Competencies for the 21st Century Health Care Worker

In the most recent issue (2005;330:637-639 – March 19) of the British Medical Journal (, there’s an interesting short article titled “Preparing the 21st century global healthcare workforce” in the Learning in Practice section. Pruitt and Epping-Jordan mostly discuss skills and needs in terms of preparing health care professionals to handle the shift from acute to chronic conditions.

What I found most interesting was how the World Health Organization (WHO) has identified a set of competencies for health care workers. The five competencies included:

  1. Patient centred care
  2. Partnering
  3. Quality improvement
  4. Information and communication technology
  5. Public health perspective

I find it somewhat amusing that information and communication technology was explicitly listed as a basic competency. Given the tight integration of technology into everyday life, I suppose it’s not too surprising. The authors then proceeded to identify elements of training a training program. Here is a short list of them:

  • Learn how to move from reactive care to proactive, planned, and preventive care, using several of the new competencies outlined above
  • Learn how to negotiate individualised care plans with patients, taking into account their needs, values, and preferences
  • Learn how to support patients’ efforts at self management
  • Learn how to organise and implement group medical visits for patients who share common health problems
  • Care for a defined group of patients over time
  • Work as a member of a healthcare team
  • Work in a community based setting
  • Design and participate in quality improvement projects
  • Develop information systems (for example, patient registries) and use available technology and communication systems to exchange information on patients
  • Learn to think beyond caring for one patient at a time to a “population” perspective
  • Develop a broad perspective of care of patients across the continuum from clinical prevention to palliative care

I agree with most of these, but the one about information systems (highlighted)? Whoa. “Develop information systems” – do the authors understand what they are asking? I can now imagine health care professionals moving toward developing systems of their own, with (presumably) little formal training in engineering, information science, or computer science. Does anyone else see a potential nightmare here? Sure, I think health care professionals need to be aware of the challenges and issues of systems development and also remain actively engaged in development (i.e., participate), but “develop” is a stretch.

Also, blanket statements like “use available technology and communication systems to exchange information on patients” is somewhat scary. I agree that perhaps existing privacy legislation may be somewhat draconian. But (and this is a big “but”), encouraging people to share and communicate patient information using available technology is another minefield. What about issues like identity theft, confidentiality, data quality issues, and so on? That’s like suggesting to people to go crazy using technology to do all of your financial transactions even though the systems haven’t been developed (yet).

Okay, so I’m being a bit critical here. I encourage health care professionals to learn how to use technology because ehealth is and will continue to be a reality in health care, like it or not. I just think there needs to be an informed/educated use of technology.