Core Competencies For Today’s Healthcare Workforce

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Core Competencies for Today’s Healthcare WorkforceCurriculum OutlineDESCRIPTIONThe transformation of New York State’s healthcare system to care coordination and care management delivery models requires new coreskills and competencies across many frontline healthcare workers, including care coordinators, care managers, patient navigators,community health workers, health educators, medical assistants, patient care technicians/associates, nurses, and home care workers.While many of the specific job responsibilities and titles of these roles vary across institution, setting, and patient population, there is alarge consensus in the field and a growing body of literature to support that healthcare workers practicing in these models haveoverlapping functions and should have a core set of skills and competencies.In order to support the workforce development field in delivering education programs that prepare the current and future workforce withthe skills now required by healthcare institutions to deliver patient-centered coordinated care, the New York Alliance for Careers inHealthcare (NYACH) and its Partners Council set out to identify and build consensus around the core competencies required for practicingin today’s healthcare environment. This core curriculum outline– which includes nine core competencies with accompanying topics andlearning objectives - is intended to serve as an industry-designed framework for educators and trainers to build off of, with the finalcurriculum ultimately tailored to the specific occupation, student population, and geographic and institutional setting that the program isintended for. The goal in providing this framework is that any student completing an education/training program designed to prepareworkers for employment and practice in care coordination delivery models should possess these critical core competencies and skills.This curriculum outline is a framework for designing a new course module titled “Introduction to Core Competencies for Today’sHealthcare Workforce” to be incorporated into many allied health education and training programs. Furthermore, this outline shouldserve as a roadmap to embedding and reiterating core competencies throughout the entirety of a course (i.e. person-centered care andcommunication) and to expand in further detail depending on the occupation the training is preparing the student for (i.e. chronic diseasemanagement for health coaches). This program is intended to be taught through a learner-centered teaching approach incorporatingroleplays, case studies, and other interactive activities into the course.1

DEVELOPMENT, INPUT AND VALIDATION PROCESSThis core curriculum was developed through the NYACH Partners Council. The development consisted of recommendations based onresearch and a literature review conducted by the Greater New York Hospital Association, and input from the following Partnerorganizations:1199SEIU Training and Employment FundsCommunity Healthcare Association of New York StateCity University of New YorkGreater New York Hospital AssociationParaprofessional Healthcare InstituteSouthern New York AssociationAdditionally, the curriculum outline was reviewed and contributed to by the NYS Department of Health DSRIP/SIM Workforce WorkgroupSubcommittee to Identify Recommended Core Curriculum for Training Workers in Care Coordination Titles. Members of this group include:Center for Health Workforce Studies, University at Albany School of Public HealthFort Drum Regional Health Planning OrganizationOffice of Academic Health & Hospital Affairs, State University of New YorkThis recommendation is closely aligned to the version being considered by the NYS Department of Health DISRIP/SIM WorkforceWorkgroup.2

SUMMARYBelow is an index of the core competencies and accompanying learning topics covered in this curriculum outline. Each corecompetency represents a course module and each learning topic –of which includes 2-4 learning objectives – ultimately shouldbe tailored and customized based on the focus of the program.1. Introduction to New Models of Care and Healthcare Trendsa. Overview of the US healthcare systemb. Introduction to care coordinationc. New models of care2. Interdisciplinary Teamsa. Working on interdisciplinary teamsb. Building positive relationships on a teamc. Communication with team membersd. Participating in team huddlese. Dealing with team conflict3. Person-Centeredness and Communicationa. Defining person-centered care planningb. Recognizing family and patient needsc. Communication and patient engagement techniques (part 1)d. Communication and patient engagement techniques (part 2)e. Health literacy4. Chronic Disease and Social Determinants of Healtha. Overview of chronic disease and co-morbidities (part 1)b. Overview of chronic disease and co-morbidities (part 2)c. Social determinants of healthd. Self-management5. Cultural Competencea. Recognizing patients’ families’ cultural needs/factors that may affect their choices or engagement3 Communicating with patients and families in a culturally competent mannerc. Recognizing and acting on potential biases in an appropriate mannerEthics and Professional Boundariesa. Ethical and responsible decision-makingb. Professional boundariesQuality Improvementa. The quality improvement processb. Quality improvement methods and processesCommunity Orientationa. Connecting patients and families to community resourcesb. Supporting families as they seek resources in the communityHealth Information Technology, Documentation and Confidentialitya. Basic technology skills and the electronic health recordb. Documentationc. Confidentiality and guidelines4

CORE COMPETENCY 1: Introduction to New Models of Care and Healthcare TrendsModule Overview: This module provides an overview of the U.S. healthcare system and the goals of healthcare reform, both at theFederal and State level. It focuses on new models of care, an introduction to care coordination, and the changes in the way that healthcareis being paid for and delivered. Students will gain an understanding of the Triple Aim and how the system is being transformed in order toreach this goal.TopicLearning Objectives (Students will be able to )ResourcesOverview of theUS healthcaresystem andpayment system Care Coordination Fundamentals: Module 1, 1199SEIUTraining and Employment Fund (1199SEIU TEF) andPrimary Care Development Corporation (PCDC) Introduction tocarecoordination New models ofcare Describe the types and interrelationships of healthcare facilities, services, and personnelUnderstand the basics of Medicare, Medicaid andprivate insurance as well as the basics of managedcare organizations, capitation, value-based paymentsand their purpose in healthcare reformUnderstand how healthcare reform will impact thedelivery of healthcare servicesDescribe the values and assumptions that underlie thechanging priorities in healthcare delivery andfinancingUnderstand what coordinated care looks likeIdentify the goals of care coordination based on theappropriate level of care needed for the individualand/or population being servedDescribe the roles and responsibilities of healthcareworkers in care coordination modelsUnderstand commonly used terms in carecoordination.Describe strategies that may support high quality careas a means to improve population healthUnderstand the Triple AimDescribe new models of care (Health Homes, PatientCentered Medical Home, ACOs, DSRIP) and what theyWhat does Coordinated Care Look Like?, Institute forHealthcare Improvement (IHI)Care Coordination Fundamentals: Module 1, 1199SEIUTEF and PCDCCare Coordination Fundamentals: Module 2, 1199SEIUTEF and PCDC5

have in commonUnderstand the basics of PCMH standards as it relatedto care coordinationUnderstand the difference between home care andhealth homesUnderstand how a value-based purchasing/pay forperformance payment model differs from traditionalfee for serviceUnderstand the differences between individual vs.population health6

CORE COMPETENCY 2: Interdisciplinary TeamsModule Overview: This module reviews the importance of delivering care as a part of an interdisciplinary team. It focuses on the variouspositions and roles of care team members and why frequent and clear communication across team members is critical to delivery patientcentered quality care. It teaches students to be productive and contributive members of care teams and provides strategies for conflictresolution when necessary.TopicLearning Objectives (Students will be able to )ResourcesWorking oninterdisciplinaryteams Geriatrics, Palliative Care and InterprofessionalTeamwork Curriculum Module #2: InterdisciplinaryTeamwork, US Dept. of Veterans Affairs Understand the definition of an interdisciplinaryhealthcare teamUnderstand benefits of teamworkIdentify various roles and scope of work ofinterdisciplinary team membersInterprofessional Collaboration Module, US Dept. OfHealth & Human Services (HHS)TeamSTEPPS Module 2: Team Structure, Agency forHealthcare Research and Quality (AHRQ)Building positiverelationships ona team Communicationwith teammembers Understand the importance of strong relationshipswithin a healthcare teamIdentify tactics to build strong relationships within ahealthcare teamUnderstand why coordinated patient care requiresexcellent communication across team membersIdentify best practices for communicating effectively,with team members by sharing appropriateinformation in person, by phone, or by emailUnderstand how body language and tone affectcommunicationPatient Safety, PS 101: Teamwork and Communication:Why are Teamwork and Communication Important?,IHICare Coordination Fundamentals: Module 2, 1199SEIUTEF and PCDCCare Coordination Fundamentals: Module 9, 1199SEIUTEF and PCDCImpact of Communication in Healthcare, IHIResources: Teams, American Academy on7

Participating inteam huddlesDealing withteam conflict Know how to seek input from team members,understanding each member of the team has specificstrengths and expertiseUnderstand the purpose of team huddlesIdentify strategies for effective team huddlesKnow how to actively participate in team meetingsand huddles, understanding barriers to effectiveinterdisciplinary team communication (i.e. power andhierarchy) and strategies to addressUnderstand basic conflict management skillsKnow strategies to deal with different types of peopleor situations in team settingsKnow when to escalate issues to appropriate teammembersCommunication in Healthcare (AACH)TeamSTEPPS Module 3: Communication, AHRQPatient Safety, PS 101: Teamwork and Communication:Communication during Times of Transition, IHITeam Huddle Toolkit, Health.milModel of Team-Based Care: Huddle Strategies andChecklist, Page 13, Cambridge Health Alliance (CHA)Morning Huddle Educational Video, National Council forBehavioral HealthModel of Team-Based Care, Appendix A, CHATeamSTEPPS Module 6: Mutual Support, AHRQ8

CORE COMPETENCY 3: Person-Centeredness and CommunicationModule Overview: This module provides an overview of the shift to and importance of person-centered care in the new healthcaredelivery system. It teaches healthcare workers what person-centered care means, how to effectively communicate and engage withpatients, and the importance of customer service.TopicLearning Objectives (Students will be able to )ResourcesDefining personcentered care Care Coordination Fundamentals: Module 2, 1199SEIUTEF and PCDC Recognizingfamily andpatient needs Understand person-centered care and how it differsfrom the prior physician-centered care systemExplain how person-centered care is related toreaching the triple aimList best practices for communicating with patientsand their families in person, by phone and emailUnderstand what good customer service looks likeand know strategies to get therePerson-and Family-Centered Care, PFC 101: Dignity andRespect, IHIPerson-and Family-Centered Care, PFC 102: A Guide toShadowing: Seeing Care through the Eyes of Patientsand Families, IHIPerson-Centered Toolkit, George WashingtonUniversityCare Coordination Fundamentals: Module 9, 1199SEIUTEF and PCDCResources: Difficult Encounters, AACHCommunicationand patientengagementtechniques(part 1) Understand how patient engagement techniques canbe applied to the management of chronic conditionsGenerally understand motivational interviewing,shared decision making and behavioral activation astechniques for patient engagementPerson & Family Centered Care Module, HHSCare Coordination Fundamentals: Module 18, 19, 20, 21,1199SEIU TEF and PCDCMotivational Interviewing Training New TrainersManual, Excellence in Motivational InterviewingMotivational Interviewing Resource Guide, Community9

Care of North CarolinaMotivational Interviewing Educational Video, NationalCouncil for Behavioral HealthThe Shared Decision Making Guide, Centre forCollaboration, Motivation & InnovationResources: Informed/Shared Decisions, AACHCommunicationand patientengagementtechniques(part 2)Health literacy Understand what health coaching is and in whatcontext it might be usedUnderstand what it means to advocate for patientsbased on their needs and desiresUnderstand health literacy and factors that influencehealth literacyUnderstand the connection between promoting healthliteracy and improving patient outcomesIdentify tactics to assess patients’ health literacy leveland understand tools to promote it, including theteach-back method and reflective listeningHealth Literacy Universal Precautions Toolkit, AHRQHealth Literacy Training, Centers for Disease Controland Prevention (CDC)Health Literacy Measurement Tools, AHRQ10

CORE COMPETENCY 4: Chronic Disease and Social Determinants of HealthModule Overview: This module reviews the major chronic diseases and the implications of poor chronic disease management on patientsand our healthcare system. It teaches students tools and strategies to help patients thrive by reviewing both chronic disease care and thesocial determinants that affect health outcomes. It includes a basic overview of the major chronic conditions. Programs should explore ingreater detail conditions relevant to the students’ occupations and work settings.TopicLearning Objectives (Students will be able to )ResourcesChronic diseaseand comorbidities(part 1) Care Coordination Fundamentals: Modules 3, 4, 5, 6,1199SEIU TEF and PCDC Chronic diseaseand comorbidities(part 2)Socialdeterminants ofhealthSelfmanagement Understand what a chronic disease is, the prevalenceof it in the U.S., and how it relates to our healthcaresystemUnderstand the basics of diabetes, cardiovasculardisease, asthma, cancer (breast, colon, cervical),mental illness, cognitive impairment/dementia,depression, substance use/addiction, and HIV/AIDSUnderstand stigmas often associated with thesechronic conditionsIdentify behaviors and risk factors related to diet,exercise and smoking that impact chronic diseaseKnow the appropriate team member to reportchanges in behavior/conditionDefine social determinants of healthUnderstand determinants that may affect a patient’shealth (such as gender, race, class, ethnicity, and placeof residence)Understand what patient self-management looks likeKnow available and relevant tools to assist patientswith self-managementA Community Health Worker Training Resource forPreventing Heart Disease and Stroke, CDCResources: Behavior Change, AACHTransforming Health Systems: Module 2, World HealthOrganization (WHO)Social Determinants of Health Learnings and Tools,WHOIntroduction to Social Determinants of Health,University of Michigan School of Public HealthChronic Disease Self-Management Program- EvaluationTools, Stamford Medicine11

Be able to help patients talk to their doctors andprepare them for medical visitsTransforming Practices into Medical Homes: SelfManagement Support in the PCMH, Safety Net MedicalHome InitiativeIMPACT Model Toolkit, AIMS Center, University ofWashingtonResources for Screening, Brief Intervention, andReferral to Treatment (SBRIT), Substance Abuse andMental Health Services Administration12

CORE COMPETENCY 5: Cultural CompetenceModule Overview: This module reviews the growing importance for healthcare delivery to meet the diverse cultural needs of NewYorkers. It teaches healthcare workers to assess and incorporate cultural preferences and needs of individuals and families into acomprehensive care plan, predominantly through culturally competent communication. It also teaches students to recognize and assesspersonal biases and handle them appropriately.TopicLearning Objectives (Students will be able to )ResourcesRecognizingpatients’ andfamilies’ culturalneeds/factorsthat may affecttheir choices orengagement Care Coordination Fundamentals: Module 7, 1199SEIUTEF and PCDC Define cultural competence, cultural awareness, andcultural sensitivityDescribe how personal bias and culture can impactthe way people interpret illness and interact with themedical systemIdentify your own biases and how they affect yourrole as a healthcare workerLearning Modules, National LGBT Health EducationCenterOMH Minority Health eResources, HHSResources: Culture, AACHCommunicatingwith patientsand families in aculturallycompetentmanner Describe effective interviewing skills to betterunderstand a patient’s cultureThe Process of Cultural Competence in the Delivery ofHealthcare Services, Transcultural C.A.R.E AssociatesCare Coordination Fundamentals: Module 7, 1199SEIUTEF and PCDCNational Heart, Lung, and Blood Institute: SelectedAudiences Resources, HHSBE SAFE: A Cultural Competency Model for AfricanAmericans (HRSA), National Minority AIDS Educationand Training CenterRoad to Health Toolkit: African Americans and LatinoPopulations at Risk for Type 2 Diabetes, CDC13

Resources: Cultural Competence, New York Associationof Psychiatric Rehabilitation ServicesCultural Competence Curriculum, Center of Excellencein Culturally Competent Mental Health14

CORE COMPETENCY 6: Ethics and Professional BoundariesModule Overview: This module reviews general healthcare ethics and professional boundaries. It focuses on making sure that healthcareworkers understand how to make ethical decisions and why professional boundaries are integral in healthcare. This module should betailored to better prepare students for situations they may face in their specific occupations and work environments.TopicLearning Objectives (Students will be able to )ResourcesEthical s Care Coordination Fundamentals: Modules 2, 23, 24,1199SEIU TEF and PCDC Identify a framework for ethical decision makingBe familiar with and know the purpose of the patient’sbill of rightsUnderstand personal and professional boundaries andwhy they are importantDescribe the role personal and professionalboundaries have in creating positive relationshipswith patients and teammatesUnderstand appropriate boundaries with social mediawhile working with patientsUnderstand risky behaviors that lead to boundaryviolationsCare Coordination Fundamentals: Modules 23, 24,1199SEIU TEF and PCDCA Nurse’s Guide to Professional Boundaries, NationalCouncil of State Boards of Nursing (NCSBN)A Nurse’s Guide to the Use of Social Media, NCSBN15

CORE COMPETENCY 7: Quality ImprovementModule Overview: This module focuses on empowering healthcare workers to meaningfully partake in the quality improvement process.It teaches students methods and tools used to measure quality improvement and evaluate performance and strategies to participate in theprocess.TopicLearning Objectives (Students will be able to )ResourcesThe qualityimprovementprocess Care Coordination Fundamentals: Module 22, 1199SEIUTEF and PCDC Qualityimprovementmethods Understand how each individual plays a role in thequality improvement processUnderstand how to assess opportunities for qualityimprovementParticipate actively in quality improvement byproposing ideas to improve processes and outcomesIdentify tools for monitoring performance, includingperformance indicatorsUnderstand what key data points are used to measurequality improvement and evaluate performanceResources: Organized, Evidence Based Care, Safety NetMedical Home InitiativeSystems Based Practice Module, HHSCare Coordination Fundamentals: Module 22, 1199SEIUTEF and PCDCQuality Measure Tools & Resources, AHRQINTERACT Tools, Interventions to Reduce Acute CareTransfers16

CORE COMPETENCY 8: Community OrientationModule Overview: This module helps students understand how to access and connect with organizations in their patients’ communities.It teaches healthcare professionals how to refer patients to appropriate resources to meet their holistic needs.TopicLearning Objectives (Students will be able to )ResourcesConnectingpatients andfamilies tocommunityresources Care Coordination Fundamentals: Module 10, 1199SEIUTEF and PCDC Supportingfamilies as theyseek resourcesin thecommunity Identify key community-based resources to providesupport for care coordination services andunderstand the collaborative role of communitysupport servicesIdentify and use resource guides (i.e. directories) tofind support services relevant to patient diagnosis andneedsUnderstand the roles of healthcare workers in helpingpatients and their families access available localresourcesDemonstrate effective skills and strategies forworking with community agenciesDescribe the tools that healthcare workers can use tohelp patients access needed resourcesUnderstand the importance of follow up with patientsafter providing resourcesHealth Information Tool for Empowerment (HITE),Greater New York Hospital AssociationCare Coordination Fundamentals: Module 10, 1199SEIUTEF and PCDCSelf-Management Support Module, HHS17

CORE COMPETENCY 9: Technology, Documentation, and ConfidentialityModule Overview: This module provides students with a general understanding of the importance of technology, documentation andconfidentiality guidelines across healthcare settings. While HIT systems and software vary by institution and setting, students should havea basic level of computer literacy and knowledge of how to properly record patient information. It is recommended that trainings caterthis module to teach the skills relevant to their students’ occupations and work settings.TopicLearning Objectives (Students will be able to )Basic technology skills and theelectronic healthrecord Documentation Confidentialityand guidelines ResourcesKnow the fundamentals of using basic technology(sending electronic health records, emails, textmessages, typing notes, systematic record transfer,phone lines, etc.)Explain how electronic health records affect patientsafety, quality care, outcomes, efficiency andproductivity, etc.Define what a health record isUnderstand the importance of thorough and properdocumentationKnow how to meaningfully use Health InformationTechnologyUnderstand how to write meaningful case notesUnderstand the requirements of the federal HealthInformation Portability and Accountability Act(HIPAA), HITECH laws, and state privacy laws (e.g.discuss specific requirements/limitations associatedwith behavioral health)Understand organizational patient confidentialityguidelines.List and describe common privacy and securityconcerns and safeguards to protect confidentialpatient health informationCare Coordination Fundamentals: Module 16 (HIPAA),1199SEIU TEF and PCDCPerson-and Family-Centered Care, PFC 101: Dignity andRespect: Privacy and Confidentiality, IHI18

5 CORE COMPETENCY 1: Introduction to New Models of Care and Healthcare Trends Module Overview: This module provides an overview of the U.S. healthcare system and the goals of healthcare reform, both at the Federal and State level. It focuses on new models of care, an introduction to care coordination, and the changes in the way that healthcare

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