Generic capabilities

This section of the website covers the generic capabilities that all experienced healthcare professionals should have, emphasising the aspects that are pertinent to the practice of rehabilitation. These capabilities are complementary to the seven rehabilitation capabilities discussed in a separate section of the website, here. They are derived from, and very similar to, the generic capabilities required of all doctors as exemplified in the Rehabilitation Medicine curriculum (here). They were initially set out in a publication in 2020 (here). This page introduces the seven rehabilitation-focused generic capabilities, with a brief description. Details of each capability are given on separate pages. They can be seen in this Mind-Map here.

Context

The primary feature of healthcare activities is their complexity. Indeed, healthcare services are among the most complex systems known. Almost all patient-related activities involves many people from many teams and different organisations, often spanning almost all society.

This organisational melange needs to be understood sufficiently to enable effective collaboration. It is also not possible to work effectively within healthcare without at least some understanding of the professional, organisational, legal and ethical environments. For someone starting in healthcare, this knowledge is very limited but, as soon as anyone progresses in any profession, they need to become familiar with their environment. Within such complex systems, it is easy for quality to become ignored, as it is no-one’s responsibility; it should actually be everyone’s responsibility.

The second major feature of all healthcare services is that they depend, absolutely, upon teamwork and collaborative working which, in turn, depends upon effective communication, and an ability to establish and maintain good interpersonal relationships with a wide variety of people including, but not limited to, patients and their families. This requires a broad understanding of the concerns, priorities, cultures, and environments of many other people.

Last, healthcare depends upon evidence, and a skilled and knowledgeable workforce. All healthcare professionals need to help in education and research, to ensure this.

The seven generic capabilities

The capabilities outlined on this page derive from these characteristics of the healthcare system. They are also based on some evidence. The General Medical Council, and others, have investigated the nature and causes of complaints against doctors, other healthcare professionals, and the healthcare system in general. The generic capabilities (high-level training outcomes) required of all doctors were based, in part, upon these analyses, and they are intended to reduce the frequency of poor patient experience, and complaints.

Capability 1: to work in healthcare and other systems.

This capability concerns the ability to identify other necessary organisations and work within the complex network of systems that may be involved with any patient needing rehabilitation.

The capability in practice is that the rehabilitation professional is “able to identify and work collaboratively with all people and teams from Health, Social Services, and the many other organisations that may be needed by a patient with a rehabilitation service.” It is important to note that the professional needs to be proactive in finding teams and organisations to help the patient. You can go to the page here.

This capability is more important in rehabilitation than in most other health services. Three notable exceptions are psychiatry, paediatrics and geriatrics, where the range of problems needing to be resolved also extend well outside heath services. This is illustrated in some posts on this site: here, and here.

Capability 2: to understand and adapt to societal contexts.

Health services are a part of Society, “the community of people living in a particular country or region and having shared customs, laws, and organizations.” [OED] and the rehabilitation professional has to be aware of many socially-determined factors that may influence choices and actions. These include national factors such as laws and ethical considerations, and more local factors, especially personally-determined factors, often termed culture: “the ideas, customs, and social behaviour of a particular people or society.” [OED] The page can be visited here.

Thus, the capability in practice is that the rehabilitation professional is “able to identify the relevant legal, ethical, and cultural frameworks that appertain to a patient’s situation, to consider them when making decisions, and to adapt plans in the light of these factors.”

Though these factors are relevant throughout healthcare, they have a greater influence and impact in rehabilitation because rehabilitation is always person-centred. In addition, in rehabilitation situations frequently pose difficult legal and ethical questions – which are not always recognised and/or acted on.

Capability 3: to maintain good communication with all parties

Rehabilitation is no different from all other areas of healthcare as far as the central importance of good communication is concerned not only between the professional and the patient, but between professionals. It is important both in collecting data, and in planning and delivering treatments.

The capability is that the rehabilitation professional is “able to establish and maintain effective communication with all patients, and their families, and with all other people, teams, and organisations involved with the patient’s rehabilitation.

Rehabilitation professionals face greater problems in communication than most other healthcare professionals for several reasons. Many patients have problems that significantly alter their ability to communicate such as diminished or absent ability to use language (aphasia), altered ability to speak clearly (dysarthria), reduced cognition, altered ability to pick up on non-verbal aspects of communication, and altered emotional state (to name a few). Families can be difficult to communicate with if they have radically different expectations, for example.

There is also a much larger range of other professionals and teams to communicate with, people who may have very different knowledge and culture from that of a rehabilitation team.

Capability 4: to monitor and improve quality and safety

All healthcare services, and probably all teams and organisations have increasing the safety and the quality of their service as a goal. Rehabilitation faces a specific challenge because, from the patient’s perspective, they are concerned about their overall service, not the standard of individual services. Even if all services were, individually, excellent, the patient might still come to harm and may well experience poor quality through lack of collaboration and cooperation. Patients ‘fall through the gaps’.

The capability is that the rehabilitation professional is “able to monitor and improve the whole network of services involved with a patient, considering safety and quality of: their own service, each other service individually, and all inter-service transferring and/or sharing of responsibility.”

In other words the professional has two additional responsibilities: ensuring that services interact and work together so that patients receive a safe effective service and, if an example of risk or poor quality is identified within another service, drawing it to the attention of that service.

Capability 5: to understand and support research

Research is essential to service development, and to the setting and maintenance of service quality standards. An expert in rehabilitation needs to understand how to assess and interpret research, so that they can increase their own expertise; they should also support it wherever possible, to improve the quality of rehabilitation generally.

The capability is that the rehabilitation professional “is able to assess critically, and interpret clinically published research, is able to use findings in their clinical practice, and is able to encourage and support any research undertaken in their service.”

It is unrealistic to expect most healthcare professionals to be researching actively, as leaders or major contributors to a specific research project. On the other hand, research is a vital activity within healthcare services – witness the success of trials of treatments for Covid-19 – and all healthcare professionals need to use research to improve their practice. One way to gain a better understanding of research is through involvement with researchers, discussing what they are doing and why. The best way to do this is to participate as a helper in research occurring in the service.

More details are on this page. (here)

Capability 6: to teach and train others

All healthcare professionals have a responsibility to teach and train, both students entering the profession and, with increasing experience, postgraduates. Rehabilitation differs from other areas of practice in being centred on multi-professional teams. Rehabilitation professions therefore have an additional responsibility, to teach other professions at undergraduate and, more importantly, at a post-graduate level about their own profession. They also need to teach and train all professionals about rehabilitation.

The capability is that the rehabilitation professional is “able to teach and to train both undergraduates and post-graduates, in two different spheres: about their own professional practice; and about rehabilitation as an activity.”

Much of this teaching is or should be part of day-to-day work within the team; some of it will be at team training events and local teaching events; and a relatively small proportion will be at formally organised large group teaching or training events.

Capability 7: to maintain and use professional expertise

One of the fears felt by professionals entering or training in rehabilitation is that they will lose or not use their professional expertise (or, more simply, being afraid of loss of status); a concomitant risk is a failure to maintain and use their professional expertise. In reality, within a rehabilitation team, it is essential to have a high level of expertise, both to know when it is reasonable to adapt or alter the accepted assessment or treatment and to know when it is inappropriate to do so and to have evidence to support this.

The capability is that the rehabilitation professional is “able to maintain their professional expertise and to use it effectively within the context of a multi-professional team, contributing o team decisions and actions, adapting practice to the patient’s benefit.” The capability is expanded upon and can be seen on this page. (here)

The important aspect of this capability is that the professional has sufficient, and well-founded self-confidence that they can ‘wear their expertise lightly’, using it without difficulty and without being difficult.

This page has introduced seven generic capabilities all healthcare professionals should have. It has focussed attention on the aspects of these generic areas of knowledge and skill that will be of specific relevance to professionals working as rehabilitation experts, usually in a team. The facets of generic expertise of particular importance to rehabilitation experts are not so important to many other healthcare professionals. The succeeding pages will, when written (!) expand on each,

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