an evaluation that adopted the concept of a “rehabilitation workforce” challenged the identity of some occupations and expanded stakeholders’ understanding of what rehabilitation is and what its workforce comprises. For example, many speech and language therapists, who in Poland work primarily in the education sector, had not considered themselves as health workers or as rehabilitation workers. Conversely, psychologists in Poland had been working hard to promote themselves as rehabilitation professionals, but had encountered challenges due to the narrow perception of rehabilitation in the country. Experts noted that rehabilitation is largely synonymous with physiotherapy and rehabilitation medicine in Poland, and that other occupations, especially those which do not primarily address ‘physical’ impairment, are overlooked. The GRoWE project officer noted, “There are two queens or kings—doctors and physiotherapists—and the rest are underestimated”. GRoWE challenged this perception, placing equal importance on the competencies and tasks of each occupation included in the evaluation.

Identifying and managing scopes of practice

The competency analysis was reported by experts to be valuable in addressing the issue of informal task sharing. Task sharing was noted to be widespread among the rehabilitation workforce in Poland, especially in relation to physiotherapists absorbing tasks from the scopes of practice of occupational therapy and speech and language therapy. Task sharing was considered to be necessary in Poland given the underdevelopment of many of the rehabilitation occupations but was not always well-supported with education and training. Furthermore, it was suggested, physiotherapists tended to assume that they were responsible for all or most rehabilitation tasks—a belief that likely stems from the absence of other occupations in many settings. As one expert reported, “we need to make the space for [other occupations], because sometimes physiotherapists here in Poland are thinking that they are all in one, but we are not” (KI5).

The competency analysis was considered by experts to be useful in showing which occupations were working at what level and what tasks were being performed by whom. This was seen as central to ensuring “proper use of available workforce” (KI2). Despite some limitations in the competency analysis (see data collection and quality below), the results were seen by experts as an important starting point for discussion and as the basis for the development of more comprehensive competency analysis tools.

Multidisciplinary collaboration

A perceived benefit of GRoWE in general and the competency analysis exercises in particular was its ability to foster collaboration between the different rehabilitation occupations. Experts noted that, although some occupations were accustomed to working together in the clinical setting, this rarely translated into cooperation in workforce evaluation and planning. Completion of the exercises necessitated teamwork, while the workshops brought all occupations together around a virtual table, with a common aim. Experts noted that this had previously been lacking. One expert stated, “I was missing this openness and the willingness to cooperate between the different sections of the rehabilitation system. Therefore, it was perfect for me” (KI5).

Data collection and quality

All experts noted challenges with data collection and quality. These related to all aspects of the evaluation, but reliability was specifically flagged as a concern for the competency analysis. This concern was linked to the subjective nature of the competency analysis exercises, which relied on a small sample of workers reporting on behalf of their wider occupation. The project officer reported that some stakeholders felt uncomfortable with the responsibility of representing their workforce. For example, when completing the competency analysis exercises, participants reported tension between responding based on what is expected of the occupation and the actual performance of workers. While the instruction for the exercises was to report actual performance, it was not always possible for the sample of workers completing the exercise to gauge this. Concerns about reliability were greater for unregulated occupations, such as occupational therapy, for which there is considerable variability in levels of proficiency and scopes of practice. Given these concerns, experts felt that the results of the competency analysis should be interpreted as preliminary and used to facilitate further investigation. It was also suggested that a survey instrument and/or focus groups could be used in addition to the exercises to obtain a wider range of perspectives and opinions, thereby strengthening the reliability of the data.

As the GRoWE pilot in Poland took place in the context of the COVID-19 pandemic, stakeholders had to meet virtually, and data collection occurred via emails, phone calls and online meetings and workshops. This format was considered by the experts to have several benefits, including greater flexibility and the ability to engage stakeholders from different geographic regions of the country. The GRoWE project officer noted however, that face-to-face discussion among stakeholders, even in a single workshop, had the potential to strengthen stakeholder engagement with the evaluation. Meeting in person was thought to enable better communication and connection among stakeholders (especially those who had not known each other prior to the evaluation) and between stakeholders and the project officer, to whom data were reported. Experts tended to agree that a hybrid approach would be optimal, with online communication complemented by at least one in-person workshop.