Employee competence and performance-based assessment: A college of American pathologists Q-probes study of larboratory personnel in 522 institutions

To survey employee competence assessment practices in departments of pathology and laboratory medicine and provide suggestions for improvement. A 3-part study consisting of a questionnaire about current competence assessment practices, an evaluation of compliance with stated competence assessment practices using personnel records of 30 employees, and a written appraisal of competence of 5 specimen-processing staff members per institution. A total of 522 institutions participating in the College of American Pathologists 1996 Q-Probes program. Institutional competence assessment practices, compliance of each institution with their own practices, and determination of competence of specimen-processing personnel. Of the participating institutions, 89.8% had a written competence plan and 98.1% reported reviewing employee competence at least yearly. General competence was reviewed by direct observations (87.5%), review of test or quality control results (77.4%), review of instrument preventive maintenance (60.0%), written testing (52.2%), and/or other methods (20.8%). In 8.6% of institutions, employees who failed competence assessment were not allowed to continue their usual work. On review of records of 14 029 employees for adherence to the laboratory's general competence plan, adherence was 89.7% for direct observations, 85.8% for review of quality control and test results, 78.0% for review of instrument records, and 74.0% for written testing. Employee failure rate ranged from 0.9% to 6.4%, depending on the competence evaluated. Adherence to an institution's plan was 90.4% for new employees, 93.1% for computer skills, 95.8% for laboratory safety, and 92.1% for continuing education. When a written competence assessment was given to 2853 specimen-processing staff members, 90.0% responded satisfactorily. Opportunities for improvement in employee competence assessment are numerous, and we provide several specific suggestions.