“How do you know this clinician is competent to run these groups?” That was the question asked by the nurse surveyor during the Human Resources interview on a psychiatric hospital survey. She was reviewing the file of an inpatient therapist who was a licensed clinical social worker. The HR Director responded by showing that all of the therapist’s credentials had been verified (license, education, etc.,) but the surveyor kept pushing the issue and asked to speak with the Clinical Director who was the therapist’s supervisor. The questions continued in the same vein. “This therapist was hired seven years ago. How do you know she’s currently competent to run these groups? What data do you have? Have you ever observed her running a group?” Although the hospital had up-to-date performance evaluations for their therapists, they received a Requirement for Improvement for lack of documented competency for therapists running groups.

This survey experience caused the organization to step back and take a look at how they were assessing competency in this area. What they did have in place was a solid process for orienting therapists to running groups when they were initially hired. This included first observing a group, then running a group under supervision, and then running a group independently. However, once that orientation was completed, there was no process in place for a clinical supervisor to ever observe a group and evaluate the clinician’s competency on an ongoing basis. In addition, the job description did not spell out specific competencies for running groups. Lastly, the performance evaluations (which were based on the job descriptions) did not clearly evaluate the clinicians’ skills in this area.

A Performance Improvement Team comprised of the HR Director, Clinical Director, and therapists developed a process for observation of groups and a Competency Assessment Checklist for Group Facilitators. The clinical supervisors are required to observe therapists running groups twice per year. The supervisors complete the rating on the checklist and provide feedback to the therapist. These observations are used as input to the annual performance evaluation. All documentation is maintained in the employee’s HR file. Below is a list of the competencies included on the checklist. Each competency is rated as “Satisfactory: Yes or No” and there is a section for comments and feedback to the clinician.

Competency Assessment Checklist: Group Facilitator

• Began group as scheduled
• Introduced the topic and reviewed group rules
• Introduced new patients to the group
• Engaged each group member
• Presented information clearly and in an organized fashion
• Maintained the focus of the group topic
• Utilized communication among group members
• Intervened as needed and supported group members
• Closed the group with a summary and check-in for group members
• Was well prepared for the group session (materials, handouts, etc.)
• Documented the session as per medical record requirements

Three years after implementing this process, the hospital reports that they have a much stronger understanding of therapists’ strengths and weaknesses in this area: “It has clearly highlighted where additional training was needed.” Also, the therapists like the real-time feedback they get and say it has made them better group facilitators. As an added bonus, the hospital did not get an RFI in this area the last time they were surveyed!